You don’t need to be Mad (Max) to wear a brace……

In fact, for the many thousands of people around the world suffering the effects of Polio, or Post Polio Syndrome (more on this later), you’d perhaps be mad not to though.

Polio, or Poliomyelitis to give it its correct name, is a disease, that whilst having been eradicated in Europe in the early 2000s, still causes pain and is massively life-changing for so many even 17 years on. Polio is a very infectious disease, and was primarily contracted orally, and in years gone by, swimming pools were often blamed for predominantly children contracting it. In up to 70% of cases, there would be no symptoms beyond an extreme cold or flu, or problems with the stomach. In a significant percentage however, the symptoms were severe, and caused a whole range of issues. There was a significant difference between what was known as ‘abortive Poliomyelitis’, where the symptoms, whilst debilitating didn’t lead to paralysis, and ‘paralytic Poliomyelitis’, where as the name suggests, paralysis was a feature. Most often, this was spinal paralysis, and was caused by a viral invasion of the motor neurones in the spinal column. Despite the severity in a large number of cases, many of those who suffered, even badly, as a child, recovered in the main to enter adulthood without the disease.

It is important to note that there is no cure for Polio, and whilst there is a very successful vaccination programme in place in many parts of the world, this isn’t the case globally. The World Health Organisation were hoping for global eradication of the disease by now, we are not quite there yet. As recently as 2015 in the Ukraine, there were 2 new cases of the disease.

The fact that Polio is something of a historic disease, does not mean that we are free from the ‘aftermath’ all these years on. There are believed to be in excess of 100,000 sufferers in the UK alone of a viral infection known as Post Polio Syndrome (PPS). As the name suggests, this is something that arises in adults, usually about 15 to 30 years after they first had polio, and the impact upon health, mobility and lifestyle is hugely significant, as this also has no cure, and the effects of it simply have to be managed, and by this, I by no means suggest that the management of it is simple in any way, shape or form.

Because the vaccination programme didn’t really kick in until the mid 1950s and early 1960s, we still have a large number of PPS sufferers living today, and many have these have significant mobility issues. One of the problems with PPS, is that it is quite difficult to diagnose, as it shares many of its symptoms with Chronic Fatigue Syndrome (CFS), and also in fact is often simply put down to signs of ageing. Unlike CFS however, PPS is progressive, and thus often results in significant loss of muscle strength. Diagnosis can now be done using electromyography, or an EMG as it is more commonly known, or MRI in certain cases. The really bad news for PPS sufferers, is that there is no reversive therapy, thus once diagnosed, it is all about treatment and management of the condition, as opposed to trying to get ‘better’ from it.

This is where Orthotic intervention comes in here. I used the image from Mad Max at the head of this post, as it shows the Max character wearing some kind of futuristic leg brace – futuristic for when the film was made I would hasten to add, and in fact, the range of Knee, Ankle Foot Orthoses (KAFO) today, is far more technologically advanced that anything available in the dystopian world of the mid 21st century envisaged by its makers in 1979! As with many of the conditions I have explored in this blog, the treatment is entirely bespoke and is specific to the individual, so there is definitely no single approach to how PPS is managed in any given person. Ankle Foot Orthoses (AFO) and KAFOs are designed to really do several jobs, and these include the desire to maximise energy efficiency, so really to ensure that any energy used by the wearer has the best outcome, to reduce pain, and of course to protect the limb and the joints from any unexpected or unusual forces, which actually we all encounter naturally as we go about our daily lives, but which have to be managed in cases such as PPS.

The great news, is that technological advances have meant that KAFOs and AFOs are now far stronger and lighter than ever before. Materials such as titanium and carbon fibre are now common in the manufacture of these Orthoses, where callipers used to be made of leather and steel, which were themselves very heavy and cumbersome. Orthotic insoles (FFOs), as well as shoe design and manufacture, all mean that now being prescribed an KAFO, with FFOs, and needing shoes wide and deep enough to accommodate all of this, is no longer an issue of being subject to instruments akin to those used in torture, and having to say farewell to any semblance of style.

Some PPS sufferers reject the PPS label, and prefer to be recognised as still suffering from the Polio that affected them as children or young adults, and there is also some resistance to orthotic intervention in their treatment, as they see this as ‘giving in’. This couldn’t be further from the truth, as this is about maximising mobility and stability, maintaining the highest level of independence, and enhancing lifestyle and making the most of what we can. We haven’t quite reached the dystopian nightmare offered in Mad Max, and even in changing times, we still have so much to enjoy, and the right Orthotics, prescribed by a qualified, experienced and HCPC registered Orthotist, will help you to do this.

