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01-12-2016 | Research | Uitgave 1/2016 Open Access

Journal of Foot and Ankle Research 1/2016

Trial and error…’, ‘…happy patients’ and ‘…an old toy in the cupboard’: a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses

Journal of Foot and Ankle Research > Uitgave 1/2016
Anita Ellen Williams, Ana Martinez-Santos, Jane McAdam, Christopher James Nester
Belangrijke opmerkingen

Competing interests

AW, JM and AM declare that they have no competing interests. CN has an equity interest in a foot orthoses company (Salfordinsole Healthcare Ltd.). Neither the company, its products nor staff were involved or mentioned during any of the research contained in this paper. The University of Salford gains financially from the activity of the company but none of the authors financially gain via this arrangement.

Authors’ contributions

AW contributed to the inception of the research, the methodological design, protocol, running of the focus groups, data analysis and lead contributor to the manuscript. AM contributed to data collection, data analysis and writing of the manuscript. JM informed the inception of the study and contributed to writing of the manuscript. CN contributed to the inception of the research, data collection and intellectual contribution to the final version of the manuscript. All authors read and approved the final manuscript. All authors have given final approval of the manuscript version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.



Foot orthoses are used to manage of a plethora of lower limb conditions. However, whilst the theoretical foundations might be relatively consistent, actual practices and therefore the experience of patients is likely to be less so. The factors that affect the prescription decisions that practitioners make about individual patients is unknown and hence the way in which clinical experience interacts with knowledge from training is not understood. Further, other influences on orthotic practice may include the adoption (or not) of technology. Hence the aim of this study was to explore, for the first time, the influences on orthotic practice.


A qualitative approach was adopted utilising two focus groups (16 consenting participants in total; 15 podiatrists and 1 orthotist) in order to collect the data. An opening question “What factors influence your orthotic practice?” was followed with trigger questions, which were used to maintain focus. The dialogue was recorded digitally, transcribed verbatim and a thematic framework was used to analyse the data.


There were five themes: (i) influences on current practice, (ii) components of current practice, (iii) barriers to technology being used in clinical practice, (iv) how technology could enhance foot orthoses prescription and measurement of outcomes, and (v) how technology could provide information for practitioners and patients. A final global theme was agreed by the researchers and the participants: ‘Current orthotic practice is variable and does not embrace technology as it is perceived as being not fit for purpose in the clinical environment. However, practitioners do have a desire for technology that is usable and enhances patient focussed assessment, the interventions, the clinical outcomes and the patient’s engagement throughout these processes’.


In relation to prescribing foot orthoses, practice varies considerably due to multiple influences. Measurement of outcomes from orthotic practice is a priority but there are no current norms for achieving this. There have been attempts by practitioners to integrate technology into their practice, but with largely negative experiences. The process of technology development needs to improve and have a more practice, rather than technology focus.

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