Survey of foot orthoses provision in the UK.

Part 1 -About you

  1. Are you:
  2. Male
  3. Female
  4. What is your age? Please select one option:
  5. 18-21 years
  6. 22-30 years
  7. 31-40 years
  8. 41-50 years
  9. 51-60 years
  10. Above 60 years
  11. What YEAR did you qualify? Please select the year that you obtained your professional qualification. Thank you.
  12. 1968
  13. 1969
  14. 1970
  15. 1971
  16. 1972
  17. 1973
  18. 1974
  19. 1975
  20. 1976
  21. 1977
  22. 1978
  23. 1979
  24. 1980
  25. 1981
  26. 1982
  27. 1983
  28. 1984
  29. 1985
  30. 1986
  31. 1987
  32. 1988
  33. 1989
  34. 1990
  35. 1991
  36. 1992
  37. 1993
  38. 1994
  39. 1995
  40. 1996
  41. 1997
  42. 1998
  43. 1999
  44. 2000
  45. 2001
  46. 2002
  47. 2003
  48. 2004
  49. 2005
  50. 2006
  51. 2007
  52. 2008
  53. 2009
  54. 2010
  55. 2011
  56. 2012
  57. 2013
  58. 2014
  59. 2015
  60. Other, please specify:
  61. What is your HIGHEST level of qualification?
  62. Higher National Diploma
  63. Bachelors Degree
  64. Masters Degree
  65. Doctorate (PhD)
  66. Other, please specify:
  67. Are you a registered: (please select the response appropriate to you)
  68. Podiatrist
  69. Orthotist
  70. Physiotherapist
  71. Occupational Therapist
  72. Other, please specify:
  73. Since qualifying in your profession have you undertaken additional training related to the lower limb in any of the following areas. Please select all that apply to you.
  74. Lower Limb Biomechanics
  75. Gait analysis
  76. Orthopaedics
  77. Specialist footwear
  78. Podopaediatrics
  79. Sports Injuries
  80. Strength and Conditioning
  81. Training
  82. Neurology
  83. Foot Orthoses Prescription
  84. Manipulation
  85. Steroid Injection Therapy
  86. I have not undertaken any additional training
  87. Other, please specify:
  88. Which geographic location do you work within? Select one answer that best represents where you work for the majority of your working week.
  89. South East England
  90. North West England
  91. South West England
  92. Greater London
  93. West Midlands
  94. East Anglia
  95. Yorkshire and North Humber
  96. East Midlands
  97. South Central England
  98. North East England
  99. Scotland
  100. Northern Ireland
  101. Wales
  102. Republic of Ireland

Part 2: Your Practice

  1. Who do you spend the MAJORITY of your time working for in the provision of foot orthoses? Select only ONE answer that best describes you.
  2. The NHS
  3. As a self-employed Independent
  4. (Private) practitioner
  5. A private or commercialcompany
  6. A private or commercialcompany providing NHS services
  7. 50-50 split in NHS and PrivatePractice
  8. 60-40 split in NHS and PrivatePractice
  9. 70-30 split in NHS and PrivatePractice
  10. 60-40 split in PrivatePractice and NHS
  11. 70-30 split in PrivatePractice and NHS
  12. Other, please specify:
  13. What department do you work in when providing foot orthoses? Select all that apply.
  14. MSK
  15. CATS
  16. Podiatry
  17. Physiotherapy
  18. Occupational Therapy
  19. Rheumatology
  20. Surgical Appliances
  21. Orthotics
  22. Other, please specify:
  23. What facilities are available to you that support your use of foot orthoses? Select all that apply.
  24. Grinding Machines
  25. Vacuum Former
  26. Ovens
  27. Fume Cupboard
  28. Treadmill
  29. Pressure Plates
  30. 2D/3D - Video analysis
  31. CAD/CAM
  32. Imaging Facilities (diagnosticutrasound-access to plain filmx-ray/MRI)
  33. Gym facilities suitable forassessment/observing gait
  34. Corridor for observing gait
  35. Other, please specify:
  36. What percentage of your working week is spent providing foot orthoses? Please select the percentage thatbest reflects you. As a guide each 10% increment represents a half day.
  37. Less than 10%
  38. 10%
  39. 20%
  40. 30%
  41. 40%
  42. 50%
  43. 60%
  44. 70%
  45. 80%
  46. 90%
  47. 100%

