Orthotics

What Are Custom Orthotics?

Custom orthotics are devices that are made specifically one person’s feet in order order to optimize the alignment of your lower limb starting at the foot and translating to the ankle, shin, upper leg and pelvis. With improved alignment, custom-made orthotics help to improve efficiency and minimize shock absorption through the lower extremity, pelvis and spine. These corrective devices are placed in an individual’s footwear similar to insoles. They can help to realign the many bones within the foot, and to control excessive mobility or excessive rigidity of these bones and connective tissues. Ultimately they maintain a neutral foot alignment during upright activities. Custom-made orthotics reduce the stress and strain on the body maintaining the most optimal foot position throughout the full gait cycle. This is critical because the feet are the first point of contact between a person and the environment. Faulty placement of the feet will result in increased energy required to balance, weight bear and move forward through weight transfer. This significantly increases the risk of injury.

How Are Custom Orthotics Made?

Even a very small abnormality in the alignment or function the feet can have a significant impact on the joints and soft tissue function above. Custom orthotics are specifically designed to correct foot issues and improve alignment all the way up the lower limb and even through the spine. A trained health practitioner will complete a detailed assessment of an individual’s gait and foot position in both a static and a dynamic state. The health professional will be looking for asymmetries and abnormalities in the feet and lower extremity. This information will be combined with a precise imprint of the feet on a foam cast. This will be sent off to a lab where the orthotics will be fabricated and created. Some facilities will also use a gait scan machine in order to analyse where the majority of your weight is dispersed while you heel strike and push off during the gait cycle. The foot specialist may request that the lab add special features to the orthotics based on the patient’s area of pain, the wear patterns in the patient’s shoes and the skin changes on their feet. The orthotics can be made to fit into your running shoes, dress shoes, flats, high heels or a combination of different shoes.

Who Needs Custom Orthotics?

Not everyone will benefit from custom orthotics. It is important that a proper assessment is conducted before a decision to get custom orthotics is reached. Custom orthotics work best and will have the largest impact if the feet are “driving” the condition being treated. Failed load transfer through your feet due to poor alignment can influence many joints above such as your knees, hips, pelvis, low back and spine however this is not an absolute unidirectional relationship. There are many situations when other body regions can influence foot alignment. If weak hip musculature is causing poor foot control during gait, then wearing custom orthotics to control the feet will be pointless. However, if the increased mobility in the feet is “driving” or causing the hip muscle weakness, then controlling feet with orthotic can improve hip strength and resolve the underlying condition. It seems logical to think that pain in the foot region links directly to dysfunction in the foot region and that orthotics are the intervention of choice. Unfortunately, it is not always that straightforward. Once again, it is important to determine what is “driving” the pain in the foot. Perhaps a low back condition is causing a limp in the gait cycle and placing excessive load through the right lower limb which is irritating the plantar fascia on the plantar aspect of the right foot. If this is the case, it is important to the intervention strategy to lumbar spine and wait to see if orthotics are really necessary.

Orthotics Uses:

Any of the following conditions as long as the feet have been shown to be the “driver” of the pain syndrome:
• Metatarsalgia or other foot pain
• Plantar fasciitis [[]]
• Morton’s Neuroma
• Flat feet
• High arches
• Knee pain
• Hip pain
• Low back pain
• SIJ dysfunction
• Degenerative Disc Disease
• Scoliosis
• Osteoarthritis in the knees, hips, pelvis or low back
• Patellofemoral pain syndrome
• Femoral acetabular impingment
• Iliotibial band friction syndrome
• Bursitis in the ankle, knee or hip
• Chronic ankle sprains
• Piriformis syndrome
• Achilles tendonopathy
• Patellar tendonopathy
• Snapping Psoas
• Gluteal tendonopathy
• Hamstring tendonopathy
• Recurrent Calf Strains
• And More...


References:

1. The Orthotic Group. Orthotic FAQ. Available from: http://www.theorthoticgroup.com/patientsite/OrthoticFAQ.aspx [last accessed 10/12/14]

2. SBI Orthotic Laboratory. Orthotic FAQ. Available from: http://www.sbiorthoticlab.ca/faq_orthotic.html [last accessed 10/13/14].

3. Rebalance Sports Medicine. Custom Orthotics. Available from: http://www.rebalancetoronto.com/sports-medicine-services/orthotics-downtown-toronto/ [last accessed 10/13/14].

4. Roger, Collier. Orthotics work in mysterious ways. CMAJ-Canadian Medical Association Journal. March 8, 2011. Volume 183:p 416-417.