Biomechanics and Orthoses
This is the main difference between chiropodists and podiatrists. Biomechanical assessment will analyse your skeletal make up and look at the way you walk and/or run and identify any link between your function and injuries you may be prone to. Treatment will most likely consist of the introduction of orthoses to address these findings. In some cases the correction obtained from the introduction of the orthoses will not be enough to fully rectify your symptoms. It may be appropriate for us to recommend other treatments, these may include; stretching, exercises, change in footwear for activity or short periods to allow the orthoses to work, injections, x-rays or scans. We may also recommend that you would benefit from other treatments offered by a specialist in their field, this could be; chiropractic, physiotherapy, soft tissue / sports massage and/or core stability training. We can also advice of more appropriate footwear and for sports footwear recommend you see the staff at Accelerate for advice.
Specialist shoe fitting and modification service.
We understand the frustration of not being able to find shoes that fit. If your foot is not a normal shoe shop shape then we may be able to help. We work with a company called Ken Hall who have a range of shoes that come in a huge range of volumes, widths, instep heights, lengths and toe room and can easily be modified or adjusted to add extra features. This is as close as you are able to get to a bespoke shoe at a fraction of the cost.
We shall assess your foot and shoe needs with you and then you’ll be able to choose the style of shoe you like. We then send away for the shoe (this takes about 4 weeks) and then see you for a fitting. The shoe will be sent back for finishing with any adjustments to be made. This takes about 2 weeks. We shall see you again for final fitting. If there is still a problem then the shoe can still be returned at this point but only small adjustments can be made.
Podiatric Biomechanical Assessments and Orthoses
Why will I benefit from a biomechanical assessment?
A biomechanical assessment will provide you with information about your walking or running style and may provide you with a link between your function and injury patterns. As we are always walking or running on our feet it is important that the function of our feet are checked. Feet have two very important jobs to do during our gait cycle; they need to be a shock absorber at the contact phase – when our foot hits the ground, and they need to become a rigid lever at the propulsive phase – so we have something firm to press against so our bodies move forward. How the foot changes from a mobile position to a rigid lever involves the rest of the limb and body and any block in this change will cause compensations to occur so the body is still able to move forward.
The biomechanical assessment will look at a number of things;
Your natural foot and limb alignment. This will tell us if you need any compensations for your foot to become flat on the floor,- Which of your foot joints are pronating, this is important to establish as the orthotic will need to control the correct joint at the right time of your stance phase,
- How you move forward over your foot once it has become flat on the floor,
- If your foot supinates (the opposite of pronation) and becomes stable at propulsion,
- Any compensations that occur during your stance phase and the effect these may be having on the rest of your body
This will be achieved by looking at the anatomy of your feet and limbs in a non-weight bearing position, in a standing position and in a dynamic situation. This will be walking barefooted in the clinic and / or on the treadmill in walking / running shoes. We may also need to see you running and this will be on the treadmill. We may take a video recording of you walking and running so we can analysis the movements closer and show you what is happening.
This assessment will provide you with a thorough understanding of your gait style, why you walk/run the way you do and hopefully provide a link between your walking / running style and any injuries you may suffer from. We shall also provide a treatment plan that addresses all of the areas that need to be addressed. This may mean a co-ordinated plan between a number of specialists at the same time or with set reviews once a level has been reached.
To address any compensations identified in the assessment will most likely mean the introduction of an orthotic. This is an insole that fits into your shoes in place of an existing footbed or insole if your shoe has one in already. This is made to fit your shoes that you wear most often or related to your activity when your injury occurs. You may not need to wear it all the time. A description of our orthoses follows this section. The advantages and disadvantages of each type will be discussed with you during the assessment.
What will the orthoses do for me?
The orthoses that we prescribe at Holywell Healthcare and Accelerate are designed to work with your natural body movements. This means that they may not hold your foot in the ‘neutral’ position as some feet do not want to work in this position.
The orthoses may;
- Accommodate the natural position of the bottom (plantar) aspect of your foot,
- Reduce for how long during the stance phase that your foot pronates,
- Change the way your foot leaves the ground,
- Support your arch from dropping too quickly,
- Provide stability of your foot at the contact phase,
- Provide a combination of the above.
