What is an Orthotic?

An ORTHOTIC is a foot-supporting device also known as a custom insole. Foot Orthotics support, correct and accommodate the 26 bones, 2 sesamoid bones, tendons, ligaments, and plantar fascia band in each foot.

Foot Orthotics allow the muscles, tendons and bones of the feet  through open and closed chain joint migration, up through the legs, hip and lower back, to function at their optimal potential for our body weight, structure, walking pattern and life styles.

When appropriately prescribed and more importantly, appropriately manufactured, Foot Orthotics can decrease pain and discomfort in the foot, ankles, knees, hips and back. Foot Orthotics increase our stability, prevent further progression of bony deformities, soft tissue pain, burning and numbness and help to improve our overall quality of life in our activities of daily living (ADLs).

Remember, foot pain is not normal and should not be ignored. The pain in our feet often is associated with other pains in our lower limbs all due to the poor inherent biomechanics of our foot.

With a foot orthotic supporting the three main arches of the foot the muscles and tendons are able to work within their intended range of motions (ROMs) and we do not run the risk of causing injury or furthering one.
 

Benefits of Orthotics

Custom Foot Orthotics help in providing relief for painful foot problems or an injury, especially for those who must walk, or stand excessively on the job or in every day activities.

The mechanical properties  of the Custom Foot Orthotic help to maintain the normal positioning of the bones in the foot, the joints in the ankle and knees leading up to the hips and lower back. The muscles and ligaments holding these bones in their intended anatomical positions are prevented from over stretching and becoming lax over time.

With enough functional correction from a Custom Foot Orthotic, the foot structure can be aligned to give more propulsion, making walking, running and even cycling more efficient biomechanically.

Along with aligning the foot structure, the Custom Foot Orthotic reduces muscular fatigue and helps to promote more efficient muscle performance thus enhancing performance during the gait cycle.

Below is an example of a foot without the corrective support of an orthotic and then another example of the same foot with a Custom Made Foot Orthotic from POL correcting and supporting the foot. Notice the difference a well made Custom Foot Orthotic makes!

 

The Structure and Function of an Orthotic

Foot Orthotics are constructed from various materials consisting of plastics, foam, rubbers, and cork composites that are utilized for their mechanical properties.

The main similarity of all Foot Orthotics is the principle of their structure. The core is comprised of a plastic material more commonly referred to as the shell. External support structures on the underside of the shell material are utilized for balance and support inside the footwear; these are commonly referred to as extrinsic posts. Soft padding is placed on the underside and the topside to absorb compression forces when walking and running, this includes the top covers, underlay materials and arch fills.
All of these materials have the goal of improving foot function and minimizing the stress forces that cause foot deformity and pain.

Dependent on the reason for the prescription of Foot Orthotics, all of the above mentioned materials can be utilized in many combinations to achieve three broad categories of Foot Orthotics:

1. Those that primarily attempt to change foot function, known as functional Foot Orthotics
2. Those that are mainly protective or accommodative in nature, and
3. Those that combine functional control with accommodation for comfort.

Common Foot Problems: do you have these ailments?

Many people believe that it is natural for their feet to hurt. That isn’t true. Any time you have foot pain that lasts longer than a week you should get the pain examined by a qualified foot specialist, these include the following:

• Family Doctor
• Podiatrist
• Chiropodist
• Pedorthists
• Orthotists   
• Chiropractor
• Allied Health Care Practitioners

Some common foot conditions in which the application of Custom Foot Orthotics is beneficial are listed below:

Pes Planus; aka Flat Feet, the Pronated Foot:

Low arched, or flat feet, are a common type of foot structure.

Most flat feet are pronated which is a foot in poor functional position. Close examination of this type of foot in a weight-bearing position shows:

• turning out of the heel bone away from the centre of the body
• inward rotation of the leg
• bulging of the inner aspect of the ankle
• shifting of the forefoot outward from the heel

Orthotic Management:

Treatment starts with a proper evaluation of the underlying cause of the conditions to diagnose the appropriate correction.

Functional Custom Foot Orthotics to compensate for mechanical faults, will allow your feet to function with improved efficiency. Orthotics relieve stress from compromised joints, ligaments and muscles, diminishing deforming forces acting on the foot.

Heel Pain, Plantar Fascitis, and Bone Spurs:

Sharp pain, aching or stiffness on the bottom of one or both heels is a very common ailment.

Pain from Plantar Fasciitis is often at its worst upon awakening in the morning (or after sitting down for an extended period and then resuming activity). This pain causes hobbling or a limping gait pattern for a few minutes before a comfortable stride can be resumed.

As weight continues to be applied during walking or standing, mild or severe pain may persist.

Another cause of heel pain is bone spurs, where bone growth originates from the heel bone (Calcaneous) and pinches into the tendons of the heel from the Achilles tendon.

