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Functional vs "custom" vs OTC Orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Footproman, Nov 5, 2010.

  1. Footproman

    Footproman Member

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    Dr. Scholl's has come out with a digital flatbed foot scanner that they're putting in Wal-Mart stores in order to sell their "Custom Fit" orthotics. It's a fairly nifty scheme: step on the scanner, it spits out a simple pressure plate diagram and suggests a "custom" orthotic for you. This concept is nothing new to all of us. A lot of companies do this.

    But here is the problem. The term "custom" should suggest something made specifically for the customer/patient. Some companies in the past have also used (and still are for all I know) the term "functional" to sell their crappy over-the-counter orthotics. Yet we know that a "functional" foot orthotic is one that is made with a cast or 3D scan of the foot (We use Amfit to scan patients in subtalor neutral, full weight bearing).

    To me, a "functional" orthotic is synonymous with a biomechanical orthotic, and a "custom" orthotic is an OTC product conformed to the patient's feet, or to correct pathology.

    So, with all this blurring of terminology by the big OTC orthotics companies, why are not the various medical disciplines (podiatrists, pedorthists, orthotists, prosthetists, etc.) not doing something about it? I mean, really, how long do we have to endure the absurd misleading claims made by these companies?

    As a sort of separate question (well, questions really), how many of you guys have seen OTC orthotics that are over 6 degrees? Most standard orthotics are at about 4 degrees, and "high arch" orthotics are about 6 degrees. Is there a requirement that OTC orthotics cannot be above a certain number of degrees?
  2. Going to sound like I´m picking on you, but best way to learn when others have done the same to me.

    1st all orthotics are functional - the big question if the reduce the loads on the stressed tissue or not.

    4 or 6 degrees of what ?

    Why do people think it´s your right to sell an orthotic device and no one else can ?- be good at what you do and you will be busy.

    Some will get helped from the ´Walmark´device - great I say those that don´t may end up in your office. Treat them well and soon their friends will be seeing you as well.

    Lots of so called medical experts make absurd misleading claims as well. Worry about your own backyard and you will be fine.
  3. Footproman

    Footproman Member

    Agreed. But I believe that historically orthotics were not marketed as "functional," that such terminology was reserved for those that actually made orthotics.

    Lateral to medial incline of most OTC orthotics, according to my understanding is between 4 and 5 degrees, with "high arch" orthotics being about 6 degrees. Perhaps my terminology needs correction. Normal forefoot varus is between 0 and 5 (degrees), which most people are a little outside of. So a 4 degree orthotic feels great to most, which is why they are successful.

    Great. I'm obviously not against that. But why should we be the constant recipients of OTC failures? The Walk-Fit company, for example (fabulous as they may be), claims that their orthotics are "custom" simply due to the fact that their orthotics feature a replaceable cog to which makes the orthotic "high arch." I'm not begrudging any business I get from dissatisfied customers. I'm just concerned about the dilution of the public's understanding of what a "custom" or "functional" foot orthotic truly is.
  4. Eeeeeasy Craig. Put the knife down.

    FPM you remind me of me some years ago. And I now remind me of simon. Firstly, FF varus is damn rare. Possibly even non existant. Secondly, you need to reference something like that. Garbalosa found average forefoot supinatus in a non patholgical population to be about 8 degrees if it helps.

    And thats a big problem right there. One cannot simple arbitarily define the meaning of terminology.

    As opposed to what? A non biomechanical orthotic? Consider what "biomechanical" means when you break it down, then consider whether any kind of insole can ever be non biomechanical.


    Again, consider the definition of the words you are using. A custom device is just that.

    We'll let that one lie.

    A funny thing. Some would consider a fully WB amfit scan to be an abomination. Certainly its not Root Canon, from whence the term "functional foot orthotic" comes and so cannot, in that sense, be called an FFO. Others might consider the idea of casting everyone the same way to make the orthoses "non custom" (after all, you're doing the same for everyone so how can it be). Still others might consider the idea that sub talar neutral is a poorly defined and difficult to repeat position and as liable to variation and inaccuracy as a 2d scan derived device, or even a pre fab.

