What are Orthoses
Orthoses are custom-made shoe inserts made specifically to reduce a foot pathology. As already outlined, the prescription and manufacture of orthoses is an important part of podiatric practice. The podiatrists is trained in the manufacturing techniques for a diversity of shoe inserts. Most inserts fall into two main categories – functional orthoses or palliative orthoses.
Functional orthoses
are prescribed after the biomechanical assessment and casting of the feet. They are made by various techniques to align the structure of the foot in its most functionally efficient position.
The orthotic, moulded from the cast, is designed to stabilize the foot and to prevent it from moving into an unbalanced position while walking or running.
These inserts involve several steps in both the diagnostic and manufacturing phases, and are usually made of a thermoplastic. Palliative orthoses are designed specifically to reduce pressure from painful or ulcerated areas of the foot. These are often softer and less complicated devices made of foam or rubbers.
Palliative orthoses
are often used for the treatment of severely deformed feet with a limited range of motion and mobility. They are often an appropriate choice for elderly people with significant soft-tissue atrophy and/or circulatory disease.
Surgery
Podiatrists are qualified to perform both nail and cutaneous surgery, but some have undertaken further education to perform additional foot surgery.
As systemic diseases such as arthritis affect the joints in the foot, podiatrists monitor feet for any degenerative changes. The effects of these diseases and the medications often used in their treatment can predispose sufferers to circulatory pathology and/or peripheral neuropathies. This can result in nail an skin lesions, deformity of the feet and the increased incidence of ulceration. The multiplicity of possible causes and complications demands a comprehensive method of examination in order to establish a sound diagnosis as a basis of treatment. The podiatrist’s role entails much more than merely attaching a label to a condition. It often includes the monitoring of circulation and neurological examination, using methods such as Doppler assessment and motor and sensory tests. The manufacture of palliative and functional orthoses also aids in the prevention and treatment of pressure lesions or deformities, enabling individuals to maintain a more normal, active lifestyle.
Children’s feet
The child’s foot is not just a small-scale model of an adult foot. Its shape is not finally determined until growth ceases at the end of the second decade of life. Podiatrists diagnose and treat children’s foot problems by careful examination of the foot, and lower limb, where required. Advice for the prevention or reduction of foot deformity which often develops later in adult life may involve the provision of appropriate information on footwear, treatment by splinting, advice on exercises and/or orthotic control of the feet. Podiatrists also treat common, chronic and acute problems of children’s feet such as osteochondroses, fasciitis and pes planus.
Occupational Podiatry
Some occupations are more prone than others to foot problems which can arise as the result of standing on hard surfaces for long periods. Hairdressers, factory workers and nurses are examples of those from professionals likely to develop long-term problems unless preventative measures are taken. Podiatrists seek to address some of the issues responsible for foot problems and can advise on occupational foot health and safety. This can sometimes involve the prescription of orthoses, or surgical advice.
Biomechanics
In treating chronic foot pain, and evaluating specific needs of patients, the podiatrist will often assess the anatomy and function of the foot and lower limbs during gait. This assessment of the shape and motion of the limb allows for an effective diagnosis of the cause of injuries and/or the development of deformities. The analysis of the function of human motion is called biomechanics. Podiatrists perform clinical biomechanical evaluation of the lower limb. Specialised equipment, including mechanized treadmills with video and computerized assessment equipment, are often used by podiatrists to detect pathomechanical anomalies to ensure appropriate and effective treatment. This treatment may include specific exercises and the prescription of foot orthoses, from precise measurements of an individual’s biomechanics.
Sports medicine
Any sport which involves walking, running, standing or jumping places greater physical demands on our body than normal day-to-day activities. Injuries to the foot and lower limb make up a large proportion of sporting injuries. Podiatrists examine the foot and lower limb, have a knowledge of the biomechanics of athletic movement, diagnose foot conditions and can recommend appropriate footwear, training regimens, and, if needed, orthotic devices to fit into the sports shoe. Common sporting injuries include plantar fasciitis, Achilles tendonitis, stress fractures, ankle sprains and shin or knee pain.
Podiatrists Education
As already outlined, to become a podiatrist a practitioner must complete at Bachelor’s Degree.Podiatry qualifications are specifically aimed at addressing the internal and external medicine involved in the systemic diseases and local pathology affecting the feet.
In Australia the profession also has formal post graduate qualifications in area including sports medicine and surgery.
Where do Podiatrists work?
Podiatrists work in a variety of areas including private practice, community health centres, hospitals, sports medicine clinics and nursing homes. Podiatrists also work as part of the health care team and often consult with other health care practitioners when managing foot or foot-related problems.
How to access a Podiatrist
It is usually not necessary to obtain a referral to see a podiatrist.However, for patients to receive podiatry treatment under various programs including those run by Veterans Affairs, Workers Compensation, or the Program for Aids for Disabled People (PADP), a medical referral is required.
Private health insurance funds cover podiatry services under their ancillary tables. Government-funded services are available in some public hospitals, community health centres and other publicly funded utilities.
Refer to your Yellow Pages for a list of podiatrists in your area, or visit www.findapodiatrist.org.
