When it comes to the possible tools and techniques we have to help patients overcome painful conditions, perhaps the most versatile is the use of orthotic therapy. Custom orthotics can be used to treat issues as diverse as bunions, cavus foot (high, rigid foot arches), flatfoot, metatarsalgia (forefoot pain), and plantar fasciitis (the leading cause of heel pain for adults), any and all problems related to how the foot is functioning.
These medical devices are customized to the unique specifications of a patient’s feet, typically fit within regular footwear, and allow normal movement (in a biomechanically-improved functional position). When ailments are discovered early on, the use of custom orthotics can prevent or delay the necessity of surgery later on down the road.
Why Do We Prescribe Orthotics?
Orthotic devices generally fall into one of two categories:
- Soft Orthotics – Soft orthotics are typically prescribed to absorb shock, increase your balance, and/or relieve pressure on sore or uncomfortable areas in your foot. Foot deformities (bunions, hammertoes, corns, calluses), arthritis, and diabetic foot care are all reasons you could benefit from soft orthotic devices. In order to provide superior cushioning, they are constructed from soft materials and may extend along the length of the entire foot.
- Rigid Orthotics – Whereas soft orthotics serve to decrease pressure and protect the foot, rigid models are used to restrict or control abnormal movement and improve function. In order to do so, this type of medical device has a solid construction necessary for regulating movement. Rigid orthotics are constructed from plastic, carbon fiber, or other firm materials. They are often intended to be worn in athletic, walking or dress shoes and can help alleviate or eliminate foot pain, aches, strains or even tears of the soft tissues in the lower limbs by shifting the body weight to the more durable boney structures.
- Hybrid-Rigid Orthotics with accommodative extensions– When you need both the cushioning benefits of soft orthotics with the motion-controlling aspects of rigid ones, our doctor might prescribe a Hybrid version. These usually combine layers of soft materials in those areas that need them and are reinforced with rigid ones to provide structure, improve balance, and still offer a certain degree of cushioning. They are especially excellent for athletic use, and may be prescribed to athletes who experience pain while training or competing. Children with certain issues, including flatfoot conditions, can also benefit from this particular orthotic style, as well as adults with painful callus areas that are protecting a boney prominence
The primary reason that orthotics are so effective at addressing medical issues is the simple fact they are customized for a patient’s unique feet and gait pattern. In addition to the aforementioned conditions, we use them to treat hammertoe, Morton’s neuroma, and limb length deformities. Additionally, we may prescribe orthotic devices as treatment (and prevention) for neuropathic ulceration.
There are also as many types of orthotic modifications as there are conditions that benefit from using them as part of a treatment plan. These include:
- Heel wedges used to guide the foot into turning either inward or outward and improve function to better align the bones in the ankle region decreasing stress on the soft tissues and cartilage.
- Heel flares used to prevent inward or outward turning and offer stability for a longer period of time during the contact phase of gait
- Rocket bars used to shift the rollover point from the metatarsal head to the metatarsal shaft to prevent discomfort under the ball of the foot from bone pressure that caused calluses with good circulation, ulcerations in patients with poor circulation.
- Toe crests used to fill the void under the under curled toes. (These devices are typically closer to the body and are often placed behind the second, third, and fourth toes to reduce pressure, causing corns at the tips of the toes)
How Do Orthotics Help Pronation Issues?
In addition to a wide array of medical conditions and injuries, orthotic devices are also used to correct pronation abnormalities. Pronation is a natural process used by feet in every step they take. During the ground portion of a step, the foot rotates inwards from the heel strike all the way through the final push of the toes. This rotation isn’t intended to be particularly great—around fifteen percent is ideal—but it is quite important for ensuring proper distribution of the forces that come from walking and running.
Depending on an individual’s foot structure, he or she may either pronate too much (overpronation) or not enough (where the foot is left in a supinated position). As a general rule, overpronation is often linked to flatfoot and supination is connected to cavus foot. These pronation abnormalities lead to unequitable distribution of force loads, which means that certain areas of the foot face more pressure than they are intended. This can lead to a variety of issues.
The good news is that custom orthotics can help with either of these biomechanical irregularities. Rigid (also known as “functional”) orthotic devices are particularly useful in this regard.
So What Are AFOs?
Whereas many orthotics are designed to slip inside your shoes and reside there unseen, sometimes it is necessary for us to prescribe Ankle Foot Orthosis where the foot plate is attached to a leg brace.
Ankle-foot orthotics (AFOs) are designed for greater control of the ankle’s position and motion to compensate for deformities and weakness caused by conditions like arthritis damaged ligaments or drop foot. AFOs are also used to treat peripheral neuromusculature, disorders that affect muscle function, and stroke patients.
No matter what type of orthotic is right for you, the office of Jan David Tepper, DPM Family Foot and Ankle Center will make sure you are prescribed custom orthotic inserts that alleviate pain and discomfort. If you experience any conditions of the foot and ankle that you prefer to take care of non-surgically or an adjunct to surgery, contact our Upland, CA office by calling (909) 920-0884 and schedule an appointment with us today!