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Wednesday, 4/5/2011Patient’s Guide to Foot Orthotics
The following is intended to help the patient for whom orthotic therapy has been recommended to make an informed decision so that they can reach the best outcome for their particular problem/s. What Are Orthotics?The term "orthotic" refers to any devices which are worn inside shoes. Items called “orthotics” are available from podiatrists, physicians and other medical professionals, in shoe stores, in infomercials, retail stores and even at trade shows. There are three very different types of “orthotics” – “custom”, “customized” and “pre-fabricated”. The educated consumer should be aware of each type and not confuse them. .
There is a confusing amount of information available on orthotics and a quick Google search will see 1000’s of results and advertisements. For many consumers making an informed decision is extremely difficult. Recognising a sales pitch and separating it from facts is the key to better health. 1 – Custom Functional Foot Orthotics
Custom functional foot orthotics are prescription medical devices made from non-weight bearing molds (plaster casts) or 3D scans of your feet. They are designed to control the alignment and function of the feet and lower limbs, in order to treat or reduce injury-causing force on bones, joints, tendons and ligaments. Often they are used to limit motions such as excessive pronation (rolling-in) and excessive supination (rolling-out). They also act to make activities such as running, walking and standing more efficient. In addition, they also redistribute foot pressures on the bottom of the foot to relieve pain from high pressure areas or corns/calluses. How do custom foot orthotics work?This is a very indepth topic and beyond the scope of this article. However, most foot pain is the result of a faulty relationship between the bones and muscles of the foot or secondary to increased tissue stresses through a certain physiological structure. Even the slightest misalignment can result in significant discomfort. This abnormal function can result in many problems ranging from bunions, hammer toes, arch and heel pain, corns, arthritis, knee pain all the way through to back pain. . A functional custom orthotic does not work merely on the principle of just supporting the arches. Orthotics re-align the structures of the foot and leg to prevent bone mal-alignment as well as muscle, tendon, and ligament fatigue. They are often used after surgery to help stop or delay the recurrence of foot deformities. It is important that they function precisly and facilitate foot function. They work to increase the biomechancial efficiency of the foot-ground interaction. Custom orthotics are designed to precise standards, using the most recent advances in biomechanics and are custom made to your feet, based on your biomechanics and foot morphology. . These devices aim to precisely control the joint motion, facilitating and increasing the motion at certain joints while restricting others, with the overall aim of setting up the foot for optimal alignment and function during each phase of the gait cycle. The optimal alignment of your foot will also assist with proper lower limb and pelvic alignment. .
As your foot rests on a properly constructed custom orthotic it is gently and consistently directed into the correct position (or at least a better position) for walking, running, and standing. Because your foot is now functioning more efficiently, the pain of muscle strain and pressure points is relieved, and the progression of deformities is often delayed or stopped. PRODUCTION OF CUSTOM ORTHOTICSThe production of custom orthotics is an exacting process and determines whether or not you receive quality devices that will best treat your condition. As with everything, there are well-made orthotics and poorly made orthotics. The ability of an orthotic device to eliminate your pain is dependent on the quality of the orthotics. The quality of the orthotics is dependent on three primary steps:
What is Involved In Producing Custom Foot Orthotics?The most important factor in designing foot orthotics that will provide optimum function is an orthotic prescription based on a thorough examination by an experienced and knowledgeable medical practitioner. This point cannot be emphasised enough. All patient examinations should include a complete biomechanical examination and gait analysis. Following a biomechanical and gait examination, there are three important components to ensure you receive the best possible orthotic devices:
Dispensing and Break-in
Your doctor should work with you to ensure that your orthotics are comfortable and are relieving your symptoms. They should also provide you with detailed information on the proper shoes for your feet. This will help you find appropriate, comfortable, and fashionable shoes. Follow-up
One of the most important parts of orthotic therapy is an appropriate follow-up. If you have a problem with orthotic fit, function, comfort, shoe fit or any other issue, your therapist must be able to diagnose and correct these concerns. This is why a skilled, knowledgeable and experienced practitioner can usually provide the best clinical outcomes. 2 – “CUSTOMISED” ORTHOTICS AND COMPUTER GENTERATED ORTHOTICSAnother type of foot orthotic is known as “customised” rather than “custom.” These devices can be difficult to distinguish from ‘custom foot orthotics’ and, unfortunately, are sometimes marketed as authentic ‘custom foot orthotics’. They are often the product of a computerised system where the patient is asked to walk across a “force plate” which then shows pressure distribution on a computer display. This does not give you any idea of the shape of the foot in its 3 planes. It only shows areas of differing pressure. Typically, this type of orthotic is made by adding extra components to a pre-manufactured insole. Sadly, patients are often told that these are custom – and are charged a custom orthotic price. So how can you tell the difference between customised orthotics and authentic custom foot orthotics? If you are receiving authentic custom orthotic devices, a three-dimensional mold of your foot, using plaster or fiberglass, must be taken or a 3D scan of your foot must be performed. Walking or standing on a force plate can be used to evaluate some aspects of foot function, but a force plate cannot capture the 3-dimensional impressions of your feet that are necessary for best outcomes. Remember, if there is no cast, it can’t be a custom orthotic. An image that is in 1 or 2 dimensions or only shows pressure data, “cannot“ create a 3 dimensional device. Do not be fooled by impressive looking images on a computer monitor. It is our opinion – and that of most experts on orthotic therapy - that it is not possible to make a quality custom orthotic from walking across a pressure mat or taking a weight-bearing scan of your foot. With the technology currently available, a custom functional foot orthotic requires a non-weightbearing cast of your foot or a 3D scan.