If you think that you may be suffering from PPS, or you are experiencing mobility issues of any kind, make that appointment and see your Orthotist as soon as possible, because contrary to the Mad Max title track, we DO need another hero, and it might just be you, and like Max himself, you won’t be much use if you are not wearing your Orthotics!!

I Believe the Children are our Future…….

As the song goes, ‘Treat them well and let them lead the way…….’ (Masser and Creed, 1977). Sadly, even in the 21st Century, with all the medical and technological advances made in the last 100 years, there are still many circumstances in which children are being born with issues that will impact upon their lives – some through childhood, and some well beyond into their adult lives. It is the worst and best part of being in any kind of healthcare or medical profession, in that you see the pain and anguish of a poorly child, but you also get to experience the absolute elation that is assisting a child to overcome some of the real issues that they face every day of their young lives. There are, of course, many such illnesses and conditions that can effect children, and it would be impossible for me to tackle all of these in this forum, but I do want to examine just a few of the more frequent cases here, and then to look at just how an orthotist can assist in reducing pain, increasing mobility, and providing the stability for a growing child as they go forward into adulthood.

One of the better know conditions is Cerebral Palsy (CP), which literally means paralysis of or in the brain. This is damage that will not be cured, and is therefore persistent. As Hinchcliffe (2003) notes however, good positioning and handling can improve some of the issues related to posture and movement in children with CP, and conversely, poor handling can worsen movement for example. Often, children with CP have high muscle tone, which in basic terms means that their muscles are tense, and this also in turn prevents muscles from developing normally, which then goes on to cause further problems regarding mobility. CP is a once-only event, and it doesn’t reoccur and is not progressive, thus children who respond well to treatment, can show significant improvement in their stability and mobility, but more on how this can be achieved later. There are several ’causes’ for CP, but in most cases, the cause is not identifiable. Similarly, the problems associated with having CP is not the same for all children. There are often sensory issues, which may include sight, hearing and touch, and one quite common feature, is that the child has an issue with locating their limbs in relation to their bodies, thus becoming increasingly relying upon their sight in order to move around. This is something that has to be seriously considered when treating a child with CP, as you cannot rely upon the presence of touch or sensation, whilst at the same time having to factor in falls and bumps during movement.

Congenital Talipes Equinovarus, or club foot as it is often called, is another issue that manifests itself in babies. The definition of Talipes is quite complex, but put simply, it is where the foot is inclined inwards, axially rotated outwards and pointing downwards. Whilst the condition isn’t painful for babies, if it goes untreated, it becomes very painful for the toddler, and causes significant issues with walking as the child gets older still. Treatment usually involves a level of manipulation of the foot or feet, as in many cases, both feet are affected, and then it is often down to the Orthotist to ensure that the positioning of the feet is correct, in order to ensure a normal gait pattern, and to prevent issues with footwear in later life.

I’ve already examined the issues surrounding hypermobility in a previous blog post, but by way of a reminder…… A large number of children who live with hypermobile joints, experience pain, and can also present with a number of other, seemingly unconnected symptoms. ‘Joint Hypermobility Syndrome’, or sometimes ‘Benign Joint Hypermobility Syndrome’ as it is known, can be associated with joint pain and movement difficulty, but can also be linked to fibromyalgia, anxiety, low blood pressure, and even Urinary Tract Infections. Much of the joint pain happens after engaging in activities, or at the end of the day, and can be present within the hypermobile joint itself, or can manifest itself in other areas. Sometimes, hypermobile joints are susceptible to ‘cracking’ or ‘clicking’, but it is not normal for this to create further damage or to restrict mobility.

The NHS, as always, are fabulous in treating these, and other conditions common in children; The issue however, as in so many cases, is the level of time and funding that is made available through our wonderful health service. Splints prescribed for children with CP for example, may not be the best for their care, and whilst they may provide a level of support, they may not always be the most comfortable to wear, or allow for more everyday childhood activities. Your Orthotist working outside of the NHS has a whole different set of options available for you, but these do obviously come at a cost. These include a variety of FFOs and AFOs, lycra suits, bespoke footwear, and in certain cases, even devices such as the Paediatric F.E.S, which provides active muscle contraction for children with foot drop, not uncommon in CP sufferers.