Part 3: Your Patients

  1. What percentage of your patients have prior experience of (any) foot orthoses before you treated them?Please select the percentage range that is most reflective of your practice.
  2. 0-5%
  3. 6-10%
  4. 11-15%
  5. 16-20%
  6. 21-25%
  7. 26-30%
  8. 31-35%
  9. 36-40%
  10. 41-45%
  11. 46-50%
  12. 51-55%
  13. 56-60%
  14. 61-65%
  15. 66-70%
  16. 71-75%
  17. 76-80%
  18. 81-85%
  19. 86-90%
  20. 91-95%
  21. 96-100%
  22. I don't know
  23. Which patient groups do you treat using foot orthoses? Select all that apply. If you feel there is an option thatis not represented please use the "other" response to give your answer.
  24. General Musculoskeletal
  25. Diabetes
  26. Inflammatory Arthritis
  27. Osteoarthritis
  28. General Paediatric
  29. Neurological (adult)
  30. Neurological (paediatric)
  31. Sports Injuries
  32. Other High Risk (e.g
  33. Peripheral Arterial Disease
  34. patients)
  35. Falls-related Patients
  36. Other, please specify:
  37. What are YOUR THREE MAIN treatment objectives for your patient groups? Select three items from thefollowing. If you feel there is another option that you would choose that does not appear here, please add it intothe 'other' section.
  38. Pain relief
  39. Pressure relief
  40. Functional control
  41. Accommodate Deformity
  42. Proprioception/stabilitycontrol
  43. Ulcer prevention
  44. Short term rehabilitation(less than 6 months)
  45. Long term rehabilitation (morethan 6 months)
  46. Other, please specify:
  47. What OUTCOMES do PATIENTS tell you they want to achieve? Please select the THREE main outcomesfrom the options below. If there is an option that we have not considered please select 'other' to enter thealternative outcome.
  48. Pain reduction
  49. To be pain free
  50. Return to sporting activity
  51. Return to a certain level ofactivity (non-sports related)
  52. Return to work
  53. Prevent injury (e.g ulcerationor musculoskeletal)
  54. Return to a certain type offootwear
  55. Prevent falls
  56. Patient not sure what theywant from Foot Orthoses
  57. Other, please specify:

Part 4: Your Practice

Sub section 4.1: General Prescribing habits

  1. How many pairs of foot orthoses do you provide (both bespoke/custom and prefabricated) per month in allyour working contexts (i.e in the NHS, commercial sector and private practice)?
  2. 1-10
  3. 11-50
  4. 51-100
  5. 100+
  1. What percentage of patients would receive a second pair of foot orthoses at or around the same time (within 3months) as the 1st pair? Please select one response.
  2. No patients receive 2 pairs
  3. 10-20%
  4. 21-30%
  5. 31-40%
  6. 41-50%
  7. 51-60%
  8. 61-70%
  9. 71-80%
  10. 81-90%
  11. 91-99%
  12. All patients receive 2 pairs
  1. What do MOST of the referrals request? Please select one response that best reflects you.
  2. Assessment of patients lowerlimb and decide if FO isappropriate
  3. Requests you to prescribe anFO
  4. Assessment of lower limb/condition without referenceto a treatment choice e.g dueto back pain
  5. Other, please specify:
  6. Do you prescribe and fit footwear as well as foot orthoses?
  7. Yes
  8. No

19.a. If you answered 'yes' which patient groups do YOU provide and fit footwear for? Select all that apply.

  1. General Musculoskeletal
  2. Diabetes
  3. Inflammatory Arthritis
  4. Osteoarthritis
  5. General Paediatric
  6. Neurological (adult)
  7. Neurological (paediatric)
  8. Sports Injuries
  9. Other High Risk (e.gPeripheral Arterial Diseasepatients)
  10. Falls-related Patients
  11. Other, please specify:
  1. If you answered 'no' to the question "Do you provide and fit prescription footwear", do you have access to aprescription footwear service if you need it?
  2. Yes
  3. No
  4. Do you ever suggest specific retail orthoses that the patients might purchase themselves?
  5. Yes
  6. No

21.a If you answered 'yes', which foot conditions is this MOST COMMONLY in relation to? Please select all thatapply.

