Are You Really Getting a Custom Functional Orthotic?
Unfortunately there are a number of shoe inserts, insoles and “arch supports” being marketed as Orthotics which the average person is unable to distinguish from the real thing. It’s a billion dollar industry and therefore attracts a lot of “gimmickry” that has caused many people to unwittingly waste their money and become soured on benefits of a true custom functional orthotic and perhaps pursuing unnecessary foot surgery.
What is a custom functional orthotic?
A custom functional orthotic is a shoe insert made from a cast of your foot that allows your foot to function in its ideal and balanced position. It can alleviate and prevent many foot ailments and deformities.
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How is a custom functional orthotic made.
Functional custom orthotics are made by casting a person's foot with the subtalar joint ( the joint below the ankle that moves the foot in and out) in neutral position and the midtarsal joint ( the large middle of the foot joint that allows the foot to adapt to uneven surfaces when barefoot) is locked. This is the position of the foot where all the bones, joints and muscles of the foot are balanced and is ideal for walking and or running on man made surfaces. The foot in this position is most efficient and effective in propulsing the body forward.
This cannot be achieved by stepping on a 2 dimensional pressure plate or foam box as done in many retail stores, shoe specialty stores and even some podiatry offices. In fact “custom” orthotics made in these ways and even some from a true cast are often from computer images at the lab and actual correction of the foot deformity may never occur. Digital technology has allowed some labs to cut corners and produce what in actuality is a prefabricated insert.
How important is the lab which manufactures the orthotic?
The lab used is critical in obtaining a true custom orthotic. The lab should make a poured in positive cast from the one taken of the foot, hand balanced and customized according to the prescription of the podiatrist and hand balanced and finished. Many have reverted to cad cam computer modeling from a library of foot types that make a device "close" to a patient’s foot. This is done by scanning the cast sent to them or data from a “step on” device used in many stores.
How can I tell if my podiatrist’s lab is making a true custom orthotic?
Have the lab send you the positive casts. If they are plaster, then they were custom made. If they are wooden, then they were digitized and made from a close approximation to a foot type in the computer library of the lab.
True custom functional orthotics can help in the treatment and prevention of many lower extremity conditions that are a consequence of poor foot mechanics such as:
Fig. 1. a. Neutral position casting.
B. Negative casts sent to lab.
Step in Foam casting
(measuring size of your foot)
Fig. 2. Positive casts from the lab.
a. plaster (custom)
b. wooden (digitized).
Fig. 3. Gait exam.
Fig. 4. Measurements.
Fig. 5. Types of custom orthotics.