the science

Biomechanics is at the very centre of injuries, most unexplained aches and pains; and failure to fully understand the science or it's implications is one of the most common reasons why people have unresolved pain.

So what is biomechanics, and why do we at DBC place so much importance on it?

Biomechanics is engineering as it relates to the movement of the human body; the way in which our joints physically line up, and the way that our muscles control, stabilise and move our joints. This goes for complex groups of joints (such as the spine), to more simple single joint movements.

Most of the time, the underlying problem can arise from us just being us - the way we have grown or the way that we are! Other times it can compensatory - due to an old injury; or bad habits and posture that have built up over a period of time. Inevitably we find muscle imbalance and mobility issues whatever the underlying problem. So in a lot of ways the approach to fix these issues is just the same.

Fundamental to getting better is to start with as accurate an assessment as possible, combining an expert eye together with a technology-based assessment.

Structural problems in feet can alter walking pattern, running pattern & cause pain throughout the body.  Clear & accurate assessment of the mechanics of lower limbs is the key to understanding the profound effect that subtle faults in the foot, ankle, knee & hip alignment can cause.

At DBC, we have an in-house biomechanics lab which provides detailed lower limb biomechanical assessment. The process of assessment involves a digital  a gait scan using a highly sensitive force platform which measures how each part of the foot works & distributes weight in standing & walking.  We then manually assess each foot incorporating the latest research into foot and ankle analysis.  If indicated, we can take a mould of the foot using foam casting methods.  This provides a complete diagnostic of foot & lower limb function, allowing treatment or orthotics to be prescribed accurately.

We understand the importance of the professional who interprets the data from this complex assessment.  Therefore, each biomechanics assessment is carried out by a specially trained Chartered Physiotherapist with a Masters Degree in Sports Medicine; we also liaise with a team of biomechanics specialists.  At DBC, our orthotics specialists are also involved in assessing athletes at the highest level; giving a sportsperson's perspective when advising on biomechanical modifications, orthotics or footwear.

Most reputable orthotists – be they Chartered Physiotherapists or Podiatrists – would rarely prescribe orthotics on the basis of the initial foot presentation alone.  The reason for this is that any orthotic made at this stage is unlikely to help with the patient’s normal walking gait – even if their regular walking gait is abnormal.  Most of the time, the pain that the patient is presenting with will have altered their regular gait temporarily.  Therefore, it is important to deal with those aspects of their pain that can be remedied – such as tight calf musculature, weak ankle stabilisers, reduced ankle joint mobility, balance – and comparing the gait pattern and lower limb biomechanics before and after these interventions.  Only that way can we be certain that the patient is getting an orthotic that fits them and their regular gait pattern.  And provide them an orthotic that will fit them for a long time – potentially for life!

This is important given that a customised set of orthotics is not cheap.  The type of plastic used in our orthotics is guaranteed by the manufacturer for life; if it breaks or wears down, they will replace it free of charge.  We can also recommend over the counter orthotics that are not customised but which may give the patient some relief at a reduced cost.  We also have an in-between orthotic which doesn’t last for life but is customisable in the clinic.  These types of insoles do need replacing however, generally every time the patient changes his or her worn-out shoes.  We also can recommend a wide variety of shoes – from street shoes for both working people and the elderly, to athletic shoes prescribed specifically for each sport.

our approach

Only about 40% of the general population will need orthotics, so we do not prescribe orthotics unless they are indicated. Even when a foot abnormality is detected, we may not prescribe orthotics; the indication is generally pain somewhere along the kinematic chain from the toes to the lumbar spine that could be remedied with orthotic wearing.

There are exceptions.  For example, if a forefoot varus is detected and there is a history of bunions in the family, we will recommend wide shoes and a corrective orthotic to prevent the development of bunions later in life.  Orthotic provision in the elderly can also help with the pain of bunions.  Turf toe can also be a condition where orthotics may be provided prophylactically to try to prevent hallux limitus.

At DBC, we can correct the pain and the source of the pain; both the victim and culprit.  Lower limb biomechanical assessment, correction of abnormalities where possible, and orthotic prescription are some of the tools we use to give patients the gold standard physiotherapy experience that can be expected at DBC.

orthotic prescription