Initial Assessment

The journey towards prescribing custom-made footwear begins with a comprehensive initial assessment, a critical step that encompasses a thorough exploration of the patient’s medical history, physical condition, and biomechanics. This holistic evaluation serves as the foundation for tailoring footwear solutions that optimise comfort, support, and functionality for individuals with unique needs.

1. Patient History:

Begin by taking a detailed history from the patient, covering a range of factors that contribute to their overall health and foot-related concerns. Elements to consider include:

• Medical History: Understand any existing medical conditions, such as diabetes, vascular issues, neuropathy, arthritis, or previous foot surgeries.
• Previous Injuries: Inquire about any past foot injuries or surgeries that may impact their current foot biomechanics.
• Medication: Explore their current medication regimen, as certain medications can influence foot health and healing.
• Lifestyle and Activities: Gain insight into their daily routine, occupation, hobbies, and exercise habits to understand their foot demands.
• Pain and Discomfort: Address any current pain, discomfort, or issues they are experiencing in their feet, lower limbs, or overall gait.

2. Diagnosis and Medical Background:

If the patient has been diagnosed with specific medical conditions like diabetes or neuropathy, pay special attention to potential foot-related complications. For diabetic patients, assess their neuropathy levels, circulation, and skin integrity, as these factors play a significant role in footwear considerations.

3. Physical Examination:

Conduct a thorough physical examination of the feet, ankles, and lower limbs. Look for any deformities, asymmetries, calluses, or wounds that may indicate biomechanical abnormalities or potential pressure points.

4. Biomechanical Assessment:

Carry out a comprehensive biomechanical assessment to understand the patient’s unique foot dynamics and how they interact with the rest of the body. (Detailed assessment techniques are covered in other Halo modules).

This assessment involves:

• Static Alignment: Observe the patient’s static foot alignment. Note any immediate concerns, such as forefoot or hindfoot disproportions due to conditions like hallux valgus.
• Range of Motion (ROM) Assessment: Evaluate the range of motion at key joints like the ankle, subtalar joint, midtarsal joint, and hallux. Identify any limitations, stiffness, or deformities that may impact gait and comfort.
• Muscle Strength Assessment: Determine any muscle weaknesses or imbalances that could influence gait and foot function.
• Gait Analysis: Observe the patient’s gait pattern during walking. Look for deviations in weight distribution, foot strike, and overall motion. Pay attention to the smoothness of movement across the three main rockers of the foot: heel rocker, ankle rocker, and forefoot rocker.
• Dynamic Gait Assessment: Note any abnormalities in gait, such as increased medial or lateral weight-bearing tendencies, which may require adaptations in footwear design.

Functional Assessment:

Understand the patient’s functional needs and daily activities. Consider factors like the type of footwear they currently wear, whether they use orthotics, and if they experience discomfort during specific activities.

6. Custom or Modular:

The main reason for needing to use custom orthopaedic footwear over modular orthopaedic footwear is the individualized and precise fit and support that custom-made footwear offers. Custom orthopaedic footwear is specifically crafted to match the unique biomechanical needs, foot structure, and medical conditions of each patient. This level of customization ensures optimal comfort, functionality, and support, which can be especially crucial for individuals with complex foot deformities, medical conditions, or specific biomechanical requirements.

While modular orthopaedic footwear provides a range of sizes and design options, it may not address the nuanced variations in foot shape, alignment, and gait that individuals can exhibit. Custom-made footwear, on the other hand, considers the patient’s medical history, foot measurements, alignment, gait patterns, and any specific conditions or deformities. This results in footwear that not only accommodates existing foot issues but also helps prevent potential complications, such as pressure sores or discomfort.

Custom orthopaedic footwear also allows for the incorporation of specialized features, such as specialist multi-layer insoles, cushioning, and adaptations that modular footwear might not adequately be able provide. These features are strategically integrated to optimize foot function, alleviate pain, and promote overall foot health.

In summary, the individualised fit, precise support, and ability to address unique foot biomechanics and medical conditions make custom orthopaedic footwear the preferred choice for individuals who require tailored solutions that modular footwear might not fully meet.

By meticulously collecting this information, healthcare professionals can paint a comprehensive picture of the patient’s foot health and biomechanics. This forms the basis for informed decision-making when prescribing custom-made footwear. With a deep understanding of their medical history, physical condition, and biomechanical intricacies, the journey towards crafting personalized, comfortable, and supportive footwear takes its first confident steps.