Orthotics in the medical field is the prescription, manufacture and application of orthotics or orthoses. Orthotics are an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system.
Foot orthotics are worn inside the shoe to control abnormal foot function and improve lower limb alignment.
Your Podiatry Canberra will only prescribe orthotics if they are clinically indicated.
Orthotics Aim to:
- To control and correct abnormal alignment and/or;
- Redistribute forces associated with the foot and lower limb and;
- To reduce pain and deformities, prevent injury and increase foot and leg comfort
- Enhance your quality of life
What specific conditions may be helped?
- Heel pain
- Flat feet
- High arched feet
- Foot pain
- Plantar fasciitis/plantar fasciosis
- Heel spurs
- Hypermobile joints
- Shin pain
- Knee pain
- Hip pain
- Low back pain
- Ankle pain
- Anterior knee pain
- Patellofemoral pain
- Posture problems
- Achilles pain
- Morton’s neuroma
- Forefoot pain
- Metatarsal stress fractures
- Toe pain and deformities
- Children’s feet problems
- Gait problems (in-toed or out-toed)
- Severs disease
- Excessive pronation
- Insufficient pronation
What types of orthotics does Your Podiatry Canberra have?
Heat moulded orthotics: for less complex lower limb conditions, the orthotic is heated and moulded to both feet. Necessary additions can be added on the day or at a later date e.g. cushioned top cover.
Joeys/pre-designed orthotics: are a cost-effective orthotic option for clients unable to financially commit to full custom devices but need more than a heat moulded device. Joeys use the same material as a custom foot orthotic but a cast or (3D) impression isn’t taken, thereby reducing the cost. Instead a tracing is taken (2D) and sent to the orthotic laboratory. They have the same characteristics as custom foot orthotics and are a great option for growing children and adolescents.
Customised/prescription orthotics: a thermoplastic orthotic that is prescribed in a similar way to prescription glasses; the data is sent off site and a customised device returns ready to be issued to the client. See below for more information.
What is the process for customised foot orthotics?
- Initial appointment: a comprehensive biomechanical assessment is undertaken followed by the podiatrist discussing the provisional diagnosis, causes and management plan. A treatment plan rarely involves orthotic therapy only; it can include exercise prescription, footwear changes, taping, massage therapy, myofascial cupping, mobilisation, superficial dry needling and injection therapy.
- Casting or scanning appointment: an impression is taken of both feet. A prescription is completed based upon biomechanical data, activity level and physical status.
- The casts/scans and prescription are sent to a podiatric laboratory where state of the art software and computerised machines manufacture orthotics. The use of computerised machines allows for a greater level of precision in angles and sizes compared to the traditional method of hand making orthotics.
- Orthotic fitting appointment: the orthotics are checked and fitted to the shoes. A gait analysis is performed to confirm improvements in alignment or pressure redistribution.
- Orthotic review/s: any concerns or problems with the orthotics are addressed by the podiatrist and on site equipment.
- 12 months after the last orthotic review, Sport & Spinal Physiotherapy will be in contact to book a 12 month orthotic check up appointment. Just like getting a car serviced it is important to attend these appointments to ensure foot and ankle mechanics remain optimally controlled by the devices.
Are orthotics uncomfortable?
No. Orthotics are designed to alter lower limb alignment and as such it is not unusual to experience some mild discomfort for a few weeks as your body adapts to its new position. Some orthotics need a little trouble shooting to resolve discomfort. Reasons why orthotics may be uncomfortable include:
Plantar fascial/arch discomfort: the plantar fascia is a ligament like structure in your arch that becomes prominent when you flex your big toe towards your body. All orthotics prescribed at Sport & Spinal Physiotherapy come with a groove in the orthotic for the plantar fascia to sit in.
Too firm, too soon: sometimes tissues can be too inflamed to tolerate thermoplastic orthotics initially e.g. heel pad bruising in the presence of a flat foot. Instead taping and shock absorbing heel cups are first worn to resolve the heel pad bruising and then orthotic therapy is implemented to realign the flat foot.
Orthotic shape: if the orthotics don’t contour the shape of the foot there is a chance of irritation. This risk is eliminated by taking a quality impression of the feet and by attentively prescribing the devices.
