Custom Made Orthotics

What is an orthotic?

Orthotics are devices that insert in your shoes and boots. These devices are custom designed to alleviate the pain and discomfort you may suffer from foot disorders such as fallen arches, heel spurs, bunions, sport injuries, etc.

Generally speaking, an orthotic is a custom device that controls the degree of pronation and supination of the foot when walking and running.

What is pronation and supination?

In simple terms, pronation is the flattening out of the arch when a person's foot first strikes the ground. This motion acts as a major shock absorber for the body. A normal person's foot will pronate starting when the heel first hits the ground until prior to heel lift.

Supination is the opposite motion of pronation. It allows the foot to be a more stable, rigid structure for when we push off. A normal person's foot will supinate prior to heel lift until the foot strikes the ground again.

The truth is that we all pronate and supinate. Problems arise when there is too much motion for an improper duration of time.

Orthotics control the foot’s range and speed of motion. The muscles that counteract the range of motion work overtime when a person over pronates or over supinates. This excess muscle contraction leads to inefficiency and fatigue. A foot with the proper biomechanics is much more efficient, requires less energy, and therefore works pain free.

Some of the consequences of improper foot mechanics inlcude:

• Plantar fasciitis (heel pain)
• Morton’s Neuroma (pain or numbness in the toes)
• Tendonitis
• Bunions

Plantar Fasciitis:

The plantar fascia is a strong, fibrous material, which is located on the bottom of the foot. It runs from the ball of the foot to the heel, and is composed of three main sections. Pain from plantar fasciitis, (inflammation of the plantar fascia) can occur anywhere in the plantar fascia, but most commonly occurs on the inside corner of the heel. The most severe pain usually occurs when a person takes their first steps in the morning. When a person is off their feet for 6-8 hours at night, the plantar fascia will actually shrink or contract. With the first step in the morning, the fibrous band goes from a state of no tension to considerable tension, often resulting in severe pain.

As you walk, the fascia stretches out, and the pain will often diminish or go away completely. As the condition persists, it takes longer and longer for the pain to ease up. Eventually it never does. The primary cause of plantar fasciitis is excessive pronation.

The long term solution to this injury - 95% of the time - is a functional orthotic. By treating the true cause of the problem (the mechanics of the foot), surgery is rarely indicated.

Morton’s Neuroma

The neuroma is a nerve tumor (swelling) that occurs in the ball of the foot, between the metatarsals. A nerve courses between each of the metatarsal bones in the foot. When this nerve passes between the metatarsal heads at the ball of the foot, they will sometimes become pinched by a shearing force that occurs during pronation. This occurs most often between the third and fourth, or between the second and third toes. When the nerve is pinched, it becomes irritated, swollen and enlarged. Patients often will describe a burning or stabbing type of pain in the ball of the foot. The pain will sometimes radiate into the adjacent toes of the foot. Transverse pressure while palpating the toe usually elicits pain. People will say they get relief from removing their shoes and massaging their foot.

Tendonitis

Treatment involves reducing the shear forces between the metatarsal heads by controlling the amount of pronation the foot goes through. This is accomplished with the use of an orthotic. Occasionally cortisone injections are also used. Tendons attach a muscle to a bone. (Ligaments run from one bone to another bone.) When a tendon is overly stressed, usually as a result of poor biomechanics coupled with increased mileage, a tendon can become inflamed. A foot that overpronates does so as a result of too much motion between the bones of the foot, especially the first metatarsal. When the bones cannot stabilize properly, the muscles in the foot and leg try to make up the difference by working too hard for too long. Each muscle is designed to contract and relax while walking and running. Contracting for too long puts excess stress on the tendon and the sheath causing inflammation and pain. Severe trauma may cause tendon rupturing.

Controlling the amount of pronation with an orthotic, is essential in alleviating the symptoms. Rest, ice, massage and NSAIDs will also help to reduce the inflammation associated with tendonitis.

Bunions

Bunions are enlargements of bone on the first toe joint. Some of the causes may be footwear, disease, genetics and by our old friend, overpronation. They are a progressive deformity. You don't just wake up one morning and there it is. How fast it develops depends on the amount of excess foot motion a person is born with. The area will often become painful and red. Controlling the excess pronation can often take pressure off the first toe joint and help to relieve the pain, but it will not change the size of the enlargement. An orthotic can stop or slow down the progression of the deformity, but only surgery can remove the excess bone.

Orthotics may also be recommended to those individuals requiring enhanced shock absorption (e.g. arthritics, atrophy of the fibro fatty padding), and athletes who desire enhanced performance. Patients with diabetes, heel spurs, sesamoiditis, metatarsalgia, pes cavus and pes planus may benefit from the use of foot orthotics.

Biomechanical orthotic devices are custom made devices that fit inside your shoes to control the way your foot functions and help them perform at their peak efficiency. Although they resemble arch supports, true biomechanical orthotics do not work on the principle of simply supporting the arch. Instead of just supporting the arches, orthotics realign the foot by applying corrective pressure where it is needed.

Orthotics for Kids

Children who are walking may benefit from orthotics if compensating for a foot deformity (e.g. flat feet, and in toeing).

Orthotics are used to correct, control or compensate for a bone deformity or soft tissue ailment.

A chiropodist may determine that a child needs biomechanical orthotic devices to improve foot and leg function. Just as prescriptive eye glasses come in different styles and correction, so do custom orthotics. These devices will fit into the child’s footwear and help the foot perform at its peak efficiency. By controlling foot function; accommodating deformities and other anomalies the foot will be given a chance to grow correctly.