  1. Plantar Fasciitis
  2. Non-specific Heel pain
  3. Achilles tendinopathy
  4. OA related knee pain
  5. OA related foot pain
  6. Morton’s neuroma
  7. Over pronation due to excessfoot joint mobility
  8. Other, please specify:
  1. How long is an assessment appointment during which you might decide to provide foot orthoses? Pleaseselect one option from the choices below. If your answer is different from those provided, please use the 'other'answer response to provide your time.
  2. 0-15 minutes
  3. 15- 30 minutes
  4. 30-45 minutes
  5. 45-60 minutes
  6. 60 + minutes
  7. Other
  8. If you, please specify:
  9. What percentage of the foot orthoses you provide are bespoke/custom made? Select one percentage range.
  10. 0%
  11. 5-10%
  12. 11-20%
  13. 21-30%
  14. 31-40%
  15. 41-50%
  16. 51-60%
  17. 61-70%
  18. 71-80%
  19. 81-90%
  20. 91-99%
  21. All are bespoke/custom footorthoses
  22. What percentage of the foot orthoses that you provide are prefabricated? Please select one percentagerange.
  23. 0%
  24. 5-10%
  25. 11-20%
  26. 21-30%
  27. 31-40%
  28. 41-50%
  29. 51-60%
  30. 61-70%
  31. 71-80%
  32. 81-90%
  33. 91-99%
  34. All are prefabricated footorthoses
  35. What are your top THREE reasons for using prefabricated over bespoke/custom made orthoses? Please usethe text box to list 3 brief reasons.
  36. What are your top THREE reasons for using bespoke/custom made orthoses over prefabricated? Please usethe text box to list 3 brief reasons.
  37. In the free text box below please outline (briefly) the problem with foot orthotic DEVICES or SERVICES thatmost need addressing?
  38. Do you use prefabricated foot orthoses?
  39. Yes - proceed to question 30
  40. No - proceed to question 29.
  41. If you do not use pre-fabricated foot orthoses what are the reasons for this? Please select all that apply fromthe responses below and use the 'other' response option to provide answers that are not given here. Thenproceed to Page 8 - question 39.
  42. They are not supplied withinthe service I work for
  43. Due to budget restraints
  44. Other, please specify

Sub-section 4.2: Prefabricated orthoses

  1. Of the prefabricated orthoses that you use, identify the THREE materials that form the orthotic shell in mostcases. Please select only THREE options from the choices below. If we have not provided an option that youwould like to select please use the 'other' answer response to give your choice(s).
  2. Low density EVA
  3. Medium Density EVA
  4. High Density EVA
  5. Polypropylene
  6. Subortholen (Polyethylene)
  7. Carbon Fibre
  8. Other, please specify:
  9. In what percentage of patients do the prefabricated orthoses need some chairside/in clinic modification, suchas the addition of rearfoot wedges, creation of apertures or minor alterations to the fit, prior to first fitting? Pleaseselect one response or use the 'other' response option if you have additonal information.
  10. No patients requiremodifications to prefaborthoses
  11. 1-10%
  12. 11-20%
  13. 21-30%
  14. 31-40%
  15. 41-50%
  16. 51-60%
  17. 61-70%
  18. 71-80%
  19. 81-90%
  20. 91-99%
  21. All patients requiremodifications to prefaborthoses
  22. Other, please specify:
  23. Do you have access to an on-site Orthotics Laboratory or equipment such as a grinding machine to makemodifications to pre-fabricated devices if required?
  24. Yes
  25. No
  26. Not applicable to me
  27. What is it about one prefabricated orthotic that convinces you it is a better choice (this could be that youthink it is a better fit or more effective, for example) than another choice of prefabricated orthotic? Please give aBRIEF outline in the text box below.
  28. What are the typical costs in pounds sterling of prefabricated orthoses when supplied direct to YOU (thepractitioner) or NHS Trust or company you work in? Please select one cost range from those below. If there is adifferent answer you wish to provide please use the 'other' answer response.
  29. £0.50 - £5.00
  30. £6.00 - £10.00
  31. £11.00 - £15.00
  32. £16.00 - £20.00
  33. £21.00- £25.00
  34. £26.00-£30.00
  35. £31.00-£35.00
  36. £36.00-£40.00
  37. £41.00- £45.00
  38. £46.00-£50.00
  39. More than £50
  40. Other, please specify:
  41. Are you happy with the choice of prefabricated foot orthoses that are available for you to prescribe/supply?
  42. Yes
  43. No

35.a If you answered 'no', what are the reasons for this? Please give a BRIEF outline in the text box below.

