Biomechanical Assessment and Orthotic Prescription

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Orthotic and Prescription Insole

Orthotics are medical devices designed to treat foot, leg and back problems. The main purpose of orthotic devices is to promote correct alignment of your foot and ankle when you’re standing, walking, or running. Orthotics are inserted into your shoe. Orthotics are custom made devices that are moulded specifically to the wearers foot. Prescription insoles are more generic devices, they are made of different material than orthotics and have less corrections built in to them.

History and Examination

Firstly, extract relevant history from the patient regarding their current presenting complaints. The following would be taken into consideration:

occupation
lifestyle
sporting and recreation activities
regular footwear

Medical Background

Surgeries, fractures, strains and sprains

Footwear Assessment

Observation of their current shoes observing heel counter, midsole, upper, sole)
suitability for purpose
suitable for accommodation of orthoses

Full Postural Assessment

Assess standing position of the entire body for alignment and symmetry, flexibility and strength combined with functional movements. Then, more specifically look at the feet. Are the feet standing in a good position or do they look to be standing in one of the following:

Pronated foot

arches rolled in
internal tibial and femoral rotation
genu valgum
anterior pelvic tilt
increased lordosis

Supinated Foot

arches rolled out
genu varum
posterior pelvic tilt
external tibial and femoral rotation
flat back

Foot Posture

Observations and palpation skills are key to assess whether the feet are positioned in a good functional position or if they are pronated/supinated. Palpating the rearfoot ankle bone (talus) and determine if they are positioned more towards the inside (medial) or outside (lateral). If neither is present, the patient is standing in their neutral position.

Supinated Position (Pes Cavus)

arches rolled out

arches

heels turned in (inverted)

sometimes clawed toes

Neutral Position

Arches not raised or flattened

The heels are normally slightly turned in (inverted)

Pronated Position (Pes Planus)

arches rolled in

arches flattened

heels turned outwards (everted) or straight

Hallux Valgus is likely present (Big toe pushes towards 2nd toe)

Gait Analysis

Gait analysis provides information on gait cycle phases, force and its distribution. Gait analysis measures the mechanical factors of joint loading, orientation, and neuromuscular function during walking/running. Specific foot area contacts are also recorded along with step and stride length, ground contact times, track width, foot rotation and cadence. Assessing whole body mechanics during both walking and running can allow clinicians to identify the presence of abnormalities and asymmetries which may be affecting the patient. Specific joint angles are also analysed to determine varus/valgus and inversion/eversion. Information is collected and used to accurately diagnose and treat issues.

The analysis is conducted statically and dynamically which is beneficial in both a clinical and performance setting.

Assessment

Standing posture of the foot ankle knee and hip – what position they face or turn on relaxed stance

Assess functional movements such as squatting, up on tip toes, hopping, jumping.

The patient is then asked to ly face up on the plinth and flexibility of the entire lower limb is assessed.

We then take a closer look at the actual mobility of the joints in the foot, the natural arch type and movement of the first toe joints. With the foot hanging off the plinth we examine the position of the front and rear foot position and estimate the amount of correction required to position the foot in neutral position.

The next part of the assessment involves standing the patient on the the platform. This allows the therapist to test the types of additions and postings needed for each prescription, to achieve a neutral position for the foot in a weight bearing position.