We briefly looked at why people may feel this way, the importance of communication and need to set realistic and achievable goals.

Today, lets have a look at different types of orthotics (foot orthoses) and why some styles, shapes and material can be very effective for one person, but may fail miserably for someone else.

In the first post in this series, I outlined 3 things that orthotics need to do if we are to have a positive outcome. These 3 points are orthotics need to:

1. Be working toward a realistic and achievable goal or treatment outcome.
2. Support or move your foot into an appropriate position that will limit further damage and enable healing.
3. Be used appropriately and long enough (often in conjunction with other treatment strategies) for that healing to take place.

Todays post is all about point number 2.

How can we use an orthotic to position the foot? or alter a force in a way that will limit further damage and enable an injury to heal?

First, we must know what is wrong. What is injured in the foot or lower leg? What are the structures involved and what is the actual diagnosis? Second, we must understand the movements or forces that are contributing to the injury? Is it an acute injury or a chronic, overuse type injury? The term currently being used by health professionals such as Podiatrist, physiotherapists and exercise physiologists is ‘load management’. An orthotic is just one of many strategies for effectively ‘managing’ these loads in the foot and lower leg. To do this, the person prescribing or making the orthotic must understand what the ‘loads’ are.

In some cases, both understanding and modifying a load can be amazingly simple. For example, a patient who works on a hard-concrete floor and reports pain in the ball of her foot, may simply require an increased cushioning inside the shoe. In this case, a simple gel innersole from the chemist or shoes shop may be perfect. However, for a long-distance runner who continually develops medial knee pain, 20km into an event, both understanding the biomechanics and altering the load may require a little more thought.

Unfortunately, the field of orthotics is plagued by an ever-increasing commercial market.

Facebook and the internet are full of adds for innersoles that are ‘guaranteed’ to fix your foot pain (even though they do not know what your foot pain is).

Most of these products are not bad, and some would quite possibly be perfect for you, unfortunately you have no way of knowing which one. This is one of the disappointing factors that can lead to the ‘I tried orthotics, and they don’t work’ mentality. It really is a lucky dip!

While it is a somewhat crude analogy, it would be similar to walking into a Chemist, without a diagnosis of your illness, and asking for a bottle of pills. The Chemist, happily provides you with a full bottle of pills from the nearest shelf. You may get lucky and have the perfect cure for your illness, but you also may have no improvement. Worst still you may get worse.

Foot orthoses are just like this.

Just as it would be grossly unfair to march out of the chemist and declare that ‘Pills don’t’ work’. It would also be disappointing to come to the same conclusion with ‘lucky dip’ orthotics. Unless we can clearly state what it is that we are trying to achieve with an orthotic, and be confident that your orthotic is doing that effectively, we really cannot come to a sound conclusion that the orthotic didn’t work.

The longer that I work with foot orthoses and the more feedback I receive from my patients, the more I am convinced that prescribing foot orthoses is not an exact science.

What works for one, may not be well received, or tolerated by someone else, despite presenting with almost identical symptoms.

Similarly, the same orthoses may have a significant difference on the foot depending on the footwear they are worn in. Patients regularly note that they feel different in new shoes. Comparing a pair that is several years old and may have collapsed or compressed on the inside. All these variables need to be considered when assessing the effectiveness of a foot orthotic.

Good communication and ongoing discussion with your health professional is essential in ensuring your orthotics are the very best they can be for your injury.

Just as your doctor may make adjustments to your medications, small adjustments to foot orthoses can really improve their effectiveness.

If you are not getting the results you expected from your foot orthoses; instead of thinking these don’t work, why not consider ‘how could these work better?’ or ‘who could I talk to about whether these are right for me?’ Remember, not all orthoses are the same. As with most things in life, you need to have the right tool for the job.

Do you need new foot orthoses?

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The post Orthotics – Part 2 appeared first on East Gosford Podiatry.

I’d like a dollar for every time I’ve heard this over the past 15 years, stating that Orthotics don’t work. I’ve heard it from patients, footwear retailers, Orthopedic specialists, GPs and even other Allied Health professionals.

