CUSTOM-MADE ORTHOTICS
Your feet help you interact with your environment. Depending on how the center of mass of your body is positioned, your feet will react to what the body is doing above it. If your body is shifting forward, weight will be felt in the front of the foot. If your body is shifting backward, weight will be felt in the heels. The same is true for a body that shifts left or right- the feet will rotate to the left or right to accommodate for the body position. As the body position drives foot position, the feet can then reflect the body function above it to create a feedback loop. If the structure of the foot is not variable, it can create a pattern in which you get stuck.
The orthotics by themselves will not fix you. Instead they help your body unlock, get out of your previous suboptimal pattern, and provide the space for you and Dr. Brian to retrain optimal movement.
Why you might need your feet assessed
How to know
if you need
orthotics
Each patient is individually assessed for their need for orthotics or a change in footwear. If your body is able to break free of its old pattern through retraining exercises alone, orthotics are often not needed. However, if you have been consistent with your retraining program and it does not stick for your body, we need to determine what other influences in your body may be pulling you back into your old pattern.
We assess the foot posture and compare each side. We test the foot and ankle in a position of form closure to see what the ankle will do when loaded then test again to see what happens to the leg as the foot has to find the ground. If we see significant rotation required of the leg when the foot has to rotate to find the ground, it means the foot does not actually allow for true pronation, which is a strong indicator that orthotics could be beneficial.
The next step would be trialing a pair of orthotics to see if that allows your body to free up and maintain the freedom after walking. If all these steps indicate the need for orthotics we can proceed with molding and fabricating a custom pair for you.
Common indicators for needing orthotics include:
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Flat feet
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High arches
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Structural deformities such as bunions, hammer toes, and tibia varum (knock knees)
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Limited range of motion despite retraining (hip abduction, hamstring length, ability to squat, calcaneal eversion, or great toe extension - hallux limitus)
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Excessive range of motion (supination)
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Toes point out even after achieving optimal hip and pelvis positioning
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Inability to effectively use glutes during push off even after retraining (using lower legs or low back instead)
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Feeling better wearing sandals or barefoot
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Specific conditions like plantar fasciitis, ankle sprains, or shin splints
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Patients with cranially driven patterns
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Heavy heel strikers
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Difficulty sensing heel, arch, or big toe
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Inability to shift from side to side
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Wearing good quality shoes but they always wear out in the same place (such as one side of the heel or your toe pokes out through the mesh of athletic shoes)
How these are
different from
other orthotics
Rigid orthotics made of hard plastic do not allow normal movement of the joint. They are typically made assuming the foot will pronate until it hits the ground. A wedge is placed to try to improve the mechanical position of the foot. This does not account for the fact that our foot actually needs to pronate. You need to capture the twists and turns as you walk and a rigid orthotic does not allow for this. Rigid orthotics simply transfer the weight of the foot to a different area. They trade overloading one area for overloading a different area. This might provide initial relief to the current ailment but may cause different problems years later.
The ideal orthotic is non-compressible in order to provide support but still flexible to allow for movement. It should help to align the joints in all positions of movement for more efficient function, not simply a single snapshot of one position. These orthotics are designed to the shape of the foot to maintain good joint positioning and help you relearn normal movement patterns while limiting abnormal foot movement. Capturing each specific foot position and not making each orthotic the same on both sides allows us to change the pattern your body chooses. They are lightweight but still durable and should last for many years. They restore optimal alternating and reciprocal movement and so the malfunction can actually be corrected.
The orthotics are made by Dr. Paul Coffin, a podiatrist with over 35 years of experience and his own laboratory where he makes the orthotics. Dr. Brian was trained directly by Dr. Coffin in how best to capture your foot position in the orthotic mold to ensure you get the best results.
Dr. Paul Coffin, DPM
Photo credit: Dr. Paul Coffin
Dr. Coffin creating an orthotic in his lab
Photo credit: Dr. Paul Coffin
How these
orthotics work
If your body is shifting in one direction, for example to the right, the right foot will be supinated and the left foot will be pronated. That foot position is then captured in the orthotic mold of a body falling to the right. Reflexively the body will adjust as if it is falling to the right. Imagine walking along a hill where the high side is to your left and the low side is to your right. Your body does not stay perpendicular to the ground, it shifts to the left to keep you upright and to keep you from falling over. The orthotics work the same way, by using the power of your brain to automatically correct your pattern based on what is felt at the feet.
The orthotics may help with specific foot issues as well as full body alignment issues.
What to expect & how to wear
the orthotics
If assessments indicate you would benefit from custom-made orthotics, Dr. Brian will create a mold impression of your bare feet at your next scheduled appointment. He will send that mold into the laboratory along with pictures of your feet in order to create orthotics specifically tailored to what your body needs to start finding relief from your symptoms. We mail them directly to the laboratory for you and we typically receive your new orthotics within 2-3 weeks. During your follow up appointment, Dr. Brian will ensure they are fitted properly and helping to provide the proper support in the correct areas.
These orthotics may be ordered in ¾ length so that they are easily transferable between different pairs of shoes or in full length to fit a specific shoe.
They work best with a good pair of shoes which offer proper support throughout the day (Dr. Brian can help you determine if what you are currently wearing is helpful for your specific needs). Typically the original liner of the shoe is taken out and the custom orthotic is fit snugly into the heel cup.
These orthotics are built to alter your biomechanics so that your feet and legs can function more efficiently. Patients frequently become aware of a different part of their foot they are not used to feeling. You may start with wearing them one to two hours a day and slowly increasing your duration in them overtime or you may begin to wear them all day from the start if your body can tolerate it.
If after a couple weeks the orthotics are not well tolerated they may be adjusted (this is extremely rare). Also, sometimes if dental and vision care are needed, the effect at the foot must be revisited as the body adapts and progresses into more optimal form and function.
Photo credit: Dr. Paul Coffin
Photo credit: Dr. Paul Coffin