Healing Through Custom Orthotics - Part 2

Introduction

Custom foot orthotics are devices that are specialized insoles that are used to correct the mechanics of the feet, putting them in a more optimal position.  The can be incorporated into the shoe directly, or be portable in which case they can be moved from shoe to shoe.

There are many different modifications that can be made to orthotics depending on how the foot behaves.  Generally, for people who over-pronate or whose arches collapse, the orthotic will contain varying degrees of arch support to stop the arch from collapsing or over-pronating.  People who have metatarsal pain (or pain in the ball of the foot), will often have a modification called a metatarsal pad added to the orthotic.  This will actually spread the metatarsals out and lessen the stresses placed on them from the rest of the foot.

Once your feet are in alignment, less stresses are placed on other parts of the body, including the ankle, knee, hip, and low back. Your body is functioning more optimally and this can help prevent pain from occurring in these areas in the future.

Orthotics will last about one year if they are being used on an every day basis and taken care of.  They are usually covered by your insurance company as well.

Research on Orthotics

In a 2004 study of 275 patients that had custom foot orthoses for over a year, the majority of subjects obtained between 60-100% relief of symptoms with only 9% reporting no relief of symptoms. (Walter JH, Ng G, Stoitz JJ: A patient satisfaction survey on prescription custom-molded foot orthoses. JAPMA, 94:363-367).

This 2004 article review stated that the evidence suggests that foot orthoses produce reductions in pain and disability associated with plantar fasciitis (Karl B. Landorf, Anne-Maree Keenan, and Robert D. Herbert Effectiveness of Different Types of Foot Orthoses for the Treatment of Plantar Fasciitis J Am Podiatr Med Assoc 2004 94: 542-549).

In a study that measured pain relief in 64 subjects with osteoarthritis in the foot and ankle, 100% of the patients wearing orthoses had significantly longer relief of pain than those patients receiving only non-steroidal anti-inflammatory drugs (Thompson JA, Jennings MB, Hodge W: Orthotic therapy in the management of osteoarthritis. JAPMA, 82:136-139, 1992).

In a 2003 study of 102 athletic patients with patellofemoral pain syndrome, 76.5% of patients improved and 2% were asymptomatic after 2-4 weeks of receiving the custom foot orthoses (Saxena A, Haddad J: The effect of foot orthoses on patellofemoral pain syndrome. 93:264-271, 2003).

In this 1999 study, subjects experienced more than twice the improvement in alleviation of pain, and for twice as long, compared with subjects in a study using traditional back-pain treatment. (Dananberg HJ, Guiliano M: Chronic low-back pain and its response to custom-made foot orthoses. 89:109-117, 1999).

Custom orthotics are great for your health and well-being and feel fantastic under your feet.  Your health and body deserve the best care possible.

Healing Through Custom Orthotics: Part 1

Introduction

Every day I treat people suffering with back pain. My patients often attribute this pain to a wide range of factors, but one that is both common and commonly overlooked are the feet and how they impact on how you feel in other parts of your body. This will be a two part-post.  The fist part will take a look at foot behaviours and how they can lead to pain in particular areas of the body.  The second part will focus on current research on custom orthotics and how they can help deal with pain, but also to prevent pain from occurring in the first place.

Just as steel and metal girders make up the foundation for the tallest of buildings, your feet make up the foundation for your body.  When something goes wrong at the foundation, the rest of the structure is affected. By keeping your foundation strong and in alignment you are able to take the stresses off other parts of your body including knees, hips, and lower back.

How Do I Know Whether I Have A Strong Foundation?

There are a few ways to test how efficiently your feet are behaving.  First of all, listen to what they tell you.  Are you experiencing pain?  If so, when? Early in the morning as you step out of bed?  Or after walking for 5, 15, 20, or 30 minutes?  Do you have back pain, knee pain, or hip pain? Do you sprain your ankles frequently?  Look at the wearing pattern on your running shoes. Do your feel have calluses on them? All of these are excellent questions to ask yourself, and if you do experience any of the above symptoms, it's a good idea to get things checked out.

In my office, I do a variety of things to check the mechanics of the feet.  One is just observation.  Observing the height of the arch and how it behaves as you walk, is a great indication of how the foot is operating.  Postural changes are also common.  Often people lean to, or favour one side or the other. This can put more stress on one foot with regards to the other.

