As we are all no doubt aware, feet, legs and bodies in general come in all sorts of different shapes and sizes. This is to the point where we can even question whether or not a 'normal' body even exists...
Unfortunately this means that skeletal problems can come in all sorts of shapes and forms also. This is especially the case as we get older, as more wear and tear becomes apparent on our joints, but also due to biomechanical imbalances that develop as a result of our sedentary lifestyles.
As we develop these issues, many patients find great benefit in orthotic (insole) prescription. These are inserted into your shoes to change the relationship between your foot and the ground, which also affects other areas of the body. For example, if you have a bony misalignment which cannot realistically be corrected and prevents a certain part of your foot contacting the ground as it should, then this can have a knock-on effect going up the body, affecting the knees, hips and back. Managing this issue at the foot level can then create a positive 'ground-up' influence, preserving joint health, and reducing wear and tear over time. This really does have great potential to improve quality of life, especially in older age as maintaining our independence for as long as possible becomes so important.
Remember that just because the orthotics are fitted to the feet it does not mean they only have the power to fix lower leg issues, as they can also influence higher structures! This relates to the holistic approach I take with my practice whereby everything is connected, and what happens at ground level can influence up there, and vice-versa!
"If the foot loses function in that certain parts can no longer reach the ground, then an orthotic can bring the ground up to the foot".
As we get older, our eyesight tends to deteriorate, to the point where many of us require glasses to see properly. These glasses change the relationship between the light entering the eye, and the eye itself - they aid the retina in focusing properly. This is very similar to how orthotics work. As we get older, the body's skeletal structure deteriorates as wear and tear accumulates and the function of the skeletal structures and soft tissues reduces. Likewise this can happen through trauma or illness. Therefore, orthotics can make up for this deficit, and restore lost function to the body. For some reason however, we always tend to wear glasses to help our eyes when required, but often neglect our poor joints and suffer chronic pain as a consequence!
To take this analogy further, just like the right eye may need a slightly different prescription to the left eye, the wear in our joints on both sides of the body is not always equal, meaning a custom pair of orthotics may be needed to account for this difference.
Does everyone need orthotics?
What conditions necessitate intervention?
No, definitely not! If at all possible, we should not be reliant on an external device to be able to stand and move properly - after all, you do not see animals walking around with orthotics! Unfortunately however there are many practitioners out there that do exploit orthotic intervention, as they use it as a means to significantly bump up their prices for nearly every patient, for many of whom it is not necessary. Or perhaps they just do not have a broad enough understanding of the body by not adopting a holistic approach, as many practitioners including consultants become specialists in a single joint such as the foot, hardly considering the influence of other structures in creating the pain experienced in a particular area. These practitioners often go through the motions of prescribing orthotics as they know no different. Conversely, my holistic approach adopting the use of so many multidisciplinary methods allows me to choose the best approach for the patient, whether it be orthotics, something different, or a combination.
That being said, there are of course many instances whereby orthotics are necessary, maybe some of the following apply to you!
Where the problem cannot realistically be corrected due to a bony deformity resulting from trauma, illness or disability - these cases can therefore be managed through orthoses.
If the individual is at a predisposed risk of harm through trauma, and orthotics can help to reduce this risk.
As a short to medium term solution - we all know that strengthening the body and gait retraining take a lot of time, so orthotics can help to correct your alignment and reduce pain until the aftercare takes effect (with the intention always being to not be reliant on them long term!)
Common treatable conditions could include:
Leg Length Discrepancy
Heel and Forefoot Deformities
See below for some case studies!
Procedure and Costs:
In order to determine if orthotics are necessary, and if so, what design features are needed, an assessment will need to take place. This will typically be part of the initial consultation whereby I normally conduct a postural assessment, or it can be during a follow-up session for existing clients. After the assessment has been completed, in the case of bespoke orthotics, an impression will need to be taken of your feet to ensure that the orthotics suit your individual need. For this I use a foam box impression.
The cost of orthotics can vary, as a bespoke pair will undoubtedly be more expensive than a prefabricated design due to the costs of manufacture at the lab, and the greater amount of time generally taken to assess the patient. Some materials are more expensive than others. It all depends upon what you need, which is is why I discuss this on a case by case basis. There are also often 'budget options' available for those who cannot afford the more expensive models. For instance, this can be done by modifying an off the shelf orthotic, which can yield similar results, albeit if more crude. Again, this can be discussed.
Which are better - prefabricated or custom orthotics?
CASE STUDY #1. (Black pair).
This client displayed a high degree of lateral (outer) ankle instability due to multiple occurrences of lateral ankle ligament sprains, and was causing the individual significant discomfort in her everyday life. This type of injury is one whereby after you do it once you are more likely to do it again in the future due to the functional and mechanical stability of the ankle being adversely affected. Whilst the massage and aftercare has been massively beneficial, the orthotics are another safeguard to reduce the possibility of the injury happening again. This was done with a lateral arch support and a lateral flange to stop the ankle from rolling outwards. This is a shorter pair to allow greater flexibility in wearing in different footwear, especially as spring approaches.
CASE STUDY #2. (Blue pair).
This client had problems with her upper back and neck region, including the right shoulder that was dropping. She had visited previous practitioners but never found the source of the problem. Upon investigation it was revealed that she broke her tibia (shin bone) around 40 years ago as a child in a horse riding accident. The biomechanics were never addressed and I found that due to the break, her right leg was significantly shorter than her left (something that several Chiropractors never identified!). This was causing her to drop on her right side which I strongly suspect is causing her neck discomfort. We cannot grow the right leg longer so the orthotic has been raised up on the right, with an arch support on the left to prevent overcompensation. Myself and the client are hopeful she can soon start running again, which is an activity she previously thought she could no longer do due to her issues.
EXAMPLES OF HOW ORTHOTICS CAN HELP (PICTURES BELOW):
This is a question that gets asked a lot, but there is no definitive answer. My response is that it is not about pitting off the shelf designs against custom made orthotics, as it has to be decided on a case by case basis. Like with spectacles, some people may be lucky enough in that they only have a very minor issue, and one of the pairs off the shelf in an opticians just happens to suit their needs which may keep their costs down. However, much more commonly, a custom prescription is required, hence the need for bespoke orthotics, or at least a modified prefabricated ('semi-custom') device. The question that should be asked is not off the shelf vs. bespoke, rather what is the solution which is going to offer the best design features capable of managing a patient's problem. If in the unlikely scenario this can be done with a prefabricated design with no further modification necessary, then there is no increased benefit to be gained by spending more money on a bespoke pair.