Recently, Rosi and I attended TalarMade’s biomechanics training course. We went into the course looking to improve our understanding of orthotics and become more confident in assessing when they may be useful and how they can form part of a patient’s rehabilitation.
Previously, orthotics were something we would generally refer to a podiatrist for. The course gave us a much better understanding of the research behind modern orthotic prescription and, importantly, how thinking in this area has changed.
Moving away from simply “correcting” the foot
Historically, orthotics were often prescribed with the aim of correcting alignment or making the feet and lower limbs appear more symmetrical.
Current thinking is different. There isn’t necessarily one “perfect” position that everyone’s foot needs to be placed into. Instead, orthotics can be used to modify the forces acting on the foot and lower limb, reducing load on irritated structures while maintaining or improving function.
That fits closely with how we approach injury rehabilitation in our practice: identify what is being overloaded, understand why it is causing a problem, and find ways of keeping someone active while we build their capacity back up.
What do we assess?
The course introduced us to four key assessments that can help guide whether an orthotic may be appropriate and what type of prescription we might consider:
- Sagittal plane function – including ankle movement and the behaviour of the foot during walking.
- SARLE/STJ position – assessing the position and available movement of the subtalar joint.
- Midfoot stability – looking at how the midfoot responds to loading.
- First MTP joint function – assessing the big-toe joint and its ability to function during walking and propulsion.
Rather than simply looking at the shape of somebody’s foot, these tests help us understand how that individual foot functions under load.
So, when might we prescribe orthotics?
The aim is not to give everyone who walks through the door an insole. Orthotics are another tool available to us when the assessment suggests they could help.
For example, different KinetiX models can provide different levels of arch support, heel wedging, forefoot support or first-ray modification. This allows us to select an orthotic based on the findings of the assessment rather than taking a one-size-fits-all approach.
They may form part of the management of conditions such as plantar heel pain, Achilles tendon problems, forefoot pain, big-toe problems or other lower-limb conditions where changing how forces are distributed could help settle symptoms.
Will I have to wear orthotics forever?
Not necessarily – and ideally, no.
Our aim will be for you to use orthotics for as long as they are useful as part of your rehabilitation. They can help offload sensitive structures and provide comfort during day-to-day life or specific activities while we work on the underlying problem through exercise and progressive loading.
That might mean a rugby player using them in rigid boots on game day, or a runner who develops discomfort through their big toe several miles into a run.
We don’t want orthotics to become a lifelong change. We want them to be one part of a wider rehabilitation process that helps you stay active, build capacity and ultimately get back to what is normal for you.