What Happens Next ...

  • By Judith Sullivan
  • 05 Apr, 2017
19 Oct, 2016
By Matthew Collison

... And Frequently Asked Questions and Useful Links

After the correct orthoses have been selected and fitted to your footwear, the next stage is to start wearing the orthoses. Orthoses alter the way that forces act on the tissues in the feet and lower limbs, and can ultimately affect the way you walk. It is, therefore best to wear the orthoses in gradually to allow the tissues in you lower limbs and back to adapt. This could take a week or two. We usually recommend wearing them for no more than an hour the first day, increasing by an hour each day until you can wear them all day. In this period some aches and pains may be normal, however if these persist, remove the orthoses and try again the next day. Should these aches or pains continue, let your podiatrist know as soon as you can.

It is very important that you continue with any exercises that the podiatrist has advised during this period, even if you feel that the orthoses have alleviated your symptoms. Although relief can be instant, it can take up to 6 weeks to get a good response from your orthoses.

After 6 to 8 weeks, we like to book a review with you to see how you are getting on. At this short appointment we will check that the orthoses are well tolerated and that they continue to fit correctly to your feet and shoes. We will also review any exercises issued to ensure that you are performing them correctly. At this point we can make minor adjustments to your orthoses or exercise regime.

After around a year we like to review progress with our patients and their orthoses. These are usually standard appointments and it allows us to ensure that the orthoses are still working and that the prescription is still correct. We can also perform an additional assessment and modify our management plan to ensure that your needs and expectations are met. If you are no longer symptomatic, we will discuss whether you need to continue with your orthoses in the longer term, or whether they can be withdrawn altogether.

  How do I look after them?

 You do not have to do much to look after your orthoses, but it helps to keep them clean and dry. It is best to avoid submerging them completely, but if they do get wet, remove them from your shoes and leave to dry in a warm dry place, away from direct heat (not on a radiator!) or sunlight. Exposing them to direct heat may cause the plastics to deform rendering them useless. To clean your orthoses, remove them from your shoes and wipe them down with a damp cloth or baby wipe and leave to dry.

Sometimes, certain shoes can cause the orthoses to squeak when you walk. This is caused by the materials rubbing. If this happens, remove the orthoses pour some talc into your shoe and spread around and then replace the orthoses. If that does not work you can rub candle wax around the back edge of the orthoses at the heel.

If the top covers on your custom orthoses are looking tired or excessively worn, but the orthoses are still working, we can offer replacement of the covers for a fee.

Finally, make sure you keep the orthoses out of reach of your dog, as often they can mistake your expensive orthoses for a chew toy!

  Orthotic myths and frequently asked questions

Do I really need orthotics?

  •  You might do, however not everyone needs orthoses, and not everyone will benefit from orthoses. Generally, they are a safe, effective treatment for many lower limb complaints. At Betafeet we see orthoses as only one part of a complete, induvidualised management plan which may include orthoses as well as activity modification, stretching and strengthening exercises, massage, manipulation, pain medications or steroid injections and footwear advice. Your podiatrist will only recommend orthoses after a full biomechanical assessment if they feel that they are appropriate and that you will benefit from them.

Don’t orthotics make muscles weak?

  • In short, no. Currently, there is no compelling evidence to suggest that orthoses cause weakness in the muscles. Orthoses work by altering the forces acting on the foot and not by supporting or splinting the foot as a cast would, so it is unlikely that they would cause muscles to weaken. In the majority of cases orthoses are provided as part of a management plan which often include specific stretching and strengthening exercises.

  Will they cure my flat feet or bunions?

  • They might help reduce the pain and improve foot function but, generally they will not permanently cure bunions or flat feet. By reducing the associated pain and tissue stress caused by these conditions they may allow you to function better and maintain your active lifestyle

  How long do they last?

