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Biomechanics, MSK and Orthotic Therapy

Biomechanics and MSK

Biomechanics and musculoskeletal processes are closely associated sciences. Both are concerned with the movement of the body and posture, biomechanics is more the mechanics of the living body and how gravity and other forces react to assist movement; MSK is more emphatically concerned with how the skeleton is used by the muscles, tendons and ligaments to interact to achieve a healthy gait and posture.

Biomechanics and MSK consider a number of theories of posture and movement which are used as a standard in looking at whether a person’s posture, gait and movement fall within a normal range of whether there is a difficulty in one area of the lower limb and foot that may be outside of this standard range.

Podiatrists use a broad range of tests and physical assessments to locate a difficulty and identify the abnormality which is causing the discomfort or pain.

Some of the more general common areas of pain which a biomechanical and MSK assessment can locate and assist such difficulties, examples may include:

  • Heel pain
  • Knee pain and shin pain (Shin splints)
  • Lower back pain
  • Knee pain
  • Discomfort at the ankle joint complex
  • Illiotibial Band Syndrome

All of these and others can be much improved or eradicated altogether by exercises, manipulation or indeed orthotic therapy.

Any age group can experience this sort of discomfort and a variety of pathomechanical disorders arising out of adverse foot function, however the practice has four major focus categories which rely heavily on biomechanical assessment, MSK functionality and orthotic therapy:

The young foot
It is important that during early development any biomechanical problems are identified early to allow appropriate intervention and correction. Many problems are transitional but without correction can last longer and often develop into a more long-term difficulty – see our section on the paediatric foot.

The active foot
A huge area is the sporting community where otherwise healthy feet sustain injury through overuse, weak muscle or tendon problems. The Biomechanical and MSK assessment assist in locating the origin and cause of these injuries and will seek to provide interventions and treatment to prevent a worsening condition, orthotic therapy to enable a sports person to continue their athletic activity or rehabilitate sports injuries.

The ageing foot
As part of our assessments in the ageing foot wellness clinic, we can assess where and how the muscle, tendon and bone interaction has become weak, causing not only pain but poor posture and balance problems. In addition to patients seen in the surgery we can arrange for assessments and visits to be carried out in our patients’ homes too.

Systemic conditions which have a biomechanical/MSK implication
Other groups of patients with systemic conditions may, because of these diseases, be more prone to develop biomechanical/MSK problems as a result. There is quite a range of pathology which can give rise to such physical consequences but the most common may include arthropathies such as rheumatoid and osteoarthritis; limb discrepancy, muscle wasting diseases, diabetes where ulceration is common and orthotic devices can assist to off-load pressure – see our section on the arthritic foot and the diabetic foot.

Orthotic Therapy

Orthotic therapy is a speciality within medical practice, and particularly, podiatric medicine concerned with the design, manufacture and application of orthoses. An orthosis is an externally applied device used to modify the structural and functional characteristics of the neuromuscular/biomechanical and musculoskeletal operation within the foot and ankle with an effect on the lower limb, back and hips which impacts the entire body in terms of motion and posture.

An orthosis may be used to:

• Control, guide, limit and/or immobilize an extremity, joint or body segment for a particular reason

• Restrict movement in a given direction

• Assist movement generally

• Reduce weight bearing forces for a particular purpose

• Aid rehabilitation from fractures after the removal of a cast

• Otherwise correct the shape and/or function of the body, to provide easier movement capability or reduce pain

We at the Oxford Foot and Ankle Centre take a simple and complex approach

With many conditions which are not serious and just need some support we can provide during an appointment consultation a “chair-side” simple orthotic using a standard off-the-shelf insole base and modifying the same to construct an orthotic which may be mostly accommodative to provide, assistance, support and comfort. With more a more complex requirement needed to modify a functional problem a more complex insole may be the most appropriate intervention, and in this case, we would write a prescription for the patient for an orthotist to construct a more sophisticated appliance – this would be fully discussed with the patient when agreeing a treatment plan.