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HOW AN ORTHOTIC IS ASSESSED, PRESCRIBED AND IMPRESSED

NORMAL BIOMECHANICS:

When your heel strikes the ground it immediately begins to pronate (flatten arch) slightly. This motion will loosen the bones of your fore foot allowing the foot to adapt to uneven surfaces. As your body begins to move forward over the supporting foot, the foot begins to supinate (roll outwards) until the bones lock up tightly readying you for push off at the toes thus propelling you forward.

To summarize, your foot begins as loose and adaptable, than proceeds to a rigid lever for propultion. This partial flattening and raising of the arch acts like a shock absorber dissipating approximately 85% of the energy created by your body mass striking the ground.

Most mechanical pathologies revolve around disruptions to the loose adaptable/rigid lever phase and or an inability in dealing with the high burst of energy created when your heel strikes the ground.

ABNORMAL BIOMECHANICS:

When a foot pronates (rolls inward) excessively it is attempting to weight bear as efficiently as possible, that is with the majority of the foot in contact with the ground. When mal-alignments occur in any of the bones in the lower extremity, the foot will contact the ground at an inappropriate angle. This causes the foot to adjust to the differences in the angle by pronating or rolling inwards.

As stated earlier a normal foot pronates moderately for a short period of time to allow the forefoot to loosen enabling adaptations to uneven surfaces. With a mal-aligned, excessively pronated (flat) foot, the foot is forced to remain in a loose unstable position throughout the entire walking cycle and is not capable of reaching the rigid position required for propulsion. As a result the muscles in your shin and calf are forced to overwork in an attempt to stabilize the foot. The smaller (fine tuning) muscles with in the foot can not neutralize the power of the large calf/shin muscles, thus larger muscles begin to pull joints out of proper position leading to deformities such as bunions, hammer toes, planter fasciitis, corns and calluses.

When your Chiropodist begins a biomechanical exam of your lower extremities he or she will usually look at your posture from head to toe. This will enable visual identification of mal-alignments outside the feet which may be contributing to your foot problem. The Chiropodist may ask you to walk back and forth to watch your gait pattern, if they suspect different conditions outside the feet such as significant differences in leg length, muscle imbalances and guarding of painful movement.

The next phase will be a non-weight bearing exam of your hips (if necessary) to your toes to determine to the exact degree where each mal-alignment and incongruent motion is occurring. These measurements combined with your weight, activity level, age, work, combined ranges of motion available for correction, will help your Chiropodist determine how much or how little correction is best to address your needs.

These assessments can be done only through your Chiropodist or their american podiatry colleagues, as only they possess the specialized biomechanical education necessary to diagnose these pathologies.

Retail products such as computer gait analysis systems determine pressure points only and will provide dozens upon dozens of suggested problems but no diagnosis. They should not be used to take the impressions for your orthotics because they cannot recreate where the causative mal-alignment is. The orthotics resulting from this method provides virtually nothing more than a prefabricated arch support. It is the opinion of this clinic and virtually the entire Chiropody and insurance industry that computer or any weight bearing impression is inferior and UNINSURABLE. Only a non-weight bearing plaster cast can put the foot in its optimum position for a proper walking cycle by adjusting the appropriate areas of correction to the exact degree. If you have been told you are receiving a functional orthotic impressed while weight bearing and your insurance company has reimbursed you, both you and your insurer should question why you were reimbursed. If your physician has referred you to these types of clinics, you should inform he or she that inferior methods have been used.

When a palliative or accommodative device is required, a minimal weight-bearing cast with the patient in a sitting position is acceptable. These devices are used when the existing medical condition determines that the foot cannot be placed in a corrected position. The accommodative device is used to deflect pressure from painful corns and calluses or to provide increased shock absorption to rigid feet. Example of medical conditions requiring accommodative orthotics could be High arched feet, Arthritic feet, Diabetic and Rheumatoid feet.

PEDIATRIC BIOMECHANICS:

Often patients will comment that they have their parents or grandparents feet in reference to their bunions or hammer toes etc. I begin by explaining that that are 50% correct and 50% wrong. Bunions, hammer toes, and other mechanically related lesions and deformities are acquired not familial, flat feet or high arched feet are inherited with some exceptions.

Most children are born with flat feet, their bones are more cartilage than bone. The bones of the lower extremity are arranged in a fashion to better accommodate limited space in the uterus. This is why you notice baby’s waddling when they begin to walk.

As they grow older they slowly begin to rotate their lower limbs inward as the ligaments begin to tighten and their bones twist and reposition as they transform from cartilage into bone. These positioning processes are usually complete at about 7-7½ years of age.

Most inherited foot problems involve an interruption to the repositioning processes. The bones never reach their final position thus the foot (pronates) rolls inward to contact the ground (flat foot). This activates the loose unstable foot mentioned earlier.

Much like vision problems, early identification and treatment of mechanical foot problems can prevent or minimize many of the adult anomalies, such as bunions, hammer toes and plantar fasciitis.

Having a Chiropodist assess your child at 7-8 years of age, particularly with a family history of foot problems, can identify and control their foot problems throughout their life.