Injury, overuse, loss of fat pad and/or non-presence of fat tissue on the heel can also cause heel pain.

Orthotic Management:

Padding added to the dorsal surface of the orthotic will aid in comforting the heel bone; the addition of soft heel spur pads will help to support the perimeter of the heel bone to aid in pain management and healing time. Addition of a hole in the shell material of the orthotic with a soft orthopaedic material plug will aid in decreasing forces on the central axis of the heel. The main support of an orthotic will help maintain proper heel bone alignment to balance the forces acting on the tissues and muscle of the foot to prevent overuse, inflammation and injury.

BUNIONS ( HALLUX VALGUS)

A common deformity of the big toe joint, a bunion occurs mostly in people who have flat feet or who wear tight fitting footwear that are too small for their dynamic foot size.

Women are more frequently affected with bunions because of tight, pointed, confining or high heeled shoes. Wearing high heels is especially stressful on the joints of the foot because all of the body's weight rests on the ball of the foot; the foot is then forced into a narrow, pointed toe box, compounding the problem.

Older people are also vulnerable to bunions because of the higher incidence of arthritis affecting the big toe joint.

A bunion is a protuberance of bone or tissue around the joint. The enlargement occurs either at the base of the great toe or on the outside of the foot, at the base of the little toe. This is called a "bunionette" or "tailor's bunion."

Orthotic Management:

Custom Foot Orthotics help maintain proper foot alignment and function thus forcing the toes to be evenly placed on the ground during walking and running. This even placement will prevent the over use or misalignment of the first toe and prevent excessive forces acting on it’s joints and displacing the bones. The Custom Foot Orthotic will also support the arch of the flat foot preventing it from overpronating and reducing added forces on the big toe joint.

Several modifications to the orthotic will also aid in bunion treatment, these include: 1st metatarsal cut outs, 1st ray cut-outs, reverse Morton’s extensions and kinetic wedges.

Diabetes:

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The Podiatrist Physician, Pedorthist, Chiropodist, Chiropractor and Allied Health Professional are an integral part of the treatment team and work effectively in the prevention of amputations.

The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, from a Podiatric Physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

• Skin color changes
• Elevation in skin temperature
• Swelling of the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal
• Ingrown and fungal toenails
• Bleeding corns and calluses
• Dry cracks in the skin, especially around the heel

Wound Healing:

Ulceration is a common occurrence with the diabetic foot, and should be carefully treated and monitored by a Podiatrist to avoid amputations.

Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished due to neuropathy. Left unattended, such ulcers can quickly become infected and lead to more serious consequences.

Your Podiatric Physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the Podiatric Physician. Clinical trials have shown impressive success rates.

If You Have Diabetes Already . . . DO:

• Wash feet daily.
  Using mild soap and lukewarm water wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily, but avoid getting it between the toes.

• Inspect feet and toes daily.
  Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

• Lose weight.
  People with diabetes are commonly overweight, which nearly doubles the risk of complications.

• Wear thick, soft socks.
  Socks made of an acrylic blend are well suited, but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

• Stop smoking.
  Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.

• Cut toenails straight across.
  Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatrist for assistance.

• Exercise.
  As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what’s best for you.

• See your podiatric physician.
  Regular checkups by your podiatric physician are the best way to ensure that your feet remain healthy.

• Be properly measured and fitted every time you buy new shoes.
  Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.
  
  New shoes should be comfortable at the time they’re purchased and should not require a "break-in" period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.

• Don’t go barefoot.
  Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls and infection. When at home, wear slippers. Never go barefoot.

• Don’t wear high heels, sandals, or shoes with pointed toes.
  These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

• Don’t drink in excess.
  Alcohol can contribute to neuropathy (nerve damage) which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves and increase the possibility of overlooking a seemingly minor cut or injury.

• Don’t wear anything that is too tight around the legs.
  Panty hose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet. So can men’s dress socks if the elastic is too tight.

• Never try to remove calluses, corns or warts by yourself.
  Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.
  
  Your podiatrist physician/surgeon has undergone extensive training in the diagnosis and treatment of all manners of foot conditions. This training encompasses all of the intricately-related systems and structures of the foot and lower leg including neurological, circulatory, skin and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles and nerves.

Information courtesy of The American Podiatric Medical Association

Orthotic Management:

The application of a soft or accommodative Custom Foot Orthotic constructed from a non corrected positive of your foot will aid in maintaining healthy feet.

The fabricated orthotic device will decrease shear forces acting on the tissue of your feet while dispersing ground reaction and gravitation forces on your feet.

The special material in our Diabetic Orthotic allows the device to be soft and flexible while  maintaining its shape over time and not breaking down like several other non-custom diabetic Orthotics.

