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| Definitions
| Frequently Asked Questions | Casting
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Our
Philosophy on Orthotic Therapy
The
use of a custom arch support is a non-invasive way to reduce or
eliminate pain in areas such as feet, ankles, knees, hips and lower
back by improving structural alignment and/or restricting or enhancing
motion. However, they do not take the place of any strengthening
or stretching exercises recommended by your healthcare practitioner.
Orthotics can be used to treat a variety of injuries and often work
best in conjunction with other therapies such as physiotherapy,
stretching, icing, and massage.
What
is a custom orthotic?
A
custom foot orthotic is a custom-made three-dimensional insert that
is placed in your shoe. They can be used to relieve pain, improve
skeletal alignment or improve the function of your foot and lower
limb. Orthotics work to support and re-position your feet. Like
eyeglasses, they help us while we are wearing them. Orthotics generally
will not permanently change your anatomy and will function only
when you are standing or walking on them. Orthotics allow us to
maintain our lifestyle and activities, while reducing the symptoms.
Orthotics are commonly used to relieve symptoms of common injuries,
such as plantar fasciitis, metatarsalgia, neuromas, and various
foot and ankle tendon injuries, as well as helping individuals with
diabetes or arthritis.
What
do orthotics do?
Depending
on the design, orthotics can cushion and support your foot by redistributing
the pressure areas on your feet.
Improper
foot function and weight distribution of the lower extremities is
often the cause of many foot, lower leg, pelvic, back and neck overuse
or stress injuries. By improving the alignment the body is able
to function more efficiently with less stress on the muscles and
ligaments that hold you together.
They
can also be designed to support and improve the alignment of the
bones in your feet and legs. Many different styles and types of
orthotics can be designed in order to alleviate various types of
pain in the feet, knees, hips and lower back. These can range from
soft flexible types to very rigid types.
Some
orthotics are made to control abnormal foot function, re-establish
proper weight distribution and overall biomechanics by not allowing
the foot to fall out of subtalar neutral position during gait. This
is achieved by first obtaining a neutral position plaster cast mold.
CONSUMERS
BEWARE!! Orthotics are often over prescribed
or made by non-certified, non-medical providers. Contrary to popular
belief, not everybody needs a custom product. A Certified Pedorthist
is educated in the anatomy, structure and biomechanics of the lower
limbs as well as orthotic prescription and is therefore able to
assess properly a client's individual needs.
It is important to have your foot and shoes properly evaluated prior
to getting orthotics. Beware of companies that provide only one
type of orthotic. It may not be right for you.
See
the Pedorthic Association of Canada's Position
Statement on Over-the-Counter Insoles vs. Custom-made Orthoses
 Orthotics
are often prescribed as a method of treatment for an injury. Orthotics
will help you to recover from the injury. Once the injury has healed,
orthotic use may need to be continued, in order to prevent the injury
from recurring.
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Frequently
Asked Questions
How
will the orthotics feel at first?
When you first wear your orthotics, it is normal for the orthotics
to feel strange; however, properly fitting orthotics should not
cause any new pain, blistering or redness. If this does occur, remove
the orthotics and make an appointment with your pedorthist for an
adjustment.
Although symptomatic relief will not usually occur over night, consistently
wearing your orthotics for a period of time will realign your foot
and allow healing to occur.
Can
my orthotics be adjusted?
Pedorthists are able to adjust your orthotics. If your orthotics
do not feel comfortable or cause new pain or blisters, you may need
an adjustment. Our facility has the equipment and materials to do
all adjustments. For orthotics purchased at Sole Decisions, adjustments
are free of charge within the first three months. After three months
or for orthotics purchased elsewhere, we charge a nominal fee to
cover material and labor.
How
do I take care of my orthotics?
To clean your orthotics, wash with warm or cool water and mild soap,
pat and/or air dry. Do not expose them to high heat.
How
long will my orthotics last?
The body of our orthotics should last one to five years for adults
and depending on wear, you may need to replace the top cover and
other additions periodically.
After three to five years if your original symptoms return or you
develop new symptoms, you may need a new pair of orthotics.
