Musculo-skeletal medicine

Biomechanics and non-surgical management

Q: What is biomechanics?

A: Biomechanics is the science concerned with the internal and external forces acting on the human body and the effects produced by these forces. There is a mathematical approach to the engineering and physics that takes the guess work out of prescribing corrective functional orthotics.

Orthotics are shoe inserts that correct abnormal or irregular walking patterns. Orthotics help alleviate pain and stabilise the feet, returning the natural symmetry of function.

Orthotics align, position, and cushion the feet, allowing people to stand, walk, and run more efficiently and comfortably.

Q: Who needs biomechanical assessment and treatment?

A: 1 Children / teens – The paediatric patient offers a unique opportunity to influence positively the development of a stable pain-free structure later in life. Look to the family history – if there is a high proportion of the family with foot and gait problems it would be considered reasonable to have the younger generation assessed and monitored by an appropriately qualified, experienced and interested specialist. It is true to say you are only young once.

Please note that growing pains are not normal. It does not hurt to grow! There is always a pathological cause for the pain. With an accurate diagnosis you have the best opportunity to acquire the best treatment.

Do not accept such an indifferent diagnosis or such indifferent management of a young child / teen without further evaluation.

An asymmetrical (lopsided) appearance or function is worthy of assessment and evaluation. In-toe or out-toe gait, flat feet, uneven toes, limping, no propulsion in their walking running, unable to stand still – all of these can be biomechanical in origin and therefore treatable.

A: 2 Active adults – By now the bones have finished growing and what you have is what you have to live with. However, a significant number of active adults do require assessment and treatment. The joint / bone / muscle / tendon symptoms that occur consistently on only on the one side of your body must be a concern if you consider the activity you engage in uses both sides of your body equally. Why the pains? Frequently, patients are found to overload their feet and legs disproportionately and this can give rise to hip, knee and low-back problems as well as foot pain and recurrent ankle sprains. An asymmetrical (lopsided) appearance or function is worthy of assessment and evaluation.

A: 3 Sporting adults – As with active adults, look to the potential cause of repetitive training injuries. Professional coaches know the value of good preventative intervention. Stretching / training / the right equipment for the sport, ideally the best you can afford. The serious athlete and sporting enthusiast knows to look after themselves, and many at the peak of their sport, look to optimise their natural talents to the full. Any structural weakness or deviation of force through the legs and feet is a potential loss of thrust and power as well as a potential source of injury such as stress fracture.

A: 4 Active Seniors – With good diet and exercise we can hope to have a long, active and fulfilling life. We can outlive our ancestors by decades. It is never too late to improve what you were given. A balanced functional orthotic can help manage the stresses that aggravate your joints and cushion bony feet. An asymmetrical (lopsided) appearance or function is worthy of assessment and evaluation.

A: 5 Pre-surgical patients – Some of the surgical procedures performed are on such levels of complexity that it is considered best practice to evaluate the patient pre-operatively with biomechanical management. The arthroereisis (sub-talar joint stent) is such a procedure.

A: 6 Post-surgical patients – Following the correction of a deformity which developed as a consequence of biomechanical instability it is logical and best practice to control the deforming forces to prevent further deformity.

Another website that may offer insight into biomechanics for your consideration is

Q: What can a biomechanical assessment and treatment actually treat?

A: A brief but not exhaustive list includes: chronic heel pain / acute heel pain / chronic shin splints / chronic muscle pain / chronic joint pain / sudden onset strains and sprains / discomfort or pain in walking / loss of speed / loss of balance / loss of distance / dropped arches / flat foot / in-toe gait / out-toe gait / repetitive ankle sprains / early shin splints / knee pain / hip pain / low back pain. Chronic overloading, pressure lesions such as corns and callus, even ulceration of weight bearing areas are also treatable.

Clearly this list spans from the growth and developmental conditions in children, to sporting injuries and includes the ravages of a hard life.

It is Mr Cozens's intention to advise all potential patients that there are alternative treatments available to just the surgical solution and that, as a specialist, Mr Cozens offers a comprehensive and holistic assessment for the benefit of his patients.

Mr Cozens will advise on all aspects of your treatment.

Q: How?

A: At your initial consultation you will have ample opportunity to describe and discuss your foot problem. You will be advised of potential treatments, whether this means surgical or non-surgical. If biomechanical (non-surgical) you will be re-appointed for a gait analysis / measurement / casting or scanning. Some gait analysis may require the use of a computerised force plate investigation as part of the assessment. With the detail and scan (or cast) of the foot, a prescription is calculated and a device is commissioned from a specialised manufacturer who utilises CAD-CAM technology to produce a functional biomechanical orthosis. This is fitted some 2 to 6 weeks later and you will be required to attend for brief follow-up consultations to monitor your progress and use of the orthotic. (The follow-up consultations are inclusive of the cost and are not charged as extras.)

Multiple variations of design and manufacturer are considered in devising the correct prescription for you. There are multiple devices currently available to the biomechanics specialist.

In certain circumstances an over-counter product is advised as this may be all that is required for some patients that have less complex problems. This action can save time and money but adequately manage a problem for years.

Q: Cost?

A: Not all medical insurances fund the cost of the devices (orthotic), the cost of which must be met by the patient. Most medical insurances will cover the cost of consultations and the gait analysis. However there are variations in policy and cover and patients are advised to discuss this with their individual company.

Many self funding patients are pleasantly surprised by the package price which includes the provision of the orthotic and is available on a fixed price tariff.

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