Patients come to us for a reason - they are in pain and they want to get out of pain and stay out of pain.  Others come to us for questions on how to prevent pain from occurring, or recurring.  And others come to us because they know there is an issue with their feet - may or may not be pain, but it may be a bony deformity or even a question about a bony deformity - but they come to us for treatment options and for answers.  Part of the treatment plan is including orthotics.

What Are Orthotics and How Does It Help With Pain?

Orthotics are inserts that fit into your shoe that give you support and allow your tendons, muscles, and joints to remain aligned and in its biomechanically neutral position.  At this position in stance and gait, your feet and ankles are able to function in their most efficient and supportive manner, minimizing stress on joints and tendons and therefore decreasing inflammation and pain.  In our practice, we carry Medical Grade inserts, which comes in different sizes aligned with your shoes size. 

It is a great alternative to start with, as it is not custom made and considered over the counter, but one of the best over the counter options on the market.  As physicians, we are privy to the latest and greatest at all of these trade shows across the country and trust me, we have tried almost all of them.  Our physicians have chosen this particular model due to its superior durability, structure, and support. Although these are over the counter, they may work for some patients.  The comparison I make is that it is like over the counter readers vs a prescription for eyeglasses.  If the Medical Grade version works for patients, then it is a great alternative.  However with some diagnosis and foot structures, custom molded orthotics are recommended.   Custom molded orthotics are just that - they are custom to your feet.  

What Is The Process For Obtaining Orthotics?

Obtaining orthotics are a simple process, but one that is very thorough as it needs to be.  Beware of other places where you "step in a box mold" and then they send them off.  In our practice, you will first have a thorough history and physical by our physicians.  If you are training or an athlete, this includes your athletic history and training schedule.  If you are a person who is active and just wants to get out of and stay out of pain, we still review your activity schedule and exercise history to make sure we are on the same page about treatment plan and expectations.  Out doctors will also watch you walk up and down the hallway or if its a nice day will watch you walk up and down the sidewalk outside the front of the office as gait contributes to pathologies in the foot and ankle.  Then, you will be seated in an examination chair and your foot is placed in a biomechanically neutral (subtalar joint neutral) position.  The foot is covered in a protective plastic (no need to get plaster or fiberglass or on your feet!) and a slipper cast is applied to each foot.  The slipper cast dries in a few minutes and it is total contact, so that the mold captures the exact contours of your arches and feet.  Our doctors examine the molds and take this information along with the exam and symptoms and write a prescription for the custom orthotic.

The prescription is specific down to the type and length of material for the shell and the top cover.  Also it is specific to each foot. Just as no two eyes or ears are the same, no two feet are exactly the same and this customization allows our doctors to make specifications for each foot.  The prescription along with the molds are then sent to a lab where the orthotic is manufactured with the finishing touches crafted by hand.  After a 2 to 3 week turn around time, the orthotics are shipped back to our office where the orthotic coordinator and the physician review the orthotics to make sure they are exactly what is appropriate for the patient before we contact the patient to dispense them.  At the dispensal appointment, it is imperative to bring the correct shoes in order to have the orthotics placed in the shoes.  We will then educate the patient on proper use, wear,  break in instructions, and what to expect.  There is an additional appointment a few weeks after dispensal to review any issues that the patient may be concerned about or to answer any last inquiries regarding the orthotics. Often, the orthotics are such a success that we discuss getting a second or third pair for other pairs and types of shoes. 

Can They Prevent Pain From Returning?

By supporting any biomechanical abnormalities, orthotics can help get rid of pain.  And with consistent use, it can also prevent pain from returning.  Orthotics as an adjunct to a proper treatment plan will keep your feet in the correct position to decrease stress on affected tendons, ligaments, and joints and will help prevent the pain from returning.

  If your pain does return after a few months or a year of use, then it is time to re evaluate if your gait has changed, if the orthotics have worn down due to use, the top cover padding has worn down, or just due to wear and tear. The padding on the orthotic could be worn down.  

 

How Does It Help After Foot Surgery?

After foot surgery, you want to maintain the correction you obtained.  Just like after getting braces off and you had to use a retainer in order to make sure to keep your teeth aligned, the same reasoning is behind the need for orthotics after surgery.  Your bones have been aligned in a certain way for many years to the point that you needed surgery, and now post surgery, the biomechanics of your foot have improved and you want the external support to sustain that improvement.  So after most foot surgeries, orthotics are imperative. 

Is It Appropriate For Kids To Get Orthotics?

Although some foot structures are appropriate for children at certain ages, there are developmental milestones that should be met.  If a child complains of pain, this is not normal.  There is no such thing as growing pains in the foot!  If your child is saying they are in pain, then this issue should be examined. 

Sometimes foot pain can be due to trauma, but it can also be due to overuse in the child athlete or due to heredetary bone structure.  It is better to have it examined and make a determination if they will grow out of it or if orthotics can help with the improvement of any foot issues.  For example, orthotics can help with many foot pain issues that a child may complain of pertaining to "flat feet."  And even if your child may not be complaining at the moment, it is smart to have them evaluated for prevention of pain in the future.  Most of the foot structure is something they inherited from mom or dad or grandma or grandpa, and if foot issues run in the family, it is a great opportunity to save your child from unneeded pain and discomfort.  

What Are Other Conditions That Can Benefit From Orthotics Besides Foot Pain?

Some patients that see us have no obvious bony deformities that can be noted, however they may still have skin lesions that build up with skin or a porokeratosis or clogged sweat gland that cause discomfort.  Orthotics can help de-weight these areas with a custom built in pocket or accommodation or extra padding.  In addition, a patient may be recovering from a stress fracture and need extra padding to get back to activity.  For our diabetic patients, it is imperative that they wear accommodative orthotics with extra layers of padding with aliplast and plastazote (specific cushioning materials) that will prevent areas of pressure from becoming areas of sores that can turn into open ulcerations.  

As you can see, orthotics are utilized for many different conditions.  Whether you use Medical Grade Orthotics or if you take advantage of the custom orthotics that our practice offers, it is a huge benefit that you can take advantage of.  Call our office today and have your feet evaluated. If anything it is the first step to get you out of pain and keep you active. 

 

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