–PRE-FABRICATED/OFF-THE-SHELF ORTHOTICSOff-the-shelf orthotics (often called arch supports) are usually found in retail stores - including sport stores, shoe stores, online stores and pharmacies. They are non-custom devices designed to provide gentle support to the arch of the foot and help spread weight more evenly along the bottom of the foot. They are sometimes called “prefabricated orthotics.”
There are many different arch supports on the market. Like everything else, some are better than others. And one brand might work well for your feet while another brand works well for your friend’s feet. Orthotic Advertising on Radio, TV and WebYou may have heard radio or television commercials promoting “custom fit” orthotics at shoe and orthotic retail stores. While these devices are not “bad” per se, they are substantially over-priced and not custom orthotics. Our advice is “let the buyer beware” – you should never pay more than $100 to 120 SGD for an “orthotic” unless it is made from a cast of your foot by an experienced and skilled medical professional. The franchise stores that advertise arch supports heavily on radio and television tend to “hardsell” and have extremely poor reputations among medical professionals and ethical shoe stores.
If you are asked to pay more than $100 to 120 SGD for orthotics in a retail store you are probably being well and truly over-charged. You may have also seen web sites selling “custom” orthotics based on a foam box of your feet. While a foam box can be used to take a cast of the foot for custom orthotics, an extensive exam by an experienced and skilled medical practitioner is necessary to write the proper prescription for orthotics —and thus for optimum clinical outcomes. This isn’t to say you won’t improve with these devices, but the odds of maximum improvement are poor. Again, just don’t spend more than $100 to 120 SGD unless a thorough examination and casting by an experienced medical professional is taking place. ORTHOTICS FOR DRESS SHOES AND SPECIALTY SPORT SHOES
Custom molded foot orthotics provide protection against pain and injury. Custom orthotics can be specially designed to match your shoe type and activity to help provide the support and comfort you need in all of your shoes. Full Length OrthoticsYour first pair of orthotics are usually not meant to fit in all shoes. Most of the time the first pair of orthotics you receive is designed to fit primarily in lace-up walking and athletic shoes. These orthotics are prescribed to be as close as possible to the full width of your foot in order to give you maximum control when you are performing activities that put the most force onto your feet. In addition, they are deeper around the heel to offer more control. These wider and deeper orthotics are called “full length orthotics ” and are meant to be worn in standard running and walking shoes.
Once your medical practitioner is sure that your first pair is comfortable and working correctly you can order smaller orthotics designed to fit in smaller shoes – such as dress shoes. Some specialty sport shoes – soccer and bicycling for example – also tend to be small and require smaller orthotics. Dress Shoe Orthotics
Dress shoe orthotics are custom orthotic devices that are small enough to fit into a dress shoe. These orthotics are very thin and narrow. They have a shallow heel cup to fit into smaller shoes and a very thin cover so that they leave plenty of room for your feet. Sport Shoe Specific OrthoticsSome athletic activities require you to wear shoes or boots that are smaller than the average walking or running shoe. This might include soccer, bicycling, skiing, snow boarding, etc. In these cases, you may have difficulty fitting your full-length orthotics into the sport shoes.
Sporting activities, however, usually put maximum force on your feet so it is important that you are protected and wear orthotics. In these situations, a pair of orthotics can be prescribed to fit perfectly into those shoes or boots. ORTHOTIC GUARENTEESNot all clinics, practitioners and “dispenses of orthotic devices” will guarantee orthotic comfort. Our podiatrists at Eastwest feel orthotic comfort should be guaranteed (unless you are advised otherwise, by the practitioner, due the nature and severity of your foot problem). But in most situations our practitioners believe orthotic comfort (not clinical outcome) should be guaranteed. When properly prescribed and produced, foot orthotics are very comfortable—in fact, you should barely be aware that you are wearing them. It is the responsibility of the prescribing practitioner to make sure that your orthotics are comfortable and that they are providing the best biomechanical solution to your foot problem.
The quality of orthotic devices varies considerably and depends on many factors. No one can guarantee exactly how your symptoms will respond to any particular orthotic (this depends on many factors), but we feel that quality practitioners should guarantee that your orthotics will be comfortable. This is a good question to ask when evaluating practitioners. WHO SHOULD MAKE YOUR ORTHOTICS
In general, podiatrists have the best backgrounds and training in foot biomechanics and custom foot orthotic therapy. Most of the best orthotic therapy experts will be podiatrists. This does not, by any means, mean that every podiatrist is an expert in orthotic therapy. As in any profession, some are exceptional; some are horrible and most are somewhere in-between. Some podiatrists specialise in orthotic therapy and prescribe many orthotics and some do it as part of a more general practice and prescribe fewer. As with all medical procedures, more experience usually means better outcomes. Also, there are some pedorthists, chiropractors and physical therapists who have taken a special interest in the foot and do an excellent job with orthotic therapy. You should, however, carefully evaluate the training of the practitioner. Pedorthists, who are trained in shoe modifications and manufacturing orthotics, are only required to have a two week course for certification. Physical therapists and chiropractors may or may not have any training on orthotic therapy. We have seen very few orthotics made by chiropractors with which we have been impressed. To find someone locally ask friends, colleagues and medical professionals in your area for recommendations. Often the same names will keep coming up.Some questions to ask in order to evaluate a practitioner include:
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