The desired effect of the orthoses will be fully explained to you and the knock on effects outlined. Whenever we change one movement in the body there will be a reaction somewhere, we can usually give you a good idea of what you are likely to experience over the first few weeks whilst your body adjusts to the orthoses. Some people notice a very rapid positive effect on their biomechanics whilst some people need a longer time period. This will depend on the individual and also what we are trying to achieve. We will work with you to get the orthoses right for you if this does not happen straight away; it is not unusual for people to need a slight adjustment to the orthoses once they have been wearing them for a while.
Will I have to change all my footwear?
No. The orthoses are designed to work with your current footwear. Your footwear will be assessed also at the assessment and we shall recommend the type and style of shoes that will be best for your needs. This may mean a short term change to your current wearing regime to enable the orthoses to have the best chance of working. If we feel that your footwear is a major factor in your presenting symptoms then we shall let you know. We shall explain the type of orthotic that will be beneficial and the type of shoes that they will work best with. It is then up to you if you want to go ahead with this type of treatment. It is important that the shoes and orthotics work together and it is important to know that a poor or worn shoe can make the orthotic not work as it will designed to work.
If you have trouble with shoe fitting then we may be able to help with our semi-custom shoe making and fitting service. Will I have to wear orthoses forever?
This will depend on your foot anatomical position and your level of activity. If your foot function is poor for whatever reason and activity levels higher than your foot can tolerate then you are likely to have an injury problem. In this case orthoses forever are a real possibility. If your injury is because you have over trained and the injury is not fully settling down we often use a temporary orthotic to allow you to overcome the injury and provide advice on a rehabilitation program so your body becomes stronger and hopefully will not be re-injured in the same way.
Will the orthoses prevent me from getting an injury?
The orthoses we prescribe are designed to allow your body to improve its function and efficiency. This means that you body should become stronger and less prone to injury. It is difficult to predict injury patterns as everybody is different and there are often many factors to becoming injured. We do see compensatory movement patterns that will overload certain structures that mean certain injuries nearly always have the same type of cause. It is why the body is stressing the structure that is injured that can be difficult to fathom out
If I have support training shoes will I need orthoses or do neutral shoes work better with orthoses?
Running shoes support the foot in a different way to orthoses. Orthoses are very much aimed to support the specific function of the foot and deal with the compensation mechanisms. This type of control is very hard to achieve with shoes alone. Running shoes companies all have differing ways of controlling pronation, if it is pronation control that you need then you need to find the correct shoe control for your foot type. Holywell staff in conjunction with Accelerate staff will be able to find the correct shoe for your pronation type and running style. If you are wearing orthoses that enable your foot to function more effectively then you are likely to need a ‘neutral’ shoe. It is essential that you have the right shoe for your running style and lower limb biomechanics and if you are wearing orthoses then this is more important still as the wrong shoe will affect the function of the orthotic.
How long do they last for? Will I need two pairs?
This will depend on the material they are made from. If they are made from EVA (a soft blown rubber – similar to training shoe midsoles) then they will last up to 2 years, custom will last longer then premade. If they are made from a plastic (we use polypropylene – a bit like Tupperware) then they could last 5-10 years, although the coverings and postings may wear before then. If you are changing the same orthotic from shoe to shoe and only wearing the one pair then they will wear a lot quicker then if you have two pairs that are designed for certain shoes. It is common for people to have a pair for day to day work shoes that are ¾ length and made from a stronger materials and if they are doing sport, a second pair for sports shoes, these are usually full length and will replace the footbed that is in the sport shoes.
Do you fit orthoses to children’s feet and what is the purpose of them?
It is becoming increasingly recognised that early introduction of orthoses into children’s shoes can be very beneficial. We generally start fitting orthoses about age 5-6, depending on activity levels. At this age children will start walking with an adult heel – toe gait pattern rather than the flat footed contact and propulsion toddlers can be seen with. With the introduction of an adult gait pattern we shall also see compensations starting to occur. We use the same assessment techniques as we do for adults and generally the same principles for orthotic prescription. We have to take into account comfort, shoe fitting and what realistically we can expect to achieve. Orthoses for children usually control the rearfoot and do not apply high pressures to the forefoot. The general aim is to try to stabilise the foot in a ‘good’ position at midstance so it is able to be more propulsive.
The introduction of orthoses will not change the bony alignment of the foot, this is predestined. What we can do is reduce the compensations and try to ensure that the supporting soft tissue is able to work to its best ability. There may be stretches and exercises recommended to back up the job the orthotics are doing. We have had good success with a large number of children, both very active and playing sport at a high level and for those who have very flat floppy feet who just find it hard to get around. Children will often need an orthotic until their feet have stopped growing or activity levels change. Orthoses can be used very effectively in the short term for treatment of problems such as Severs Disease (pain in the heel – common in 11-12 year old boys who play a lot of football) and Osgood Slater’s Disease (pain in the top of the shin bone – tibia – again usually in more active children, boys or girls).
