21 Sep, 2016
By Matthew Collison
Foot orthoses are often prescribed for foot and lower limb pain. The main way that orthoses work is by altering the way your foot interacts with the ground when you walk or run. The aim of an orthosis should be to reduce pathological forces acting on the foot, whether that be to pain in a tissue such as the plantar fascia (heel pain) or to prevent skin breakdown in patients with diabetic neuropathy (sensory loss related to diabetes).
The way forces act on an object (such as the foot) are called kinetics, and the movement and angle of these forces is called kinematics. Often, orthoses are sold to ‘improve alignment’ or to ‘straighten’ feet and joints with the hope of reducing pain; however often it is not necessary or achievable or desirable to modify kinematics with an orthosis. The focus of treatment should be on reducing the kinetics or forces within tissues to reduce pain, rather than purely on alignment.
Different materials and shapes of orthoses can have different effects on tissues, some materials such as low density foams can provide cushioning, whereas other materials like carbon fibre or polypropylene provide more support. Even the top covers can affect the way the orthosis works.
Foot orthoses have been shown to be useful in the management of foot pain in chronic conditions such as rheumatoid arthritis and juvenile idiopathic arthritis as well as specific lower limb pathologies such as plantar fasciitis (heel pain), medial tibial stress syndrome (shin splints), pes cavus (high arches), to name a few.
What kinds of orthoses does Betafeet Podiatry offer?
We offer a wide range of orthoses, ranging from simple wedges, pads or props added to your existing footwear, to prefabricated devices and fully custom devices made from moulds of your feet. Following a biomechanical assessment, your specialist podiatrist at our Tring or Hemel clinic will advise you on what is most appropriate for your needs, and will often offer you a choice of appropriate interventions based on your condition. The key is finding the right tool for the job. You may also find that you need different devices for different footwear or activities. For example, a runner, cyclist or hiker taking on the roads in and around Ashridge or the Tring reservoirs will likely need different devices for his or her running shoes and for their work shoes. Betafeet Podiatry also sees clients who are on their feet most of the day such as those who work in restaurants in Tring and Hemel, and surrounding areas, as well as hairdressers, builders and others.
Orthoses will almost always be prescribed alongside other advice and interventions such as activity modification, stretching and strengthening exercises, self-massage advice and footwear advice.
Stayed tuned for further orthoses blogs.
Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.
This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.
As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.
Now you are probably wondering what this has to do with podiatry?
Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.
As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.
The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.
How did all this lead me to Africa, I hear you say?
In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.
This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.
Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care.
It is with
this experience I now look to move on to my next adventure focusing on Aboriginals
and the utilisation of technology in the prevention of major non communicable
disease such as diabetes.
Final comment from Reggie Simpson and Betafeet Podiatry
We wish Andre the very best in his future and thank him for this interesting blog account. We look forward to his next blog focused on his work with the Aboriginal population.