  1. How many types of prefabricated foot orthoses are made available for you to choose from? Please select oneresponse.
  2. 1
  3. 2
  4. 3
  5. 4
  6. 5
  7. 6
  8. 7
  9. 8
  10. 9
  11. 10
  12. More than 10
  13. Are you able to influence the choices of prefabricated orthoses that are made available to you?
  14. Yes
  15. No
  16. Not applicable to me

37.aIf you answered 'yes', by what processes do you influence these choices. Please select all that apply.

  1. Through the results ofclinical audit
  2. Through the results of patientsatisfaction surveys
  3. Through discussion withcolleagues
  1. How often are the patients provided with a new pair of prefabricated foot orthoses? Please select theresponse that is most reflective of your practice.
  2. Once a year
  3. Every two years
  4. Whenever they are needed
  5. We do not replaceprefabricated foot orthoses
  6. Do you prescribe/fit bespoke/custom foot orthoses?
  7. Yes - proceed to question 40
  8. No - proceed to question Page9, question 52.

Sub-section 4.3: Bespoke/ custom madeOrthoses

  1. Of the bespoke/ custom made foot orthoses that you use, identify the THREE materials that form theorthotic shell in MOST cases. Please select THREE from the responses below or use the 'other' option if there is aresponse you wish to give that we have not provided.
  2. High density EVA
  3. Medium density EVA
  4. Low density EVA
  5. Polypropylene
  6. Carbon Fibre
  7. Other, please specify:
  8. Of the bespoke/ custom made foot orthoses that you use, identify the THREE materials that form theorthotic top cover in MOST cases. Please select THREE materials from the responses below or use the 'other'option if there is a response you wish to give that we have not provided.
  9. Low density EVA
  10. Poron
  11. PPT
  12. Fabric
  13. Leather
  14. Suede
  15. Plastazote
  16. Other, please specify:
  17. In what percentage of patients do the bespoke / custom made foot orthoses need some chairside/in clinicmodification prior to or at first fitting. Please select ONE response from the choices below.
  18. No patients requiremodifications to bespoke/custom made orthoses
  19. 1-10%
  20. 11-20%
  21. 21-30%
  22. 31-40%
  23. 41-50%
  24. 51-60%
  25. 61-70%
  26. 71-80%
  27. 81-90%
  28. 91-99%
  29. All patients requiremodifications to bespoke/custom made orthoses
  30. Do you have access to an on-site Orthotics Laboratory or equipment such as a grinding machine to makemodifications to bespoke devices if required?
  31. Yes
  32. No
  33. Not applicable to me
  34. What methods do you TYPICALLY use to capture foot shape? Please select all that apply. If there are otherresponses that we have not considered please, select 'other' provide your response.
  35. Foam Impression Box
  36. Plaster of Paris bandage
  37. Digital Scanning technology
  38. Direct measures of footdimensions
  39. I don’t take foot impressions
  40. Other, please specify
  41. Are the bespoke/ custom made orthoses you use handmade (i.e. vacuum formed to a cast) or milled usingCAD/CAM? Please select one response.
  42. Hand made (vacuum formed to a
  43. cast)
  44. Milled using CAD/CAM
  45. I don't know
  46. Not applicable to me
  47. Other, please specify
  48. Where are the bespoke/custom made orthoses you prescribe made? Please select one response.
  49. Bespoke / custom made orthosesare made 'in-house'
  50. Bespoke / custom made orthosesare made via a commercialcompany
  51. In-house (within a thecommercial company that I workfor)
  52. Not applicable to me
  53. Other, please specify
  54. How long does it take for bespoke / custom made orthoses to be supplied to YOU once they have beenordered via a commercial company?
  55. 0-2 working days
  56. 3-5 working days
  57. 6-9 working days
  58. 10-14 working days
  59. More than 14 working days
  60. Not applicable. We don't usecommercial companies for footorthoses.
  61. Other, please specify:
  62. If the bespoke/custom made orthoses that you use are manufactured 'In-House (on NHS facilities by NHSstaff): What are the AVERAGE costs in pounds sterling, to the practitioner or NHS Trust? Please select oneresponse from below. If your bespoke/custom devices are made ONLY by a commercial company please go toquestion 49.
  63. Less than £25
  64. £25 -30
  65. £31- 35
  66. £36-40
  67. £41-45
  68. £45-50
  69. £51-55
  70. £56- 60
  71. £61-65
  72. £66 -70
  73. £71 -75
  74. £76-80
  75. £80 -85
  76. £86-90
  77. £91-95
  78. £96-100
  79. More than £100
  80. Other, please specify:
  81. If the bespoke/custom made orthoses that you use are manufactured via a commercial company, what arethe AVERAGE costs in pounds sterling of bespoke/custom made orthoses (to the practitioner or NHS trust)?Please select the nearest value.
  82. Less than £25
  83. £25 -30
  84. £31- 35
  85. £36-40
  86. £41-45
  87. £46-50
  88. £51-55
  89. £56- 60
  90. £61-65
  91. £66 -70
  92. £71 -75
  93. £76-80
  94. £80 -85
  95. £86-90
  96. £91-95
  97. £96-100
  98. More than £100
  99. Other, please specify:
  100. Are there any restrictions upon your ability to provide bespoke/custom made foot orthoses?
  101. Yes
  102. No
  103. How often are patients provided with a new pair of bespoke/custom made foot orthoses? Please select oneresponse or provide an alternative response using the 'other' option.
  104. Once a year
  105. Every two years
  106. Whenever they are needed
  107. We do not replacebespoke/custom made footorthoses
  108. Other, please specify:

