Find the best match for your patients’ feet with a few simple benchmarks.
The importance of the feet, which serve as the foundation of the body, is well-known, so making the choice to offer orthotics in your practice is often a natural one.
Foot health has a dramatic impact on the functioning of everything above the body—including the joints, soft tissues, and bones. So the question that remains is: “How do I choose the right orthotics for my patient?”
When choosing between rigid, semi-rigid, and flexible material and custom versus generic products, chiropractors want to know: “Which orthotics will best support my chiropractic care and help my patients get better?”
First, there are two major ways orthotics are made:
- Using a non-weight-bearing cast or scan, which many in the medical profession favor, and
- Using foot impressions from a weight-bearing cast or scan.
Consider the telling characteristics of these different processes.
Non-weight-bearing orthotic construction
During this process, a plaster-like material is spread around the foot to make a mold. It comes off the foot and forms a negative impression. That mold is then used to form a hard, rigid, or semi-rigid orthotic. Non-weight-bearing foam casts and scans are created while the patient is seated with their foot barely pressing downward.
Podiatrists generally prefer this orthotic construction, but there are a few issues associated with it:
- This type of orthotic casting method assumes that if a person has some arch support when the foot is not bearing weight, that same arch support will be mirrored in the standing position.
- Hard orthotics can over-support or “crutch” the foot, thereby impairing normal biomechanics. Often the feet start to fall asleep and normal function is compromised in these cases.
- The rigid plastic or semi-rigid materials can transmit more shock to the body and joints upon heel strike. Consider that the average heel strike creates 5 Gs of shock, which is plenty on its own. You don’t want increased force applied to the joints and soft tissues. The resulting biomechanical compensation may further stress the system.
In specific circumstances, rigid orthotics can be helpful. In cases of severe plantar fasciitis, the harder orthotics will actually crutch the feet effectively and allay pain. This does not help with the stability of the foot, but some patients are so affected by the pain that relief is the first thing they want.
After a period of up to six months, the transition can be made to a more flexible pair. Hard orthotics are typically used in extreme cases, and in general will have negative effects on the body down the road if used for too long.
Weight-bearing construction
The weight-bearing method of making orthotics takes into account functionality, foot and ankle biomechanics, and the relationship between the spine and the feet. In years past, foam casting kits were the method of choice. Although these kits are still in use today, the state-of-the-art method now is the digital foot scanner. Scanners allow for a nearly zero margin of error as the patient need only stand on the footplate and look straight ahead.
This method analyzes the patient’s foot as it bears full weight. The maximum amount of pressure and arch depression is sensed by the footplates on the scanner. Then specific measurements are made based on the patient’s weight, height, age, and gender to formulate a custom pair of orthotics. You can convey a wealth of information to patients from one simple scan that will solidify their understanding and need for properly proscribed orthotics.
With enhanced knowledge about how orthotics are made, you might look at the plethora of premade orthotics hanging in drugstores with a more critical eye. Cheaper is rarely better when it comes to a quality orthotic. Don’t be fooled by commercials or sales staff who lack the knowledge you have.
Walk a mile, comfortably
Finally, you must choose a specific orthotic size and type for your patients. This process does not have to be complicated. Full-length orthotics tend to be for athletic shoes, dress shoes, or work boots. These work best with lace-up shoes because the foot can move in and out without much effort. Most shoes of this type have a removable insole that comes standard from the factory. This needs to be removed before the orthotic is placed inside so the foot had ample space.
Three-quarter or seven-eighths length orthotics are made for dress shoes, low heels, boots, women’s footwear, and even some sandals. Here, the orthotic stops as it gets to the ball of the foot or the metatarsal region to give the toes more wiggle room.
The actual arches are a tad thinner in this type of orthotic because the foot needs to be able to slip into the shoe comfortably. Arches that are too thick or long in these types of shoes will be too tight for the patient’s foot and result in discomfort.
Choosing the proper orthotics for your patients doesn’t have to be a daunting task. And, given the right match, orthotics can be an important way to support your quality care.
Stabilizing the body’s foundation will help your adjustments hold longer and stronger, and will keep your patients feeling their best. Patients who feel great will tell others, and your practice will grow.
Kevin Wong, DC, is an expert on foot analysis, walking and standing postures, and orthotics. He discusses spinal and extremity adjusting at speaking engagements. He can be contacted through orindachiropractic.com.
