Practical Orthotic Question

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How much of the beneficial effect of custom orthotics results from just taking a mold of the foot and having a device that increases the total contact area of the sole of the foot? Ignoring the prescription variables (if this is possible, maybe it isn't, but I do see practitioners that write on their prescription "custom foot orthotics, diagnosis plantar fasciitis, hav,...etc.").

Put another way, how would you rate the effectiveness of an orthotic that just fits the foot versus an orthotic that was prescribed and made by a knowledgeable practitioner and lab?

I fully respect biomechanics and this question is not meant as an insult, but it is just a question that I have wondered for several years.

 

Depends on what you objective is.

If the total contact is the design feature that lowers the load in the tissue that there is a problem with, then yes, it is beneficial.
If the total contact design feature does not lower the load in the problematic tissue, then it won't be beneficial.

 

Those practitioners are pretty lazy! Or they don't know any thing about the biomechanics of the lower limb. They'd get an ok hit rate, some of the time.

I have no studies to back this up, but I think a thorough understanding of biomechancs of lower limb human function MUST improve orthotic success. I find myself seeing many patients with previous orthotic therapy (failed), and am able to have success.

For example, medial band plantar fasciitis treated with a full contact custom orthotic that doesn't address a FnHL will probably fail. Treatment with an orthotic to consider FnHL probably will succeed, whether it's custom or prefabricated.

Probably a better question- Where do podiatrists get off charging for custom orthotics, if all they do is scan/ foam mould/ plaster cast and send a script to the lab saying "plantar fasciitis"? At least learn your subject, and provide a service worthy of the fee.

 

Troy,

Cant really add to craigs' point other than to elaboate in a practical sense.

A TCO for a peroneus longus tendinitis without lateral wedging/skiving, lat forefoot posting will likely fail.
A TCO for a post tib tendinitis in a severely medially deviated foot type without medial wedging/skiving/ med forefoot posting will likely not apply enough external force to reduce the load on the tendon.
I have manufactured thousands of devices for customer over the last 10 yrs, many practitioners request a neutral posted device with min cast dressing regardless of the pathology. Despite issuing guidance of many occasions the prescription seldomly changes.

Scott

 

Yep...

 

Except pushing up the arch during stance phase, will reduce the tension in the plantar fascia in a lot of cases, reduced tension ------> reduced dorsiflexion stiffness at the MTP.

 

Perhaps this will help:

http://winchestersportspodiatry.co.uk/onewebmedia/Foot orthoses.pdf

 

Scott, why cant the foot be held in the desired position at time of casting/impression/scanning, so that external posting/skiving not be required?

 

We used to say to the patient, custom orthotics are like prescription eyeglasses, prefabs ( that includes foam casted ) are like reading glasses from Walgreens.

Teri Green
Atlas Biomechanics

 

What do you say now?

 

It can david

However this will have greatest influence on arch morphology

i.e plantarlexing the 1st ray to give a higher arch contour when a greater supinatory force is required, dorsiflexing the 1st ray to reduce mla high when less supinatory force is required.

scott