Orthotics - The facts

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Jul 10, 2007
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Below is an extract from the Joint Service Publication (JSP 950) which hopefully makes clear the official service take on this vexed issue.

In short - Prescribed Orthotics can be a bar to entry. Orthotics can be prescribed in Recruit Training & at any point in your military career and they aren't necessarily a cause of discharge - BUT, if you leave & wish to rejoin, the history can be an issue.

To complicate matters nationally not all service medical professionals are necessarily aware of this issue as the standards to enter service differ from the standards required to continue serving.

Leaflet 12: MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS including conditions affecting the U & L gradings


3.12.1. Conditions are grouped as follows:

a. General

b. Conditions affecting the U assessment

c. Conditions affecting the L assessment (including spinal (cervical and lumbar) conditions)

3.12.2. In all cases, the first principles in determining whether a recruit with a musculoskeletal condition is fit for military service comprise the following aspects that can generally be determined by an appropriately trained medical officer following the functional assessment examination procedure:

a. Asymptomatic.

b. No deformity that interferes with function or use of “off the shelf” military equipment, i.e. any residual deformity should not prevent the use of clothing (especially gloves and boots).

c. A full range of movement.

d. Satisfactory functional assessment.

e. Inquiry about physical activity comparable with military service (see also Leaflet 1, paragraph 3.1.3.) This is especially important in the assessment of recovery from previous injury or surgery but should not be construed as a pre-selection physical fitness requirement.

3.12.3. Referral for specialist opinion. In circumstances in which referral is recommended for orthopaedic/rheumatology conditions, this should be to single-Service Occupational Physicians responsible for the selection of recruits, who in turn may advise a specialist clinical assessment.

The foot and toes

3.12.35. Hallux rigidus. Hallux rigidus is a bar to entry.

3.12.36. Hallux valgus. Candidates with existing hallux valgus should be graded L8 (Permanently Medically Unfit). However, those who have had hallux valgus osteotomy, have normal function and are asymptomatic during activity comparable with military training should be referred for specialist assessment. One year must have elapsed since the surgery.

3.12.37. Toe deformities. Candidates with minor conditions that allow the usage of normal footwear (and simple “off the shelf” orthotics if necessary) and are asymptomatic during activity comparable with military training for 3 months may be graded L2 (Fit). However, candidates who require to use “custom made” footwear and/or orthotics should be graded L8 (Permanently Medically Unfit). Candidates with evidence of abnormal pressure areas (e.g. red inflamed skin, soft or hard corns) should be graded L8

3.12.38. Hammer toes and clawed toes. Candidates with mild conditions without history of symptoms may be graded L2. However, those with fixed clawing of toes and hammer toes should be graded L8.

3.12.39. Loss of toes. Candidates with total loss of either great toe should be graded L8. Those with loss of terminal phalanx of great toe with no painful stump may be graded L2. Those with total or sub-total loss of other toes may be acceptable subject to the outcome of functional testing. The ability to retain a shoe without using an in-shoe orthosis is probably sufficient evidence of acceptable function.

3.12.40. Flat feet. Flat feet do not affect the grading under L simply because the longitudinal arch appears to be flat, unless there is a history of discomfort on running, walking or standing. Those with mobile flat feet causing no symptoms are graded L2. Those with mobile flat feet causing symptoms or with rigid flat feet are graded L8.

3.12.41. Claw feet. Candidates with a deformity that has caused no trouble in the past with a foot that is mobile with no pressure areas or fixed clawing may be acceptable if the condition is considered compatible with the demands associated with training and the wearing of boots, and provided that there is no associated neurological disorder (such as peroneal muscular dystrophy, etc). Candidates with a positive past history, or limitation of movements or evidence of pressure areas are graded L8.
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