Custom OrthosesThe introduction of custom orthoses generated a lot of excitement and debate within the profession. This changed the concept of an 'insole' into something more scientific and was based on a deeper understanding of the biomechanics of the foot. The ground breaking work on foot biomechanics was developed in California in the late 1960s and has been taken up with enthusiasm by many British Podiatrists. The manufacture of an orthosis is based on an accurate measurement of the relationship between joints both within the foot and between the foot and leg. Purists declared that very minor adjustments to an orthosis could have a major effect on the function of the foot and leg and solve many mechanical lower limb problems.
Over the years some of this rash enthusiasm has been tempered. Certainly there is a place for custom orthoses in the management of a wide variety of foot and lower limb complaints but they do have their limits and are not successful for all problems.Functional orthoses (ie those that change foot function) can only be usefully used when the foot is mobile. In many cases there is no evidence to support their use as in the fact that they will not reverse a bunion deformity and will not help with trapped nerves in the foot.
They provide a useful function in the Diabetic and Rheumatoid foot. They can support a very flat foot and should probably be considered before proceeding with major reconstructive flat foot surgery.
In general a custom orthosis is manufactured from a plaster cast taken of your foot in a corrected position. This is sent to a factory where the orthosis is manufactured. Clearly these need to fit into everyday shoes and I have worked for many years with a factory that can provide a slimline functional orthosis.
I am happy to discuss their indication and use as they do have an important role in the management of the painful foot but form a part of an array of treatments available.