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Sunday, March 27, 2011

To Orthotic or Not to Orthotic

Ok, so it's been awhile since my last post.  Sorry about that!  It's been an interesting past 2 months or so.  So, at this point in time, and with what I've been dealing with in the recent past, has really intensified my dislike of "custom" orthotics, or orthotics in general for plantar fasciitis.  From recent people that I've been working with in the clinic, I truly, truly, truly dislike the concept that people have about how an orhotic will change an acitve person's life!  The concept that I'm talking about is that if a person begins to have foot pain then an orthotic is the answer.  Wrong, wrong, wrong!  I'm not saying that an orthotic wouldn't be prudent in specific cases.  What I'm saying is that an orthotic is not the answer the majority of the time.

Let me say something about persons pushing orthotics.  First of all, it's a big money maker for them.  Second, the orthotics are typically made from the foot of a person who is currently experiencing foot pain.  The orthotic is made from an imprint of the persons foot.  The imprint is usually done by the person pressing their foot into a foam that retains the imprint.  Then it's sent out to a lab that creates the orthotic.

Now let's just think about this for a moment and reflect on this technique.  OK, are you done reflecting?  What did you conclude?  This is my conclusion and it comes from years of experience as an applied physical therapist, physiologist, elite competitor, and from many, many, many case studies as a Doctor of Physical Therapy.  The problem with this technique is that the imprint taken is an imprint of an injured foot.  It's a mirror image of the problem!  There was no consideration taken into account to possibly "customizing" the orthotic to correct the mechanics of the problematic foot.  The only thing that the orthotic accomplished is to keep your foot in the same position in which it orginally was when the foot pain initially began.

So, I'm not going to only point out why this technique of making an orthotic can be problematic.  I am going to tell you the correct way to make an orthotic.  First, if possible, make an imprint of the problematic foot while during the single leg stance phase of the running or gait pattern.  Then adjust the orthotic so that when the foot is in full contact with the orthotic, it promotes the correct mechanical operation of the foot during the single leg stance phase during walking or running.  However, this then creates another problem.  How would a person get an imprint when running?  I have some ideas but their not really workable.  The best way is to have an experienced physical therapist observe you running, oh let's say on a treadmill!  It would be great if the person was video taped while running.  Then the therapist could go frame by frame and analyze your mechanics from torso down and identify any abnormalities or areas in which need changing.  Then, from the therapists extensive experience, devise an orthotic appropriate for you that works on the "contact cue" principal!

Let me explain the contact cue principal.  In my opinion, orthotics really work via what is called "contact cueing".  This means that the contact of the orthotic promotes a different way of stepping, walking, or running.  This in turn causes different or the desired muscle groups in the foot or leg to begin working in the appropriate manner.  Remember, plantar fasciitis is usually a product of weakness somewhere in the leg or foot.  If the weakness is not addressed, then the muscles that are working in the place of the weak ones will eventually become overworked and stop supporting you they way they previously have or should have.  Then, the force of the gait cylce is  transferred onto the plantar fascia.  Once the plantar fascia becomes overworked, the inflammation of the fascia begins.

So, who do you go to in order to get the correct orthotic?  My advice is to wean yourself out of the orthotic.  Get advice from a phyical therapist that has extensive experience in gait mechanics!  And whatever you do, don't waste your money on the Dr. Scholls consoles!  In my opinion, this is purely a money maker for them using your ignorance about orthotics.  Don't let their propoganda reel you in!  Our feet are the way they are because they are made to your bodys' order.  The easiest fix is to get up off the couch and get your legs and feet moving the way they were intended to!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM.

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