Here is a case of a young man who had a pair of rigid orthotics that he felt were very uncomfortable. He had been wearing them for a long time as this was the only help he could come up with. After finding out about soft/functional orthotics, he decided to give them a try. Needless to say he finds them far more comfortable than his previous pair. This was a first pass with the posting the orthotic, and I would bet in a short period of time, we may actually increase the amount of posting though you can see here the improvement in the angle of his Achilles tendon.
When you go to the drug or sports store and buy an over the counter arch support, that’s just what you get, a device that helps support you full weight over the length of the arch. Over the counter orthotics are made for the “Average” foot meaning they are a middle ground, not to high of an arch, not to low and if you have an average foot, sometimes they can be helpful. On the other hand, if you don’t have average feet, and if you are reading this article, you probably don’t, an average orthotic isn’t really going to help very much. A custom orthotic is made for your particular joint mechanics and molded to hold you foot in its most advantageous position. This helps to control the entire mechanism of gait from foot strike through mid-stance to toe off. When you get a pair of custom orthotics there is much more science in the design, which a over the counter pair just can’t hope to attain. With a custom pair of orthotics we can adjust them to best support YOU and your proper mechanics of gait.
One of the very common things we see with people having foot issues is arch pain. Here are some thoughts and ideas that may be helpful to those suffering with arch pain.
Anatomy: There is a band of tissue that connects the heel to the base of your toes called the "Plantar Fascia" this is fan shaped at its attachment to the base of the toes and forms the main structural component of your arch. The Plantar Fascia is important to the mechanics and control of your gait as we transfer weight from the heel to the toe. When this area becomes inflamed it can cause a lot of pain in the foot with even simple motion.
The most common culprit in the type of pain we are discussing is in fact termed "Plantar fasciitis." This is a catch all term for inflammation in the bottom of the foot from the heel to the toes. Often times this is worst early in the morning and can be exacerbated by prolonged standing or long walks.
There are other common causes of arch pain such as:
The symptoms of arch pain may range can run from a minor annoyance to total incapacitation and inability to do ones normal range of activities without pain. Symptoms of arch pain may include some or all of the following:
In the early stages of arch pain the most common treatment is the old adage "R.I.C.E." which stands for rest, ice, compression and elevation. Rest is self explanatory. The instructions for icing would be fifteen minutes of ice two hours between applications as many times a day as you can stand it. Compression would be a compression stocking or ace bandage, not so tight as to affect circulation. You check this by pinching the toenail for fifteen seconds, when you release them the toenail should be blanched. You want to see it return to its normal color within seconds. Elevation is placing the foot above heart level which will help with vascular drainage and swelling. One can try an over the counter anti-inflammatory but these don't tend to be very effective for this type of condition.
And of course big surprise here, custom orthotics more often than not help arch pain by correcting the mechanical changes that take place due to gravity, age, and the stresses we place on our bodies. (Yes athletes this is you, and those of us who work on our feet for prolonged periods as well.)
Needless to say you can guess which way I have gone myself, and as a result, taken many patients there with me. The joys of orthotics on our aching feet.
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.
What is a custom orthotic and do I need one ?
A custom orthotic is a specially made shoe insert designed to increase the mechanical efficiency of the foot. My goal when making them for my patients is to have the patient standing in their shoes at the best mechanical position for the maximum function of their mechanism of gait. An orthotic will compensate for any structural or postural instability in the foot, thereby relieving abnormal stresses on the foot, ankles, knees and low back.
How does an orthotic differ from an arch support you can buy at the drugstore?
The over the counter arch support does just that, it helps the arch support your full weight. The custom orthotic, on the other hand, maintains the foot in the normal position through the entire footstrike, from heel contact through mid-stance to toe-off. There is more science in a custom orthotic taking your joint mechanics into account where one size fits all drug store type just doesn’t have the flexibility to adjust for your particular foot or gait mechanics.
Why is this overall control of footstrike necessary?
Because errors in footstrike cause most overuse injuries, contributing to injuries in the foot, ankle, knee, hip and lower back. Depending on the individual foot, the origin of injury may arise in the rearfoot, midfoot, or a combination.
Does every athlete/everyone need an orthodic?
One of my mentors once said “50% of your patients desperately need orthotics, the other 50% will merely benefit tremendously from having them.” I think this may be a slight overstatement but most people do benefit from orthotics. Often times they have positive results other than the ones they presented in my office to address.
The reason this is so often the case is that when one joint in the kinetic chain is not functioning at its best, the joints above and below start to have issues due to their compensating for the joint between them that isn’t performing at its best. As a result often times a patient will come in for a problem in a foot or knee and find their low back or ankle benefits from the adding of an orthotic to their health care regimen.
I've heard people say that they spent hundreds of dollars for orthotics and are still have issues in their foot or legs, why is that?
There are numerous factors one needs to be aware of when making custom orthotics. If your doctor is unaware of these factors or just “Missed” the orthotic may require some correction or re-manufacture. That being said, there is no guarantee with any medical procedure or device that you'll achieve perfection. I can say however that statistically speaking orthotics have a very high success ratio in helping people with lower extremity problems.
The points to consider when making custom orthotics are:
Your orthotic has to support your foot in its neutral position. This position can be hard to find particularly if your practitioner isn’t aware of or looking for it. The result of missing this point is an under or over correction of your joint mechanics which can lead to further issues in any of the lower kinetic chain.
You should also be assessed by your practitioner for anomalies that may appear in the leg itself. If you have a short leg for instance the orthotic needs to have a heel lift added in order to stabilize the pelvis.
It may also be that you have asymmetrical muscular development, which can also aggravate the situation and may need to be addressed with proper training.
What do I do if I get a pair of orthotics and they don’t seem to be working for me ?
Don’t be afraid to contact your provider should you have issues with your orthotic. It may be that there is some further adjustment needed to the device itself based on your user experience.
There is also a break in period and sometimes the patients are not informed of this by their practitioner and therefore their expectations are not being met when it may be they need to alter the pattern of wearing their orthotic for a week or so based again, on their user experience.
I’ve been wearing orthotics more often than not for about fifteen years. What I noticed was amazing as the main positive effect for me was a massive reduction in chronic low back pain. I had no expectation of my back pain improving due to the orthotics and this is the main reason I have become such a proponent of custom orthotics.
Orthotics aren’t a panacea and can’t fix all things for all people. But there are amazing amounts of people who get them and are VERY impressed by the results.
Dr. Camp is a San Francisco Chiropractor with the postdoctoral designations of C.C.S.P. ~Chiropractic Certified Sports Physician~