subject: Patient's Guide to Foot Orthotics by:Lawrence Huppin [print this page] This is a long articleThis is a long article. Much of it is based on the best available research, some is our opinion. It 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. It is not intended to help one decide if orthotics are appropriate for their particular problem.
The article will cover:
- What are orthotics
- How do custom orthotics work
- Production of orthotics
- Dispensing, break-in and follow-up
- Custom orthotics
- How the foot should be casted for orthotics
- Customized and computer generated orthotics
- Off-the-shelf orthotics
- Custom orthotics for dress shoes and specialty shoes
- Orthotic guarantees - what should you expect
- How do custom orthotics work in treating plantar fasciitis
- Who should make your orthotics - how to find a skilled practitioner.
What are Orthotics?
The term "orthotic" can refer to almost any device which is worn inside a shoe. Items called "orthotics" are available from 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 off-the-shelf. The educated consumer should be aware of each type.
There is a confusing amount of information available on orthotics. For many consumers making an informed decision is difficult. Recognizing a sales pitch and separating it from facts is the key to better health. The information presented here should help you make an informed decision.
What are Custom Functional Foot Orthotics?
Custom functional foot orthotics are prescription medical devices made from non-weight bearing molds of your feet. They are designed to control alignment and function of the foot in order to treat or prevent 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 - even standing - more efficient. Finally, they can act to redistribute pressure on the bottom of the foot to relieve pain from excessive pressure or calluses.
How do Custom Foot Orthotics work?
This is a very involved subject and too much to get in to here. But in general, most foot pain is the result of a faulty relationship between the bones and muscles of the foot. Even the slightest misalignment can result in significant discomfort. This abnormal function can result in problems such as bunions, hammer toes, arch and heel pain, corns, knee pain ... even back pain.
The function of custom orthotics is much more than an arch support. Orthotics realign 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 the recurrence of foot deformities.
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 properly, the pain of muscle strain and pressure points is relieved, and the progression of deformities is often stopped or slowed.
PRODUCTION OF CUSTOM ORTHOTICS
The 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:
- The cast of your feet
- The prescription the doctor writes (based on the examination and the doctors knowledge and experience)
- The work of the orthotic lab in producing your orthotics and following the doctor's prescription
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. We cannot emphasize this enough. The exam 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:
- An accurate cast or scan of your foot must be taken. This is a very exacting process as your foot must be placed in a precise non-weightbearing position to ensure the best clinical outcomes. To help ensure that a proper model is taken, we feel that the doctor, and not a technician, should position your foot for the cast or optical scan of your foot.
- A proper prescription must be written to accommodate your biomechanical problems, your activities, and your shoes. This process requires that an exacting gait evaluation and biomechanical examination be performed.
- A high-quality foot orthotics laboratory should be used to produce your orthotics. This will ensure that the prescription is filled correctly, that the orthotics are comfortable, and that high-quality and long lasting materials are used.
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 appropriate follow-up. If you have a problem with orthotic fit, function, comfort, shoe fit or any other issue, your doctor 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.
CUSTOMIZED ORTHOTICS AND COMPUTER GENTERATED ORTHOTICS
Another type of foot orthotic is known as "customized" 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 computerized system where the patient is asked to walk across a force plate which then shows pressure distribution on a computer display. Typically, the orthotic is made by adding extra components to a pre-manufactured insole. Sadly, patients are often told that these are custom - and charged a custom orthotic price.
So how can you tell the difference between customized orthotics and authentic custom foot orthotics? If you are receiving authentic custom orthotic devices, a three-dimensional mold of your foot, using plaster, fiberglass or a non-weightbearing optical scan, must be taken. 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. Keep these two points in mind:
1. If the information for making your orthotics is received from walking across or standing on a platform or force plate, custom functional orthotics cannot be produced.
2. A 3-dimensional cast or scan of your feet, with the feet held in a non-weightbearing position, must be taken in order to produce effective custom functional orthotics.
Don't 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 or optical scan of your foot.
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 (now, keep in mind, we are podiatrists and may be biased, but in consulting with many different practitioners on a daily basis this is what we have found to be true). 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 specialize 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 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 may or may not have training on orthotic therapy. We have seen very few orthotics made by chiropractors with which we have been impressed, but they may be out there. Now, there are exceptions to every rule, but in teaching and consulting with thousands of practitioners and students over the past 15 years, we have found the above to be true.
Finally, make sure that the the doctor - not a staff member - takes the cast or image of your foot. Only the doctor has the experience and knowledge to take the most accurate casts. An accurate cast or image is critical to orthotic function. This is a very exacting process as your foot must be placed in a precise non-weightbearing position to ensure the best clinical outcomes.
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:
- What kind of cast do you take? (it should be a non-weight bearing or "neutral" cast in most cases)
- Who takes the cast? (you will likely get better results if the doctor takes the cast rather than an assistant)
- How many orthotics do they prescribe per week? How many years have they been in practice? (experience counts!)
- Are orthotic adjustments done in the office or do the devices have to be sent back to the lab (always look for someone to does their own adjustments. It is faster, more convenient and we guarantee they will know more).
- Do you guarantee orthotic comfort? (comfort only - not clinical outcomes. Clinical outcomes can not be guaranteed with any medical device or procedure. In fact, a "guarantee" of a cure should be a red flag that you may not be dealing with an honest and ethical practitioner).
2006-2009. Lawrence Z. Huppin, Douglas S. Hale; Seattle, Washington
About the author
Dr. Larry Huppin is a nationally recognized lecturer and teacher on orthotic therapy and biomechanics. He specializes in orthotic therapy in Seattle at the Foot and Ankle Center of Washington. Visit us at http://www.FootAnkle.com.
