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This is a long article. Much of it is based on the best				Your doctor should work with you to ensure that
available research, some is our opinion. It is intended				your orthotics are comfortable and are relieving your
to help the patient for whom orthotic therapy has				symptoms. They should also provide you with
been recommended to make an informed decision so				detailed information on the proper shoes for your
that they can reach the best outcome for their				feet. This will help you find appropriate, comfortable,
particular problem. It is not intended to help one				and fashionable shoes.
decide if orthotics are appropriate for their particular				Follow-up:
problem.				One of the most important parts of orthotic therapy
The article will cover:				is appropriate follow-up. If you have a problem with
• What are orthotics				orthotic fit, function, comfort, shoe fit or any other
• How do custom orthotics work				issue, your doctor must be able to diagnose and
• Production of orthotics				correct these concerns. This is why a skilled,
• Dispensing, break-in and follow-up				knowledgeable and experienced practitioner can
• Custom orthotics				usually provide the best clinical outcomes.
• How the foot should be casted for				CUSTOMIZED ORTHOTICS AND COMPUTER
orthotics				GENTERATED ORTHOTICS
• Customized and computer generated				Another type of foot orthotic is known as
orthotics				“customized” rather than
• Off-the-shelf orthotics				“custom.” These devices can be
• Custom orthotics for dress shoes and				difficult to distinguish from custom foot orthotics and,
specialty shoes				unfortunately, are sometimes marketed as authentic
• Orthotic guarantees – what should				custom foot orthotics . They are often the product
you expect				of a computerized system where the patient is
• How do custom orthotics work in treating				asked to walk across a force plate which then shows
plantar fasciitis				pressure distribution on a computer display. Typically,
• Who should make your orthotics –				the orthotic is made by adding extra components to
how to find a skilled practitioner.				a pre-manufactured insole. Sadly, patients are often
What are Orthotics?				told that these are custom – and charged a
The term "orthotic" can refer to almost any device				custom orthotic price.
which is worn inside a shoe. Items called				So how can you tell the difference between
“orthotics” are available from				customized orthotics and authentic custom foot
physicians and other medical professionals, in shoe				orthotics? If you are receiving authentic custom
stores, in infomercials, retail stores and even at trade				orthotic devices, a three-dimensional mold of your
shows. There are three very different types of				foot, using plaster, fiberglass or a non-weightbearing
“orthotics” – custom,				optical scan, must be taken. Walking or standing on a
customized and off-the-shelf. The educated				force plate can be used to evaluate some aspects of
consumer should be aware of each type.				foot function, but a force plate cannot capture the
There is a confusing amount of information available				3-dimensional impressions of your feet that are
on orthotics. For many consumers making an				necessary for best outcomes. Keep these two points
informed decision is difficult. Recognizing a sales pitch				in mind:
and separating it from facts is the key to better				1. If the information for making your orthotics is
health. The information presented here should help				received from walking across or standing on a
you make an informed decision.				platform or force plate, custom functional orthotics
What are Custom Functional Foot Orthotics?				cannot be produced.
Custom functional foot orthotics are prescription				2. A 3-dimensional cast or scan of your feet, with the
medical devices made from non-weight bearing molds				feet held in a non-weightbearing position, must be
of your feet. They are designed to control alignment				taken in order to produce effective custom
and function of the foot in order to treat or prevent				functional orthotics.
injury-causing force on bones, joints, tendons and				Don’t be fooled by impressive looking images
ligaments. Often they are used to limit motions such				on a computer monitor. It is our opinion – and
as excessive pronation (rolling-in) and excessive				that of most experts on orthotic therapy - that it is
supination (rolling-out). They also act to make				not possible to make a quality custom orthotic from
activities such as running, walking – even				walking across a pressure mat or taking a
standing – more efficient. Finally, they can act				weight-bearing scan of your foot. With the
to redistribute pressure on the bottom of the foot				technology currently available, a custom functional
to relieve pain from excessive pressure or calluses.				foot orthotic requires a non-weightbearing cast or
How do Custom Foot Orthotics work?				optical scan of your foot.