Part 5: OtherInformation

  1. Do you provide other treatment interventions alongside foot orthoses?
  2. Yes
  3. No
  4. Not applicable to me

52.a If you answered 'yes', what type of interventions do you provide? Please select all that apply and add in extraanswers not covered here via the 'other' option.

  1. Exercise programme (such asstretches,strengthening/conditioning)
  2. Footwear advice
  3. Footwear
  4. Acupuncture
  5. Taping
  6. Steroid Injection
  7. Manipulation
  8. Mobilisation
  9. Trigger point therapy
  10. Therapeutic Ultrasound
  11. Other, please specify:
  1. Do you provide advice on how to use the foot orthoses as part of your fitting service?
  2. Yes
  3. No
  4. Not applicable to me

53.aIf you answered 'yes' you give advice, please indicate how you provide the advice, and select all that apply.Provide additional responses not offered via the 'other' option.

  1. Verbal
  2. Written
  3. Both verbal and written
  4. Other, please specify:
  1. What percentage of the foot orthoses are sent directly to the patient, rather than being fitted by you? Pleaseselect the closest percentage from the list below:
  2. 0%
  3. 1-10%
  4. 11-20%
  5. 21-30%
  6. 31-40%
  7. 41-50%
  8. 51-60%
  9. 61-70%
  10. 71-80%
  11. 81-90%
  12. 91-100%
  13. Do you routinely review patients for whom you provide foot orthoses?
  14. Yes
  15. No
  16. Not applicable to me

55.a If you answered 'yes' to this question, how is this undertaken? Please select all that apply. If 'no' please go tothe next question.

  1. By clinic appointment
  2. By telephone review
  3. Other, please specify:
  1. Do you measure or monitor (i.e with an outcome measure tool or questionnaire) outcomes from the footorthoses you provide?
  2. Yes
  3. No
  4. Not applicable to me

56.a If you answered 'yes' to this question please list here the outcome measurement tools or questionnaires thatyou use (for example: you may use a pressure measurement system or a foot specific outcome measure).

  1. If you are looking for new orthotic designs or choices, where do you go to find information? Please select allthose that apply. If there are options that we have not considered then please select 'other' and then include youradditional responses.
  2. Orthotic manufacturercatalogues
  3. Online resources
  4. Fellow colleagues in other
  5. Trusts at Special Interestgroups
  6. Through research presented atconferences
  7. Through research published injournal articles
  8. Not applicable to my role
  9. Other, please specify:
  10. What factors have influenced changes to your practice in the use, manufacture and/or prescription of footorthoses in the last five years. Please use the text box to give a brief outline.
  11. What are the top TWO ways in which your practice will change in the next FIVE years (this could be thepatients you treat, patients expectations, how long patients might have to wait, fittings, choices, suppliers,costs...) Please use the text box to BRIEFLY outline your answers.
  12. Do you have any other comments you wish to add in relation to the prescription, supply and fitting of footorthoses that we have not considered in this survey? Please use the text box below