Prescribing Orthotic Footwear

What to expect at an orthopaedic footwear consultation


There are a number of reasons why orthotic footwear is necessary for a patient, rather than simply wearing a standard shoe. Orthotic footwear is designed to accommodate for a variety of ailments, the purpose of which is to support the foot during rehabilitation and ultimately improve the patient's health and wellbeing. The key features of orthopaedic footwear include:
 
  • Optimum fit can be achieved for individuals with foot deformities or oedema (excess of fluid)
  • Seam-free lining to reduce the risk of pressure from the upper – particularly suited to diabetic or ischaemic patients
  • Easily customised heel/sole unit
  • Choice of upper materials and liners to suit the patient’s condition
  • Easily accommodate orthoses inside the shoe (for example insoles), or as a part of the combined footwear/orthosis treatment
  • Increased room can be created in the toe box

Assessment process

When assessing for any orthosis, the orthotist will carry out a number of verbal questions and physical tests to determine each patient’s specific functional loss, and then create an appropriate orthosis design to provide the support required for normal function. The assessment process will usually consist of the following practices:

Patient history
The orthotist will ask a number of questions about the patient’s health history, paying particular attention to any pattern in symptoms as this can reveal problems quickly. Research has shown that patient history can, in some cases, be more effective in diagnosing a problem than clinical tests alone.  Example questions would be:

 
  • Where is the problem?
  • How did it start?
  • How long have you had the problem?
  • When does it trouble you?
  • What makes it worse and what makes it better?
  • What treatments have you had/are currently trying?
  • What are your current/previous activity levels?
Look – Feel – Move
Your orthotist will then carry out a series of physical tests, focusing on the look, movement, and how your foot feels. These assessments may include:

Look

 
  • Examining the entire lower leg and foot area. Orthotists often advise patients to wear shorts so that the knee can also be easily examined.
  • Examining the soles of your shoes for signs of asymmetrical wear. This will highlight any irregularities in your gait.
  • Looking for side to side asymmetry when the feet are planted, or abnormal contact with the ground.
  • Examining general standing position and posture.
  • Examining skin condition on the legs, feet and soles.

Feel
 
  • They will ask if the patient is experiencing any areas of tenderness or swelling. They may then test for pitting oedema by pressing onto the swollen area gently.
  • Checking that all bony landmarks on the foot are in the correct place and can be felt.
  • Testing the skin temperature gradient from the knee to the toes.
  • Patients may be questioned about any abnormal sensations experienced, e.g. cramp, burning etc.
  • Checking that the pulse can be easily taken from certain areas on the foot.

Movement
 
  • The orthotist will test that the foot alignment is correct when placed in various positions.
  • Weight bearing on the foot will be examined.
  • An observational gait analysis is carried out, to ensure the entire body is moving correctly and there are no abnormalities in areas such as shoulder position, head tilt or pelvis level.

Specific tests
If the orthotist feels that they require more information for specific prescriptions, they may carry out further tests which are specific to certain type of function within the foot.
 
Prescription
 
The orthotist will then discuss if the patient requires an orthosis or orthotic footwear, or both, and assess what available options there are to suit their needs. Once a treatment plan has been agreed, they will measure, take drafts and/or moulds of the patient’s feet.

If you would like more information on our orthopaedic footwear, or to enquire about an assessment at Steeper Clinic with one of our orthotists, please contact us today.