Biomechanics

Foot problems are many and varied, and the potential causes can be so too. Common problems include plantar fasciitis (‘policeman’s heel’), shin splints, achilles tendonitis, painful bunions, corns, calluses, aching feet or specific joints and Morton’s neuroma. These are usually associated with a particularly tight muscle(s) somewhere, a difference in the length of your legs, too much/limited movement available around a specific joint or even simply wearing footwear not suited to your feet or activities. Also, walking or running in a way which overloads or overuses a particular structure could cause it to be injured. Note that your underlying problem may actually be located elsewhere in your lower limb eg knee or hip, or even higher up in the back.

A biomechanical assessment involves your specialist taking a detailed history and performing a physical examination to identify the root cause(s) of your pain/concern. This will allow a treatment plan to be established to address your musculoskeletal problem. She will assess the range of motion at different joints throughout the lower limb to establish whether the limitations are bony or muscular in nature. Your gait cycle (walking) and your standing stance will also be assessed.

Treatment for musculoskeletal problems can begin once we have identified the injured structure and factors contributing to, or causing your problem. We will develop a personalised treatment plan which may involve several or all of the following: specific stretching exercises, appropriate medication, footwear advice and the prescription of orthoses/insoles following a biomechanical assessment. The orthoses may be a prefabricated orthotic, a slim line insole which can be customised or a fully bespoke pair of orthotics made specifically for you and your problem. The purpose of the orthotic is to improve foot function or reduce pressure away from any problem area.

A bespoke orthotic is a device designed to align the foot and ankle into the most anatomically efficient position. It looks like an insole but is a biomechanical & medical appliance that is custom-made to correct your specific foot imbalance. Custom orthotics work on your feet much like glasses work on your eyes – they reduce stress and strain on your body by bringing your feet back into proper alignment. The plastic body of the custom orthotic helps to re-align the foot by redirecting and reducing certain motion that takes place during the gait cycle. Our 3D optical foot scanner captures accurate measurements of your feet by measuring thousands of different points of the contours of the foot. This allows the lab to mill out a precise orthotic for your prescription.

They are milled precisely to the contours of your feet thus taking up less space than would be thought, however, it is advisable to remove any existing insoles from your footwear to increase space. We also provide different orthotic styles and lengths to accommodate different styles of shoes. You may find you need a second set of orthotics of a different style for different footwear. For example, if you wear narrower court shoes/dress shoes to work but generally at home or for leisure you are in a wider, deeper shoe. During your assessment, the podiatrist will discuss your footwear and so we ask that you bring in a variety of shoes that you wear day to day.

• The customised insoles: depends on the wear they get plus the weight of the patient. These usually last about a year.
• Prefabricated orthotics: approximately one year but dependent on your body weight and number of hours per day these are worn.
• Bespoke orthotics: these take the patient’s weight and height into consideration. As long as the prescription has not altered (broken bones, progression of condition due to lack of orthotic use or considerable weight gain) the orthotic shell should not change shape nor break. The leather covering however will need refurbishing within a couple of years for a small charge, due to expected wear and tear.

Initially, your orthoses may feel odd or even a little uncomfortable whilst your feet adjust to their new positioning. Therefore, it is important your devices are worn gradually over the first week or two; starting with just 2-3 hours and adding an extra hour a day till they are able to be worn all day. It is advisable to wear these as much as possible even in the house where we do a vast amount of weight bearing/walking. The frequency of wear relates directly to the rate of recovery.

For long-standing foot concerns, it is advisable to wear the orthotics continuously for at least the first 6-8 months to see the best results. Once your muscles and lower limb structures have strengthened to be able to hold your foot in a better position the wear time can be gradually reduced. However, it is advisable – when possible – to wear your orthotics.