In short, whilst some of these childhood issues are likely to impact upon their lives into their teens and beyond, the best treatment can certainly work to improve mobility –  often unaided, reduce pain, possibly reduce the need for surgery, and certainly work to improve quality of life. So if your child has any of these issues, then make an appointment to see your Orthotist as soon as possible, as this will certainly count as ‘treating them well’.

Now This Will Definitely Get on your Nerves……

Multiple Sclerosis, or MS as it is more commonly known, is something that affects over 100,000 people in the UK according to the MS Society website. Strangely, MS affects almost 3 times as many women as it does men, and the reason for this is largely unknown. Like so many other conditions and disorders, the symptoms of MS can vary from person to person, and they can also change significantly across a period of time. What isn’t so common however, is that an MS sufferer can begin to experience symptoms long before a diagnosis would be sought. So what precisely is MS?

In the proverbial nutshell, MS is a condition that affects the brain, the Spinal Cord, and the Central Nervous System (CNS). The nerve fibres within the Central Nervous System are protected with a coating called myelin, and this shields the nerves. In someone with MS however, the immune system begins to attack the myelin, mistaking it for a ‘foreign body’ that it needs to fight, as it would with any other disease or illness. This then leaves the nerve fibres unprotected, and often results in lesions that slow down information as it passes through the CNS, and at it’s worst, causes these messages to be stopped completely, thus resulting in the disability or lack of mobility, so often associated with MS. Put in a completely lay-persons terms, if you cut a piece of electrical cable, you will see several wires, all covered with a protective plastic coating – think of this as myelin. Whilst this coating is intact, the electricity flows though the cables safely and without interruption. Cut through these protective inner cables however, and you will create electrical shorts, and at the worst, a complete failure in the power reaching whatever it is you’re trying to use, thus disabling the piece of equipment.

It is impossible to provide a list of symptoms, as this would very much depend upon which part of the CNS is damaged, and as this serves the entire body, it would then be specific to the individual concerned. The symptoms can range from fatigue, to dizziness, to pain, emotional or mental issues, and through to impact upon mobility and speech for example. Symptoms can also change very quickly, even during a single day, someone can relapse or conversely can enter into periods of remission, where the symptoms ease, or change.

A great deal of research is being undertaken to find causes and cures for MS, but this is a lengthy and expensive process, and it is unlikely that there will be any significant breakthrough imminently. It is therefore important, for people diagnosed with MS, which incidentally usually requires an MRI or a Lumbar Puncture, to manage their symptoms in order to minimise pain, and to maximise mobility, particularly through the earlier phases of the condition.

This is where your Orthotist can help. As with so many other issues where mobility is impaired, or where pain resulting from mobility is increased, the Orthotist can conduct a thorough biomechanical assessment, and from this, prescribe the most appropriate course of action. It is important to note at this stage, that this ISN’T just about the feet or insoles! Whilst this may indeed be relevant for some, it’s not going to make much difference if the pain manifests itself in the upper limbs; the arms or shoulders for example. BUT, your Orthotist may still be able to assist in reducing your pain and increasing your range of movement, whilst preventing further damage and maximising stability.

So, if you have been diagnosed with MS, or are suffering symptoms in the stages pre-diagnosis, then it is time to make an appointment to see your Orthotist, as whilst they can’t prevent the onset, ‘treat or cure’ MS, they can assist you with managing your life around the condition.

Ruin A Good Walk? Certainly Not…….

If you play any sport, then it is vital that you maximise stability and mobility, whilst minimising pain, and with many sports, this boils down to ensuring that you have the correct footwear and making sure that it is performing the way it should. In most sports, the shoe itself has a part to play in assisting you to achieve your best, be this a specific sole on a running shoe, a stud on a football boot, or the spikes on a golf shoe; however, the shoe can only ever be part of the process.

If we take the game of golf as our example here, you could own a pair of the best golf shoes available today, and yet the key to ensuring that stability and mobility are maintained, rests primarily with understanding what your foot does in that shoe. If you have existing issues such as Hallux Valgus, or a bunion to you and me, suffer with an arthritic foot, plantar fasciitis, fallen arches, in fact, any number of foot problems, then it is vital that you seek help and advice from a qualified Orthotist at the earliest opportunity, as this can reduce pain, and prevent future deformity or injury. Playing on regardless, will also be doing your game no favours either, as lack of stability and pain resulting from not addressing underlying issues, will only serve to hinder your progress towards the 19thhole!

