Orthotics (shoe inserts)

Orthotics – what they are, what they help and how they work

Orthotics, or orthoses are inserts/insoles that go inside your footwear to help you with foot pain. When I was training in the 90’s we believed that these orthoses would help correct your foot position and potentially prevent injury. However, over the last 10 to 15 years this thinking has changed and as a result we have had to change the way we use and prescribe orthoses. This has been backed up through quality scientific research and study. We now use orthoses to help directly with foot and lower limb pain. In the majority of cases we only need to use them for relatively short periods of time to allow the damaged area of the foot to recover. However, in some cases, the injury may not be repairable, like osteoarthritis, or take a long time to repair, like a tendon injury, in which case we may recommend that you use orthoses for an extended period of time. In the event of major deformity or previous major injury it may be advantageous to use them on a permanent basis. It is a requirement of our professional registration with the Healthcare Professions Council that we follow evidence-based medicine at all times and all of the treatments and recommendations occur for orthoses are backed up through up-to-date research papers.

The orthoses will be specifically designed with the shape of your foot and only the injury you are suffering from in mind. There are some types of orthoses that are prefabricated and have characteristics to help with certain common conditions. If your foot and problem is suitable for this type of device you will be given that option.

Once your history has been discussed and an examination of your foot and ankle has taken place, your podiatrist will discuss the best options available to you. In most cases you will be given multiple treatment options that can be combined to give you the best result. We will often use an exercise plan, shock wave therapy, or possibly injection therapy in combination with orthoses. We will talk you through the pros and cons of each of these options and how they combine to give you a powerful treatment model. The ultimate decision for all treatment rests with you but we can give you the information you need to make your choice.

If you decide to go ahead with orthoses we would take a model of your foot either with a three-dimensional scanner or with an impression box. Your podiatrist will then write the prescription with the information gathered from your history and their examination. The topography of design is important as it will be this that will help rest the damaged areas of your foot and give them time to recover.

In some cases it may be desirable to have multiple sets of orthoses and this can be catered for. We always suggest your initial set is designed for cross purpose use and is often designed in carbon fibre minimising bulk and allowing them to be worn in a wide variety of footwear. As your foot model data is stored electronically additional pairs of orthotics can be ordered easily although periodically we will suggest that you pop in for a rescan to assess any changes that may have occurred.

We always look to fit the orthoses into your chosen footwear and adjustments can be made to help accommodate this. We do recommend you gradually wear in the orthoses, particularly the sport, but often people get used to them quite quickly. All our custom-built orthotic shells come with a lifetime guarantee against breakage from normal activities.

Once your foot pain is reducing we may look to make adjustments to the orthoses or possibly transition you out of the orthoses with a rehabilitation plan. In some cases this may take a while. However, contrary to popular belief there is no detriment to continuing to wear the orthoses if you find them comfortable, as long as you do the rehabilitation plan. Evidence has proven that orthoses do not weaken your foot in fact they do quite the opposite which is why we are usually able to eventually stop using them.

One of the more difficult issues we come across are historical prescribing of orthoses particularly with children. As we know children have this annoying habit of growing which means that an orthosis that could have been issued as recently as six months prior may no longer fit or be suitable for that child. It is important that the child is reassessed regularly as only on very rare occasions will orthoses need to be continually used. One of the worst reasons for prescribing orthoses that can be given is that the person has had orthoses previously. Where possible we will look to use a cheaper off-the-shelf orthoses with children to reduce the financial burden on parents or guardians.

 

Edd Henstridge,  ULTRASOUND SPECIALIST PODIATRIST

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