Orthotic stiffness: Some feet need a lot of force to correct abnormal biomechanics, some don’t. If the prescription gets this wrong the orthotics may be uncomfortably too hard or too soft. A comprehensive biomechanical assessment will identify how much force is required.
Inappropriate footwear: a soft heel counter and a lack of fixation will mean the feet are not locked onto the orthotics which can lead to skin friction against the on top of the devices causing discomfort. Below are supportive footwear features to look out for.
What footwear will orthotics fit into?
Shoes with the following features will generally cater for orthotics:
- Closed, firm back/heel counter
- Fixation such as lace, buckle or Velcro closure
- Adequate depth
Sport and Spinal Physiotherapy offers a variety of orthotic lengths to match a client’s footwear choices.
A discussion with a podiatrist will identify which length is most appropriate for your footwear and diagnosis.
Standard length: extends to just underneath the ball of the foot. Will fit and transfer between a variety of shoes e.g. court shoes, oxfords, runners. A heel stabiliser is added to prevent orthotic movement in the shoe. Depending on the shoe type a standard length device can be worn instead of or with the shoe’s innersole.
Web length: Covers the ball of the foot and stops underneath the toes. For those that need cushioning at the ball of the foot but have a variety of shoe types that a full length device will not fit into. A heel stabiliser is added to prevent orthotic movement in the shoe.
Full length: Same length as a shoe innersole which decreases risk of orthotic movement in the shoes. Prescribed for people with similar work and casual shoes e.g. work boots and runners. The orthotics do not need to be worn with an innersole.
The Your Podiatry Canberra Advantage
- Orthotic guarantee: orthotics are designed to alter lower limb alignment and as such it is not unusual to experience some mild discomfort for a few weeks as the body adapts to its new position. However, if the orthotics are unduly uncomfortable and we have modified the orthotics many times without relief, then we will discard these devices and replace them with a new pair (probably from a different laboratory) for FREE.
- Quality customised orthotics are prescribed using Footwork Podiatric Laboratory technology. Some features of Footwork orthotics include:
- High quality polypropylene/plastic is used to make the orthotics lightweight but still effective. Previously, carbon orthotics were used to achieve a lightweight yet controlling orthosis. The disadvantage was that carbon orthotics cannot be altered in clinic. Carbon orthotics are still used in space limited cycling shoes.
- CAD/CAM technology and computerised direct milled orthotics to reduce human error. The contour is more precise and the angles of correction are exactly as requested.
- Long lasting polypropylene/plastic means the base of the orthotics can last for years. Your feet can change before the polypropylene does.
- Full length and short length orthotics can be manufactured.
- See footwork.com.au for more information.
- Scanning technology: Your Podiatry Canberra’s scanner has 5 cameras to accurately capture the foot to create a 3D image. Some scanners only have 1 camera. Standing pin point impressions can measure height to the 1mm but not the width. Our scanner can measure all 3 planes (height, width and length) to the 1mm or below. Additionally, scans are taken in the seated position. You may have noticed your arch is much higher when seated. By capturing the arch at its best the orthotics can ‘hold’ that position in standing and walking.
- We look beyond orthotic therapy: to get you better you may need mobilisation, massage, superficial dry needling, myofascial cupping, exercise prescription, footwear advice and injection therapy. All these therapies can be done in clinic by experienced practitioners.
- Multidisciplinary team environment: if you need to attend physiotherapy or massage therapy you will not need to go to another clinic, they are on site.
- Evidence based medicine: all practitioners at Your Podiatry Canberra and Sport & Spinal Physiotherapy undertake continuing professional development which means the practice remains on the forefront of musculoskeletal principles and management.
- Orthotic therapy is prescribed only when clinically indicated; they are not handed out to everyone.
- We know which type of orthotics are best suited to you. There are different types of prescriptions depending on your biomechanics. There is no one prescription fits all.
- We listen to what you want and thoroughly explain what you need and why
- We understand injury pathology and lower limb biomechanics
- You will be entitled to a rebate from your private health fund since a podiatrist supplied them