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Answers to some of your orthotic questions. 

3/12/2014

 
  Orthotic inserts have been gaining in popularity and usage since the mid 1980’s. They are used for a large variety of condition such as: Plantar Fascitis, heel spurs, calluses, bunions, forefoot pain, knee pain, sports injuries, low back pain, and a myriad of other conditions.

So how it is so many conditions respond to orthotics a seemingly simplistic device ? I’ll try to simplify the answer as best I can.

Orthotics alter the mechanism of gait by supporting the foot in its best mechanical position. Each joint in the Kinetic chain of the lower limb is dependent on the joints above and below the one we are examining.

Pronation and supination are needed for tibial rotation on the femur, tibial rotation is needed for eversion and antiversion for the hips, eversion and antiversion of the hips is required for neutation and counter neutation of the illia. And so on. When any of these natural motions is effected, you cause issues with the joints above and below the area of mechanical deficiency. In a direct attempt to be silly, “The foot bones connected to the leg bone, the leg bones connected to the thigh bone” and so on.

Suffice it to say in my experience, orthotics are very helpful for a large segment of the population and seem to effect positive changes on a wide variety of conditions.

The next debate is what type of orthotics should I wear ? Soft, semi rigid or rigid ones and what determines the choice that’s right for you. I do have a bias in this based largely on what Dad used to call my personal B/S meter.

It makes no sense to me to install something in ones shoe that inhibits normal range of motion. We are trying to restore that by the very application of orthotics. It also makes no sense to me to try to force a shape to the foot that (Insert deity of choice) failed to give you. If we try to create arch where one doesn’t exist, we are creating a patho-mechanical problem. The goal of orthotics in my professional opinion is to have you in your shoes in sub-talar neutral. This is the best position to support normal mechanics above and below the ankle.

The process of making rigid orthotics, to the best of my knowledge is as follows: The patient sits in a chair, a cast is made of the patients non weight bearing foot, the cast is cut off, sent to a factory, sealed and filled with a solid material, that solid “Model of your foot” then has a solid orthotic made to fit it, which is then returned to you to be placed inside your shoe.

To simplify that to it’s most absurd…. When we stand up, our foot widens SO a weight bearing foot is not the same shape as a weight bearing one.

The above process is, make a mold of the non weight bearing foot, send that to a place where they make a mold of the mold of the non weight bearing foot, then make a mold of a mold of the non weight bearing foot and return the mold of the mold of the mold of the non weight bearing foot to the patient. Mmmm sounds Comfy doesn’t it ? There is notoriously low patient compliance with rigid orthotics any wonder why ?

Anyway, silly as it seems, I think I’ve made my point.

So are Orthotics right for you, the only way of knowing is to try them. I can say that they do help a wide variety of conditions with a great percentage of my patients reporting success in treating their symptoms.

Hope that helped you if you are trying to decide if they are right for you !

As always you can reach Dr. Camp by telephone if you have any further questions, and thanks for reading.  

    Author

    Dr. Camp is a San Francisco Chiropractor with the postdoctoral designations of C.C.S.P. ~Chiropractic Certified Sports Physician~
    C.C.E.P. ~Chiropractic Certified Extremity Practitioner~ and he is also a Q.M.E. ~Qualified Medical Evaluator~ for the state of California Department of Industrial Relations.

    He has been in private practice in San Francisco since 1994 and making Custom Orthotics since 1997.

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