The term “orthotic” is defined as an external device used to modify function of a body part. It generally applies to professionally made or prescription devices but is also used loosely by non-medical personnel to define a large range of over the counter products.
True prescription custom are designed to modify foot and ankle function and are available from podiatrists or similarly trained practitioners. Most over the counter foot inserts tend to be arch supports and may be sold at retail outlets. Many people can benefit from a store-bought arch support but need to realize that such items are never custom devices.
Prescription orthotics may have a number of components designed to modify foot function and gait. Some of the more important components are known as posts which are angular wedges incorporated into the orthotics to change the way in which the foot contacts the ground. Orthotics may include arch support but that is often not a major part of the . Other components incorporated into prescription foot orthotics may include apertures designed to remove pressure from painful areas or flanges which come up along the side of the orthotic and designed to stabilize the foot. We utilize over 58 different potential orthotic modifications to help the orthotic improve foot function.
The foot orthotic prescription is based on a biomechanical exam performed by a specialist. Podiatrists are specialists who are trained exclusively in the diagnosis and treatment of foot and ankle disorders and have years of training in biomechanics of the lower extremity along with courses in orthotic design and fabrication.
The prescription and fabrication of custom foot orthotics is process that involves a number of steps:
- A biomechanical exam to identify the underlying causes of foot/ankle pain or dysfunction.
- The podiatrist makes a mold of the feet while manipulating the foot/ankle into a corrected position. That position is different from patient to patient and is based on the changes in foot mechanics prescribed. Such a mold cannot be made with the patient standing as that does not allow the foot to be placed in a corrected position.
- A prescription is formulated which tells the orthotic lab what changes need be made to the foot mold or impression. Such molds are generally made using plaster of paris or fiberglass casting material.
- The casts and prescription are sent to an accredited professional orthotic laboratory. The lab will then create a corrected model of the foot based on the casts and prescription.
- The lab molds the orthotic material such as plastic or carbon-graphite over the corrected model then adds additional correction to the orthotic such as posts/wedges and other prescribed correction. The lab sends the final prescription device to the practitioner.
- The podiatrist/practitioner fits the orthotics to the patient.
- The practitioner evaluates the therapeutic effect of the orthotics including changes in gait and foot/ankle function after several weeks and makes modification to the prescription orthotic device as necessary to achieve optimal results. This can be one of the most important steps in the process.
- It is important not to look at prescription orthotics as a process more than a device.