Have you ever seen orthotics or insoles in people’s shoes and wondered “what do those actually do?”, “Do I need them?”, “Do they make a difference?”or “Do orthotics work?”.
At Footcare Scotland, we specialise in the treatment of foot, ankle and lower limb musculoskeletal injuries. We use orthotics (foot orthoses), where appropriate, to help manage a wide variety of painful conditions. However, we believe that foot orthoses should only ever form part of a successful treatment plan. We also utilise education, rehabilitation, activity modification, injection therapy and footwear modification to ensure that we can get you back to your chosen activity as quickly and safely as possible.
What’s the difference between off-the-shelf and custom-made orthoses?
While off the shelf devices, like the ones you buy online or from a pharmacy have a place, I don’t think that we can compare them to a device that has been specifically prescribed by an experienced practitioner for your particular problem.
When it comes to prescribing foot orthoses, there are lots of things to consider. The diagnosis, activity levels, footwear, weight, occupation, goals…. Then there are the design variables, of which there are hundreds of combinations. We consider material choice, stiffness, shell geometry, top cover and additions. Your Podiatrist should be able to clearly explain your diagnosis, what role orthotics will have in your treatment plan and what they are designed to do for your specific problem.
Custom made orthotics
Custom foot orthoses should be unique to you and your presenting complaint, not look the same as every other pair out there. We work closely with a leading Scottish based orthotics lab Epione Orthotics. We utilise state of the art 3D scanning as well as CAD/CAM and 3D printing to produce our custom made devices. Each pair are carefully designed and manufactured for precision and comfort. Depending on the materials that are chosen, custom orthotics will normally have a useful lifespan of at least 5 years.
Off the shelf orthotics
We also use lots of different types of off-the-shelf orthoses in clinic. When using an off the shelf device, the design and materials should be carefully chosen to give the best chance of a positive outcome. Using off the shelf orthotics doesn’t give us the same control over the design of the device and they tend not to have the same lifespan as a custom device. However, they can be a good option when orthotics are only needed in the short term or when a cheaper option is required.
Do orthoses work?
We often see patients in clinic who have been given foot orthoses that have failed to work for them. This could be down to many factors. Maybe orthotic therapy wasn’t the correct intervention or treatment in the first place. Maybe the patient wasn’t compliant with wearing the orthotics as advised. Or maybe, orthotic therapy was the appropriate treatment, but the orthotics supplied were not the correct prescription or design.
Getting the dose right
An esteemed colleague of mine, Ian Griffiths (www.sportspodiatryinfo.co.uk), very eloquently likens orthotic prescription to the prescription of medication. Firstly, we need to make sure we are prescribing the correct treatment for the problem. For example, a drug used to treat high blood pressure will do nothing to reduce blood sugar in diabetes. Orthoses are not a silver bullet for all foot and ankle conditions- is orthotic therapy appropriate for the presenting problem?
Once we have selected the correct medication, we must be sure that it is given in the correct dose. Too small a dose of a drug will be ineffectual and too high a dose may be harmful. To further complicate the matter, each of us will react differently to the same dose of the same drug, meaning that predicting how an individual will respond can be difficult. The same can be said to the response to foot orthoses. This means that orthotic therapy can be the correct treatment option but if the orthotic is not designed correctly (given at the correct dose) it may well be ineffectual.
How do orthotics work?
Historically we have been led to believe that orthotics re-align or correct the skeleton, whether that be at the level of the foot or as far up as the hips or back. Unfortunately, there is no evidence to support the argument that orthotics realign your skeleton. Their actual action is much more complicated. There are a few different theories as to how orthoses work. The theory that I subscribe to is that they alter kinetics. Simply put, they modify or change the forces and stresses that are placed upon tissues, dependant on how they are designed.
When we are discussing orthotic therapy with our clients, there are many things we consider. Firstly, we must have a clear working diagnosis of the problem. Without a clear diagnosis, we cannot begin to consider planning your treatment and we certainly cannot think about prescribing orthotics. With a clear diagnosis, good clinical reasoning and well-designed orthoses, you are likely to have a positive outcome.
We have worked with many people to help them on the road to recovery with the right orthoses. Here are just a few of examples:
“I’ve been having insoles made for the past 18 years or so, from various NHS sources. I came to Scotland and for a variety of reasons decided to give Footcare Scotland a try and they have made me possibly the greatest pair of insoles I have ever had. If you need a Podiatrist, I would recommend these guys (especially Alastair) as your first port of call.” NS
“After giving up on ever running due to my flat feet and the pain I usually experienced on the few occasions I attempted a short run, Alastair recognised a variety of problems that were contributing to my difficulties and recommended a series of exercises combined with custom orthotics. Within a few months I was running 5K and not long after I completed a half marathon.” SH
“Alastair quickly diagnosed my problem, that I required bespoke orthotics which would relieve the pressure on my metatarsal. The Physio app Alastair recommended is ideal for you to undertake your exercises at work or home, and in the correct manner. I’d definitely recommend Footcare Scotland and Alastair.” WB