So, if you play golf, and you’re finding that you are experiencing greater pain, reduced mobility, and are feeling less stable, then book your consultation with an experienced and HCPC registered Orthotist, and let them help you to bring down your handicap!

Bend it Like Baryshnikov……….

More often than we probably imagine, children develop with several joints that are more flexible than others. This is usually called ‘Hypermobility’, and it happens when the connective tissue, which is an integral part of the joint, is more easily stretched than usual. Hypermobility is not always a problem, in fact it is almost necessary for some athletes, gymnasts and dancers, particularly ballet dancers. Children’s joints almost always have a greater range of movement than that we would expect to see in an adult, and this flexibility usually limits with age. Interestingly, girls are usually more prone to Hypermobility than boys too. So if Hypermobility is normal, and even seen as a advantage in some fields, why is it an issue, and why are we discussing it here?

Well, a large number of children who live with hypermobile joints, experience pain, and can also present with a number of other, seemingly unconnected symptoms. ‘Joint Hypermobility Syndrome’, or sometimes ‘Benign Joint Hypermobility Syndrome’ as it is known, can be associated with joint pain and movement difficulty, but can also be linked to fibromyalgia, anxiety, low blood pressure, and even Urinary Tract Infections. Much of the joint pain happens after engaging in activities, or at the end of the day, and can be present within the hypermobile joint itself, or can manifest itself in other areas. Sometimes, hypermobile joints are susceptible to ‘cracking’ or ‘clicking’, but it is not normal for this to create further damage or to restrict mobility.

Hypermobility is often easiest to identify visually in the knee, as increased ligament flexibility in the knee, allows it to ‘hyperextend’, and the child, when stood, has their knee behind the pelvis, if this makes sense. Where this is present, there is an increased likelihood of flat feet (which I wrote about last month), and ankles more susceptible to damage due to the lack of support that hyperextension creates. Kids with Hypermobility, also often have some tighter muscles, and whilst this sounds contradictory, it can often be a product of posture, due to the flexible joints themselves. Take for example, if children sit on a floor with their legs wide apart, sometimes with their spine flexed, then they will experience stiffness and find it difficult to sit with their legs outstretched.

There are a couple of more serious conditions where Hypermobility is present, but this alone is not a specific indicator of Ehlers Danlos Syndrome or Marfan’s Syndrome, and parents should not automatically assume the worst case scenario.

So, how can an Orthotist help a child with Hypermobility? The simple answer is by not attempting to ‘over-brace’ the child. Hypermobile ankles or Hyperextended knees for example, can often be best treated starting at the foot, and this would be with an insole, or sometimes even a heel lift. The key is not to automatically reach for the brace that would hold the joint in a corrected position, as this may then hinder muscle development, which could rectify the problem by itself. Allowing the muscles to develop, will often  bring about reduced flexibility in the affected areas, but if a brace is used, then the muscles might not do their job correctly. Of course, in cases where the flexibility remains, and a Functional Foot Orthosis is not providing the stability required, then of course options such as braces, or boots are available, but the best person to give this advice is your Orthotist.

If you think your child is a little too ‘bendy’ then, it would be a good idea to make an appointment to see an Orthotist sooner rather than later, because whilst it might be the muscles that are developing to tighten the joint, the pain will need to be managed, and the foot and ankle will be held in a corrected position, to allow the muscles to develop as they should. After all, this is what your Orthotist is there for.

You’d Better Put Your Flat Feet On The Ground……..

You might not be Mustang Sally (sorry, a music reference for those younger than 50), but you may have been told at some point that you have ‘Flat Feet’. It could also be that you’ve self-diagnosed flat feet, but what exactly are flat feet?

The truth, is that this is far too often an ‘easy’ label that can be applied, to what can actually be a number of different issues. There is certainly no single cause, effect, or course of treatment that can be applied to this label. The reality, is that if you do find yourself with a ‘flat foot’, then this can be really painful, and not always in the foot itself.

There are actually 3 arches in the foot, but the one usually concerned here, is the Medial Longitudinal Arch. If for some reason there is an issue with this giving way, or falling to use the more common term again, then this can indeed result in a flat(ter) foot. There are also a number of reasons why this could be the case.