Children and adolescents' orthotics should be replaced after their
feet grow 1 to 2 shoe sizes. We will ensure that their new orthotics
will last at least one year.
Can
my orthotics be repaired?
As orthotics compress and wear out over time, your activity level
and body weight directly relate to the life of your orthotics. The
life of your orthotics may be extended by repairing replaceable
components, such as top covers, extensions, cushioning, posts, and
metatarsal pads. Fees for repairs vary according to amount of material
and labor required.
What
shoes can I wear my orthotics in?
Your orthotics are only as good as the footwear you put them in.
Proper footwear selection and fit is vital to the success of your
orthotics.
Can
I Wear Orthotics With Any Shoes?
Orthotics can be designed for virtually any shoe type but are usually
designed with a particular shoe type in mind, depending on your
needs, and as such should work well with shoes of similar style.
If an orthotic is designed for running shoes, it will not fit properly
into a heeled shoe. Sandals also restrict orthotic use, as the orthotic
is not secure without a closed shoe unless it was designed for a
removable insert.
Do
They Transfer From One pair Of Shoes To Another?
Yes, they are removable and transfer nicely between similar pairs
of shoes. On occasion you may require a second pair to use in some
footwear, such as high heels, loafers, and ski boots, for example.
Will
I Have To Wear The Orthotics For The Rest Of My Life?
Chances are that when your pain is resolved, you will be able to
go without them, but once you are accustomed to the great support
they provide you may miss them! Some individuals are advised to
wear them indefinitely because the orthotics correct their gait
and prevent problems from recurring.
HOW
MUCH ARE THE CUSTOM-MADE ORTHOTICS?
Prices
are competive and available upon request. There are no taxes on
custom-made devices.
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Casting
Patient
Assessment to Fitting
Julie's
clinical assessments take approximately 45 minutes. If she determines
orthotics can help she creates a three-dimensional cast of the patient's
feet. From this cast, Julie creates orthotics from her London Lab.
Once finished she meets with the patient again for a follow up appointment
and fitting. Julie will also lend her expertise on over the counter
(O-T-C) orthotics for those who do not require custom orthotics
or do not have insurance coverage to cover the cost of custom-made.
Julie will offer consultation regarding O-T-C Orthotics and their
modifications.
After
a thorough physical, biomechanical and gait assessment, a casting
technique must be used to capture the foot. The method of casting
is critical to the success of the orthotics. There are various ways
to accomplish this. There are many different casting techniques
used to obtain a 3-D image of a foot. Each casting method has advantages
and disadvantages and your pedorthist will determine the best method
for you.
Once
the total-contact orthotic has been fabricated, a detailed fitting
takes place to assure that it meets all prescription requirements.
This fitting is also important to make sure that the orthoses is
comfortable. At this time, a follow-up visit is scheduled and any
necessary adjustments are performed. Our Certified Pedorthist uses
years of experience and pedorthic knowledge to provide the best
fitting, most accommodative device possible.
Casting/Moulding
At
Sole Decisions we fabricate custom-casted orthotics
by 3 methods: plaster slipper, fiberglass slipper and impression
foam box.
- Hands
cast using a slipper plaster casting technique
with the subtalar joint in neutral. By capturing the correct foot
position in the cast this technique is superior to all others.
This is usually taken non-weight bearing. When done weight bearing
or semi-weight bearing you get more tissue deformation and may
lose rearfoot to forefoot alignment. Plaster slipper casting involves
applying plaster directly to the foot in order to capture the
contours and shape of your foot. The casting will be done with
you lying down on your stomach or seated with your foot in the
air. This is a non-weight bearing technique and takes 5-7 minutes.
- Fiberglass
slipper casting is similar to plaster except that it is
less messy and time consuming as it is in a sock not fabric roll
format and leaves no residue on the client's foot since a bag
is placed over the foot first.
