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Choosing the right custom foot orthotic for overpronation

Are you a runner and have not had success with custom orthotics in the past because they were uncomfortable and too rigid?  If so please read on and learn about the best material that Sports Podiatrists can use so that your orthotic is comfortable as well as provides the correct amount of support.

Q: What materials are available for orthotics and which are the best?

A: : In order to understand why certain orthotic materials are typically recommended by podiatric physicians, it is important to understand the fundamental goals in orthotic therapy. The purpose of the functional orthotic is to accurately and precisely position the foot throughout the gait cycle so as to promote proper function. Its function is not merely to support the arch, as is often the case with commercial appliances or arch supports purchased in retail stores. The functional orthotic is prescription fitted and is very effective in alleviating symptoms and establishing proper alignment. In order to achieve the desired and expected results from the use of functional orthotics, several steps must occur. First, a detailed range of motion and muscle testing examination is performed by your podiatrist. The purpose of this is to measure and quantify the motion of all lower extremity joints, identify abnormalities such as excessive laxity or limitation of motion, and determine the weightbearing and non-weightbearing functional positions of these joints. The muscle testing portion of the examination is performed in order to determine muscle groups which may be excessively weak or tight and to determine their part in the overall cause of injury, symptoms or biomechanic problem.

Following the examination, a non-weightbearing neutral position cast or three dimenstional image of the foot is taken. The specific method of casting or imaging is critical and must be done accurately in order to achieve an accurate impression of the foot in its neutral position. The negative casts or three dimensional image (email) are then sent to an orthotic laboratory accompanied by a prescription written by your podiatrist indicating not only the specification of the foot pathology that needs to be addressed, but also the materials to be used and the dimensions and accessories to be used in the manufacture of your functional foot orthotics. The manufacture of functional foot orthotics is thus a multi-step process involving detailed and intricate cast correction, orthotic fabrication and application of additional items prescribed by your podiatrist for the treatment of your specific condition.

In order to achieve the desired results, the functional foot orthotics must be made from materials which have the ability to resist the pathologic symptom-producing forces which have ultimately produced the injury. Typically, plastics or graphite are used, both offering a range of flexibilities, designed to appropriately resist abnormal injury-producing forces while allowing comfort and compliance so as to be compatible with the sport. The plastics that are used are generally made of a family of materials called polyolefins, the most common being polypropylene. The thickness of these materials ranges from 1/8" to 1/4". These materials range from quite flexible and compliant to relatively rigid. Graphite also ranges from quite flexible to quite rigid and is generally one-half as thick and one-half as heavy as orthotics made from polyolefin materials. The flexibility, or compliance, of an orthotic is a subjective choice determined by the requirements of your sport and the degree of rigidity required to resist the abnormal forces resulting in injury. Highly flexible devices are used when the forces imposed are relatively minor or the requirement of the sport mandates a compliant device. However, these materials possess shorter life spans due to the cyclic fatigue inherent in an orthotic device that has a high degree of flexibility. More rigid orthotic devices are used when more significant forces are present or the sport of choice is compatible with the more rigid device. More rigid devices have the advantage of being quite durable and can often last for many years without modification or adjustment. Typically, stop-start complex motion and/or cutting sports (ie. soccer, basketball, aerobics, tennis) require more compliance in an orthotic device, while repetitive-motion sports such as walking or running are quite compatible with more rigid devices.

Soft materials such as Neoprene, various open- and closed-cell foams or similar cushioning materials may be used in conjunction with functional foot orthoses to provide both support and comfort. A patient should always discuss these options with their podiatrist and even entertain the possibility of having more than one pair of orthotics using materials of different flexibility and/or covers as determined by the requirements of their sport, the constraints of their shoe gear, and their overall comfort.

Successful orthotic treatment should always include an orthotic device that is effective in reducing eliminating symptoms and is comfortable to wear. By selecting the appropriate flexibility material and cover material, both of these goals can generally be achieved.

Our foot specialists at Carolina Foot Specialists are active athletes that have experienced a majority of the foot ailments that patient's present with in the office. When custom foot orthotics are dispensed a detailed plan includes the proper break in period  as well as a plan to get patient's back to their chosen sporting activity. We have a policy where orthotics can be refurbished or remade within a six month period of time if required to insure that our patient's are please with the custom orthotics  that they have received.

For more information of a variety of foot conditions please refer to our website at www.carolinafootspecialists.net

Our foot specialists at Carolina Foot Specialists see a larger number of patients who have bunion and tailor bunion deformities. We would like to ease your anxiety if you feel as if you have a bunion deformity and talk about how you get them as well as all conservative and surgical treatment options in the next few blogs this month.

Bunions are typically an inherited condition and is more often found in women. Bunions can become larger over time and become painful in tight shoe gear such as a high heel shoe. A bunion and a tailor bunion is a prominence on the inside of the foot (head of first metatarsal with great toe deviating in) and outside of the foot (fifth metatarsal head deviating out). A majority of our patients that we see have bunions but do not have pain. Half the battle is selecting proper shoe gear that has a wider toe box. Upon your first visit we will take digital x-rays to not the angular position of the bunion and discuss a conservative treatment plan to try to avoid surgery and slow the progression of the bunion.

If surgery is needed techniques have changed over the years which affords the patient to be weight bearing in a surgical shoe or boot following the surgery in most cases. Our foot specialists use internal screw fixation which allows patient to begin weight bearing right after surgery. The surgery is outpatient under local and IV sedation and takes about 45 minutes to an hour. Healing time is 6-8 weeks and patients are followed weekly during until the bone has healed. Detailed programs to resume light activity is reviewed with our patients. Bunion surgery would be the most common surgery that our foot specialists perform at Carolina Foot Specialists.

We have a nice video on our home page that discusses bunion surgery for your information.

Please contact our offices if you have bunions or tailor bunions. If the bunions are asyptomatic it may be good to at least get a baseline x-ray in order to evaluate the progression of the bunion in the future.

Look out for more blogs about Bunion surgery in the next few weeks.