Firstly, we are all born with flat feet, and the issue is one usually discovered after the age of 7, as our arches develop during the first 7 years or so of our lives. This is commonly an issue with the boney structure of the foot itself. Even once you are up and walking unsupported, the arch issue may not be quite so obvious, as the body tends to adapt and cope with the issue, with muscles and tendons holding the arch for as long as they can. At some point, this situation may change, possibly following an injury, after surgery somewhere else in the body like a knee or hip, and it might be the case that during rehabilitation, there is greater strain placed upon the foot, causing the arch to ‘fall’.

Secondly, the issue with the arch can be acquired. In this case, the issue is not an intrinsic structural one, but instead comes as a result of an injury perhaps, over-use, or quite simply, through old age; the result however is often the same.

Thirdly, there is sometimes a link between flat feet and plantar fasciitis, although it is unwise to always assume that one goes with the other, as this is certainly not the case. If you’re wondering what plantar fasciitis is, I’ve blogged about it before, but in a nutshell, it’s a severe pain, usually felt most in the heel, and is an inflammation of the tissue that runs across the bottom of the foot, and which joins the heel bone to the toes.

Whatever the cause of ‘flat feet’, the bigger issue is that once it occurs, it begins to impact on pretty much most of the body above it, from the foot itself, through the ankle, the knee, the hips, the spine……… you get the picture! This again, is generally because there is a change in gait and posture, which then affects the way we walk, stand, sit, sleep etc etc.

So, what can be done to treat flat feet? The key issue here, is to ensure that you get a full and thorough biomechanical assessment from a qualified Orthotist, as this will determine the best course of action. The solution is generally a non-invasive insole, that sits inside the shoe(s). It may be that a simple off-the-shelf insole will be sufficient to prevent further damage and reduce pain, but unless you seek professional help, you won’t know this, and trust me, simply putting something in your shoe and trying it for a few minutes/hours/even days, won’t be enough to establish whether it is working, or in fact creating further harm in the long term. It is possible, that in order to treat most effectively, you would need bespoke insoles, made specifically for your own prescription, but this can be discussed with the Orthotist during your assessment.

I guess the message here, is that if you think, or you are told that you have flat feet, don’t simply brush this off as something that will go away, as it won’t. Seeking help from a qualified and HCPC registered Orthotist, will begin the process of reducing pain, managing better posture, and preventing yers of pain in so many other parts of the body that aren’t the foot. Book an assessment today, and stop being Mustang Sally!

He’s Making a List, Checking it Twice…….

Christmas is definitely a time for lists, be they presents, cards, shopping, etc etc, but there is often one thing we don’t think about at this festive time of the year: our health and wellbeing. The reality of Christmas for many, is that we actually do quite the opposite. We plan for parties, and drinks, and most people expect to over-indulge in one way or another. It’s OK, because we all use the New Year as our opportunity to ‘atone’ for our excesses of December. If this is about about losing a few pounds that we’ve gained through having that extra chocolate, or helping of pudding, or that extra bottle of something, then this is fine for most, as a firm resolve to hit the gym or the streets can often do the trick. One area of our general health that isn’t quite so easy to fix however, is the pain that results from wearing inappropriate footwear, or excessive tripping or falling as a result of seasonally poor weather.

One thing we should all put on a list, is to make sure that we have planned for going out in the frost ice and snow, and that we are NOT planning to wear ridiculous footwear either to parties, or around the house. Everyone wants to look their best at the office party, but this isn’t a competition as to who can wear the most absurd shoes. This is as much of an issue for men as it is for women, as it’s not just the size of a heel that causes problems, but can also be how tight, narrow, stiff, or ‘sloppy’ footwear is. If people spent as long looking after their feet, ankles, knees, hips, backs and necks, as they did choosing wrapping paper, then Christmas would be a happier event for so many more. It’s also very true that Christmas is an expensive time of the year, but again, people will spend more on stuff that’s forgotten by January than they do on their own wellbeing.

I mentioned the weather, and of course we can’t legislate for that, but we can make sure that our winter footwear gives us a chance to at least stay on our feet. Well fitting shoes and boots really can make the difference between “I’m Still Standing’ and ‘Slip Sliding Away’. It is also important for some with an ‘awkward’ gait to seek help in order to reduce the chance of a fall. I for example, walk at ’10 to 2′, with my feet wider at the toes than at the heels, and this isn’t conducive to walking in snow, as the natural step is to slide out. There is something that can be done about this.