Interestingly, when you start probing into each situation to better understand what is meant by “don’t work”. It’s almost always a combination of poor communication. This is usually between the prescribing health professional and the patient, unrealistic expectation from the patient; or a case of the wrong orthotic for the particular situation.

When I first hear that a pair of foot orthoses either ‘didn’t work’ or ‘no longer work’; I always ask what the orthotics were prescribed for, and what they were supposed to do?

Surprisingly, in most cases where a patient is unhappy with their outcome, they are unable to answer with anything more detailed than ‘fix my feet’. If the end goal, desired outcome, and likely time frame is not clearly established, how can the effectiveness of the orthoses be assessed?

To better understand why a foot orthotic may or may not work, let us have a look at what foot orthoses are, what they do, and what they don’t do.

What are foot orthoses or ‘orthotics’?

In basic terms, it is a device used to change the movement or function of a part of the body, in this case, your feet. It may change the position of a body part, it may change the total movement of a body part, or it may change the forces within a body part, with very little visible change evident on the outside. Common orthopedic devices include splints, braces or strapping. If you really want to stretch this concept, you could even say a scrunched up piece of paper stuck in the end of your shoe could be an orthopedic device, as it will almost definitely change the way you walk. Although, I dare say it would not be a particularly helpful orthotic device though.

The orthotics or foot orthoses often used by Podiatrists are usually a ‘foot bed’ or ‘innersole’ that is placed inside your shoe. For this orthotic to be perceived as helpful or ‘working,’ they need to change your foot position or force sufficiently for your injury and symptoms to improve, according to the goals that have been set.

To successfully achieve this, the orthoses need to do 3 things:

1. Be working toward a realistic and achievable goal or treatment outcome.
2. Support or move your foot into an appropriate position that will limit further damage and enable healing.
3. Be used appropriately and long enough (often in conjunction with other treatment strategies) for that healing to take place.

Even with a good understanding of these 3 points, and the correct foot orthotics, you will still need to play an active role in the management of your foot injury.

What foot orthoses will not do, is offer a miracle cure, fixing all your worldly concerns, without you needing to take responsibility for your own health and healing. I think this is where a lot of people come unstuck!!

Let have a brief look at the first point, ‘setting a realistic goal’, and we can unpack the other points in greater detail at another time.

Realistic Goals

In some cases, expecting a complete resolution of injury or pain is simply an unrealistic goal. Therefore, the orthotics will always be perceived as ‘not working’. Factors such as age, activity levels and underlying medical conditions such as arthritis, may make ‘being pain free’ highly unlikely.

More realistic goals may include;

• Successfully complete the week long hike I am currently training for, in 6 months time. Even though my feet are still likely to be a little sore at the end of the day.
• Reducing my midfoot pain by 50% over the next 3 months, allowing me to delay or avoid surgery.
• Enable me to continue working 12hr shift, on a concrete floor, until my retirement in 1 years time.
• Allow my foot to heal prior to the soccer season beginning in 3 Months time. (“Even though I know soccer will most likely aggravate my chronic injury again”. And “I should probably retire like my wife suggested”).

When a fair and reasonable goal is set and if orthotics are considered to be a helpful part of your treatment plan; We can set about finding the correct orthotic device for you.

In a future blog, we will look at why all orthotics are not the same. Secondly, how we can determine what will and will not be helpful.

If you hear someone say, or you are tempted to think ‘orthotics don’t work’, you could ask ‘are my goals really achievable? ‘are these the right orthotics?’ ‘Am I using these correctly?’ or ‘was my original diagnosis correct?’ It may be worth discussing any or all of these points with your health professional again.  

The right orthotics, used in the correct manner can work incredibly effectively, so don’t write them off too soon.

Do you have issues with your orthotics?

Contact us today to book an appointment with one of our skilled Podiatrists.

https://ahpa.com.au/allied-health-professions/podiatry/

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