An orthosis is any externally applied device used to modify the structure and function of the skeletal system.

Foot and ankle orthoses are used to:

• Control, guide, limit and/or immobilise the foot and ankle
• To restrict movement in a given direction
• To assist movement generally
• To reduce weight bearing forces
• To aid rehabilitation from fractures after the removal of a cast
• To otherwise correct the shape and/or function of the body

A custom orthotic is a device designed to align the foot and ankle into the most anatomically efficient position. They look like insoles, but are biomechanical medical appliances that are 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 body of the custom orthotic helps to re-align the foot by redirecting and reducing certain motion that takes place during the gait cycle.

An orthotic can either be functional or accommodative. Functional orthotics restore the foot into a neutral biomechnical position. They work if the foot is flexible. When the foot deformity is fixed and the joints arthritic an accommodative insole is used.

Custom orthotics fit into your shoes as comfortably as an insole. This is because they have the advantage of having been made from precise imprints of your feet. Foot orthotics can be made of varying materials, from very rigid carbon fibre to very low density foam.

Orthotics will provide many people with immediate relief from foot pain. However, if the orthotic is correcting the alignment of your foot to a new position that your foot is not used to then this could cause some initial discomfort.

Your feet and legs may have functioned abnormally over a number of years. Your orthotics will encourage them to work in a better manner and this may initially feel strange. To correct a situation that has developed over years will take time. You should not wear your orthotics all day from the first day, but gradually increase the duration for which they are worn by half an hour per day.

If you suffer initial discomfort, for example mild aches along the outside and backs of your legs, then it is recommended that you only wear the orthotic for less than an hour per day for the first week and gradually increase the duration for which you use the orthotic. You should not increase the duration of wearing an orthotic until any aches have subsided.

When you can wear your orthotic comfortably for four hours, then it is likely that you will be able to wear them comfortably all day.

Once the wearing in period is completed and appropriate footwear is being worn, most people begin to notice an improvement in the first 4-6 weeks. Between 6-12 weeks is generally when you can expect the most improvement. These time frames will obviously vary depending on the individual foot problem.

You may also have been referred to a physiotherapist or shown some stretching exercises, please remember to carry out the appropriate stretches and exercises.

If the pain is not improving after 12 weeks, please arrange a follow up appointment with your surgeon Mr Malik.

Orthotics will not change the underlying structure of the adult foot. If they are not worn, abnormal function will most likely return.

Orthotics will control the position and motion of your foot as long as you use them. This may reduce pain and disability, and prevent or delay any further deformity. However they will not cure any underlying deformity. It is impossible to predict without trying an orthotic whether it will be successful or not.

Some people develop discomfort in the foot, leg, or lower back when they first start to wear orthotics. This is normal and is due to a realignment of the whole lower extremity and pelvis. Muscles and ligaments (the Kinetic chain) have to readjust to this new alignment. When they do the discomfort disappears.

Most patients never have any “break in” discomfort. When it does occur, it usually disappears in a two or three weeks. If the discomfort occurs, it is advisable to gradually “break in” your new orthotics. Persistent discomfort may necessitate adjustment to your orthotics. Please speak to your orthotist or podiatrist who may decide to adjust the orthotic accordingly.

Podiatrists, orthotists and even some specialist physiotherapists are able to provide custom orthotics.

The key to successful use of an orthotic is getting the right diagnosis in the first place. This sounds obvious, but many patients fail conservative treatment because the wrong diagnosis has been made previously. Discuss with your surgeon Mr Malik for a referral and for further details.