What are orthotics?
Orthotics or foot orthoses are a device that inserts into your shoe to improve the efficiency of your foot function and lower limb, as well as help with alignment of the feet with the knees and hips. Orthotics are made of high-impact, durable materials which are contoured specifically to your foot. Even though there are different types of orthotics, your foot is unique, therefore Podiatrists aim to prescribe orthotics specific to your foot and your concerns that you present to the Podiatrist.
How to tell if you need orthotics
Usually the notion that orthotics are needed is usually based on an uncertain hunch that something is wrong with the way a person runs or performs their daily activity, or if there is pain in the foot and/or lower limb. However, there is more to assessment and orthotic prescription. Podiatrists undergo many different assessments to determine if orthotics will aid in decreasing your pain and solving your foot and lower limb problems.
How a podiatrist diagnoses problems and prescribes orthotics
- Initial appointment: an in-depth biomechanical assessment is undertaken followed by the Podiatrist discussing the likely diagnosis, causes and management plan. If the treatment plan involves orthotics, it is paired with other treatments to increase your foot function. The other treatments can include; a strength and conditioning program, footwear changes, strapping, shockwave therapy, dry needling, foot mobilisation and manipulation.
- Scanning for orthotics: a 3D impression is taken of both feet. A gait analysis is also recorded for the Podiatrist to later look through when writing up the orthotic prescription. This prescription is then sent to a podiatric laboratory where the orthotics are printed.
- Fitting appointment: the client is asked to bring their footwear to this appointment in order for the Podiatrist to fit the orthotics into these shoes. A gait analysis is performed to confirm that the orthotics are comfortable not causing any discomfort. It is recommended that the new orthotics are worn in slowly. This is so that the four layers of muscles in your feet slowly get use to firing and working differently. Start with 1-2 hours on the first day and add time per day as tolerated. Once inserts can be tolerated for 6-8 hour periods, you may begin to wear them for activities. Once your gradual wear in period is completed, wear your inserts as much as possible to protect the foot and lower extremity. Once symptoms have abated, other footwear without orthotics can be worn periodically, depending on your injury or the advice of your podiatrist.
- Orthotic review/s: this is undertaken to make sure that any problems with the orthotics are addressed by the Podiatrist and can be altered on site. Different modifications can be made on the spot if needed by our qualified Podiatrists. We are very lucky to have an orthotic lab on site which allows us to complete all top covers and any other modifications needed to customidse the fit to the foot even more.
- 6-12 month review: Due to the fact that feet change throughout our lifetime, it is important that the orthotics get checked by the Podiatrist every 6-12 months. This is to ensure that the orthotic is still fulfilling its purpose. It is also very important to review these orthotics if a new injury presents, if foot and/or lower limb surgery has occurred or if the client is a child whose feet are still growing and developing.
What conditions are orthotics used to treat?
Orthotics can treat many different conditions of the foot and lower limb. Some of the main ones include:
- Heel pain
- Flat feet
- High arched feet
- Plantar fasciitis
- Heel spurs
- Shin pain
- Knee pain
- Sever’s disease
- Mortons Neuroma
- Achilles pain
- Back pain
How can orthotics help?
Orthotics are often only one part of a management plan for a client. For example, a Podiatrist may prescribe orthotics in conjunction with a strength and conditioning program, manual therapy and supportive shoes. Whether orthotics are a temporary treatment or not, the Podiatrist may prescribe them for various reasons and will also decide whether the client needs fully customised orthotics or perhaps an off-the-shelf orthotic.
Orthotics aim to:
- Control and correct abnormal alignment
- Redistribute forces associated with the foot and lower limb
- Reduce pain and risk of deformities and prevent injury
Orthotics are also designed to fit into most of your shoes. Shoes with the following features will generally cater for orthotics:
- Closed, firm heel counter
- Fixation for example lace, velcro or a buckle
- Adequate depth
How are Orthotics made?
First you must be fitted for them. Your podiatrist gives you a complete examination and determines your particular foot problem. A 3-dimensional scan is taken of your feet while in your neutral foot position. The scans and your personal prescription are sent to the orthotic laboratory where they are used to produce your orthoses. Here, technicians, following your podiatrist’s specification add modifications to ensure the orthotic is a perfect fit for your foot. The laboratory sends them back to your podiatrist and then they’re ready for fitting. Here at Foot Centre Group, we have an orthotic lab within the clinic which also allows for the Podiatrists to make any modifications needed.
Types of orthotics for feet
Different types of orthotics are prescribed depending on the condition being treated, the severity of the person’s foot posture and the age of the person.There are three main types of orthotics:
- Prefabricated or off-the-shelf orthotics: These are generic orthotics which can be modified depending on the condition. They can be used for children or temporary conditions.
- Joey or semi-custom orthotics: This is a cost-effective option which doesn’t require a 3D scan. They are pre-moulded and have different options in terms of correction. They are made by the same material as a custom made orthotic and are a great option for growing children and adolescents or adults. However, these generic arch profiles usually need specific modifications to customise the fit specific to the individual’s foot. This can luckily be done at the orthotic lab at our clinic.