- Foam
box impressions involve pushing the foot into a foam box
either from a standing or seated position. This can be a semi-weight
bearing or full-weight bearing technique often used if someone
cannot get on a table for plaster casting or if a less aggressive
(more accommodative) shell shape is desired such as for severe
arthritics or diabetics (sores on foot). This technique is used
for clients with no forefoot to rearfoot misalignment.
What
about computer-generated or "Dynamic Orthotics"?
"Bells
and Whistles" Although to the
general public these high-tech systems may look impressive, all
they are really doing is playing on their perception of what a computer
can do these days. Some methods do not give a 3-dimensional image
of the foot in a non-weight bearing subtalar neutral position in
which to manufacture a corrective device. If the information is
based on a two dimensional image of a foot that has already failed
biomechanically there is no mathematical equation in existence that
will take this data and transform it into a three dimensional image
of the foot in a non-weight bearing subtalar neutral position. It
is this neutral position that is the essence of a truly corrective
custom foot orthoses. Therefore some computer-generated orthotics
are not always custom moulded.
There
are some systems that are contact digitizing such as the
Amfit, CAD-CAM system which is used full-weight or semi-weight bearing
a 3-D presentation of the foot is captured from elevated sensors
against the foot in a static situation. This can work well since
modifications to the mould can be made and evaluated for success
prior to manufacturing. There are some limitations to material types
that can be used though since the mill is limited by what it can
grind down and it is not a complete total-contact due to spaces
between sensors. The use of laser scanning with multiple
lasers, a newer invention to create an electronic 3-dimensional
image, is evolving and will likely be capable of equaling the flexibility
of slipper casting in the coming years. This system eliminates messy
plaster and removes the need to modify models by hand prior to orthoses
fabrication.
Some
computer generated orthotics use an injection moulding method to
mass-produce a variety of prefabricated shells such as orthotics
made for you from inkblots at Home Shows. These prefabricated products
may then be slightly modified or "customized" to mimic
the look of a custom moulded orthotics. These orthotics may well
help alleviate mild symptoms and feel generally comfortable. But
you should be cautioned on the expense of these devices as they
are not a truly custom device and may have the same therapeutic
affect as a much less expensive off-the-shelf arch support. These
types of arch supports are generally made of a fairly flexible rubber-like
material and claim to be custom to your feet. They are however,
massed produced products providing little more support or benefit
than a non-custom insole. All the modifications and adjustments
will never make them a truly custom moulded orthotic. Some insurance
companies will not cover these types of devices - check your policy.
Dynamic
orthotics are usually produced from the information produced
when you walk across a pressure sensitive pad such as when using
the Footmaxx system. This means that the images are taken in a weight
bearing position and therefore captures an image of your foot when
it is already compromised in function - already pronated or supinated
- the position that may be contributing to your symptoms. Ultimately
this is a 2-dimensional image derived from where you foot makes
contact with the mat. The computer uses algorithms to best estimate
the actual shape of your foot. It does not in fact know whether
the arch of your foot is 1mm or 10mm off the ground. Though sometimes
the orthotic made from this system is sufficient enough.
While
several methods exist for making orthotics, including some that
are computer generated, the majority of foot care professionals
consider the plaster slipper cast taken with the foot in a non weight
bearing position, to be the gold standard. However a poorly taken
slipper cast is not superior to a well-taken cast of other means.
Any casting method can be satisfactory in skilled hands however,
and alternative casting techniques are often superior in specific
conditions.
Position
Statement on Casting Techniques for Custom Foot Orthoses
Advantages
of slipper casting in non-weight bearing are:
-
The non-weight bearing foot does not capture its structural defects:
for example if the arch flattens excessively (hyperpronation,
pes planus) then this occurs when the weight is on the foot. This
is why most of us believe that our arches are fine - we look at
them when there is very little weight on them, for example when
we are sitting.
-
Precise positioning of the foot: the pedorthist can hold the joints
including the ankle, subtalar (below the ankle), midtarsal (bones
in the middle portion) and the forefoot. Positioning the forefoot
up or down can increase or decrease the height of the arch and
the overall correction of the foot. Most other casting methods
cannot provide this degree of flexibility of "intrinsic "
cast correction.
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