Anyway, enough of the lecture. Just time for a couple more warnings. If you have children in the house, then beware standing on widely spread toys and games, particularly those famous little Danish bricks, as stepping on one of these unawares, can cause tremendous pain. Finally, if you’re planning to climb up and down chimneys in huge black boots, then take it steady, as it will be a long night, and I don’t think you’ll find an Orthotist on call after 4pm on Christmas Eve!

On a more serious note, my self and all the team at the Quays Orthotic Practice in Lincoln UK, would like to wish you all a fabulous Christmas, and a healthy and prosperous 2019. Remember, if you are going to give yourself a treat this Christmas, make time to book in to see your Orthotist either before the holidays, or early in the New Year, and make reducing pain and increasing mobility your New Years resolution.

A Spoonful of Insulin Helps the Sugar Go Down……..

Diabetes UK, through there website, suggest that that there are 4.6 million people living with Diabetes in the UK today, and that by 2025, this will have risen to 5 million, despite advances in detection, medication, and a wider understanding about lifestyle and diet. 10% of this number have Type 1 diabetes, which is a lifelong condition that impacts upon the heart, eyes, kidneys and feet, and the remaining 90% have Type 2, which has very similar impact upon the body, but which more often occurs in later life.

Diabetes is a condition that exists because the levels of glucose in the bloodstream become dangerously high, all due to the bodies inability to create insulin, which assists in allowing this glucose to enter our bloodstream and be converted into energy. Type 2 Diabetes is often associated with poor diet or lifestyle, whereas there is little known about the causes of Type 1.

The reason Orthotists are interested in Diabetes, is that one of the key areas where the impact of the condition can be severe, is in the foot, and this is something that really should not be overlooked. A key feature of Diabetes is that cuts and wounds don’t heal as well or as quickly in a sufferer, and thus the foot, which is usually tucked away into socks and footwear, becomes increasingly vulnerable. Another symptom, for want of a better word, of diabetes, is that certain parts of the body, usually at the extremities such as the fingers or toes, begin to have reduced sensation or feeling, and this is called ‘Peripheral Neuropathy’. If you experience this, then it is easier to harm the foot, and not realise it quickly enough to prevent any damage. Ben Yates (2009) suggests that this peripheral neuropathy leaves diabetics at a greater risk of developing an ulcer, and sadly, he also argues that this increases the chances of reduced mobility, poor life quality and even amputation.

This is all quite scary, but I guess that this is where the Orthotist comes into the equation. The Orthotist will be able to identify risk at the earliest stages, will work with the patient to develop an appropriate prevention strategy, develop an integrated care plan if appropriate, and then refer to other clinicians if necessary, with the aim of maintaining foot health and reducing the risks that may ultimately cause problems into the future. Some of the challenges around a diabetic foot can be biomechanical, and as this is something I’ve discussed a great deal in this blog already, I won’t go on; but, it is important that the diabetic gets assessed by an Orthotist significantly early enough, in order that any issues with gait for example, are managed before they go on to be a bigger problem. The Orthotist is also the most appropriate clinician to advise on footwear, and whilst this may sound a little odd, they are in the best position to advise where an individual requires support, and as importantly, where pressure may become an issue. Appropriate footwear, including socks and hosiery for example, can make the difference between developing an ulcer or not, and where ulceration is already a factor, it is important to understand how to manage this for the best.

In truth, the diabetic patient will probably need the specialist intervention of several clinical experts, but the key message here, is that the Orthotist is an important part of this team, and should be one of the first people to intervene, if mobility is to be maintained, pain reduced, risk to the foot minimised, and a clear pathway established moving forwards, that will enable the diabetic patient to maintain quality of life, and reduce the chances of more severe treatments.

Look up at the stars, and not down at your feet….. (Stephen Hawking)

When we discuss Orthotics, we far too often make the assumption that this is all about the foot and ankle, perhaps the knee, and occasionally the hips. All of my posts thus far have really been focussed on the importance of skeletal stability in reducing, managing or preventing pain, and this does often begin with gait and posture. This situation isn’t helped when you consider that the good old ‘Functional Foot Orthosis’ (FFO) has become known as an ‘Orthotic’, thus fuelling the assumption that Orthotics is all about the foot; we need to be careful however, not to forget that the role of the Orthotist is to ‘straighten’ and to brace, and this is equally as important in all other parts of the body. What I want to do in this post, is to provide a whistle stop, and incredibly basic, introduction to the other types of orthoses that would be used from the pelvis up.

