A custom-made foot orthosis is made via scanning the feet and designing a script around the needs of the individual to suit his/ her conditions. They’re designed to fit into various kinds of footwear, the orthotic is the equivalent to prescription eyeglasses for feet, bespoke made to suit every person differently.
They’re implemented to assist in correcting or re-direction of abnormal foot and lower extremity function, thereby reducing strain or injury susceptibility in the lower limb and further up the chain. They also delay or prevent further injuries from occurring, by reducing abnormal pathomechanics of the foot, ankle and lower limb.
An orthosis can be either functional or accommodative, or a combination. A functional orthotic is used to correct abnormal function of the foot, whilst correcting abnormal lower extremity function. Functional and accommodative foot orthotics are often made of different materials, often looking and feeling very different.
Accommodative Foot Orthotics
Accommodative foot orthotics are used to relieve pressure from painful, injured and wounded feet and to prevent such issues from arising from high risk foot types, via offloading and/ or cushioning areas of concern. They are generally softer than a functional device, ranging in materials from cork, foam and other soft materials. They can be used to offload painful callouses, corns and diabetic foot ulcers. They are generally well tolerated by patients, as they’re soft and comfortable, however relatively bulky and in need of adjustments to fit into shoes.
Functional Foot Orthotics
Functional foot orthotics assist in correcting abnormal lower extremity function. There is an ability to accommodate painful areas also, whilst still controlling function. Historically, they were rigid and often not well tolerated, however now there is far greater room to provide function and still remain more wearable. It is far easier to design functional devices to fit into a wide variety of shoes, everything from ladies court shoes, sports shoes to work boots.
They are used to treat a variety of painful lower limb conditions. They can be used to accommodate and improve function of Hallux Abducto Valgus or “bunions”, arch pain, ankle pain, heel pain, shin splints, Achilles tendonitis, knee and hip pain and lower back pain are commonly treated with functional foot orthotics. As mentioned, there is an array of issues to correct function, so looking at the whole picture and working on strength and mobility imbalances alongside functional orthotic issue is imperative. Functional devices are durable, long lasting and once “worn-in” are well tolerated.
Foot, Ankle, and Lower Limb Biometrics
Biomechanics is the study of foot and lower limb function, using principles of physics to study motion and forces on the human body. A Podiatrist has specialised, in-depth training of the foot and ankle, and how this effects motion and force placed on the lower limb and body. No other medical specialist has as much training in foot, ankle and lower limb pathologies relating to biomechanics of foot and ankle function, making podiatrists the most qualified medical specialist to diagnose and treat foot pathologies.
An orthosis is often enough to fix an array of issues; however, we don’t issue orthoses without prescribing stretching, strengthening and movements designed to work alongside the orthoses. As there is always work to be done to become more mobile and stronger, to heal, prevent or delay further issues from arising. It is imperative to understand the in-depth nature of foot and lower limb biomechanics to determine the mechanism of injury and appropriate treatment plan. In many instances a functional or accommodative foot orthotic is enough to fix most foot pathologies alone, or improve or prolong painful needs for surgery such as “bunions” and other deformities. Often foot and ankle surgeons will often suggest the prescription of orthotics after surgery as well.
A biomechanical assessment to determine to the appropriate treatment plan is needed, measuring angles of toes, feet, ankle, knees and hips to determine imbalances and structural or functional deformities. The patient is assessed lying down, standing, walking/ running (where applicable) to determine how the foot, ankle and lower limb is functioning.
Pros and Cons to Customised Orthotics
To create orthotics, the podiatrist will then make a three-dimensional scan of the patient’s feet and fill out a prescription form accordingly. They are custom made for each person’s feet, so are often well tolerated in comparison to an over the counter device (OTC). OTC devices serve a purpose, as they’re both cost effective or a good interim measure and sometimes enough to assist in getting the required result for an individual. Functional or accommodative devices can be used temporarily or long term, depending on the case. Often functional devices are used for children, to prevent or realign abnormal development such as intoeing or outtoeing. Or adults and athletes to perform activities without pain or disability. They can be expensive in comparison to “over the counter devices”, however will last several years minimum, whereas OTC orthotics will last approximately 1 year and often aren’t tolerated well as they’re made for a “generic” foot.
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