Orthotics - Custom Devices Correcting Lower Limb Problems

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At the Yorkshire Foot Surgery & Biomechanics Foot Clinic  we have a fully equipped orthotics laboratory to make custom made orthotics. Many patients are unaware of what an orthotic actually is; patients also have a plethora of questions, which they ask. We have compiled the most commonly asked questions. Hopefully, this will help answer any queries you may have as a patient or practitioner. Remember that we be contacted in all manor of ways, please don't be afraid to get in touch we are here to help.

What are Orthotics?

Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely "arch supports," although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient, by altering slightly the angles at which the foot strikes a walking or running surface.

Podiatrists prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form. Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain. Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Semi Rigid / Rigid Orthotics

The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic or carbon fibre, and is used primarily for walking or dress shoes. It is generally fabricated from a plaster of Paris mould of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary.

Rigid orthotics are chiefly designed to control motion in two major foot joints, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function.

The second type of orthotic device (semi-rigid) provides for dynamic balance of the foot while walking or participating in sports.  This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semi-rigid orthotic is constructed of layers of soft material, reinforced with more rigid materials.

Flatbed Orthotics

The third type or flatbed, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be moulded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes. The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished.

It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthotic is usually bulkier and may well require extra room in shoes, or prescription footwear.

Orthotics for Children

Orthotic devices are effective in the treatment of children with foot deformities. Most Podiatrists recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe, or an athletic shoe.

Usually, the orthotics need to be replaced when the child's foot has grown. Different types of orthotics may be needed as the child's foot develops, and changes shape. The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.

Do any other types of Orthotics exist?

Various other orthotics may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot, ice skate boot, or inline skate boot. Combinations of semi flexible material and soft material to accommodate painful areas are utilized for specific problems.

Research has shown that back problems frequently can be traced to a foot imbalance. It's important for your Podiatric to evaluate the lower extremity as a whole and to provide for appropriate orthotic control for foot problems.

What medical problems can benefit from an orthotic?

• Pronation                
• Flat feet
• Polio
• Arthritic conditions
• Obesity
• Downs Syndrome
• Poor muscle tone
• Heel Spurs
• Shin splints
• Bunions
• Hallux rigidus
• Hallux limitus
• Lower back pain
• In-toeing walking
• Metatarsalgia
• Muscle fatigue
• Ankle sprains
• Morton's Neuroma
• Leg lengths
• Sesamoiditis

This is by no means a exhaustive list of pathologies orthotics can help with. If you are in any doubt please consult your Podiatrist regarding your foot problems.

Do I need my Orthotics reviewing?

Yes. It is perfectly possible for a patient to use a pair of orthotics for many years. After many millions of footsteps even the most sturdy orthotic may need some repair work. Materials do wear out.

• Top Covers - This is the covering on top of the orthotic. From time to time this may need replacing.
• Posting - This is the material added to the outside of the orthotic. The posting is virtually never replaced but it is possible that it can wear out or the Podiatrist may decide that a patient's prescription needs altering. This can lead to a different type of posting being needed hence replacement.
• Shock absorbing materials - A Podiatrist may use shock-absorbing material to help a patient absorb and dissipate pressure more efficiently. These materials work extremely hard to absorb shock, but they do not last forever and may need replacing. A telltale sign is when a previously symptom free patient reports that pain has reoccurred, a quick orthotics examination may reveal the shock absorbing material has completely petered out.

Over many years feet can change shape and an orthotic may need to be updated to take this into consideration. By visiting a Podiatrist on a regular basis your feet and orthotics can be kept in perfect condition.

Do Orthotics cure every thing?

No, and the Yorkshire Foot Surgery & Biomechanics clinic believes that any practitioner claiming this is misguiding patients and practising dangerous Podiatric Medicine. An orthotic is not a magic device IT WILL NOT CURE EVERYTHING. Orthotics can give wonderful results and can be used for a wide plethora of complaints.

Patients that are recommended for orthotics will be helped in one of either three ways: -

1. A patient will be completely cured and need orthotics reviewing once yearly.
2. A patient will respond very well and need some attention to become pain free.
3. A patient will not be pain free and will still remain in pain.

The vast majority of patients fall into groups 1 and 2. Group 1 patients are self-explanatory, group 2 patients may need orthotics altering or reviewing. When this occurs patients usually fall into group1 category. Podiatrists are not perfect! We make mistakes and sometimes a little experimenting and reviewing is needed to cure a patient. Group 3 patients are rare, a Podiatrist will try everything to get a patients problems corrected but sometimes all the best efforts in the world are not enough, these patients are usually very hard to treat and it may need several people at once to help treat this type of patient.

Are orthotics expensive?

