As an Orthotic and Prosthetic practitioner for more than 20 years in private practice, dealing with problematic feet has become one of my specialities.
I would like to present to you our various treatment plans for a range of foot conditions.
Hallux Valgus
Plantar Fasciitis
Flat feet (Pes Planus)
Heel Spur
Gout
Diabetic neuropathy
Sesamoiditis
Metatarsalgia
Leg Length discrepancy
Gait abnormalities
Hallux Valgus
In the case of Bunions, we provide the following treatment.
1. Moulded silicone toe separator- This is not the same as an off the shelf toe separator, this orthotic is completely bespoke and is moulded directly between the client’s toes, taking the shape of the webspace perfectly. Once the soft 10 Durometer silicone has completely set (5min) it can be removed and washed for everyday use.
2. Studies have found that there is a correlation between Hallux Valgus and the sesamoid bones. We have noticed that providing a three-quarter length foot orthotic with a metatarsal support (Dome) has a positive effect on the 1st metatarsal and underlying anatomy.
2. ActyToe™ is designed to aid pain relief in patients with symptomatic Hallux Valgus (bunion) and mild or moderate mal-positioning of the big toe, and to maintain position after bunion surgery.
Plantar Fasciitis
A common condition, normally caused by an increase of repetitive movement, i.e. the overseas trip walking all day long or the “back to gym” syndrome of “too much - too soon”.
We all know the symptoms of waking up and the first few painful steps says it all.
1.Foot Orthotics. There are foot orthotics, which are ready made off the shelf that can assist with mild cushioning, but I have found that these “inner soles” provide only mild cushioning and support.
2.Typically, what is needed in most cases is a custom-made foot orthotic which provides support to the 3 main arches of the foot. Not only do these custom orthotics provide crucial weight redistribution for the whole foot, but also are specially made to apply more pressure to the plantar aponeurosis, which responds well to increased pressure, stimulating blood supply.
Custom made orthotics are normally manufactured in 3 different lengths, namely, three quarter, Sulcus and Full length.
The three-quarter orthotic length is the most versatile as it will fit into most shoes and sandals(Attached with adhesive Velcro), while a Sulcus length is suitable for metatarsal cutouts and forefoot weight redistribution. A full length is normally prescribed for persons requiring accommodative diabetic inners and for runners and sports persons, preventing the orthotic from shifting.
3.A night resting splint can be used on its own, with or without a foot Orthotic, but I have found from treating many clients suffering from P.F, that its best to use a foot orthotic for when the client is walking. There are different types of night splints, but I have found one type to be superior.
4.“No bare foot” for 3 months. I advise my clients that they should try not walk on hard surfaces like tiles and concrete floors for a few weeks. I advise them to purchase Crocs or similar slippers that have a moulded inner.
5. A pair of Tuli's® heel cups is cost effective heel cushion that can be worn inside a closed shoe.
6. Aircast Airheel
Here’s how it works…The AirHeel™ brace is equipped with two interconnected aircells located under the foot arch and in back of the achilles tendon. When you take a step, the first air chamber (under the arch) begins to collapse thus reducing the stress to the plantar fascia under the arch. Air is forced into the chamber surrounding the achilles tendon which then inflates. The inflated achilles chamber applies compression to the achilles tendon to shorten the lever arm thus reducing strain on the tendon.
Flat feet (Pes Planus Acquired or congenital)
Flat foot or Pes Planus does not normally cause foot pain, but in many cases, I find that if clients participate in sports activities that requires a lot of running, they may experience the following problems, namely, Shin Splints (MTSS), Iliotibial band Syndrome (ITBS), back ache, Calf pain, Midfoot pain and Ankle complex Arthrosis to name a few.
AirLift™ PTTD BraceOff the Shelf with a Customizable FitThe Aircast® AirLift™
PTTD Brace has a versatile stirrup design that aids in the treatment of posterior tibial tendon dysfunction (PTTD). The anatomically correct design and new intuitive Integrated Inflation System allow for customization of the air cell to help lift the foot arch for a more natural position. Along with Aircast® technology, durable cross strapping and easy step-in design, the AirLift provides an off-the-shelf customized fit for comfortable relief from PTTD symptoms.Recommended for those with: Posterior tibial tendon dysfunction (PTTD) or adult acquired flatfoot (AAF).
