Orthoses

What will the orthoses do for me?

The orthoses that we prescribe at Holywell Healthcare 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,
  • – enable your foot to resupinate earlier in the stance phase (this means that your foot will become stable earlier and so more effective at become a propulsive lever)
  • – 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 be 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 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).