ORTHOTICS

ProTech Light Orthotics

Originally created by Alan Jacobsen, PhD, and now distributed exclusively to healthcare professionals by Powerstep, Light Orthotics are composed of a polyurethane foam on top of a lightweight supportive shell. They come in 11 different sizes and are flat upon arrival. With the use of UV-light, these prethotics are cured to a person’s feet in under 10 minutes and are ready to wear immediately afterwards.

The Process

  • Once the appropriately-sized prethotics are selected and the lightbox is set-up, the patient’s lower extremity is positioned.

  • The lights are dimmed, if possible, and protective eyewear is worn. Once the foot is correctly positioned, it is pushed through the plastic wrap, which supplies negative pressure against the prethotic.

  • The lightbox is turned on and the prethotic is cured against the foot after just a couple minutes. After it is set, it should be checked against the patient’s foot and trimmed to fit the shoe, as necessary. Then, the other prethotic is formed against the other foot using the same method.

  • Watch the video below to see how quickly and easily it is to make Light Orthotics.

 

Custom Orthotics

WHAT ARE CUSTOM ORTHOTICS?

Custom orthotics are specially-made foot devices that go into shoes to help cushion,

support, and/or control abnormal motions of feet. In turn, they can improve performance,

prevent injury, and relieve pain, as well as slow down the progression of foot deformities

and osteoarthritis. In addition, orthotics can also help with realignment of the lower

extremities, including the knees, hips, and back. 

 

FUNCTIONAL VS ACCOMMODATIVE ORTHOTICS

Most custom orthotics are functional orthotics (example seen at right). Whether worn for

everyday use or for sporting activities, the goal of functional orthotics is to improve the

alignment of the lower extremities, support the feet, and control abnormal biomechanics

that lead to the progression of foot deformities and disorders, including flatfoot deformity,

bunions, and osteoarthritis. As such, the shell is more rigid and durable and is oftentimes composed of materials like polyprophylene, graphite, or carbon composites.

 

Unlike functional orthotics, accommodative orthotics are usually made with softer materials, such as ethylene-vinyl acetate (EVA). Instead of trying to realign the foot, accommodative orthotics are meant to provide cushion, support, and help offload any bony prominences, mainly along the plantar sides of the feet. Accommodative orthotics are commonly used for patients with diabetes or other neuropathic disorders.

 

ORTHOTIC PROCESS

Biomechanical Exam

Before impressions or scans of the feet can be made, it is important to perform a thorough lower extremity biomechanical exam and gait analysis. The exam consists of evaluating the foot structure of both feet (e.g. flatfoot, pes cavus/high-arched foot), the range of motion of certain joints, the flexibility or rigidity of any deformities, and the muscle strength of certain muscle groups.

 

The gait analysis is important for evaluating how a person walks and how he/she possibly compensates for his/her foot type, certain foot deformities, or any related neuromuscular disorders that exhibit signs in the lower extremities. It is important to not only look at the feet, but to also evaluate for any discrepancy between shoulder heights, abnormal motions at the hips, and the position of the knees during gait. 

 

These exams, along with performing a comprehensive and thorough history and clinical exam, help the podiatrist put together the best custom orthotic prescription for the person’s feet and needs.

 

Foot Impressions & Scans

After performing the biomechanical exam and gait analysis, foot impressions or scans need to be taken. This can be done a variety of ways, including using plaster to create molds of the feet, using a foam box to obtain impressions, or even digital scans to create 2D or 3D models.

Plaster Casts

Using plaster is still my desired way of creating molds of the feet for custom orthotics because

it allows me to have the best control over the position of the feet while they are being casted,

and the plaster itself produces great impressions of the feet.

