|
Custom Foot Orthotics
An 'orthotic' is a device designed to restore your natural foot function. Many 'biomechanical' (walking) complaints such as heel pain, knee pain and lower back pain are caused by poor foot function. Orthotics re-align the foot and ankle bones to their neutral position, thereby restoring natural foot function. In turn this helps alleviate problems in other parts of the body.
In addition, orthotics give a more even weight distribution, taking pressure of sore spots (e.g. the ball of the foot, corns in between toes, bunions etc) and they provide some shock absorption.
Who needs orthotics?
Orthotics benefit people with foot pain or discomfort due to walking imbalance (biomechanical complaint). Imbalances such as Flat fee, heel pain, knee pain and shin pain are known to cause pain and discomfort.
Can you wear the orthotics during all daily activities?
People who stand or walk all day will benefit from orthotics.
If you suffer from pain during any form of sporting exercise then orthotics can reduce the pain associated with your condition.
For overweight individuals, orthotics will help to counteract the extra stress being placed on the feet.
What specific conditions may be helped?
Below is a list of all the conditions that orthotics can help.
Achilles Tendonitis, Corns, Metatarsalgia, Sesamoiditis, Ankle Sprains, Flat Feet, Neuroma, Tendonitis, Arch Pain, Heel Pain, Pronation, Top of the foot pain, Bunions, Knee Pain, Shin Pain, Toe Pain. Imbalance in your feet can alter the bony structure of your feet and lower legs, foot orthotics may eliminate posture problems and foot and leg pain.
Do I need a physician's prescription to get custom orthotics?
No. Chiropodists are primary health care professional and therefore do not need a physician's referral. Custom orthotics are orthotics that are especially molded to your feet. Only a registered Chiropodist can properly determine if you require orthotics. The best orthotics are formed from a plaster cast rather than a computer foot pad and the orthotic needs to be made by a Chiropodist.
Why do I need orthotics?
Imbalances of the bones of the feet can result in abnormal foot motion (over pronation). This can impair foot function which can result in abnormal rotation of the legs and sometimes affects the knees, hips or back. If we combine these tremendous forces with the need for precise balance, we can see how small structural changes in the foot can make significant differences. Orthotics help to improve those structural changes.
How long will my Foot Orthotic Last?
Usually between 12 to 18 months.
Does it take time to get used to orthotics?
Your feet need time to adjust to the correct biomechanical (walking) position. Orthotics should be gradually used to begin with. During the first 48 hours of use, use the orthotics for approximately 3-4 hours. After this period of time it is recommended you use the orthotics for 6-8 hours. In the second week of use the orthotics can be utilized all day.
|
William M. Austin, DC, CCSP, CCRD Director of Professional Education
|
Low Back Pain and Orthotic Support
The lumbar spine and pelvis balance on the lower extremities during standing, walking, and running. If leg or foot asymmetries or misalignments exist, abnormal forces transmitted along the closed kinetic/kinematic chain can interfere with spinal function.1
Most chronic low back pain is the result of some form of structural weakness or failure.2 The cause of chronic lumbar spine breakdown is microtrauma, which is produced by the conditions found in Table 1. The source of these conditions must be recognized and treated in order to prevent further breakdown and chronicity. And that source is often an imbalance/condition in one or both of the feet.
 The Pedal Foundation
The feet are the foundation of the body. Statistical evidence shows that at birth, most of us have perfect feet. By age 20, 80% of those "perfect feet" have developed some type of problem, and by age 40, nearly everyone has a foot condition of some sort. Many foot conditions eventually contribute to health concerns farther up the kinetic chain, especially the generalized condition of "back pain" (Fig. 1). Therefore, it's in the best interest of both you and your patient to be able to spot a potential low back problem before it is allowed to affect a patient's health and/or lifestyle.
Orthotic Supports
A significant factor in reducing excessive biomechanical forces on the lumbar spine is frequently overlooked by practitioners: the use of orthotics to decrease external forces. The following are commonly seen conditions in which the lower extremity can have a major impact on lumbar spine function. In each of these situations, orthotic supports are not only appropriate, they will contribute significantly to a cost-effective treatment outcome:
- When excessive pronation and/or arch collapse of the foot is present, a torque force produces internal rotation stresses to the leg, hip, pelvis and low back. (Fig. 2)3 The result is recurring subluxations and eventual ligament instability affecting the sacroiliac and lumbar spine joints. These forces can be decreased significantly with the use of flexible, custom-made orthotics.
- In patients with degenerative changes in the lumbar discs and facets, the external force of heel strike may aggravate and perpetuate low back pain, and is easily reduced with the use of shock-absorbing shoe inserts4 or orthotics which contain viscoelastic compounds. The reduction in symptoms is often dramatic.
- An anatomical difference in leg length produces abnormal structural strains on the pelvis and low back. These strains can cause not only chronic pain,5,6 but also have been shown to result in specific degenerative changes.7 The use of lifts and orthotics has been shown to reduce these structural strains and bring about significant response.8 Yochum demonstrated how a 15.5 mm LLI in a patient could be reduced to just 4 mm with the use of Foot Levelers' orthotics (Figs. 3A and 3B).9 Not only had the pelvic deficiency been markedly reduced, but the right compensatory listing of the lower lumbar spine had also diminished.
Figure 2. Effects of Excessive Pronation
Screening Patients
Asking your patients a few simple questions (below) can provide valuable insight into the cause(s) of their back pains. When the back acts up, look to the feet.
- Do you stand or walk on hard surfaces for more than 4 hours daily?
- Do you participate regularly in any physical sport (basketball, baseball, tennis, golf, bowling, etc.)?
- Are you age 40 or over?
- Have you ever had a prior injury to your knee, back or neck?
- Do your shoes wear unevenly?
- Do you have joint pain while standing, walking or running?
- Is one of your legs shorter than the other?
- Do you have knock-knees or bow legs?
- Do you have any obvious foot problems (bunions, corns, flat feet, etc.)?
- Do you feet "toe out" when you're walking?
If your patient gives an affirmative answer to any of the above, consider this patient a likely candidate for flexible, custom-made orthotics.
References
1. Keane GP. Back pain complicated by an associated disability. In: White AH, Anderson R. eds. Conservative Care of Low Back Pain. Baltimore: Williams & Wilkins, 1991:307.
2. Fulton M. Lower back pain: new protocols for diagnosis and treatment. Rehab Management1988; Nov/Dec:39-42.
3. Hammer WI. Hyperpronation: causes and effects. Chiro Sports Med1992; 6:97-101.
4. Light LH, et al. Skeletal transients on heel strike in normal walking with different footwear. J Biomechanics1980; 13:477-480.
5. Giles LGF, Taylor JR. Low-back pain associated with leg length inequality. Spine 1981; 6:510-521.
6. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine1983; 8:643-651.
7. Giles LGF, Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine1982; 7:159-162.
8. Hoffman KS, Hoffman LL. Effects of adding sacral base leveling to osteopathic manipulative treatment of back pain: a pilot study. JAOA 1994; 94:217-226.
9. Yochum TR, Barry MS. The short leg (revised edition). Practical Research Studies1994; 4(5).
Ortho Notes is published periodically by Foot Levelers, Inc. as general informational material.
For more information on this issue, or to suggest other topics you would like covered, contact the Educational Division of Foot Levelers, Inc. , Post Office Box 12611, Roanoke, VA 24027-2611.
|