The expense of an orthotic is directly dependent upon the condition it needs to treat. Pain can be a terrible thing. One must consider that the cost of an orthotic can be expensive but consider this, spread over many years of pain free activity and improved quality of life the outlay for an orthotic is nothing. Would you sooner suffer pain and poor quality of life or invest money in a device that can improve and cure your problem?

Will an Orthotic fit in all my shoes?

Yes, an orthotic is designed to fit all shoes. This may take a little time to perfect and a patient may even have to change shoe styles (this is usually for the better). Sometimes an orthotic may need to be altered or changed in size to fit inside a shoe but this does not affect the way an orthotic will work.

A Podiatrist may ask you to fetch a selection of your favourite shoes along, by doing this we can make an orthotic, which will fit, in your favourite shoes. An orthotic will not restrict your activities and you can place the orthotic into anything from a slipper to a Wellington boot, high heels to training shoes.

A common question is what about sandals and high heels. With some well-placed Velcro orthotics will fit into sandals. Specially designed Slim-orthotics can be designed for high heels. For special occasions you need not wear orthotics, but make sure you return to wearing them the following day.

What is an orthotic made from?

Orthotics are made from a wide variety of materials ranging from simple foams to space age carbon fibre compounds. These materials may be used for special purposes depending upon what the Podiatrist deems to be necessary. An orthotic can be very flexible (to help a patients joints move more easily) or very rigid (for strength and good control of a patients feet).

Some materials absorb shock, other help retain heat (good for people with circulatory problems), others remove friction thus stopping blisters continuously occurring. A Podiatrist will explain why a material is being used and how it will help a patient's problem.

Do orthotics carry side effects?

Yes. Ligaments, tendons, and muscles are all attached to bones. Considering one of the main roles of an orthotic is to control bones all of these structures can become inflamed. However with slow progressive build up of usage the orthotic this should not cause any problems. Knees, hips, and the lower back can become painful if a Podiatrists advice is not followed.

Orthotics are very comfortable to wear some patients are lulled nto a false sense of security by this phenomenon. Orthotics will be used all day and muscles may become fatigued or inflamed. Follow the Podiatrists advice!

Which types of people require orthotics?

We see three main patient categories: -

1. The chronic pain sufferer who needs some pain relieve. An orthotic may not cure this individuals pain completely, but it may decrease the pain levels sufficiently enough to make life more bearable.

This patient had polio as a child. The sole (plantar) aspect of his foot was extremely tight; as a consequence each footstep was very painful. Unfortunately for this patient the changes, which had occurred in the feet, could not be reversed. The patient had tried many different treatments in the past but to no avail. Our clinic  fitted this patient with a simple shock absorbing flatbed orthotic, which contoured to the patient foot anatomy. Even though it did not cure this patient's symptoms the orthotics decreased the symptoms enough for the patient to continue working.

2. The sporting / active individuals. These people include athletes who are trying to improve their sporting performance or combat a repetitive injury. Usually after a full gait and pressure analysis orthotics can be produced. All variables are taken into consideration and a relevant prescription pair of orthotics can be formulated. YPS has seen all manner of athletes from cyclists, hammer throwers, marathon runners, rugby players, hurdlers, the list could go on. Each sport is different and each orthotic has to be specially designed to take in the needs for the patients sporting discipline.

3. The surgery / borderline surgery patient. Some patients may be advised to have surgery to there feet. A large amount of people are put off the idea of foot surgery simply because they have heard of someone that has had it and it didn't work This is partially true, 20 - 30 years ago we did not have Podiatric surgeons in the UK, and all bone surgery was performed by Orthopaedic surgeons. There is nothing wrong with this, the best results come from a surgeon who specialises in feet, and not a general orthopaedic surgeon. Orthotics can be used for patients who are not sure or scared of having surgery to there feet. We can make patients comfortable and even pain free but this is may only a temporary measure and buy a patient some time, surgery may ultimately have to be performed.

I have had orthotics before and they did not help, why?

Did a Podiatrist fit the orthotics? Lots of other medical practitioners use orthotics Chiropractors, Osteopaths, Physiotherapists, and Doctors. These people are trained and highly skilled but they do not spend as much time as a Podiatrist learning how the foot works. A Podiatrist will spend three years gaining a degree in Podiatric Medicine, and if they become a Consultant Podiatric Surgeon, up to 13 years. This is more than ANY health care professional in the UK which works with feet.

It is not surprising that your orthotics did not work; perhaps a Podiatrist did not examine you or advise you on your treatment options. Another common reason why Orthotics do not work is simply because they have been bought from a shop. These orthotics are mass-produced, feet are not! Every individual has two different unique feet, so, how can a mass produced orthotic from a shop cure a patients pain fully?