ACHILLES TENDONITIS:

Achilles Tendonitis is characterized by inflammation of the sheath surrounding the Achilles tendon.

The presence of pain behind the heel, ankle and lower calf are signs of this condition.

The condition arises from counter rotational forces acting on the tibia against the femur as a result of excessive pronation of the feet which causes the heads of the tendon to torque against one another and over stretch the tendon.

Orthotic Management:

Custom Foot Orthotics help maintain function and alignment of the heel and prevent over pronation of the foot.

Additions of rear foot posts to stabilize the orthotic device inside your footwear with a removeable heel lift of about 3mm or 1/8  inch will allow the Achilles tendon to be lax and not stretched while in its resting state. The application of the heel lift is only temporary, for about 6-8 weeks until further consultation by your foot specialist’s follow-up assessment.

METATARSALGIA, a.k.a Ball of the fot pain:

Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot).

This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot.

The first step in treating metatarsalgia is to determine the cause of the pain.

If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot.

Orthotic Management:

Custom Foot Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad.

The Custom Foot Orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.

 

Premier’s Orthotic Process

Manufacturing Process PowerPoint (Click to View)

In order for POL to supply you with a truly custom product, we first receive a foam or plaster cast impression of your foot corrected in sub-talar neutral.

Once your cast impression is received, we start our Quality Control process.

Your order and the selected materials and choice of correction as well as shoe selections is confirmed by our dedicated and highly competent customer service team.

Measurements of the cast are taken and marks are placed on the negative cast impression to indicate bony prominences such as 1st met head and 5th met head, navicular and sulcus line. The Calcaneous is marked for mid line vertical and then a plaster positive mould is made from the negative cast.



Process of pouring liquid plaster into plaster and foam negatives to make a plaster positive.

Once the plaster is cured, the negative mould is broken away and discarded. The  markings on the negative cast impression transfer onto the new plaster positive.

The rear foot and fore foot are corrected to lab evaluation or otherwise instructed via the prescription form (Rx form).


correcting plaster positive



cast markings

Once the plaster positive is corrected another Quality check is performed including a complete evaluation of the cast dressing, rear foot alignment, forefoot alignment in plane with the rearfoot and amount of tissue expansion necessary.

The Rx form will indicate which types of materials to use in the fabrication process and any other special instructions.

The shell material selected will be heated and then vacuum moulded following specific standards used at POL based on the material, its thickness and overall desired effect of support required by the patient.

 

Plastic being heated according to specific standards

 

Plaster corrected positive is ready for moulding of the shell in the vacuum former

 

Plastic is placed over the positive

 

Vacuum is applied and the table top platen cover bladder is drawn over the plastic over the mould to form the desired shell shape and design

 

The formed shell ready to be ground into shape to the foot and desired footwear

 

The shell is shaped using various grinders and buffers

After the shells are ground, a third Quality check is performed. The choice of material, the length of the shell, width of the shell, the intrinsic and extrinsic posting of the shell, any shell modifications and fitment into desired footwear are evaluated.

 

Shell evaluation to corrected positive

Once passed, the order is then processed to select the desired soft materials required to finish the fabrication of the product.


The order is then in production for completion.

 

Desired soft materials are in the process of being applied to the shell

Once the orthotic is finally put together, it is then shaped again to the desired foot bed , cleaned and polished.
The order then goes through its final 4th Quality Control check.

The orthotic is evaluated on its cosmesis, functionality, performance, prescription order and all paper work, including labels.

The order proceeds to the shipping department to be packaged on its way to the prescribing practitioner with any other product or materials requested.

That’s the POL way; we have no scanners, no e-mailed in files of your foot or an endless room of pre-fabricated Orthotics from another supplier.

It’s all done the old fashioned way, by hand and eye. That’s why we are a 5-7 business day turnaround, not a 3 day or faster. At times we may need 7-10 depending on the type of orthotic requested, as there is more time involved in its creation.

 

Proper Use and Care of your Custom Foot Orthotics

Prescribed Custom Foot Orthotics are designed to change the way you walk. As your new foot Orthotics interact with your bone structure forcing your feet and legs into proper alignment, care must be taken when first wearing your new prescribed Foot Orthotics.

They may feel uncomfortable when worn at first but with time this will change.

Your Orthotics will feel more comfortable and you will become more accustomed to the support they provide.

Once you have received your Prescribed Custom Foot Orthotics, please follow these following guidelines when introducing their functionality into your body’s alignment.

Initially wear your new Orthotics for approximately one (1) hour the first day, two (2) hours the second day, three (3) hours the third day, and so on. Follow this until you are able to accommodate to them for a full work day of 8- 10 hours. Note if your Orthotics are extremely uncomfortable when wearing them before the time period of break-in, stop wearing them that day and start from day one (1) the following day.