Your back supports your torso and head, and consists of 26 bones all with their own muscles and ligaments which allow you to bend forwards, backwards, side to side and also rotate round. Poor back health is a major issue with some staggering statistics. For example:

– Back pain will affect 80% of us at some point in our lives.
– One in six working days lost in the UK is due to back pain.
– It is estimated that back pain costs the NHS, business and the economy over £5 billion      a  year.

Back pain can occur due to damage to the bones, ligaments or muscles of the spine and can occur suddenly due to a trauma such as a whiplash injury or can be a chronic and degenerative condition such as arthritis. In any case the results are devastating to the sufferer.

We need to remember that the correct orthosis potentially has several jobs to do, ranging from immobilising specific body parts in order to promote the healing of tissue, correcting deformities, restricting motion to prevent harmful postures, to increasing the range of motion or strengthening muscle, thus it is crucial that the correct device is prescribed, and the appropriate advice given. Let’s begin with the lower spine, and specifically with what are called ‘Lumbasacral’ orthoses. These are generally used for issues with the lowest part of the spine, often for such conditions as Spondylolisthesis – this is a disease which causes one of the lower vertebrae to slip forward onto the bone directly beneath it. A Lumbasacral orthosis is usually used to prevent movement, thus preventing further damage or pain.

Scoliosis is something that more people may have heard of, and put simply, this is a curvature of the spine. This is, in the most serious cases, managed with surgery, but orthotics play their part here too. It is generally believed that where a spinal brace is used, in 80% of cases, the curve will remain the same size, thus sometimes removing the need for surgery for some. One of the big issues for researchers in recent years, has been how to develop a spinal brace that provides the right amount of immobilisation and support, whilst still permitting the wearer to function – even standing and sitting for example. Modern Orthoses are generally fantastic at doing both, but as they are all fitted to meet a specific need, the amount of bracing or movement you are permitted, will vary.

Moving up the spine to the neck, we move on to ‘Cervical Orthoses’, or more commonly known as the neck brace. These can range from soft collars, which are designed to provide support and to restrict movement, right up to a ‘Halo’ assembly, which can involve the head and the shoulders in order to brace a more serious neck injury for example. As with all bespoke orthoses, the type of brace prescribed will be determined by the specific requirements of the wearer, and whilst the anatomical needs will always take priority, the Orthotist will also take lifestyle into account where possible. There are a multitude of braces available today, and your Orthotist will discuss these with you if and when required.

We often refer to orthotic intervention in other areas above the pelvis, which don’t necessarily involve the spine, as ‘Upper Limb Orthotics’. These can cover issues with the shoulder, the elbow, the wrist, the hand or even individual fingers, and again, they are all designed to do different jobs, depending upon the needs of the wearer. Lehneis (1977) stated that the role of Orthotics is not only to enhance function, but to protect the limb in a functional position. This is particularly the case with upper limb Orthotics. Let us use ‘Lateral Epicondylitis’, or tennis elbow as you may know it better, as an example here. This can be treated with surgery or injections, but these are not risk free, and can have long-term effects. Wearing a simple Counterforce Orthotic brace however, keeps pressure off the inflamed muscles, by spreading the tension to different parts of your arm – thus enhancing function whilst protecting the damaged area in a functional position. A simple brace such as this, can keep people playing tennis and golf, which are the big two sports where this is  common, whilst removing the need for surgery or injections.

I know this is a awful lot to take in in one post, and I’m sure that I’ll revisit some of these in greater depth as time goes on, but I guess my point here is to take some of the focus off of the foot, and help us to realise that orthotics are for the whole body, not just for Christmas – whoops, sorry, I appear to have mixed my clichés! You are clearly not going to pop along to your Orthotist and ask for something as complex as a Halo neck brace, as this will undoubtedly be something that will be provided if required; however, how many people are living with back pain and thinking that there’s nothing that can be done, or worse, that surgery is the only option? How many people give up playing sports like tennis or golf because of excruciating pain, when actually, a chat with an Orthotist might see you back on the court or the green in no time? Make an appointment to see your Orthotist, and discuss what they might be able to do to help you reduce your pain.