 

The feet can be casted either with the patient in a supine or prone position, depending on the

physician’s preference and/or the ability of the patient to lie prone. Next, strips of Plaster of

Paris are dipped in luke warm water and then conformed to one foot at a time. As the plaster is

drying, the foot is held in a certain position, pre-determined by the physician, keeping in mind

the clinical and biomechanical exams, as well as based on the type of orthotic the doctor

wishes to create (functional vs accommodative). Once the plaster cast is dried, it is removed

from the foot and the other foot is done repeating the previous steps. 

 

Using the biomechanical exam, gait analysis, and the plaster molds, a customized orthotic prescription can be made. The molds are then sent to a lab for manufacturing. Once ready (1-3 weeks later), they are returned to the podiatrist and a follow-up appointment is made for fitting and dispensing of the orthotics to the patient.

 

Casting Socks

Some physicians do not want to deal with messy plaster and, therefore, choose using casting socks, which are made with a polyurethane resin that hardens when wet. The same principles apply as with plaster molds with applying and positioning of each foot.

 

Plastic wrap is first placed on the lower extremity. Next, the sock is dipped in water and then applied to one foot. While it is drying, the sock is worked and massaged around the foot, making sure to get an accurate impression. At the same time, it is held in a certain position by the doctor. Once dried, the top (or front) of the sock is cut and removed from the foot. The other foot is then casted in a similar fashion. 

 

After the sock impressions are created, they are then sent out to a lab for manufacturing and are returned to the podiatrist so they can be fitted and dispensed to the patient.

 

Click here to watch how STS socks are applied to create impressions of feet.

Foam Box

Unlike plaster and socks molds, the foam impression box simply involves stepping into a box that creates an immediately impression of the feet. Think of it like leaving an impression in wet sand. Despite it being a very clean and quick method for creating impressions, it requires skill to create a good and accurate impression that will produce the custom orthotic one is hoping to achieve. There are many different techniques to placing and positioning the feet in the foam box, so it’s important to take your time and not be careless with the process.   

 

Digital Scanners

With technological advances, numerous digital foot scanners have become available. There may be a learning curve for the physician, depending on the scanner and technology used, however, it appears that these scanners will become the future, potentially saving time, money, and a  mess (2). Future research will likely need to be conducted to compare the use of these scanners to the other techniques.

 

Orthotic Prescription

The prescription is a form podiatrists use to create and order the custom orthotics. Each part of the orthotic is carefully crafted based on the patient’s medical history, the clinical and biomechanical examination, as well as the foot impressions. Below is an incomplete list of some of the customizations that can be made with the custom orthotic prescription.

 

Orthotic Shell

This is the base and foundation of the orthotic. As mentioned above, more

rigid materials (e.g. polyprophylene, graphite, carbon composites) are used

for functional orthotics while softer materials (e.g. EVA) are used for

accommodative devices. The thickness of the shell, often based on the

weight of the patient, also helps determine the flexibility/rigidity of the

orthotic. Other shell modifications include choosing the width of the

orthotic, heel cup depth, and the addition of shell cut-outs, grooves,

and/or flanges.

 

Rearfoot Posting

Rearfoot posts are the added material on the bottom heel section of

custom orthotics. The purpose of the rearfoot post is to control the amount

of foot pronation or supination during gait (1). They are usually left off in

dress (and other low-profile) shoes because the orthotic may not fit into the

shoes with the post added. 

 

Top Cover

The top cover adds cushion and comfort over the top of the orthotic shell. Several different materials are available. For sport orthotics, materials that absorb shock and have moisture-wicking and antimicrobial properties may be considered, while thinness and durability may be more important qualities for dress orthotics.

 

Additional Pad Options

- Metatarsal Pad:  Helps offload the metatarsal heads. It is used for metatarsalgia or fat pad atrophy along the ball of the foot.

- Dancers Pad:  Offloads the 1st metatarsal head. It is used for sesamoiditis and other sesamoid problems.

- Reverse Morton’s Extension:  Offloads the 1st metatarsal head and hallux digit. It is used for early stages of hallux limitus.

