Prescription Insoles and Orthotics

 

An orthotic device is an orthopaedic appliance that is used to support and align the joints of the foot, to prevent or correct deformities and to improve function. Optimal alignment of the feet is important for a number of reasons. They include the prevention of postural deformities, the prevention of musculoskeletal pain, the reduction of mechanical stress on joints and thus the prevention of joint dysfunction. They can vary from ‘off-the-shelf’ heel raises, wedges and arch supports, to clinic-made temporary devices, to prefabricated devices and then to prescription insoles and custom made orthoses designed from an impression of the foot at the upper end of the scale. Bespoke devices incur a considerable expense which is prohibitive for many patients.  However, only a limited percentage of patients require these casted orthoses. The type of orthotic that our Physiotherapists recommend for individual patients is determined by many factors, including the findings on biomechanical assessment, the type of injury sustained or presenting condition, footwear, budget and lifestyle. All the Chartered Physiotherapists at Neasa Long Partnership Physiotherapy and Sports Injury Clinic have completed postgraduate education in biomechanical assessments and orthotic prescriptions and participate regularly in in-service training and workshops to ensure that we are familiar with the latest developments in the pre-fabricated device market. This allows us to recommend non-customised but nonetheless very sophisticated devices to our patients if these devices meet their biomechanical requirements. We firmly believe that the best device is not necessarily the most expensive!

For those patients who require a custom-made device, we take a plaster-cast mould of the foot in the neutral position, which we then send to a reputable laboratory. We feel that this system achieves a better outcome for patients than scanners and force plate impressions. As the cast is intimately moulded to the contours of the foot, a more accurate impression can be achieved and the foot can be aligned and held in a neutral position which is more difficult to maintain on a platform or plate.

Prior to orthotic prescription, a detailed biomechanical assessment is undertaken. This includes the following:

• A detailed history of the injury or presenting complaint
• An assessment of posture
• Examination of the joints of the spine, pelvis and lower limbs
• Muscle Flexibility testing of the lower limb muscle groups
• Gait analysis
• Advice regarding footwear
• Recommendation of the appropriate orthotic device
• Measurement and impression taking if a custom-made device is indicated

In terms of cost there is a wide variation in range depending on the findings of the biomechanical assessment and the requirements of the patient. Simple temporary devices can start at €20, pre-fabricated options range from €30 to €55, and prescription insoles from €70. Casted orthotics cost an average of €300. However, this also includes the assessment and impression taking for the devices.

Often, the prescription of a corrective device is recommended as part of the overall physiotherapy management of a condition or treatment. Conditions such as heel spurs, plantar fasciitis, Achilles tendonopathy and recurrent injuries such as ankle ligament sprains may be attributable in part to faulty biomechanics. However, these types of problems require physiotherapy treatment in the first instance to settle symptoms prior to the introduction of a device if one is indicated. In these cases, it is important to be aware that an insole or orthotic is not a substitute for physiotherapy treatment but rather one important facet of overall management.