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I wouldn’t want to be in your shoes………

‘You can’t understand someone until you’ve walked a mile in their shoes’ (Anon), is now quite a famous quote, and it gets rolled out frequently when discussing empathy. This is a ridiculous concept if you think about it, as how would walking in someone else’s shoes help you to understand anything about another human being? Well actually, now that I say this, I realise that the entire science of forensic orthotics is precisely this – ascertaining the identity of someone based upon their distinct gait pattern. Anyway, I digress. The main point here, is that shoes are a vital component in maintaining mobility; they are however, far more than this for many people. Shoes are an enormous fashion statement, and isn’t it true that a man can be judged by his shoes, his wallet and his watch? Probably not, but you get the point. Gone are the days when most people only had a solitary pair of shoes, and now most of us have numerous pairs. If you are lucky enough to be able to wear fashion shoes, without incurring great pain or a reduction in stability, then I take off my metaphorical hat to you, as this is not the case for many. If you are not in this group however, and you find shoes are either too shallow, too narrow, too heavy, too flexible, insufficiently supportive, too high, too low, or generally just a pain in the ‘tarsals’, then read on….

There are certain conditions that necessitate bespoke footwear, but this is not the topic for this month. What I want to discuss here, is the world of non-specialist, but sort-of-specialist footwear. If you have been diagnosed with Hallux Valgus, or a ‘bunion’ to you and me, or if you have arthritic feet, or even if you are prescribed a Functional Foot Orthosis, again, an insole to you and me, then you may need shoes with greater depth or width, either to accommodate the orthotic insole, or simply your foot itself. There are of course, many more reasons that you may need wider or deeper shoes, but the outcome is just the same.

Many people, faced with this issue, head for the High Street (other streets, roads and avenues are available), and they attempt to get the best fit possible given the circumstances. This sounds perfectly reasonable, until you consider that if the best you do is to compromise, then you may be making matters worse for your feet, which may already be delicate or in need of ‘protection’ where possible. The closest I can come to any kind of sensible analogy here, and bear with me, is for you to imagine borrowing your friends reading glasses to read a menu, because you’ve forgotten yours. This may be very useful in the very short term, but if you were to use these regularly, and they weren’t your prescription, then you are going to really damage your eyes. A pair of regular shoes will be OK in the short term, but are really not a sensible idea for any prolonged period. So, if this is the case, what can you do, because ‘special’ shoes are ugly right? WRONG!!

Orthotists are constantly signposting people to appropriate footwear, and I guess this is the issue – what is appropriate? There are some fantastic brands of footwear out there that claim to be for wider feet, and some are better than others. I’m going to stick my neck out here, and name a brand, which is not really what this blog is about, but I do feel that this is important. DB Shoes is a family business, and their humble beginnings in footwear began back in 1841. They make a bold claim, that they make the ‘Perfect fit for wider feet’ – quite a claim I’m sure you’d agree; it has to be said however, that their shoes are fantastic for anyone who needs a deeper or a wider shoe, and partly this is in the construction of the shoe itself, but also in the fact that they offer a number of different width and depth sizes. They are not unique in this, but they do have a best choice around in my experience.

Now I can hear you all thinking, well this is OK, but that’s no good if they all make me look like I’m 95 years old! This is simply not the case either, and whether you’re after a casual or smart shoe or boot, whether you’re 15 or 95, then they have styles that not only look good, but that also give you the room and the stability you need, and that your Orthotist has been begging you to get!

Advertisement over, the really important message here, is that whatever footwear you buy, it needs to fit correctly, and this is sadly something we pay little attention to. People believe that they are a certain shoe size, and henceforth, they buy shoes of that size, almost regardless. Any shoe manufacturer will tell you, that their finished products can range in size, and the most important thing to do, is to have the shoes ‘fitted’ – yes fitted. This isn’t simply trying them on and walking for a couple of paces, but actually having them fitted by an expert. A good shoe shop or footwear supplier will happily do this for you. If you need any advice on footwear, then speak to your Orthotist, and I’m sure they’ll point you in the right direction.

Anyway, the message here is to make sure that you wear appropriate footwear, and if this means stepping away from the high heels or ridiculous Kangaroo skin fashion boots, then make the leap, or if this is too ambitious, then maybe a shuffle as opposed to a leap. One thing is for certain – even expensive designer shoes look ridiculous if the wearer is hobbling along in them – function NOT fashion is the key here.