Custom Made Orthotics in Chelsea

Foot orthoses are widely used in the prevention and treatment of foot and lower limb disorders.  Foot orthoses are categorised as prefabricated devices and custom-made devices.  Prefabricated devices have a generic contour and can then be purchased over the counter from health professionals, pharmacies or shoe stores.  On the other hand, custom-made devices are manufactured from a cast, impression or a scan of an individual’s foot and are also most commonly manufactured by commercial laboratories according to specifications requested by podiatrists.  Custom made orthotics are very bespoke and also helpful in specific foot problems with a more complex foot type.

Background

The custom-made approach to orthotic intervention is based on the premise that by manufacturing foot orthoses with patient-specific design features, selected aspects of foot function can then be modified in a therapeutically beneficial manner.  To facilitate this process, custom foot orthotic laboratories provide clinicians with a wide array of options to select from when prescribing orthoses, including different shell materials, degrees of cast correction, shell modifications such as cut-outs, skives, grooves and apertures, and a range of different layering materials.

Orthotic prescription is not only an applied skill manipulating gait patterns but an art which takes many years of refinement.  In 2001, Landorf et al., administered a questionnaire regarding orthosis prescription habits to 617 podiatrists in Australia and New Zealand.  The majority of respondents (72%) prescribed custom-made orthoses most of the time, and then the ‘typical’ prescription was a modified Root style orthosis, balanced to a neutral  position, a plastic shell type selected or an an ethyl vinyl acetate (EVA) device with some rearfoot posting.

How are custom orthotics made?

Making bespoke orthotics is a multi-step process that first begins with a thorough assessment by a podiatrist.  During this assessment, your podiatrist will ask how and when your symptoms started.  After that, your podiatrist will do a foot examination.  This assessment of your feet as well as lower extremity includes a visual gait assessment with measurements undertaken.

If you require any additional imaging for your feet to assess an underlying pathology (such as X-ray or ultrasound), your podiatrist will refer you for an X-ray but we will undertake an in-house ultrasound scan.

Factoring in your symptoms,  activity levels, foot shape, age and also footwear you desire will just form a small part of how we will design a pair of  orthoses for your individual requirements.  

Can custom made foot orthotics be ineffective and why?

Like any form of treatment, foot orthoses can be ineffective and I would only want mine prescribed by a well-trained, qualified as well as an experienced practitioner.  This is important, as it is common place to have to adjust custom made foot orthotics, to optimise their fit into footwear and also to ensure that they are comfortable.  Sometimes orthoses need adjustments to reduce or increase their correction.  Sometimes a patient feels their devices are not working when in fact they just need adjustment.  As I say to my patients, if an orthotic is uncomfortable, then it is difficult for it to be therapeutically effective.  Therefore, a practitioner has to have the skills to be able to adjust or modify a device and if they can’t, then they should not be prescribing custom orthotics or custom insoles as a form of treatment.

Custom Made Orthotics at The Chelsea Clinic

Here at the Chelsea clinic, once it has been determined that you are a suitable candidate for custom made orthotics and bespoke insoles, we can then commence the process of making custom devices specific for you.  Gait Analysis includes in this procedure.

Measurements are undertaken to assess your foot, ankle, knee as well as hip motion.  We will take a number of images of your feet and ankles in a weight bearing as well as non weight bearing position.  With some markings, we then use plaster of paris to take moulds of your feet.  The casts take a day to fully dry.

At this point, alongside a customised prescription form, we then choose high-quality materials specially selected for you.  As part of our green campaign we are looking to source more and more vegan products that will be just as efficacious but kinder to our environment.  Our ethos has always been to look for a win win solution.  The devices include the shell, a bottom, middle and also top cover.  We will then fine tune the devices to add or remove any shell modifications and any additions where indicated. 

Are Custom Made Orthotics worth it?

These devices are custom so that only you will:

a. benefit from the devices and also

b. be able to wear them comfortably.

We use a world recognised lab that only use advanced computer technology and also automated orthoses manufacturing systems. Hence, there are no prefab moulds.  Everything is then made from scratch based on the mould and the prescription which includes a cast scanner, digital corrections workstation and computer numerically controlled milling equipment.  We cater corrective insoles, custom made orthotics for flat feet, flat foot insoles, insoles for sore feet, and other custom made orthotic insoles.

Of course for children devices, we have a whole selection of colours and shell top covers which are not only fun to look at but also children love them.

-South Kensington Podiatrist

Check out our blog about Orthoses here https://www.thechelseaclinic.uk/the-science-of-orthoses/

Read our article about Gait Analysis here https://www.thechelseaclinic.uk/gait-analysis/

Learn more about Ankle Injuries https://www.thechelseaclinic.uk/ankle-injuries/

References:

Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. 2008;3:CD006801

Bonanno DR, Landorf KB, Munteanu SE, Murley GS, Menz HB. Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis. Br J Sports Med. 2017;51(2):86–96

Menz HB. Foot orthoses: how much customisation is necessary? J Foot Ankle Res. 2009;2:23

Bonanno DR, Zhang CY, Farrugia RC, Bull MG, Raspovic AM, Bird AR, et al. The effect of different depths of medial heel skive on plantar pressures. J Foot Ankle Res. 2012;5:20

Telfer S, Abbott M, Steultjens M, Rafferty D, Woodburn J. Dose-response effects of customised foot orthoses on lower limb muscle activity and plantar pressures in pronated foot type. Gait Posture. 2013;38(3):443–9

Williams AE, Martinez-Santos A, McAdam J, Nester CJ. ‘Trial and error…’, ‘…Happy patients’ and ‘…An old toy in the cupboard’: a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses. J Foot Ankle Res. 2016;9:1

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