National profile of foot orthotic provision in the United Kingdom, part 1: practitioners and scope of practice

Abstract

BackgroundFoot orthoses have been advocated in the management of a wide range of clinical foot and lower limb problems and are within the scope of podiatry, orthotic and physiotherapy practice. Previous reports into the provision of orthoses have consistently identified significant issues with services and devices, but data were never specific to foot orthoses. The aim of this first of a series of papers was to report the first ever national multi professional profile of foot orthosis provision in the United Kingdom.MethodsQuantitative and qualitative data were collected from podiatrists, orthotists and physiotherapists via an online questionnaire. The topics, questions and answers were developed through a series of pilot phases. The professions were targeted through electronic and printed materials. Data were captured over a 10 month period in 2016.ResultsA total of 499 responses were included in analysis, including 357 podiatrists, 93 orthotists and 49 physiotherapists. The results reveal wide ranging practices across podiatrists, orthotists and physiotherapists, provision of orthoses through different health care departments (uni and multidisciplinary), for different health conditions (acute and chronic), and involving different types of orthoses (prefabricated and customised).ConclusionFoot orthoses in the United Kingdom are provided in areas of well recognised health and rehabilitation priorities. A wide range of orthotic devices and practices are employed and different professions provide foot orthoses in different ways.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-017-0215-4) contains supplementary material, which is available to authorized users.

National profile of foot orthotic provision in the United Kingdom, part 2: podiatrist, orthotist and physiotherapy practices

“…Some 36.6% of orthotists provide more than 30% of their patients with a second pair of orthoses, compared to 11.4% for podiatrists and 8.1% for physiotherapists. A second pair of orthoses might negate the need to return for further pairs as it may not require a further appointment, but does not allow for adjustment of orthoses, which is common [ 1 ]. It might also reflect the fact that a company supplying an orthotist may do so at cost or a loss thus creating an incentive to supply as many orthotic products as possible [ 11 ].…”

“…A questionnaire suitable for online completion was used to capture the foot orthotic practice of podiatrists, orthotists and physiotherapists (same data set as [ 1 ]). The survey was approved by the institutional ethics committee (HSCR14/125) and online data capture provided a means of securing informed consent.…”

“…Provision of foot orthoses falls within the scope of practice of a range of health care professionals and a national survey of the foot orthotic practice of podiatrists, orthotists and physiotherapists was recently reported for the first time [ 1 ]. That a range of professions are involved is positive since it encourages delivery of suitable care at various points within a health care system, which might better suit patients.…”

“…Our previous article that reported on a survey of foot orthoses practice at a national level [ 1 ] also identified differences in almost all aspects of practice between podiatrists, orthotists and physiotherapists. This may relate to prior training, scope or nature of practice and work place, or the different contractual arrangements for the professions.…”

INSoles To Ease Pressure (INSTEP) Study: a multicentre, randomised controlled feasibility study to compare the effectiveness of a novel instant optimised insole with a standard insole for people with diabetic neuropathy: a study protocol

“…The efficacy of offloading the diabetic, neuropathic foot through the use of therapeutic footwear and insoles varies considerably 7 9–12. This variability may be explained by different study designs, and a lack of consensus in prescriptions for therapeutic footwear and insoles between clinicians, clinics and services which are largely based on expert opinion and clinical experience 13. There are no studies or protocols to indicate the optimal features or efficiency of the different devices designed to improve outcomes.…”