Foot specialist: November 2012

This article will help you understand:

- What Orthotics are

\"Foot Specialist\"

- Different types of Orthotics available

Orthotics, Orthotic Insoles - How They Help Relieve Aches and Pains

- Difference between Orthotic Insoles and regular Footbeds

- How Orthotics work

- Which common ailments can be treated with Orthotics

What exactly is an 'Orthotic'?

An Orthotic is a generic name for Orthotic Insoles/Shoe inserts or Orthoses used as a device that can be placed inside shoes to correct and restore the normal function of our feet. Improper foot biomechanics are responsible for many complaints such as heel pain, knee pain, and lower back pain.

Biomechanics is the science of movement that studies motion during walking, running, and sports.

Over-pronation is the term used to designate poor foot biomechanics. It makes your foot arch drop or flatten while the feet and ankles roll inwards. It is anticipated that nearly 70 percent of the population suffer from over-pronation.

Orthotics correct this over-pronation effect by restoring the feet and ankles to their normal position desired for natural foot functioning. The procedure not only alleviates foot problems but also gives relief to various other functions of the human body.

What are the different types of Orthotics available?

Generally speaking there are 3 different types of Orthotics. These are:

1) Custom-made (rigid) Orthotics

For patients suffering from more serious biomechanical disorders the custom-made (rigid) Orthotics provide a better solution. The devices are only available from a Podiatrist. Over-pronation is the most common ailment most people suffer from. Conversely, the opposite of 'pronation' is 'supination'. People suffering from this manifestation find their feet roll outwards or 'supinate' and the arch stiffens up remaining high as the foot makes contact with the ground. The deformity affects a mere 5 percent of the population and is called a Cavus or High Arch Foot. Supinators need custom-made Orthotic devices that correct the malfunction.

Persons who suffer from other deformities like large bunions, foot ulcers or completely flat feet also need to consult a Podiatrist.

How Does a Podiatrist Perform?

After initial diagnosis the Podiatrist decides on a 'customised' prescription orthotic. This is followed by a plaster cast of the patients foot (namely a negative or 'female impression') after which the initial cast is sent to the Orthotic Fabrication Laboratory to process further. From this mould a positive or male impression is formed by pouring plaster and the result is an accurate copy of the underfoot. The Orthotist or Orthotic technician fabricates the custom Orthotic that includes all the adjustments as prescribed by the Podiatrist. Now the rigid or semi-rigid Orthotic device is ready for use by the patient. Though these are very useful devices many patients find the use cumbersome and do not easily get used to the Orthotic.

2) Heat-mouldable Orthotics:

Heat-mouldable Orthotics are cheaper alternatives to expensive customised Orthotics that can cost 0 - 0 per pair. They are standard 'off-the-shelf' flexible devices made from medium density EVA material. The device can be heated to slightly alter its shape. Sometimes, wedges are added for a more customised result. Heat-mouldable Orthotics cost around 0 to 0 and are much easier to get used to than custom rigid Orthotics.

3) Pre-fabricated 'off the shelf' Orthotic:

Pre-fabricated Orthotics are soft-medium density shoe inserts available from pharmacies, on-line specialist websites, and some physiotherapists or chiropractors. People will get used to such Orthotics almost immediately and the cost ranges from to per pair. Research has shown that for 80% of people suffering from over-pronation, a pre-fabricated Orthotic will provide sufficient correction. Also after a few weeks of wear, these types of Orthotics will customise to the wearer's foot shape as a result of body weight and body heat. Most pre-fabricated Orthotic are made from EVA, a flexible material that supports the foot without hurting the arches. Especially children and elderly people benefit from a softer type of Orthotic since they cannot tolerate anything hard under the foot.

What is the difference between orthotics and regular footbeds?

There is a large difference between Footbeds and Orthotics! Regular Footbeds are purely designed to provide a cushioning effect and shock absorption. At first they may feel comfortable however footbeds do not effectively address any biomechanical problem since they do not correct over-pronation. Whereas orthotics are functional devices designed to correct and optimise our foot function. Some footbeds also feature an arch support though it may be too weak to have any appreciable effect. This is especially true if the material of construction is very soft and rubber-like.

How does an Orthotic exactly work?

First of all orthotics do a lot more than just supporting the arches. They realign the feet and ankles, restoring faulty foot function. Additionally, orthotics provide even weight distribution and take the pressure of sore spots from heels, ball of the foot, corns and between toes, and bunions. Though it is not their main purpose, the orthotics do provide some degree of shock absorption as well.

