Footwear

Foot Measurement 

We use both traditional methods and new technology to measure feet. We are highly experienced in making complex plaster casts, scanning and taking foot measurements for shoes and boots. In addition, as part of a continuous drive to use the latest technology to improve our service, we can take a 3D scan of your foot.  

This enables us to capture and measure the exact shape and contours of the foot and ankle, resulting in more accurate lasts being made. The last itself is created via CADCAM technology, which is far more versatile than traditional methods. There are a number of key advantages derived from this technology:  

  • higher degree of accuracy;  
  • faster manufacturing times; 
  • each client's individual measurements and lasts can be stored for repeat orders. 

Footwear 

The London Orthotic Consultancy (LOC) is able to provide a complete range of footwear, from simple, extra volume high street styled shoes, to complex, bespoke orthopaedic and diabetic footwear. We understand that our clients want to have something that looks as stylish as possible while enabling them to walk in comfort. 

We use a range of suppliers that offer a unique service in terms of quality and design. Our suppliers include some of the most experienced shoe manufacturers in the country, but we also source from new, innovative companies who are at the forefront of footwear design in Europe. 

Patients have three options when deciding on the type of footwear that is suitable. The decision will primarily be based on your specific foot type or condition. The options are: 

  • off the shelf – shoes with extra depth and width for use with foot orthotics. Only certain styles and colour ranges are available; 
  • modular – shoes made on a standard last that is adjusted specifically to the measurements taken by your LOC clinician. Any style or colour available;
  • fully bespoke – footwear made from complex measurements, plaster casts, pictures and 3D scans of your feet. Any style – even a picture or old shoe can be copied, any colour possible. 

Your orthotist will guide you in terms of what is possible, given your foot shape and condition. Once the shoe type has been chosen and measurements taken, we can give you an exact quote for the costs involved. 

Conditions Treated 

Footwear plays a key role in our day-to-day lives. When we develop foot problems it is essential to take great care with the type of shoe we wear and the way it fits and functions. Different medical conditions require different design characteristics: 

Diabetes: fully-lined shoes with care taken to leave no rough edges - see below for more information about care for diabetic feet 

Rheumatoid arthritis: extra volume and padded lining 

Lymph odema: extra volume, padded lining and easy to access. 

Forefoot deformities, hallux valgus, clawed toes: extra depth and width.  

Orthotic users – split size shoes possible if wearing lower limb orthotics.  

Paediatric Footwear 

We are able to supply children's orthotic support footwear for a wide range of conditions such as: 

  • Cerebral palsy
  • Club foot (CTEV)
  • Down's syndrome
  • Hypermobility

We understand that children have to have well-fitted footwear with up-to-date styling. We have access to many suppliers who manufacture shoes or boots, ranging from trainers to high-stability ankle boots. 

LOC believes that sometimes paediatric footwear can be over-prescribed. We will often discuss the other options available that can offer improved biomechanical control. All of the shoes prescribed will be able to accommodate foot orthotics. 

Diabetic Footwear 

Diabetes can lead to foot problems caused by reduced sensation and poor circulation. This can be in conjunction with foot deformity, as a result of weakening musculature or the more serious condition of the Charcot foot. Poor fitting footwear and foot care can cause pressure and rubbing, leading to blisters, ulcers, infection and ultimately gangrene and amputation.  

Wearing the correct footwear and foot orthotics are essential and can prevent these problems from occurring. Therefore, diabetic shoes have to have many different design characteristics, depending on how advanced the condition is. LOC works in conjunction with podiatrists to manage their clients’ diabetic feet. We understand this condition and that it evolves and changes with time. We are always available to review and adjust the foot orthotics as the condition requires us to. 

ENGO PATCHES

Blisters and blister prevention 

Walkers, runners and many sports players develop painful blisters that are not caused by any pre-existing medical condition. A repetitive activity - such as marathon running - causes friction to develop between the foot and the footwear, which, in turn, generates heat. It is the heat that breaks down skin tissue, resulting in lesions developing. 

ENGO Blister Prevention Patches tackle the root cause of the problem, by reducing the level of friction between footwear and feet, so that blisters do not form. Uniquely the patches are applied direct to the footwear NOT to the skin, so they do not slip or wash off. They should last 300 miles of wear before they need replacing. 

The Australian distributor of ENGO is Rebecca Rushton who is a podiatrist and knows a thing or two about feet. She recently compiled a comprehensive information resource about blister prevention. 

For more information about ENGO and to purchase online visit: www.GoENGO.co.uk

FAQS:

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.

No one fully knows what causes bunions to form, certainly family history plays a part, as do ill-fitting shoes and shoes which are too narrow but also a mechanical history of overpronation when the foot rolls inwards as you walk, can be a factor.

The technical term for bunions is hallux valgus, and although more studies are required, anecdotally we have seen that bunions can be aided by an insole holding the medial arch up for longer while walking, which can slow the rate at which a bunion develops or worsens. Although we cannot help with the hereditary aspect, we can advise on footwear and determine if the mechanics of the foot can be improved through biomechanical assessment.

Standard Insole Service: £400

This includes the cost of the initial assessment, scan, manufacture and separate fitting appointment, as well as any additional appointments required to modify them in the first 6 week period.

Express Insole Service: £480

This includes our unique, while-you-wait service which we can complete – from initial assessment to manufacture and fitting – in just two hours. There is no need for a second appointment for the final fitting.

Standard Service with Two Pairs of Insoles: £530

This includes the cost of the initial assessment, scan, manufacture and separate fitting appointment, any additional appointments required to modify them in the first 6 week period as well as an extra pair of insoles that can be designed for a separate pair of shoes.

It largely varies dependent on the patient’s individual requirements, but often our insoles can be made on the same day or as quickly as the next.

We do offer our express insole service which takes 2 hours from initial assessment to manufacture and fitting. We open late on Monday, Tuesday and Thursday evenings late until 19:00 to accommodate for people who would like the express service after working hours.

Many common foot conditions can lead to irregular posture, back pain and gait (walking pattern) including plantar fasciitis, bunions, overpronation (when the foot rolls inwards as you walk) or supination (foot rolls outwards). Compromised posture in the back, particularly in the lower back, can often be a result of poor alignment in the feet.

In theory, any biomechanical malfunction in the foot or ankle can result in poor posture and back pain, as well as the knees and hips. If a bespoke insole can realign the joints and allow the soft tissue in the back to heal, this can reduce pain. Once we have carried out a biomechanical assessment, we can establish whether you would benefit from bespoke insoles.

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.

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