- Morton’s Extension:  A rigid extension is added under the 1st metatarsal joint and hallux to prevent the 1st metatarsal-phlangeal joint from bending in end-stage hallux limitus (aka hallux rigidus).

 

BREAKING THE ORTHOTICS IN

Once the custom-molded orthotics are returned from the lab, a follow-up appointment is made for the fitting and dispensing of the orthotics. Because the orthotics can have effects on the entire lower extremity, it is important to break them in SLOWLY. Recommended break-in time is about 1-2 weeks; therefore, they should only be worn for no more than one hour the first day, 2 hours the next day, 3 hours the following, and so forth until they are comfortably worn full-time.

 

It is recommended that you wear them in any shoe they fit. Think of them as eyeglasses, in that they only work when wearing them!


Orthotics FAQ

What is the Difference Between Over-the-Counter (OTC) Orthotics & Custom Orthotics?

OTC orthotics are shoe inserts that are bought off-the-shelf, most often at running shoe stores. They come in set lengths and arch heights and are made of specific materials, which will determine how rigid or flexible they are and how much cushion they will provide.

 

Custom orthotics, as mentioned above, are specialized shoe inserts made from molds, impressions, or scans of the feet that are constructed by a lab after a customized prescription is created based on clinical and biomechanical exams and a gait analysis are performed by a healthcare professional.

 

OTC orthotics are significantly cheaper than custom orthotics but are not covered by insurance and may only last a year; whereas, custom orthotics are sometimes covered, or partially covered, by insurance and may last several (5+) years.

 

To learn more about OTC vs custom orthotics, read my blog “Over-the-Counter vs Custom Orthotics: Which are Right for You?

 

Do I Need Custom Orthotics?

Not necessarily. Dr. Falk will perform a comprehensive physical exam, along with a biomechanical exam and gait analysis to help determine what is best for you. The doctor offers Light Orthotics & Custom orthotics and can refer you to local running shoe stores for OTC orthotics.

 

How Do I Get Custom Orthotics?

Just ask the doctor! After a physical exam and biomechanical analysis are performed, a mold of each foot is taken using plaster casts. The molds are then sent to a lab for manufacturing. Processing usually only takes 10-14 days! Once they are made and returned to the doctor, a follow-up appointment will be made to ensure the orthotics fit properly to your feet and in your shoes.

 

Can I Wear Them Immediately?

Yes; however, because the orthotics can have effects on your entire lower extremities, it is important to break them in slowly, unless you have had similar orthotics in the past. Read the orthotic break-in period section above to learn how to properly transition into using your orthotics daily.

 

Will the Orthotics Fit into All of My Shoes?

It depends. Full-length orthotics will typically fit into most athletic shoes. If you need your custom orthotics to fit into specific shoes, such as athletic cleats, dress shoes, or even high heels, let the doctor know. The orthotic prescription can be created to completely customize the orthotic to not only fit your foot but to also fit your shoes. This may mean using thinner materials, not adding a rearfoot post, or even creating a ¾-length orthotics (instead of a full-length one).

 

How Long Will the Orthotics Last?

The lifespan of an orthotic depends on several factors, including which orthotic you purchase (OTC vs custom orthotics), the materials from which the orthotics are made, your activity level, and how much your feet change (e.g. length, shape). In general, an OTC orthotic may last about 1 year, whereas a custom orthotic could last up to 5 years or longer.

 

References:

1. Kirby, K.A. (1996). Troubleshooting Functional Foot Orthoses. In R. L. Valmassy, Clinical Biomechanics of the Lower Extremities(pp. 327-348), St. Louis: Mosby.

2. Williams, B., Fuller, E. (2015). Point-Counterpoint: Scanner Casting: Is It Better Than Plaster Impression Casting? PodiatryToday 28(6) 50-55. Retrieved from https://www.podiatrytoday.com/point-counterpoint-scanner-casting-it-better-plaster-impression-casting

Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.

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