The main purpose of an orthotic insole is to improve the foot function and in many cases it will reduce pain and will help prevent future problems and injury.

There have been suggestions from various quarters that the use of Orthotics may weaken the foot muscles. According to a recent research paper from Australia "there are no reasons to doubt any decrease in muscle activity even after four weeks usage. Therefore Foot Orthoses users may not be worried through these unsupported statements."

What ailments can orthotics be used for?

Years of use has proven that most foot complaints will respond favourably to treatment with orthotics. These devices are found to be very effective for treating heel pain, heel spurs, Plantar Fasciitis, pain from bunions, callous and corns, Achilles Tendonitis, Ball of Foot Pain and Morton's Neuroma.

Our feet are the foundation of our body. Many problems in the legs, knees and back can be attributed to poor foot biomechanics. Therefore, orthotics can be very useful in the treatment of shin splints, knee pain and lower back pain. This is the reason that many physiotherapists and chiropractors have started using orthotics.

Over-pronation of the feet is the cause for the lower leg to rotate inwards and the pelvis to tilt forward - in turn putting a lot of strain and stress on the legs, knees and back. Orthotics corrects the problem of over-pronation and therefore greatly reduce internal leg rotation and forward pelvic tilt.

A study from the USA "identified the nature of a person's walk as a source of chronic lower back pain," The study further showed more than a fifty percent improvement in alleviation of back pain after wearing orthotics.

Sources:

The Journal of American Podiatric Medicine May 1999, Sobel E, Levity S T,Caselli MA Division of Orthopedic Sciences,New York College of Podiatric Medicine

Vol. 94 Number 6 542-549 2004 Journal of American Podiatric Medicine

"The Conservative Management of Plantar Fasciitis"- Pfeffer GB , University of California, San Francisco, CA.

"Chronic Low-Back Pain and Its Response to Custom-Made Foot Orthoses" HOWARD J. DANANBERG, DPM, MICHELLE GUILIANO, DPM

Orthotics, Orthotic Insoles - How They Help Relieve Aches and Pains

Peter Van Dyke is a Dutch foot specialist and orthotist with a special interest in heel pain, knee-pain, low back pain and orthotics. He gives advice on effective remedies to help relieve aching feet and prevent further problems. He also works closely with a number of large orthotics manufacturers in Europe, the USA and Australia.

Blue toe syndrome is the bluish discoloration to toes as a result of tissue ischemia (lack of blood flow). The syndrome is caused by the blockage of small vessels that lead into the toes. One or more toes may be affected; in severe cases this can also manifest itself as a multi-organ problem.
There are a few causes of blue toe syndrome but the most common is the breakage of a small piece of arterial plaque usually from the abdominal aorta-iliac-femoral arterial system (located in the abdomen and groin area) which then travels down the arterial tree into the small vessels of the foot where it becomes lodged. This is known as an embolism. All tissue distal (in front of) the blockage will then turn a bluish color which represents a lack of oxygen to the tissue.
Generally patients are in their 40s, 50s, 60s, and older. The condition can occur insidiously or may be the result of abdominal surgery or an invasive vascular procedure or test.

The affected toes become cyanotic but there are other etiologies such as trauma, connective tissue disease like Scleroderma, hypercoagulability of blood as seen in polycythemia vera , atrial fibrillation and Raynauds phenomenon. In Raynauds the fingers will usually also be involved and this generally occurs in younger patients without any known history of atherosclerotic disease.
At the local level, blue toe syndrome may occur in diabetic foot infections and those who have undergone foot surgery.

\"Foot Specialist\"

Blue toe syndrome is easily misdiagnosed because in most cases the larger arteries of the foot are palpable and that directs the doctor away from a diagnosis of occlusive disease.
Treatment is geared towards alleviation of the blockage further up the arterial tree through stenting, bypass surgery, or anticoagulant therapy. Vasodilator drugs have no proven effectiveness in treatment of this condition, since this is not a vasospastic disorder.
Mild forms of the disease which affect just the toes have a good prognosis and usually subside on their own. It should be noted that sometimes the pain in the toes is disproportional to the extent of involvement of the toes and adequate analgesics should be prescribed. Multi-systemic forms where the kidney is also usually affected, the prognosis is more dubious.
In the foot, should the condition not resolve itself there is always the possibility that the condtion will worsen to gangrene and subsequent amputation of the affected toes.

Blue Toe Syndrome

Dr. Mitnick is a foot specialist with over 25 years of clinical practice treating conditions of the foot, ankle and lower leg. For more information visit www.foot-pain-explained.com