How do you know if your orthotic is working?
Foot orthotics are easy, no? You get casted, it gets built, you put it in your shoe and you’re good to go, right? Wrong!
Orthotics or Orthotic Therapy as we like to call it in our offices, is an ongoing process. If an orthotic is doing it’s job, your foot should change (for the better) and your prescription should become less. At least in an ideal world.
Remember, orthotics are designed to help you adapt to your environment better. Unlike a footbed (which merely creates a level playing field for the foot), they change the biomechanical function of your foot. A lot should go into getting fit for an orthotic, otherwise they can actually cause some of the problems they are purported to fix!
First of all, there should be a comprehensive history of you and whatever is going on, with an inventory of all your past injuries. That appendectomy or laporoscopy which invaded the abdominal wall could be a culprit for future problems. Next you should have a thorough examination of your lower kinetic chain, including the feet, ankles, knees, hips and low back. This should include range of motion, muscle strength, muscle recruitment patterns and joint function, along with reflexes, sensation and balance or proprioception. Next there should be an analysis of your gait, preferably with stop motion video which allows you to slow down movements and assess subtle abnormalities that may not be visible during normal speeds of movement.
At this point, it should be obvious to both you and your orthotic provider whether or not an orthotic is needed. If so, a non weight bearing cast (weight bearing casts show you what the problem or compensation is, why would you want to cast someone in their pathology and perpetuate it?) The non weight bearing cast is usually done in a mid to terminal stance position of the foot. This should be followed by the prescription of appropriate stretches and exercises, specific to your condition. Shoe recommendations should also be given, since different foot types require different footwear characteristics (good news for the ladies who like shoes!).
So, if you need an orthotic (remember, the prescription should become less over time AND should be accompanied by appropriate exercises), these are the steps we feel are imperative, otherwise, you may just have a really expensive doorstop….
The Gait Guys….Promoting Gait Literacy, one stride length at a time.