Orthopedic footwear and insoles are among the most common aids an orthotist makes. The article reviews foot analysis, the materials behind an insole, and the rules that determine whether a user gets insoles or completely individually made footwear. You also get a glimpse of why pressure relief is a safety issue for users with reduced sensation.
From foot analysis to finished shoe: how an individually made aid becomes reality
Feet bear the entire body's weight, day after day, and when the shape, load or sensation in the foot is not as it should be, it is felt immediately. Orthopedic footwear and insoles are among the most common aids an orthotist makes, and the task ranges from a simple insole in an ordinary shoe to a completely individually made set of footwear for a foot that is severely deformed. Common to both is that the solution must be built on a thorough understanding of precisely that foot it is to fit.
§From foot analysis to measurements
Work always starts with a foot analysis. The orthopedist examines the shape of the foot, observes the load pattern when the user stands and walks and notes any deformities, calluses, scars or tender points. Often a pressure test or podoscope is used which shows how weight is distributed under the foot and can reveal areas with abnormally high pressure. Together with a gait analysis this gives a picture of what the foot needs before any measurements or impressions are taken at all.
§Inlay or footwear – what determines the choice?
A central principle in the rules on aids is that orthopaedic footwear is normally not approved if the need can be met with an insole in ordinary footwear instead. This appears in the guidance to the social services act where insoles are only approved if the foot deformity would otherwise refer the user to orthopaedic footwear. The orthotist must therefore always assess whether the less intrusive solution is sufficient before a whole set of individually manufactured footwear is started.
| Material | Property | Typical use |
|---|---|---|
| EVA foam | Light and shock-absorbing | Flexible insoles |
| Polyurethane foam | Durable and form-stable | Inlay with stronger support |
| Termoplast/polypropylen | Can be heat-formed and becomes rigid on cooling | Shells lasts and support |
| Leather | Breathable and formable | Upper leather on individually made footwear |
§Pressure relief — a safety matter, not just comfort
For many users an insole is primarily about comfort. But for users with reduced sensation for example as a result of diabetes pressure relief is a safety matter. When sensation is impaired the user may not feel that a spot in the shoe rubs or presses and a small pressure sore can develop long before being discovered. Here the orthotist's work of distributing pressure correctly and removing sharp transitions in material helps prevent serious complications.
- 01Foot analysis: shape loading and any risk points are mapped
- 02Measure shape or 3D scan of the foot
- 03PLACEHOLDER_106
- 04The inlay or footwear is adjusted and fitted to the user
- 05Follow-up is done and the solution is adjusted if necessary
§Rules on replacement and licensing
Granting of orthopedic footwear and insoles takes place through the municipality according to the Service Act rules on personal aids. It requires that the user has a permanently reduced functional ability and that there is a specific need for compensation. According to the Service Act guidance orthopedic footwear can normally be approved for replacement every 18 months but the specific assessment always depends on the user's needs and wear. It is therefore important that the orthotist documents the work so both user and municipality can follow the course.
“A good insole is not noticed in everyday life – but it prevents damage the user would not have noticed coming.”
— Professional basic rule.