12 January 2016
Ellen came to LOC having suffered a stress fracture of her 2nd metatarsal in her right foot. She has high arched feet and given the intensity of her training and her recent injury she attended LOC to see what could be done to lessen her symptoms, allow her to continue training and to enable her to compete in and complete the challenge of running 6 marathons over 6 days in the Sahara desert.
This is her story….
“In February 2014 I started to experience soreness in the outside of my right foot. It wasn't bad and I was able to run but it didn't feel right. I was due to go on a Triathlon camp the next month and I decided to get my foot checked out by a sports physician so I could ensure that I could put my all into the camp. I suspected I had a mortons neuroma; an irritated nerve, something I have experienced in the past. To my horror, an x-ray revealed a fracture of my 2nd metatarsal. I was perplexed, as was the physician, as I had no symptoms at the fracture site. At that point, 2 months in a boot commenced. At the same time I had been diagnosed with celiac disease and with this double whammy, alongside a master's degree exam, I was really down. I decided that I needed to take action and pursue a dream; do the Marathon Des Sables.
From the day I made that decision my training started, although it started on a bike and water running, this really helped. I went from a boot to starting to walk, initially for 30 minutes and finally starting to run. This started as a 1-minute run followed by a 4-minute walk for 30 minutes. I had a long way to go!!!
In order to live my dream, I did everything I could and this involved seeing Alan at the London Orthotic Consultancy to get some orthotics to support my foot. I wanted to ensure my biomechanics were as good as possible to go through my endeavour of not just doing the Marathon des Sables but actually enable me to do the training to get there. The orthotics help support my foot. Not only that, they have endured daily use, training for the Marathon des Sables, the race itself and they are still going! I am amazed that they survived the MDS and they are still being used today. They have started to wear now but only from a compression point of view. This is after approximately 4000 miles of running alone!!!
I am sure that they have helped me to achieve my goal and they are continuing to support my training. My next goal is the Druids Ultra which is in November and I hope to get a new pair in readiness for this and to take my ultra-running training into 2016 and beyond. ”
An insole is a contoured orthotic device which alters the characteristics and biomechanics of the foot and ankle area. Biomechanics are concerned with mechanical laws and how they affect the living body, especially the musculoskeletal system.
They are removable devices, often made from plastic, that are designed to fit inside a shoe to provide additional support for your feet. As well as offering shock absorption, an insole can help distribute the weight of your body more effectively across the foot and can be made bespoke to cover a range of biomechanical conditions.
If you have symptoms in your feet, ankles, hips or your lower back that are intermittent or were not there to start with in early life, and have started to cause you pain over a period of time, bespoke orthotic insoles could be an excellent option.
If you have already tried rest, icing, compression and elevation and your feet have not recovered, we recommend a biomechanical assessment to consider the possibility of insoles. They are a non-invasive approach to treatment and in many cases, are a great option for symptoms that are not severe enough to warrant surgical intervention. Alternatively, they can be considered as an option prior to surgery.
We will send patients away when an insole is not appropriate, if a patient is suffering with iliotibial band syndrome for example, the problem can be helped with physiotherapy and a stretching programme. That’s what our biomechanical assessment is all about; determining whether there would be any benefit from altering the alignment of your feet.
Every physical and medical intervention carries a risk of ineffectiveness, even surgery as the most extreme form can fail. There is substantially more scientific evidence for the efficacy of bespoke foot orthotics than not, and our clinicians have successfully treated countless patients for a range of conditions over the years, all using our bespoke orthotic insoles.
It is important to acknowledge the difference between custom-made insoles and pre-fabricated, ‘off-the-shelf’ insoles which can be purchased cheaply. We offer an orthotic insole service that is thorough and takes a detailed look at your feet using advanced orthotic technology and software. We believe this gives us a leading advantage over other clinics. That combined with our highly qualified team means we can design orthotic insoles of the best quality and see them through to their manufacture, all onsite, which means the chances of finding a successful resolution to the problem are greater.
You can, and in some circumstances, a non-custom pair will resolve symptoms if the main problem is mainly to do with cushioning. Bespoke orthotic insoles provide an effective alternative once you have tried off-the-shelf orthotics and you can see some improvement in your symptoms, but not enough to feel like you can go about daily activities or return to sport for example. At this point, increasing the biomechanical support of the foot could be a way forward.
Most people visiting running shops are offered insoles as part of a deal when buying new trainers but often do not have anything necessarily wrong with their feet, they are asymptomatic. The insoles supplied by most running shops have standard contouring under the plantar surface – or the sole – and will be determined by looking at the foot on a treadmill. Normally you will be given one of three grades of insole that have a non-specific profile. They are designed to be more flat, so that they do not cause any problems when you start running in them.
At best, they can offer cushioning, but they are unlikely to treat any specific conditions or symptoms you may be suffering from, as ultimately runner shop insoles are not manufactured for you, they are a stock product with light customisation.
The Paromed technology and software we use at LOC uses a 3D scan to take a precise copy of the bottom of your foot to work out the exact distribution of pressure, no two insoles we produce will look or perform in the same way.
Insoles are made from varying densities of a plastic called ethylene-vinyl acetate (EVA) which is a plastic that can be reinforced if necessary. The density changes depending on the amount of cushioning and support required, and can be split throughout any insole. Higher density EVA will often be used towards the back of the foot, where more support is generally required, and lower density EVA to the forefoot where more cushioning is needed.
We can also produce insoles from carbon fibre which are suited to more supportive orthoses, however carbon fibre cannot be manipulated once it has been milled out. While it provides excellent support, it is not always the most appropriate of materials.
Insoles can be made to fit into any shoe, but will be designed to be worn in one pair of shoes that you wear most of the time, or for a specific activity that aggravates your symptoms. Some shoes are easier to fit with orthotics than others, such as trainers, walking boots and flat plimsolls. Your choice of shoe also affects the way the insole is manufactured and will be discussed during your initial assessment. A men’s Italian dress shoe, for example, will require a smaller insole than that of a running shoe. We then must determine which one represents usage 70% of the time and then we can make an insole appropriate to that shoe.
Proprioceptive insoles have specific adaptations, like nodes, added to the top surface of the insole in order to stimulate nerve clusters on the plantar surface of the foot in a different way so that when you walk, the nerves in the foot are stimulated to provide more feedback as it is bearing weight.
Proprioceptive nodes are not required for runner’s insoles but are helpful to patients with a neurological deficit. They help with sensory feedback to improve balance and give the brain more information about your positioning every time your foot hits the ground, which should help you walk more naturally.
We have the following facilities and amenities at our Kingston Upon Thames location:
We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.
The orthotics help support my foot. Not only that, they have endured daily use, training for the Marathon des Sables, the race itself and they are still going! I am amazed that they survived the MDS and they are still being used today.
Working with LOC and Elaine has been a great experience – they really take the time to look at your child and understand their individual challenges and needs. For parents who are in the same position that we were, I would say do your research – see what clinics are available near you and what the costs are, but my feeling is it’s worth every penny.
After 10 years of daily physiotherapy and swimming, not to mention SDR, hamstring and tendon lengthening, we have finally achieved independent walking – it was a mother’s day gift that would take some beating.
LOC’s video vector technology measures exactly where Austin’s weight is being distributed, how his hips are moving and how his legs are moving. It’s those insights that have made his new AFOs so effective. Even within a few days, LOC’s splints have had more impact on his independence of movement than anything else we have done.