Remember that some individuals adjust and accommodate more quickly than others.

Some people report mild aches and pains at the beginning of their initial Orthotic wear. These discomforts can occur in the legs, knees and lower back. Usually this is merely an indication that your Orthotics are working. Your skeletal posture has been conditioned to accommodate feet that do not function properly, and now it may need time to readjust to correct posture positioning. These aches are usually transitory and disappear in the short term.

Your choice in footwear may also affect the way your Orthotics fit and perform.

Shoes with a shallower heel seat or lower heel counter may cause you to experience heel slippage.
Optimal footwear would have a deeper heel seat and higher heel counter. Removable inner liners are excellent as this facilitates more room in the shoe once removed.

If your Orthotics squeaks, try applying a small amount of baby powder in your shoes or apply wood furniture polish spray to the underside of the orthotic plastic shell. This eliminates the problem until the Orthotics have seated into your footwear.

Once your Foot Orthotics have been dispensed to you, it is possible that they may need adjustments and/or modifications. This is particularly due to change in the volume of your foot due to swelling or atrophy, footwear selection or your body’s response to the corrected position. Premier Orthotics Lab will work closely with your Foot care Practioner to help alleviate any of these issues.

From time to time Clinical/Technical staff at Premier Orthotics Lab are consulted on information and recommendations on your particular case and findings from clinical assessments. The suggestions that may be offered for your Practioners consideration are meant only to provide feedback, awareness of options unique to your case to help facilitate your Practioners management of care for your feet, legs, hip and back. Premier Orthotics Lab in no way offers an implied or expressed acceptance of responsibility for the inappropriate presence or lack of therapeutic outcome or patient intolerance of the Orthotics.

These steps are guidelines for your new Orthotics. All individuals are different and their requirements are unique.
Always follow your Practioners instructions and follow with them if you have any questions or concerns.

 

Orthotic Modifications

  HEEL SPUR PAD

Indicated for centrally located heel spurs to lift the Calcaneous off the orthotic shell

ARCH FILL

Addition of soft or firm durometer EVA padding on plantar aspect of the full shell to add rigidity to MLA as well as absorb ground reaction forces

1 ST MET CUT OUT

A 45 degree angle cut out under the 1st metatarsal head to the lateral edge of the 1st metatarsal head. Indicated for strong supinators, functional hallux limitus, bunions, hallux valgus and plantarflexed 1st met heads

1 ST RAY CUT OUT

An angled grind from the lateral edge of the 1st metatarsal head to the apex of the navicular. Indicated for strong supinators with plantarflexed 1st ray

FULL HEEL CUSHION

Standard 1/16 nyplex cushion addition to dorsal aspect of shell for full calcaneal contact. Indicated for heel pain, shock absorption, non-centrally located heel spurs and loss of fat pad/boney heel syndrome

KINETIC WEDGE aka DANCER’S PAD, SESAMOID PAD

Standard 1/8 poron distal extension to sulcus transversing from medial edge of foot to lateral edge across the metatarsal heads with a 1 inch hole cut out under the 1st metatarsal head. Indicated for sesamoiditis, plantarflexed 1st ray or bunion

MORTON’S EXTENSION

Standard 1/8 micro cell distal extension from distal/ anterior edge of shell under the great toe to Proximal Interphalangeal joint (IPj). Extension can be to end of toes if instructed and also made from 1/16 or rigid out of shell if instructed. Indicated for short 1st ray, hallux limitus or hallux rigidus

REVERSE MORTON’S EXTENSION

Standard 1/8 micro cell distal extension to sulcus from medial edge of 2nd metatarsal head transversing laterally to lateral edge of 5th metatarsal head. Thickness can be 1/16 if instructed as well as specific choice of material. Indicated for plantarflexed 1st metatarsal head, sesamoiditis or bunions

METATARSAL PAD

Standard grey latex low dense metatarsal pads ranging in sizes from 1, 2, 3, and 4 ( size is dependant on foot width). Standard is full thickness but can be modified to medium thickness (1/16 less) to thin (1/8 less). Placement of pad is located under 2nd and 4th centered under 3rd metatarsal head proximal to the metatarsal heads. Placement can be otherwise if instructed. Indicated for metatarsalgia, dropped transverse arches and clawed toes

  PROXIMAL METATARSAL PHALANGEAL PAD (PMP)

Standard 1/16 poron thickness extending from distal edge of shell to sulcus transversing from medial edge to lateral edge of forefoot. Thickness can be otherwise if instructed. Indicated for calloused metatarsal heads

HEEL HOLE

Standard centrally located 1 inch diameter hole cut through orthotic shell filled with poron plug. Indicated for centrally located heel spurs