It depends on the type of device, how often it is used, how heavy the patient is and what kind of activity it is used for. Generally softer, accommodative orthoses do not last as long as more rigid devices, and custom devices tend to last longer than prefabricated devices. You will be able to tell if the orthoses have worn out as they may appear worn or tatty and may not be relieving your symptoms any longer. As a general rule we tend to expect:

  • Simple devices may last several weeks
  • Prefabricated devices may last between 1 and 3 years
  • Modular devices usually last 1 to 3 years
  • Sidas devices usually last 1-5 years
  • Firefly devices last far longer, the shells have a lifetime guarantee against breakage.

However, it must be noted that we can make no guarantee for the longevity of the devices (except Firefly carbon/polypropylene) as some patients subject their orthoses to heavier use than others, different conditions such as heat an moisture levels will also cause the glues and plastics to degrade over time at different rates.

  They look bulky, will they fit into my shoes?

Orthoses will not fit into all shoes. Ballet pumps and high heels are particularly problematic, and we would often advise against wearing these types of shoes whether or not you have foot pain. Many foot complaints are caused or exacerbated by inappropriate footwear. We would recommend that you wear sensible shoes with adequate room, suitable fastening and supportive soles- running shoes are often ideal. We do however, understand that there are times where you can’t wear trainers or lace-ups, in which case we can offer slim or fashion orthoses to fit into your shoes. Custom orthoses can also be made to fit specific shoes such as running, golf, or cycling shoes as well as walking or ski boots. Your podiatrist can advise on the most appropriate orthoses for your needs.

  Is there any discount for second/third pairs?

If at the time of casting you request additional pairs of orthoses we can offer a discount of £50 off Sidas or Firefly orthoses, however if these are requested at a later date, a subsequent casting appointment will be required and the orthoses will be charged at full price. We are unable to offer discount on additional pairs of simple, prefabricated or bespoke modular orthoses.

  What happens if I lose/break my orthoses or the dog eats them?

Unfortunately, these things do happen. Firefly offer an insurance policy called SHIELD where orthoses are covered for loss/theft or damage. Refurbishment and re-covering is also covered, and the policy costs £55 for 2 years. Some fees may apply and the scheme is run by Firefly Orthoses and Betafeet Podiatry accepts no responsibility for any issues with this scheme.

Unfortunately, there is no insurance policy available for simple, prefabricated, bespoke modular or Sidas orthoses.

Will they work in my work/running/cycling/walking shoes?

Yes, we have models of orthoses suitable for most types of work or sports shoes. Ask your podiatrist who will be able to advise further.

References/ useful links:

http://www.firefly.ie/products/shield-insurance/

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006801.pub2/full

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002302.pub2/full

http://www.ncbi.nlm.nih.gov/m/pubmed/19530750/

http://www.nksportspodiatry.co.uk/blog/

http://www.sidassport.com/sidas-home-2-1.html

http://www.running-physio.com/mechanics/


By Judith Sullivan 18 Jul, 2017
Andre was an associate podiatrist at Betafeet for five months.  His contributions to the practice were considerable.  Sadly we lost him to a higher professional and personal calling.

After a stellar educational background and career, Andre joined babylon Healthcare Services, UK based, with a view to helping them set up and deliver the first digital healthcare pilot services to the NHS.   Digital healthcare is a cluster of new and emerging applications and technologies that exploit digital, mobile and cloud platforms for treating and supporting patients. Digital Healthcare is being applied to a  wide range of social and health problems, ranging from monitoring patients in intensive care, general wards, in convalescence or at home – to helping doctors make better and more accurate diagnoses, improving drugs prescription and referral decisions for clinical treatment.

Rwanda then beckoned.

Since joining babylon Rwanda in April 2016, Andre has been instrumental in successfully setting up and launching Africa's fastest growing digital healthcare service.  According to Lindsey McConaghy, babylon's PR manager, 'Rwanda has a population of around 12 million but doctor numbers are in the hundreds. There’s an imbalance between supply and demand'.  

Digital Healthcare is not without its sceptics nor controversies - at what point do you let an app do the diagnosis?  Will GPs embrace technology in this way?

Here is Andre's report about his experiences in Rwanda:  

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. 

'Footnote'

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.  

By Judith Sullivan 12 Jun, 2017
By Reggie Simpson
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