Foot Orthotics and Orthotic Therapy
Foot orthotics are easy, no? You get casted, it gets built, you put it in your shoe and you’re good to go, right? Wrong!
Orthotics or Orthotic Therapy as we call it in our office is an ongoing process. If an orthotic is doing it’s job, your foot should change (for the better) and your prescription should become less. At least in an ideal world.
Remember, orthotics are designed to help you adapt to your environment better. Unlike a footbed, they change the biomechanical function of your foot. A lot should go into getting fit for an orthotic, otherwise they can actually cause some of the problems they are purported to fix!
First of all, there should be a history of you and whatever is going on, with an inventory of all your past injuries. Sometimes there is a pattern that can be recognized and gives your provider clues as to what may be going on with you.
Next you should have a thorough examination of your lower kinetic chain, including the feet, ankles, knees, hips and low back. This should include range of motion, muscle strength, muscle recruitment patterns and joint function, along with reflexes, sensation and balance or proprioception. This gives us a benchmark and defines weaknesses and strengths.
Next comes a pedograph of your foot. This an imprint of your foot which shows areas of increased or decreased pressure and also how forces travel through your foot. This will assist in pinpointing areas of biomechanical faults which may exist in your lower kinetic chain.
Now there should be an analysis of your gait, preferably with stop motion video which allows us to slow down movements and assess subtle abnormalities that may not be visible during normal speeds of movement. If you are there for cycling orthotics, then a video of your stroke pattern is made. Sometimes, footage of your skiing technique can be helpful as well.
At this point, it should be obvious to both you and your orthotic provider whether or not an orthotic is needed. If so, a non weight bearing cast in terminal stance phase (This is a specific position of your ankle and foot) should be performed. This is usually followed by the prescription of appropriate stretches and exercises, specific to your condition. Shoe recommendations should also be given, since different foot types require different footwear characteristics. This will be good news for the ladies who like many shoes. Most guys just want the pain to stop and won’t care what they look like, as long as they are not pink!
Now you have an idea of what goes into (or should go into) building the perfect orthotic for you. Ask lots of questions of whoever is building them for you and make sure they are answered to your satisfaction. After all, it is an investment in your health!
Common Questions and Answers about Orthotics
What is an Orthotic?
An orthotic is a device or insert, which is placed inside footwear, to change the mechanical function of the foot. It works dynamically while you are moving. It can be constructed of plastic, EVA foam, graphite, carbon, metal, or a combination of these. Ideally, they should provide full arch contact, throughout all activities and motions of your feet, so that the foot is constantly supported and biomechanical correction made.
What are full arch contact orthotics, and how are they different from other orthotics?
Full arch contact orthotics maintain contact with the longitudinal arch of you foot at all times, providing support during all phases of walking, running and other weight bearing activities. Other orthotics often support the foot when it is neutral, but fail to maintain arch support when the foot starts moving, sometimes allowing too much motion (pronation or supination). This can often result in pain and injury.
What are pronation and supination?
The foot is a biomechanical marvel. 26 bones and 31 joints, working together in concert to provide balance, stability, and locomotion. As we walk or run, the foot is supposed to go through a series of biomechanical changes, so that it can either adapt to the environment or become a rigid lever for propulsion. When these mechanisms fail, problems usually arise. When the heel hits the ground, the arch of the foot is supposed to partially collapse (pronation), so that the foot can adapt to the ground; in this position, it is flexible and “unlocked”. After the weight of the body passes over the foot, the arch is supposed to retract, and the foot becomes more rigid or “locked” (supination), so that you can use it to propel yourself forward. If the foot remains in pronation for too long, or does not supinate correctly, problems will develop over time.
What kinds of problems result from too much pronation or supination?
The problems secondary to bad foot mechanics can be far reaching, from the feet all the way the spine and to the neck and shoulders.
During pronation, the arch partially collapses and the foot remains “unlocked”. This elongates the foot (your arch is longer when standing than sitting) and can stretch the ligaments and muscles on the bottom of the foot, causing pain often referred to as plantar fascitis. If this goes on long enough, you can actually develop a heel spur. The abnormal pull of the muscles on the feet can cause bunions, claw, and hammer toes.
The lower leg rotates inward (medially) when the foot pronates. If this happens excessively, it can cause damage to the knee resulting in pain in the knee or kneecap.
If the lower leg rotates inward, the hip follows it. In excess, this can cause hip and low back problems. Because the spine is a series of curves and compensations for what happens after the foot comes in contact with the ground, problems can occur in the mid back, neck and shoulders as well.
Can problems be prevented or corrected with the use of an orthotic?
Yes. If the problem is caught early enough (bad mechanics with or without pain), it can often be prevented, but the key is that the problem needs to be found before it becomes a problem. That means getting an evaluation before you have pain. By correcting bad mechanics, we are often able to alleviate pain and cause changes in foot mechanics in people with existing problems. You will often be given stretches and exercises to do, along with any other therapy you may need.
How long will it take for my symptoms to go away?
Foot orthoses unfortunately do not work like eyeglasses. You often do not get “instant resolution”. Some people respond amazingly quickly, although this is the minority. Most people are more complex for whatever reason and they may take up to six months to begin to respond favorably. The majority of people feel a 40-60% minimum average improvement in their symptoms within 8 weeks, (this is not the same as being cured). As time continues it is possible to feel like progress has stopped or that the pain is coming back. As you wear the orthoses you begin to absorb the prescription so you may start to feel the residual inflammation and tension temporarily. If your orthoses are comfortable and you are able to wear them most of the time they are working. The healing of biomechanical inflammation takes time. It can take 1-2 years for an orthoses to generate its maximum effective range of healing. As your foot flexibility increases, the optimal position of alignment will change (due to reduction in tension and inflammation). Then regardless of your symptoms you need to get another prescription in order to keep your feet and body working to their best efficiency. If your orthoses work correctly you can expect 2-3 changes in your lifetime. Most of these changes should occur in the first to the second year. The next change should be very gradual over the next 4-6 years. After that changes may or may not occur. If they do it will take a long time.
Please feel free to call and ask Dr Waerlop or Dr Asthalter questions regarding orthotics or to schedule an appointment to determine if you are a candidate for orthotics.