Another great thing I do is examine your feet through something called a Gait-Scan.  Gait-Scan is a technology whereby it takes pressure data from your feet as you stand on a force plate.  The data obtained from the Gait-Scan can help to determine more precisely, how pressure is distributed throughout the feet, and the extent to how the arches are behaving.  This information can then be used to accurately customize orthotics to your foot and its particular needs.

Keeping your foundation strong is essential in order to be pain-free and to prevent pain and problems from occurring in the future.

What Are The Types Of Feet?

An “optimal foot” acts as a foundation by providing adequate shock absorption and evenly distributing forces that occur when we walk.  In an optimal gait, the foot behaves in the following manner:

•Heel strikes the ground on the outside

•Transfer weight from the heel to the forefoot

•Foot will roll in inwards (pronation)

•Weight is distributed evenly across the forefoot.

Rolling inwards motion is the way that the body naturally absorbs shock. This is the most ideal, efficient type of gait.

Overpronation Vs. Supination

Over-pronation and supination are behaviours of the feet where either the ankle rolls inward excessively (collapsed arches) or the ankle does not roll in enough (high arches), respectively.  I diagnose these extremely common foot behaviours everyday and can design custom orthotics that put your feet in the most optimal alignment.

An overpronator's arches will collapse, or the ankles will roll inwards (or a combination of the two) as they cycle through the gait. An individual who overpronates tends to wear down their running shoes on the medial (inside) side of the shoe towards the toe area. A supinator's foot will not roll far enough when tranferring weight from heel to forefoot unevenly distributing the weight across the forefoot. An individual who supinates tends to wear down their running shoes on the lateral (outside) side of the shoe towards the rear of the shoe in the heel area.

When your foot over-pronates, or supinates, extra stresses are placed on the ankles, knees, hips, and low back. Eventually, these structures tend to give out and pain can occur as a result. Keeping your feet in balance can deal with and prevent pain from occurring

What Conditions Can Occur As a Result of Poor Foot Mechanics?

•Over-pronation

•Supination

•Meta-tarsalgia – pain in the forefoot

•Neuroma – inflammation of nerves of feet

•Achilles tendonitis

•Plantar Fasciitis

•Shin Splints

•Jumper's knee

•Low back pain

And More.....

The next post will deal with current research on orthotics and how they can help fix and prevent many of the above conditions, and more.

Plantar Fasciitis

Last reviewed: February 19, 2011.

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot.

Causes, incidence, and risk factors

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.
Risk factors for plantar fasciitis include:

• Foot arch problems (both flat feet and high arches)
• Obesity or sudden weight gain
• Long-distance running, especially running downhill or on uneven surfaces
• Sudden weight gain
• Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
• Shoes with poor arch support or soft soles

Plantar fasciitis most often affects active men ages 40 - 70. It is one of the most common orthopedic complaints relating to the foot.
Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

Symptoms

The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.
The pain is usually worse:

• In the morning when you take your first steps
• After standing or sitting for a while
• When climbing stairs
• After intense activity

The pain may develop slowly over time, or suddenly after intense activity.

Signs and tests

The doctor will perform a physical exam. This may show:

• Tenderness on the bottom of your foot
• Flat feet or high arches
• Mild foot swelling or redness
• Stiffness or tightness of the arch in the bottom of your foot.

X-rays may be taken to rule out other problems, but having a heel spur is not significant.

Treatment

Your doctor will usually first recommend:

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
• Heel stretching exercises
• Resting as much as possible for at least a week
• Wearing shoes with good support and cushions

Other steps to relieve pain include:

• Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.
• Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
• Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your doctor may recommend:

• Wearing a boot cast, which looks like a ski boot, for 3-6 weeks. It can be removed for bathing.
• Custom-made orthotics
• Shockwave Therapy
• Steroid shots or injections into the heel

In a few patients, nonsurgical treatment does not work. Surgery to release the tight tissue becomes necessary.

Expectations (prognosis)

Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain.

Complications

Pain may continue despite treatment. Some people may need surgery. Surgery has its own risks. Talk to your doctor about the risks of surgery.