Over-the-counter or off-the-shelf orthoses are suitable
when the foot problems don't warrant custom-made devices or cost
is of a concern.
Currently I'm carrying 3 types in stock retailing
between $30-50/pr.
Two are full-length kinds in adult sizing in varying
thickness and can be modified at extra cost. The ½-lengh
ones are in adult sizing, are modifiable, and flexible enough
to work in different heel heights. A few other brands can be ordered
in.
In regards to small children's sizing these can be ordered in
as well."
As written in the PAC website "Over-the-counter
foot orthotics can be effectively used as a temporary solution
for children who are rapidly growing or as a 'first' step for
any age to provide insight into how a patient will initially respond
to a foot orthotic before receiving a more corrective support
with a custom-made foot orthotic," it explains. "However
the one-size-fits-all adage of most over-the-counter foot orthotics
can prove detrimental to a patient who requires specific support
or material only found in a custom-made foot orthotic."
Footwear Modifications
These can be a simple as lacing techniques to the
more complicated shoe lifts. These are needed when the present
shoe or a suitable over-the-counter shoe doesn't come with all
the required characteristics needed and a custom-made shoe from
scratch isn't affordable.
Tongue pads, excavations, stretching, flares, buttresses, rocker
soles, elevations, lacing to Velcro conversions are some of the
more common modifications.
Tongue pads
can be used to cushion the instep, decrease the depth of the shoe
or help excavate relief pockets for prominent foot bumps on the
instep.
Excavations
can be done internally on the shoe platform that the foot rests
upon. These are necessary when the orthoses are not able to relieve
enough pressure by themselves. Examples would be for dropped metatarsal
heads, midfoot collapse as with the Charcot foot.
Stretching of
the shoe on the upper is common for hammer toes and bunions. The
stretch is most successful when wetted and when done on an all
leather upper where no seams or stitching reside. Some thermomoldable
uppers are designed with this in mind and when carefully heated
can be shaped into the desired fit.
Flares are an
external sole widening technique that can widen the base of whichever
side of the shoe requires it. Most common material used is EVA
(ethyl vinyl acetate) which is easily moldable, grindable and
comes in different densities and colours.
Buttresses are
very similar to flares but continue further up the shoe to cradle
the shoe upper for more stability.
Rocker
Soles vary for their purposes. A rocker is decreased
thickening of the plantar surface of the shoe sole to aid in forward
of backward roll as seen on a rocking horse. When added to the
shoe they are usually done on both shoes to prevent height variations.
A heel rocker can decrease foot slap that occurs
with a rigid squared heel. Most runners have this naturally for
increased shock absorption and decreased foot whiplash into pronation.
When rockering is done at the toe of the shoe it
can aid those with limited extension of the large toe when pushing
off or when extension of the toes causes pain for the patient.
The flex point of the rocker starts where the big toe joint is.
Rockering back towards the middle of the shoe causes
more instability for the patient but helps to decrease load on
the heel and forefoot areas and aids those with fused ankles.
The new full rocker sole types as seen in the MBT or Sketcher
shoes suggest that it simulates a more natural barefoot movement
creating more active musculature to strengthen the feet and torso.
These are contraindicated for those with present balance issues.
Elevations or
lifts are used to balance leg length discrepancies in patients.
They are done on one shoe only and can be elevated full sole or
heel only or a combination of both. The patient should only do
this when functional (non-structural) leg length differences can't
be accommodated for such as with physiotherapy.
Most
people are born with small structural differences that the body
can adapt to without discomfort. When the true (structural) leg
length difference cannot be adjusted to consideration must be
made as to how long the patient has gone without the height difference.
It is suggested to start with ½ the measured difference
and slowly raise the height. If for example someone recently broke
their leg and lost some leg length, the full amount would be added
full sole to the shoe right away.
Often clients lift the heel only inside the shoe
for convenience and cost issues but this may cause trouble at
the pelvis since it is now rotated forward more on the lift side.
Eventually the lift has to go externally since the height needed
is too much for the shoe to keep the heel from popping out the
back.
Velcro conversions
may be needed if the client has difficulty lacing his shoes but
doesn't want to buy new shoes with Velcro or can't find a suitable
Velcro shoe.
Sometimes lacing changes to elastic or spring laces
are convenient.
Bracing
The
Adjustable Plantar Fasciitis Night Splint features adjustable
straps that control dorsiflexion and limit the nocturnal movement
and contractures (tightening) of both the Achilles Tendon and
the Plantar Fascia. Use of the removable foam wedge facilitates
additional stretching of the fascia as needed. It is latex free
and manufactured from orthopaedic polyethylene, which can be heated
and molded for a custom fit. Its neutral design will fit either
the left or the right foot.
It
is available in 3 sizes and has a non-slip walking sole. Pic dorsiflexion
night splint alone
Hallux valgus night splints are for the crooked
big toe as seen with bunion victims to help keep the tendons stretched
out to prevent permanent contractures.
They can be worn in daily activities to separate
toes rubbing that cause corns to develop. They can also help hold
down knuckles to prevent rubbing on the top of the shoe and also
help prevent clawing of toes.
Custom
made silicone toe separators can be made for more complex
toe conditions.to treat corns and calluses,
separate toes, and provide
protection for bunions and
hammer toes and also help with overlapping
or amputated toes.
It is a non-toxic, hypoallergenic, silicone compound
that can be safely made in approximately 5 minutes. It easily
creates tear-resistant devices that can be later adjusted with
a grinder if necessary.
Dictus Band
The Orthopaedic aid for easier walking for drop-foot
problems with and without footwear.
The
Dictus Band, helps raise the foot direct after toe-off.
Which eliminates everyday obstructions such as doorsteps, carpets
and pavements.
The Dictus Band,
takes no room in the shoe, and it is discreet and easy to mount.
Good for when you want a little extra lift but use
your muscles as much as possible to prevent atrophy that occurs
from more controlling braces.
