What Are Foot Orthoses

Feet are a lot like children. If you don't offer them proper control and guidance they may develop problems later on. Many foot problems develop from lack of control (wearing ill-fitting shoes, shoes without any arch support, shoes that are not appropriate for the activity engaged in, failing to warm-up properly exercise, etc.). Offer your feet proper control, and you can avoid many problems later in life. The object of Orthotic Therapy, therefore, is to establish or restore control, diminished through injury or aging, and re-create normal foot functioning to eliminate existing problems and to avoid new ones.

A foot orthotic is a shoe insert prescribed by a medical practitioner to treat certain types of foot and ankle pain; bunions; osteoarthritis; fallen arches; some consequences of diabetes; limb length discrepancies; heel pain, and other more technical disorders. Many foot problems caused by disease and injury or resulting from the normal aging process can be improved with foot orthoses. Still other problems, such as knee, hip or back discomfort, may have their origins in foot-related disorders. Children who have developed in-toe or out-toe gait problems, teenagers with sports injuries, adults experiencing overuse injuries, or seniors who have morning foot discomfort when first standing are typical examples of conditions which respond well to orthotic therapy.

Orthoses are either prescription or prefabricated , and are further subdivided into functional and accommodative types. A prescription orthosis is custom designed for a particular patient, while a prefabricated orthosis is generic. Prescription orthoses start with an electronically scanned foot image, plaster cast or foam block impression made by a clinician from a patient's feet. That image or cast is then sent to an orthotic laboratory where it is electronically or manually corrected and a mold block is designed which will produce an orthotic device that treats the patient's individual disorder. The type of orthosis chosen by the practitioner depends on the patient's particular problem, age, activity level, weight and other factors affecting foot function.

A prefabricated orthotic is formed on a pre-constructed mold block and sized to a patient's shoe. Why a "generic" foot orthotic? Sometimes a patient only needs support in the foot arch area, a problem easily solved with this type of device. Better quality prefabricated foot orthoses are specially designed to provide good arch support and comfort. Prefabricated orthoses can be fitted with additional external heel control or "post" to further improve foot function.

Both types of orthoses, prescription and prefabricated, offer varying degrees of biomechanical support, control and correction. Biomechanics, by the way, is the study of normal and abnormal body motion and function, sort of like engineering applied to humans. The prescription device, designed exactly to a model of the patient's feet and for that person's particular problem, is a more aggressive and effective treatment modality. People without significant foot pathology, but who experience minor discomfort, especially related to the normal aging process, may still benefit from simple arch support.

Prescription foot orthoses can be either functional or accommodative. A functional device is generally more rigid and usually has an external heel device or "post" attached to the bottom of the orthotic for better foot control. This type of orthosis acts to change impaired foot motion and re-establish normal foot function. An accommodative orthosis, on the other hand, is not designed specifically to change foot function, rather, it allows the patient to continue to function as usual but with greater comfort and support.

 Foot orthoses can be activity-specific, as well as shoe-specific. For instance, the dynamic forces encountered by people playing tennis, soccer or skiing are all different, thus each person might require different control features designed into their orthoses. The same is true for someone who is more active than another. Women wearing more stylishly designed pumps have different orthosis fit requirements than those wearing roomier shoes. Special orthoses are available that provide support and correction while fitting higher heeled women's shoes. All of these considerations are taken into account by the clinician prescribing foot orthoses. The more aggressively an orthosis is shaped to fit a stylish shoe, the more functional control is compromised by narrowing the device. After all, it is the design of the orthotic that makes it perform effectively. To avoid problems associated with shoe fit, your practitioner may recommend that patients purchase slightly larger foot wear.

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