CUSTOM
ORTHOTICS
By: Corinne Gehegan, DPM
Custom orthotics are inserts that are placed in shoes and sneakers
that should ultimately correct the alignment of the bones and joints of
the foot. This subsequently improves the function of the muscles,
tendons, ligaments, and fascia and addresses areas that are under excess
pressure. There are several factors that distinguish custom orthotics
from prefabricated devices. Aside from the fact that an exact mold is
taken of the patient’s feet, additional distinguishing factors include
the durometer (hardness/stiffness) of the material used, the degree of
cushioning, the length of the orthotics, the depth of the heel cup, the
location and extent of posts (wedges) if any, and other specialized
features for specific needs.
A consultation will allow the patient to explain the history of the
complaint and allow the doctor to examine the lower extremity both on
and off weight bearing as well as the individual’s gait cycle. The first
determination is whether or not a patient actually needs orthotics. It
is important to bring any over the counter or custom orthotics that have
been used in the past. It is also advised to bring in pairs of shoes and
sneakers that are typically used. Sometimes a patient’s current pair of orthotics only need to be refurbished or simply adjusted.
There are many ways to create an impression or mold of the feet. Once
the mold is made it is sent to an orthotic laboratory for manufacturing
along with my prescription to address the patient’s specific needs. Many
technologic advances have allowed patients’ feet to be scanned. The scan
will exhibit patterns of pressure distribution. The data can be
transmitted electronically to the laboratory. I prefer to use plaster
and manipulation techniques that place the feet in a corrected position.
I also prefer to rely upon the patient’s history and my clinical
examination which includes observation of callus/corn patterns, presence
of deformities such as bunions and hammer toes, arch height, muscle
testing, range of motion of joints, overall biomechanics and gait
analysis.
Custom orthotics are used to treat many conditions such as
pes planus (flat feet), pes cavus (high
arches), plantar fasciitis,
tenosynovitis/tendonitis, neuromas,
apophysitis (growing pains), diabetic related foot problems,
knee/hip/back pain, and shin splints. Custom orthotics may not be the
only ingredient in managing a patient’s complaint. Modifying shoe style
and physical therapy may also be required. Prescription medication and
injection therapy could be indicated as well.
Custom orthotics are not typically covered by insurance plans. In
cases where a plan does cover orthotics, the cost may be applied to a
deductible. However, orthotics can be used for many years and most
laboratories allow a time frame within which the orthotics can be
tweaked or adjusted. The doctor may suggest that a patient try a less
expensive, prefabricated device as a trial before committing to a pair
of custom orthotics.
Article written by Dr. Corinne Gehegan
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