Heel Spur
Heel spurs affect approximately 10% of the population. Normally caused due to repetitive stress on the feet. Caused due to the increased pulling forces from the Achillis tendon and plantar fascia on the calcaneal entheses. This creates calcium deposits and bony formations.
Orthotic treatment
There are many ways to treat a heel spur. I found that a combined treatment is normally successful in reducing the pain as the “spur” should not be removed through surgical intervention.
1.Tulis Heel cups have a honeycomb matrix to absorb pressure from the ground. These are inexpensive heel supports that seems to work well.
3.Croc (Or other soft sandal) sandals with lite ride footbed technology.
2.Night resting splint to keep the foot in a neutral position while sleeping helps to deduce the excruciating pain with the first few steps in the morning.
4.Accommodative custom-made foot orthotics, redistribute the ground reaction forces over the entire plantar surface of the foot.
Gout
People who suffer from Gout can benefit from using shoes that have an extra wide design.The Doctor Comfort range provides various styles of shoes and sandals that speak to this condition.
Diabetic neuropathy
For less severe casesInitial treatment with accommodative “custom-made” diabetic full length foot orthotics with a pair of Diabetic Extra wide and depth Dr Comfort shoes. I would also recommend a Mohair diabetic socks to keep the foot dry and provide a friction resistant interface between the skin and shoe.
More severe conditions may require healing shoes for offloading a plantar ulcer. Plantar honeycomb foot bed can be adjusted to accommodate an ulcer/wound.
A diabetic walker can be prescribed for severe plantar wounds and early stage Charcot foot. In certain cases, I have manufactured a custom-made Charcot restraint orthotic walker (CROW) See above. The CROW’s rocker sole provides a smooth rollover. allowing for normal gait. Bilateral CROW’s are a viable option, maintaining and improving mobility.
Sesamoiditis
An accommodative foot orthotic with a 1st Metatarsal cutout/soft insert normally provides relief for inflamed and painful sesamoid bones.
These cutouts are also helpful in increasing forefoot mobility for persons with Hallux Limitus and Rigidus.
Metatarsalgia
This common foot condition responds well to orthotic treatment.
Met pads and Met bandages are not recommended as they shift inside the shoe and the bandages restrict interstitial fluid flow, which can exacerbate the condition.
The aim of the orthotic design is not necessarily to provide cushioning directly under the met heads, but rather to shift the weight posterior to the metatarsal heads, which will respectively unload the pressure under the Mets. The symptoms presented by a Morton’s neuroma may be similar to the symptoms of metatarsalgia, however treatment will be the same offloading technique/
The yellow area depicts where the offloading would occur. The positive plaster of Paris is modified to provide redistribution of the weight under the metatarsals.
Leg Length discrepancy
There are a few options when treating clients that have a leg length discrepancy. If the discrepancy is less than 10mm, its possible to add a heel raise inside the shoe or sandal. For a discrepancy of more than 10mm, we would split the sole off the shoe, add the build-up and then reattach the sole.It is important to raise the shoe in a balanced way, this technique is called Heel Sole Balance
Gait abnormalities
Pathological gait can be visually observed if the condition is severe, however many slight gait abnormalities are not easily observed or diagnosed. New technology is able to provide objective measurements to inform us of even the slightest gait abnormalities. I utilise the digitsole pro system that records real time data from a sensor innersole. The data is uploaded onto a microprocessor, which in turn is then uploaded through blue tooth onto the phone app. The app uses machine learning algorithms to diagnose gait abnormalities.
 Tulis Heel Supports |  Formfit pro ankle sleeve |  Speed brace |
|---|---|---|
 Air-stirrup Ankle brace |  Aircast standard |  Exoform night splint |
 Bort Diabetic Orthopaedic shoe |  Xp diabetic walker |  Airlift PTTD brace |
 Pedisoft Texline Metatarsal bunion pad |