Adherence in podiatry: why do therapeutic exercises make the difference?

One in three patients no longer uses their foot orthoses six months after they are prescribed. This figure, well documented in the literature, illustrates a reality that every podiatrist knows: the technical quality of an orthosis is not enough to guarantee treatment effectiveness. Adherence—that is, the patient’s active engagement in their care—is a determining factor in clinical outcomes, yet it is still too often overlooked in consultations.

This article explores the mechanisms of adherence in podiatry, the contribution of therapeutic exercises to continuity of care, and the digital solutions that now help bridge the gap between the consultation and the patient’s daily life.

Adherence, the Achilles' heel of podiatric treatment

Podiatry relies on treatments whose effectiveness depends on the regular and prolonged use of prescribed devices. Whether it involves custom foot orthoses, offloading insoles for diabetic foot care, or orthopaedic devices for hallux valgus, the duration and consistency of wear are directly correlated with the outcomes achieved.

A prospective study of 53 patients treated with an orthosis for hallux valgus showed that at 24 months, 81% of patients were still using their device, a high rate achieved through structured and regular follow-up, with pain assessment at 3, 6, 12, 18, and 24 months. (1) These figures remind us that adherence is not spontaneously acquired: it is built within the therapeutic relationship, through progress measurement and regular reassurance of the patient.

Other studies on ankle-foot orthoses in older adults confirm that patients with better daily adherence to wearing the device achieve significantly greater benefits in balance and in reducing fear of falling. (2) Adherence is not a secondary parameter: it is a therapeutic lever in its own right.

Why do patients drop out?

The causes of non-adherence in podiatry are multifactorial. They are not limited to a lack of patient motivation. Research identifies several recurring factors.

1. The first is the absence of feedback on progress. A patient who does not perceive improvement in the short term tends to question the usefulness of their treatment and discontinue it. Standardized measurement of pain and quality of life before and after treatment, as proposed by the POIE index developed by PodOptimize, directly addresses this need: to objectify change in order to ground the patient’s confidence in tangible data.

   
   

2. The second factor is the lack of continuity between consultations. Podiatric care is still focused mainly on the consultation itself, leaving the patient alone with their exercises and functional discomfort between appointments. This break weakens engagement.

   
   

3. Finally, the underuse of therapeutic exercises is a frequent shortcoming. Podiatric treatment is still too often centered on the passive device (orthosis, insole), without active support for the patient through targeted strengthening or stretching exercises.

Therapeutic exercises: an essential complement to the orthosis

The scientific literature is clear on this point: exercises performed at home significantly improve the outcomes of podiatric treatments, particularly in foot and lower-limb conditions.

In plantar fasciitis, one of the most commonly encountered conditions in podiatry, a clinical study showed that a home stretching program performed over three weeks leads to a significant reduction in pain and an improvement in the extrinsic and intrinsic muscle strength of the foot. (3) These benefits are achieved with a simple program, feasible without specific equipment, provided the patient understands the exercises and performs them correctly.

A second study on the same type of protocol confirms that pain reduction is measurable through biomechanical gait parameters, with an improvement in ground reaction forces in patients with moderate to mild pain. (4) These results highlight the concrete functional impact of exercises on locomotion, a directly relevant element for the podiatrist assessing a patient’s gait.

In this context, prescribing exercises should no longer be considered an optional add-on to the orthosis, but a full pillar of podiatric care.

The challenge of remote prescribing: how can we ensure exercises are performed?

Prescribing exercises is one thing. Making sure they are understood, properly performed, and practiced regularly is another. This is where digital tools change the game.

Exercise prescription apps now allow podiatrists to send personalized programs directly to patients, in the form of guided videos with movement demonstrations. Patients have permanent access to their exercises, can view them at any time, and the clinician can monitor the patient’s engagement in the program remotely.

Andrew®, an exercise prescription software used by more than 6,000 therapists in France, offers podiatrists exactly this functionality: prescribing video exercise sequences from more than 1,500 pieces of content, encrypted messaging to support the patient between consultations, and real-time tracking of patient engagement. This continuity of care between sessions is one of the most effective ways to improve adherence—and therefore clinical outcomes. To see Andrew® in action in your podiatric practice, you can connect with the Andrew® team.

Measuring to better support: the contribution of the patient score

Beyond prescribing exercises, improving adherence requires the ability to show the patient that their treatment is working. This demonstration requires standardized tools for measuring pain and quality of life.

That is the goal of PodoScore, developed by PodOptimize: to collect patient feedback before and after the consultation, turn that data into an objective score, and enable the podiatrist to integrate changes in the patient’s experience into therapeutic decision-making. Combined with the POIE index, this tool provides a reproducible measure of the effectiveness of podiatric treatment, both for pain and for quality of life and patient satisfaction.

The combination of these two approaches—measuring the patient’s experience on one side, and prescribing and monitoring exercises on the other—forms the foundation of truly patient-centered care.

Andrew® and PodOptimize: a partnership serving podiatrists

It is in this spirit of complementarity that Andrew® and PodOptimize have formalized a strategic partnership, with the shared ambition of structuring more complete, more connected, and more effective podiatric care for the patient.

In practical terms, this collaboration brings together two complementary tools:

• PodoScore (PodOptimize) measures changes in the patient’s pain and quality of life before and after each podiatric treatment, using the POIE index. The podiatrist thus has objective data to adjust their therapeutic strategy and highlight their results.

• Andrew® extends care between consultations through personalized video exercise prescriptions, remote follow-up, and secure messaging. The patient remains supported, motivated, and active in their rehabilitation long after leaving the clinic.

Together, these two tools address the same gap: the silo between the consultation and the patient’s daily life. PodoScore objectifies what happened during and after the consultation. Andrew® structures what happens between two consultations. One measures, the other supports, and both are part of a patient-centered care approach grounded in data and oriented toward outcomes.

For podiatrists wishing to integrate this approach into their practice, this partnership opens the way to a coherent care pathway, from the initial assessment to home rehabilitation. To learn more or request a free Andrew® demo, the team is available for a personalized discussion.

Conclusion

Patient adherence is one of the most underestimated challenges in podiatry. A technically perfect orthosis will not produce its effects if the patient does not wear it, or if no strengthening work supports its action. Home therapeutic exercises, supported by digital prescribing and follow-up tools, now provide a concrete response to this challenge.

The partnership between Andrew® and PodOptimize is part of this vision: combining objective measurement of outcomes (PodoScore, POIE) with active support for the patient in daily life (Andrew®), for more complete, more personalized, and truly patient-centered podiatric care.