This is a very involved subject and too much to get				WHO SHOULD MAKE YOUR ORTHOTICS
in to here. But in general, most foot pain is the result				In general, podiatrists have the best backgrounds and
of a faulty relationship between the bones and				training in foot biomechanics and custom foot
muscles of the foot. Even the slightest misalignment				orthotic therapy. Most of the best orthotic therapy
can result in significant discomfort. This abnormal				experts will be podiatrists (now, keep in mind, we are
function can result in problems such as bunions,				podiatrists and may be biased, but in consulting with
hammer toes, arch and heel pain, corns, knee pain ...				many different practitioners on a daily basis this is
even back pain.				what we have found to be true). This does not, by
The function of custom orthotics is much more than				any means, mean that every podiatrist is an expert
an arch support. Orthotics realign the structures of				in orthotic therapy. As in any profession, some are
the foot and leg to prevent bone mal-alignment as				exceptional; some are horrible and most are
well as muscle, tendon, and ligament fatigue. They				somewhere in-between. Some podiatrists specialize in
are often used after surgery to help stop the				orthotic therapy and prescribe many orthotics and
recurrence of foot deformities.				some do it as part of a more general practice and
As your foot rests on a properly constructed custom				prescribe fewer. As with all medical procedures, more
orthotic it is gently and consistently directed into the				experience usually means better outcomes. Also,
correct position (or at least a better position) for				there are some pedorthists and physical therapists
walking, running, and standing.				who have taken a special interest in the foot and do
Because your foot is now functioning properly, the				an excellent job with orthotic therapy. You should,
pain of muscle strain and pressure points is relieved,				however, carefully evaluate the training of the
and the progression of deformities is often stopped				practitioner. Pedorthists, who are trained in shoe
or slowed.				modifications and manufacturing orthotics, are only
PRODUCTION OF CUSTOM ORTHOTICS				required to have a two week course for certification.
The production of custom orthotics is an exacting				Physical therapists may or may not have training on
process and determines whether or not you receive				orthotic therapy. We have seen very few orthotics
quality devices that will best treat your condition. As				made by chiropractors with which we have been
with everything, there are well-made orthotics and				impressed, but they may be out there. Now, there
poorly-made orthotics . The ability of an orthotic				are exceptions to every rule, but in teaching and
device to eliminate your pain is dependent on the				consulting with thousands of practitioners and
quality of the orthotics. The quality of the orthotics is				students over the past 15 years, we have found the
dependent on three primary steps:				above to be true.
• The cast of your feet				Finally, make sure that the the doctor – not a
• The prescription the doctor writes (based				staff member – takes the cast or image of
on the examination and the doctors knowledge and				your foot. Only the doctor has the experience and
experience)				knowledge to take the most accurate casts. An
• The work of the orthotic lab in producing				accurate cast or image is critical to orthotic function.
your orthotics and following the doctor’s				This is a very exacting process as your foot must be
prescription				placed in a precise non-weightbearing position to
What is Involved In Producing Custom Foot				ensure the best clinical outcomes.
Orthotics?				To find someone locally ask friends, colleagues and
The most important factor in designing foot orthotics				medical professionals in your area for
that will provide optimum function is an orthotic				recommendations. Often the same names will keep
prescription based on a thorough examination by an				coming up.
experienced and knowledgeable medical practitioner.				Some questions to ask in order to evaluate a
We cannot emphasize this enough. The exam should				practitioner include:
include a complete biomechanical examination and gait				• What kind of cast do you take? (it should
analysis.				be a non-weight bearing or “neutral”
Following a biomechanical and gait examination, there				cast in most cases)
are three important components to ensure you				• Who takes the cast? (you will likely get
receive the best possible orthotic devices:				better results if the doctor takes the cast rather
• An accurate cast or scan of your foot				than an assistant)
must be taken. This is a very exacting process as				• How many orthotics do they prescribe per
your foot must be placed in a precise				week? How many years have they been in practice?
non-weightbearing position to ensure the best clinical				(experience counts!)
outcomes. To help ensure that a proper model is				• Are orthotic adjustments done in the office
taken, we feel that the doctor, and not a technician,				or do the devices have to be sent back to the lab
should position your foot for the cast or optical scan				(always look for someone to does their own
of your foot.				adjustments. It is faster, more convenient and we
• A proper prescription must be written to				guarantee they will know more).
accommodate your biomechanical problems, your				• Do you guarantee orthotic comfort?
activities, and your shoes. This process requires that				(comfort only – not clinical outcomes. Clinical
an exacting gait evaluation and biomechanical				outcomes can not be guaranteed with any medical
examination be performed.				device or procedure. In fact, a
• A high-quality foot orthotics laboratory				“guarantee” of a cure should be a red
should be used to produce your orthotics. This will				flag that you may not be dealing with an honest and
ensure that the prescription is filled correctly, that the				ethical practitioner).
orthotics are comfortable, and that high-quality and				© 2006-2009. Lawrence Z. Huppin, Douglas S.
long lasting materials are used.

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