Orthotics 101: The prescription for proper foot alignment

Credit: Nathan BIlow/Allsport
An orthotic is an insert for the shoe, manufactured to exacting specifications of the foot (usually from a cast).

The purpose of an orthotic is to alleviate foot pain; control or correct abnormal gait biomechanics; accommodate sore, inflamed or calloused areas of the feet; add control of high-impact movements for the competitive athlete; provide better support for the geriatric patient; and/or alleviate back or knee pain due to misalignment.

What is biomechanics?
Biomechanics is the application of the principles and techniques of mechanics to the human body in motion. Biomechanics addresses the structure and function of the segments of the feet as they relate to each other and to the legs, hip and spine.

Why is the foot so important to proper biomechanics?
The foot is a highly complex structure consisting of 26 bones designed to balance and propel the rest of the body. At first, the foot is a loose bag of bones capable of being placed on any surface while still maintaining the equilibrium of the leg and body above. At heel strike the foot must act as a shock absorber, then a mobile adaptor, helping to move a body across the ground. Then it must be capable of locking itself into a rigid structure so that it can act as a lever, first to stabilize and lift the bodys weight, then to propel the person forward.

In a normal foot, these two functions occur at specific times within the cycle of your walking or running activity. If the timing is off, the bodys weight and stress enter the foot at a time when it is not prepared to receive it. Therefore, the foot is not stable; bones move in abnormal directions with abnormal forces magnified into the knee, hip and back. The result can be muscle fatigue, internal inflammation of tissues, and/or postural discomfort.

Without the support and proper function of your bony architecture, you rely on the soft tissues and tendons to hold you up. As breakdown occurs in an effort to tolerate ongoing stresses, the bones of the feet and legs can actually change their shapes and positions. To halt or possibly reverse the changes occurring in the body, feet should be made to function as closely as possible to what is known as a neutral position.

What treatment is available to improve your biomechanics?
Strengthening and stretching muscle imbalances, altering training routines or shoe gear are often prescribed to improve the way a person moves during athletic or daily activities. If your feet have been compensating over time, an orthotic device worn inside the shoes can maintain the proper foot and leg relationships for improved function.

Adjustments made by your forefoot, rear foot and leg against the ground can be controlled through the use of an orthotic device that allows the normal motions of gait to take place in their proper sequence. By wearing custom orthotic devices prescribed precisely for your problems, foot function will be more optimally controlled, allowing you to function in a better position. Normal leg and upper body movement can occur without stress, and your body will no longer compensate to help you with propulsion. Orthotics permit control of foot function and help to slow down deterioration of your skeletal structures.

Will a foot orthotic improve activity performance?
The use of an orthotic device as part of a total treatment for biomechanical dysfunction is as important as orthodontics for mouth rehabilitation or eyeglasses and contact lenses for vision correction. An orthotic device prescribed for individual needs should improve body efficiency and the efficiency of daily, athletic, occupational or recreational performance. Stress on feet and legs can be minimized with added foot stability, and certain injuries or pains can be prevented.

What is the difference between a store-bought orthotic and a prescription orthotic?
Some drugstores and sporting goods stores offer devices for consumers that sometimes help to alleviate painful symptoms. Self-treatment with store-bought devices can provide hit-or-miss pain relief because they are not specifically prescribed for one persons problem. However, a prescription orthotic, developed from a cast of your own foot, will yield precise control over gait and function.

How long do orthotic devices need to be worn?
Once orthotic devices are prescribed, it is likely that they will be worn for the rest of your life. Think of orthotics in the same way as you think of eyeglasses. Eyeglasses are prescribed because of abnormally shaped eye lenses or corneas. The same applies to foot orthoses, which help to control a functional deficiency in your body. While orthotics often are utilized for rehabilitation from an injury, they are most often utilized to maximally control abnormal foot/leg function. Therefore, it is likely they will be worn forever.

Often it is not just the fitness activity that requires an orthotic to control foot and leg function, but also everyday wear. Orthotic devices may require periodic adjustment. A foot-care specialists examination will determine if there will be changes. Childrens orthotics should be changed to accommodate the growth of the foot and should be worn throughout the active growing years. Those who wear orthotics as children will preferably wear them for life.

Can injuries be avoided or minimized?
Many elements and stresses affect the biomechanical functioning of the body. Some stresses can be reduced or avoided by taking the following precautions:

  • Always warm up before and cool down after any sport or recreational activity.

  • A functional orthotic is only as good as the condition of the running shoe in which it is worn. Buy athletic shoes from a reputable store where they will be properly fitted and sized.

  • New athletic shoes should be broken in gradually by walking in them for a few days. They should only be worn for about one-third of the usual workout when they are new.

  • See your foot-care specialist for biomechanical evaluation to determine if your foot is compensating for a foot, leg or postural function problem.

  • Listen to your body. Pay attention to the signs of stress or pain.

    Julie Snowden, PT, MHS, OCS, is a physical therapist in private practice at Parrott & Associates, PSC, in Louisville, Ky. She is a board-certified specialist in orthopedics from the American Physical Therapy Association, and can be reached at julie@worksense.com

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