Orthotics patient guides for patients needing knee and hip surgery

What is an orthotic?

An orthotic is defined as a device which controls the movement of a joint. There are therefore many different orthotics for different parts of the body. In my practice, the most frequent use of orthotics is to improve the biomechanics and forces acting across the knee joint which have contributed to an underlying knee problem.

Most braces and orthotics applied to the knee can be somewhat cumbersome and are tolerated with some difficulty by patients. There is however a more subtle, indirect way of controlling the position and movement of the knee joint, by putting orthotics in the shoe!

How does this work? The foot and ankle is a complex unit of joints that effectively acts as a torque converter. In simple terms, rotational movements of the foot can be turned into rotational movements of the leg itself. Kneecap and tendon problems are often seen in patients who tend to “squint” their kneecaps. I.e. because the leg tends to be turned inwards, the kneecaps have a tendency to look at each other as opposed to directly forwards. By putting an orthotic in the shoe which elevates the inside arch and rotates the foot outwards, this rotational change is reflected in an outward turn of the leg itself. This can partially correct the “squinting kneecap” and improve symptoms.

You can try this yourself by looking at your bare legs in a long mirror. Look at the position of your kneecap when you stood relaxed. Then turn your feet so that you are standing on the outer border of your feet and you will see the difference in the position of your kneecap.

Although they can take some getting used to, they seem to be effective in about two thirds of people. Perhaps more importantly, it is a treatment which is completely reversible simply by removing the orthotics from your shoes!

It would be unusual for this to correct a problem as sole treatment but can be very useful as an augment to other treatments such as physiotherapy, as a conservative (non surgical) approach to relieving patients with certain types of knee pain.