Correct Use of Orthotics

Foot Orthotic Therapy

Foot orthotics are easy, no? You get casted, fork over at least several hundred dollars, 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. The foot should not be allowed to become lazy and dependant upon the orthotic, for what good is a device that allows your feet muscles to become weaker Orthotics need to be approached much like eyeglasses SHOULD be approached.  In other words, improper prescription eyeglass therapy means you need a stronger prescription every few years as your eye muscles are allowed to become weaker and accomodate to the prescription.  Improper orthotic therapy means the doctor gives you your pair of "custom" orthotics and lets you walk out the door only to let the foot muscles go on vacation and weaken since an external device has now replaced the muscle function that is necessary and expected.  This is incorrect use of an orthotic.  Rather, the orthotic should be used as a therapeutic tool only in specific cases to help the therapist gain better foot position while working on helping the muscles to recouperate and gain skill, strength and endurance in the hopes of returning to their normal prior function and hold the foot and lower limb in a more advantageous position to help reduce your pain and problems.

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!

Please feel free to call and ask Dr Allen, Egan, Plaskett or Lois questions regarding orthotics or to schedule an appointment to determine if you are a candidate for orthotics.