Orthotics Insoles: Treating Recurring Biomechanical Injuries
Orthotics Insoles for Plantar Fasciitis
Orthotics are a vital tool in my clinical arsenal and without them I would not have achieved the necessary clinical outcomes with certain types of injury. It is important to be able to recognise when an orthotic should be prescribed and how they can help. I will explore of when this could be the case, for example, people with flat feet who have recurring retro-patella knee irritation. It is also important to prescribe the right type of orthotic for your patient. This can potentially be a minefield as there are a number of variants, from the cheap £10 ones on Amazon, to the £300+ cast ones prescribed by podiatrists. Getting the correct orthotic for your patient is imperative for achieving desired clinical outcomes.
It is estimated that up to 30% of the world population have flat feet or a fallen arch. This amounts to 19.5 million people in the UK alone. In cases of severe flat feet where there is irritation in the lower limb kinetic chain, pelvis and spine, the only treatment is an orthotic. It is impossible to correct the biomechanical anomaly in any other way. Often people do not actually realise that their injury or irritation is caused by a flat foot, so they will spend a lot of money on various treatments and exercise programmes with minimal impact on the clinical features. That is why it is important to be able to identify the biomechanical anomaly and to prescribe an orthotic that is customised to your patient. Once prescribed it is important the patient continues wearing the orthotic, as their anomaly is similar to somebody who needs glasses, i.e. the glasses correct the vision and as soon as they are removed they lose the correction. If they take out the orthotic out of their footwear, over time the injury will return. The patient must keep the orthotic in their footwear even when the injury has been resolved, otherwise they risk reinjury. I also recommend that the time of orthotic I prescribe is changed every 18 months in order to maximise effectiveness.
If one of my patients says they have tried an orthotic device in the past and it has failed to work, this is often due to various issues. First of all, the incorrect orthotic has been prescribed by the practitioner. This may be because the orthotic was too rigid, or not rigid enough, for the patient, or because it was customised incorrectly. Secondly, it is likely the patient was prescribed the device and told it would resolve their injury and that they would no longer have any issues. This is not necessarily the case. Orthotics must be used as part of a multi-faceted treatment approach. If somebody has a lower limb kinetic chain, pelvis and spine issue, the first priority should be to correct the biomechanics. After this we must implement other treatment and exercise strategies to aid resolution of the injury. Finally, they must continue using the orthotics after treatment, as mentioned previously.
We can use an example of somebody suffering from retro-patella knee irritation to highlight this further. If somebody has this issue as well as profound flat feet then the focus of the treatment management programme must be to get correct osteological alignment of the knee, lower limb kinetic chain, pelvis and spine, so it can work as designed. After this, the knee injury itself can be treated with appropriate treatment and exercise strategies. This injury can be compared to a car that has an issue with it’s tracking. If the tracking is out, the tyres will need replacing every 5000 miles, but if the tracking is perfect they would only need replacing every 50000 miles. Without the correct alignment somebody will keep having to spend large amounts of money and time on attempting to resolve their injury, but it will keep recurring until they correct their biomechanics. This method of combined treatment does not just apply to knee irritation, it can also apply to lower limb kinetic chain, pelvis and spine irritation.
Once malalignment has been identified, it is important to correct the anomaly with the correct orthotic. I prefer to use a mid-range, semi-rigid, semi-permanent orthotic that can be customised for each patient. I keep away from using the £300+ rigid cast orthotics that are used by podiatrists. This is because I cannot justify asking my patient to spend this sort of money on something that their body might not be able to tolerate or may need a further customisation. The mid-range orthotics I use will typically cost the patient around £40 and have much the same effect and outcome at a much fairer price. Your patient might argue they can get the same orthotic off Amazon for less than £10. Whilst this may be the case, the quality provided on Amazon at this price is so poor. They are unable to be customised with additions. They also lack sufficient rigidity to have any corrective effect. A high quality, £40 orthotic can easily be customised for your patient with the relevant training and it is well within our scope of practice.
I am a great proponent of using orthotics to correct patient’s biomechanical anomalies. Flat-footedness cannot be corrected any other way, and with a relatively high percentage of the UK population suffering from this issue, it is vital that we can recognise when an orthotic needs to be prescribed. They must be used correctly as part of a multi-faceted treatment programme and not as a standalone treatment, and also, they must be of a high enough quality to actually work, not the cheap rubbish on Amazon!