- Custom made orthotics: These orthotics are individually prescribed using precision machinery to deliver a device custom made to the clients’ feet. They can be made out of a variety of durable materials depending on the needs of the client.
The other characteristics that are considered when designing an orthotic for an individual include:
- Different arch profiles: There are three different arch profiles to choose from. These choosing of the different arch heights depends on the foot type and the pathology.
- Lengths of the orthotic: The orthotic cover can be cut into three different lengths; shell length, ¾ and full length. The Podiatrist will be able to determine the appropriate length of the orthotic depending on the pathology and the shoe fit.
Difference between orthotics made by a Podiatrist and those at the Chemist:
Chemists usually provide off the shelf orthotics made out of gel which are advertised to help with shock absorption, comfort and pressure redistribution. These off the shelf orthotics are usually made for an individual with a “normal” foot type. Individuals who have “normal” foot types do not always develop problematic feet and lower limbs. This is when a Podiatrist may recommend a device more customised to your foot type and the issues which are of concern. Which is why a full biomechanical assessment is warranted to deficer what is best for your foot and lower limb function.
This decision on whether to buy from the Chemist or a Podiatry clinic can be compared to buying glasses from the chemist to help with concentration tasks such as reading or driving. While they may provide temporary relief, they do not offer corrective support suited to your individual prescription.
Ankle-foot orthoses are amongst the most common custom made orthotics prescribed. It is used to improve walking patterns by reducing, preventing or limiting the movement of the lower limb and foot and also through supporting weakened muscles. In addition, they are used to maintain joint alignment and accommodate deformity.
A biomechanical assessment is conducted as per normal, the casting however is done differently. A netive cast will be taken of the lower limb through rolling plaster bandages around the leg and waiting for it to set. This will be the cast from which the ankle-foot orthoses is made. A fit appointment will then be made to ensure the fit of the ankle foot orthoses.
Cycling orthotics are vastly different to those or a runner or walker. Cycling orthotics are much thinner and support the foot in a different way to a standard orthotic. They are also made of a lightweight carbon fibre which fits perfectly into any cycling shoe. Therefore if you are a competitive cyclist or someone who enjoys the sport of cycling, it is important to consider if a cycling orthotic will be beneficial.
How do cycling orthotics work?
An unstable foot in a cycling shoe leads to loss of power and therefore performance. This can ultimately lead to increased movement of the knee, leg and hip. Through stabilising the foot into a rigid lever, this will therefore transfer power to the foot and pedal to increase performance. Cycling orthotics can also reduce overuse injuries through altering the direction of force put through the pedal. This is done by shifting the angle or the orthotic and adjusting the direction at which the load passes through the foot and ankle. Furthermore, additional modifications can be added to the orthotic to alter specific pressure points. Either way, each orthotic is designed and customised to the individual depending on their foot mechanics.
Footwork is the main orthotic laboratory and supplier in Australia. The orthotics are prescribed by Podiatrists and then sent to Footwork, where more Podiatrists design the 3D printed orthotics. Footwork is the leader in cycling orthotics where they work directly with professional cyclists to achieve the perfect result.
Children and orthotics
Children are always growing and developing, especially in their feet. Which is why it is important to adopt a thorough yet conservative approach when it comes to children’s feet and orthotics. Different assessment tools are used to determine the functionality of a child’s feet and lower limb. These assessments include:
- Pregnancy, birthing & development history
- Footwear Assessment (school, sport & casual)
- Foot Posture & Shape Evaluation
- Joint Flexibility & Muscle Testing
- Gait analysis
- Reflex testing
After all these assessments are complete, orthotics may be warranted depending on the severity of the problem. However, strength and conditioning exercises will also be prescribed (usually in the form of fun games) to help with the efficiency of their feet.
The bottom line
Orthotics can be a part of a comprehensive management plan to those who have foot and lower limb concerns. It is advised that an in-depth assessment of the lower limb and foot is undertaken by a Podiatrist to determine if orthotics will be beneficial to your management plan. There are many different types of orthotics that can help with various different types of conditions. They are made of a durable material and can fit into most shoes. Footwork is the main orthotics lab who are Podiatrists working with Podiatrists to bring the client the best possible outcome for their feet and lower limb concerns.
It is advised that a full biomechanical assessment is undertaken by a Podiatrist to determine if orthotics are for you. This assessment includes:
- An in-depth history of your feet, lower limb and the problem in which your are experiencing
- Assessment on the range of motion of your feet
- Assessment on the strength of the muscles in your foot and lower limb
- A foot posture assessment
- A gait analysis
- A running assessment (if warranted)
Need an orthotics examination?
Our team are specialised in the assessment and development of foot orthoses. Our fully equipped onsite laboratory including improved technology such as the 3D scanning equipment and dynamic biomechanical assessment video ensures accurate and individualised orthotic prescription.
We would love to be a part of your journey to provide you with pain relief and allow you to get back to the activities you love.
Call 03 9553 0044 or make an appointment HERE for your orthotic assessment with one of our team!