    I'm not saying I beleive any of those things (or that I don't). But the point is, you can't state that YOUR interpretation of the terminology is correct, and someone elses is not! You are neither of you using what was originally described by Root as a FFO, both of you are making insoles with potential to change the function of the foot. So in essence, either both of you are entitled to call what you do an FFO (by the literal and modern definition) or neither of you are (by the historical one).

    RE OTC orthoses by the way, they come in all shapes and sizes. There is not neccessarily a correlation between arch height and heel wedge. Many have a relatively lower arch as the heel wedge increases. Interpod modular for one.

    Make sure your own understanding is correct before you worry about the publics. I don't mean that in an unkind way, but your post shows a few holes in your understanding. Before you seek to change the world, be sure you are changing it for the better, not just propagating a DIFFERENT misunderstanding.

    Perhaps a thread on "what is a functional orthotic, what is a custom orthotic" may be in order...
  5. Griff

    Griff Moderator

    I don't like this term. An orthotic device cannot have biomechanical properties, only mechanical.
  6. rodmack

    rodmack Welcome New Poster

    As can be seen by the posts on this topic so far...terminology is not standard throughout different health professions (physical therapy/physiotherapy, pedorthics, podiatry, chiropody, chiropractic, physiatry, orthopedic surgery...etc.) or even within the same discipline from country to country.

    When discussing with someone who hasn't been trained in the same exact discipline or in the same country (or even in a different university or training program within the same country) defining terms before the conversation starts is always a good idea.

    Professionals do not have a consensus amongst themselves on the precise meaning of many terms that are thrown around by marketers...which is how the public often gets "educated" about foot orthotics...so I don't think we'll see any consensus about how the public understands these terms any time soon!
  7. footproman,

    Ive got some reading for you - As Roderick say terms can get mixed up country to country etc - but have a read .

    Re ff varus - most likely a FF supinatus and very hard to measure and state degree - have a read of these related threads -http://www.podiatry-arena.com/podiatry-forum/tags/index.php?tag=/forefoot-varus/

    and this thread we we discuss a OTC which especially post 48 I think which breaks down the devices -http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=51178
  8. Correct. Unless we make it out of living flesh...
  9. Gerbilothotic?

    Like the picture micheal! ;)
  10. footdoctor

    footdoctor Active Member

    Biomechanics (from Ancient Greek: βίος "life" and μηχανική "mechanics"[1]) is the application of mechanical principles to living organisms, such as `humans, animals, plants and the functional basic units of life, the cells

    So i guess that the term "biomechanical" wouldn't correctly apply to a foot orthotic device.

    functional [ˈfʌŋkʃənəl]
    1. of, involving, or containing a function or functions
    2. practical rather than decorative; utilitarian functional architecture
    3. capable of functioning; working

    Doesn't that make any type of device functional?? They all do something/function.

    custom (not comparable)
    made in a different way from usual, specially to fit one's needs
    My feet are as big as powerboats, so I need custom shoes.

    So is flat bit of leather board with a heel raise applied to the plantar heel aspect a custom foot orthotic if the "needs of the patient were to balance a structural leg length discrepency? Or could this example be a custom functional foot orthotic??

    My point:These words are incredibly open to varied interpretation.

  11. joejared

    joejared Active Member

    One of my customers sat on the pressure plate, and the machine suggested a device for his butt. Other than the device capturing the wrong kind of data for everything but the arch area and using that data to provide misleading information to the customer for chosing an arch support, I see nothing wrong with the device. Each time I see a device like this used to select devices, my first thought is... Where's the beef?

    Considering where most of these devices are installed (mostly walmart), probably for quite some time. This town has 3 sources of entertainment, A bowling alley (Currently closed for remodeling), a movie Theatre, and Walmart. Given demographics of some towns, people will try anything if they're cheaper than a prescription device.

    Keeping the focus of maintaining our own reputations for delivering a quality product is probably more productive, but yea, I've had a desire to vent on that product line too.

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