Conditions we can treat with orthoses.
| Heel pain | Plantar fasciitis | Arch pain | ||
| Achilles tendon problems | Forefoot pain | Metatarsalgia / neuromas | ||
| Ankle sprains | Shin splints | Knee pain | ||
| Illiotibial band problems | Hip pains | Lower back pain | ||
| Walking problems | Balance | Posture problems |
Basic Biomechanics assessment
£50 30mins
Will include history of problem, foot assessment and basic lower limb assessment. We assess your stance position and undertake a barefoot walking assessment. We will discuss with you what we think your problem is and why it is happening. We shall also discuss which treatment options are open to you and why (this may or may not include orthoses).
Suitable for everyone who thinks that their function is causing or contributing to their problems. This assessment will highlight any compensation movement patterns and identify if they are coming from your feet. Treatment could involve orthoses to change your foot function and possibly physiotherapy, soft tissue therapy or chiropractic intervention to address other issues such as alignment, muscle tightness or weakness.
Running Biomechanical assessment
£90 60 mins
As above but will include a more thorough assessment of your lower limb flexibility and strength both in a non-weight bearing and stance position. As well as the visual walking assessment we are also able to video both walking on running. Running assessment will be carried out on a treadmill and we shall review the results with you at the time.
Discussion of why we think you are getting your problem and the best way to address these issues will be carried out with you.
Suitable for runners or those of you who use running as a form of training. You will need to bring shorts and your current running shoes and any orthoses that you are currently wearing.
For all assessments a report can be generated for paper or computer reading. With all assessments we recommend a follow up appointment 6-8 weeks after fitting of the orthoses.
Orthoses (Insoles)
We have a variety of orthoses that can be prescribed. These range from basic off the shelf arch supports to more complicated custom made orthoses that will affect your gait style and change your function.
Basic orthoses
£25
These are made from a soft EVA, are ¾ (half) length and will fit into most shoes. They are designed to stop your arch from fully dropping when you stand on it and can help with basic foot problems such as arch, heel and forefoot pain.
Pre-made Orthoses
£45
This is a semi-custom type usually made from EVA and will provide more support and can start to change your function. The can be half or full length, this will depend partly on what we are trying to do but also on what footwear they are intending to be used in. They need to be fitted to your foot type and gait style. They come as two parts; firstly the correct shell size and shape and secondly we are able to alter the way they sit by adding ‘posts’ (blocks) under them. This will be determined at the assessment. They are good if you do not need a longer term solution or we feel that your orthoses may need to change in the short term as function improves. This could be due to a traumatic injury or over training injury. They can be used to support your feet and therefore posture and function in a new position whilst you are undertaking physiotherapy type rehabilitation to help your body work in a new way.
Custom Orthoses
£90
This type is made at Holywell Healthcare and are made from an impression of your foot that is taken at the assessment appointment. They can be made from EVA or polypropylene (thermoplastic). The impression of your foot is turned in a plaster positive mould and this is then altered to a new position and the orthoses pressed directly from this. Further alterations may be made to the finished pressing to further customise the fit and alter the function. This type of orthoses will alter your gait style and address the compensation movement patterns that we identify at the assessment. They should directly reduce your symptoms by reducing the stresses on the tissues that are being overloaded. They may take a couple of weeks to fully adjust to wearing them and may make other structures ache, we will advise on what you are likely to expect during the wearing in period at the fitting appointment. This type of orthoses is good if you need to change an aspect of your function to address your injury presentation. These can be made to fit any shoe and may be shoe or sport specific. You may need more than one pair to achieve the ideal position and rehabilitation plan. You are likely to need further intervention from physio or sports massage if you are active on your orthoses. This will help your body adjust more efficiently.
CAD Designed Custom Orthoses
£150-£200
These have the same effect on your body as above but are made by a computer aided design process rather than a plaster mould. This means we can be more accurate and do things slightly differently. It will mean your orthoses should be more accurately made and if you need replacements or second pairs they will be identical. If there are small changes to be made to the initial prescription, again, we can be sure of the accuracy of the adjustments.
These orthoses can be from EVA or polypropylene (£150) or carbon fibre (£200). We can explain which material will suit your needs at the assessment.