‘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

Williams, AE; Nester, CJ; Martinez Santos, A; McAdam, J

Abstract

Background: 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.

Methods: 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.

Results: 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’.

Conclusions: 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.

Citation

orthoses. Journal of Foot and Ankle Research, 9(11), 1-8. https://doi.org/10.1186/s13047-016-0142-9

• Journal Article Type: Article
• Acceptance Date: Mar 11, 2016
• Publication Date: Mar 22, 2016
• Deposit Date: Mar 23, 2016
• Publicly Available Date: Apr 5, 2016
• Journal: Journal of Foot and Ankle Research
• Electronic ISSN: 1757-1146
• Publisher: Springer Verlag
• Volume: 9
• Issue: 11
• Pages: 1-8
• DOI: https://doi.org/10.1186/s13047-016-0142-9
• Publisher URL: http://dx.doi.org/10.1186/s13047-016-0142-9
• Related Public URLs: http://jfootankleres.biomedcentral.com/
• Additional Information: Funders : European Commission funded; Projects : Smart Tools for the Prescription of Orthopaedic Insoles and Footwear; Grant Number: SME-2012-1 GA nº 312573