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Custom Foot Orthotics

| Definitions | Frequently Asked Questions | Casting |

Our Philosophy on Orthotic Therapy

The use of a custom arch support is a non-invasive way to reduce or eliminate pain in areas such as feet, ankles, knees, hips and lower back by improving structural alignment and/or restricting or enhancing motion. However, they do not take the place of any strengthening or stretching exercises recommended by your healthcare practitioner. Orthotics can be used to treat a variety of injuries and often work best in conjunction with other therapies such as physiotherapy, stretching, icing, and massage.

What is a custom orthotic?

A custom foot orthotic is a custom-made three-dimensional insert that is placed in your shoe. They can be used to relieve pain, improve skeletal alignment or improve the function of your foot and lower limb. Orthotics work to support and re-position your feet. Like eyeglasses, they help us while we are wearing them. Orthotics generally will not permanently change your anatomy and will function only when you are standing or walking on them. Orthotics allow us to maintain our lifestyle and activities, while reducing the symptoms. Orthotics are commonly used to relieve symptoms of common injuries, such as plantar fasciitis, metatarsalgia, neuromas, and various foot and ankle tendon injuries, as well as helping individuals with diabetes or arthritis.

custom foot orthotic

What do orthotics do?

Depending on the design, orthotics can cushion and support your foot by redistributing the pressure areas on your feet.

Improper foot function and weight distribution of the lower extremities is often the cause of many foot, lower leg, pelvic, back and neck overuse or stress injuries. By improving the alignment the body is able to function more efficiently with less stress on the muscles and ligaments that hold you together.

They can also be designed to support and improve the alignment of the bones in your feet and legs. Many different styles and types of orthotics can be designed in order to alleviate various types of pain in the feet, knees, hips and lower back. These can range from soft flexible types to very rigid types.

Some orthotics are made to control abnormal foot function, re-establish proper weight distribution and overall biomechanics by not allowing the foot to fall out of subtalar neutral position during gait. This is achieved by first obtaining a neutral position plaster cast mold.

CONSUMERS BEWARE!! Orthotics are often over prescribed or made by non-certified, non-medical providers. Contrary to popular belief, not everybody needs a custom product. A Certified Pedorthist is educated in the anatomy, structure and biomechanics of the lower limbs as well as orthotic prescription and is therefore able to assess properly a client's individual needs.
It is important to have your foot and shoes properly evaluated prior to getting orthotics. Beware of companies that provide only one type of orthotic. It may not be right for you.

See the Pedorthic Association of Canada's Position Statement on Over-the-Counter Insoles vs. Custom-made Orthoses

over-the-counter orthoticOrthotics are often prescribed as a method of treatment for an injury. Orthotics will help you to recover from the injury. Once the injury has healed, orthotic use may need to be continued, in order to prevent the injury from recurring.

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Frequently Asked Questions

How will the orthotics feel at first?
When you first wear your orthotics, it is normal for the orthotics to feel strange; however, properly fitting orthotics should not cause any new pain, blistering or redness. If this does occur, remove the orthotics and make an appointment with your pedorthist for an adjustment.
Although symptomatic relief will not usually occur over night, consistently wearing your orthotics for a period of time will realign your foot and allow healing to occur.

Can my orthotics be adjusted?
Pedorthists are able to adjust your orthotics. If your orthotics do not feel comfortable or cause new pain or blisters, you may need an adjustment. Our facility has the equipment and materials to do all adjustments. For orthotics purchased at Sole Decisions, adjustments are free of charge within the first three months. After three months or for orthotics purchased elsewhere, we charge a nominal fee to cover material and labor.

How do I take care of my orthotics?
To clean your orthotics, wash with warm or cool water and mild soap, pat and/or air dry. Do not expose them to high heat.

How long will my orthotics last?
The body of our orthotics should last one to five years for adults and depending on wear, you may need to replace the top cover and other additions periodically.
After three to five years if your original symptoms return or you develop new symptoms, you may need a new pair of orthotics.
Children and adolescents' orthotics should be replaced after their feet grow 1 to 2 shoe sizes. We will ensure that their new orthotics will last at least one year.

Can my orthotics be repaired?
As orthotics compress and wear out over time, your activity level and body weight directly relate to the life of your orthotics. The life of your orthotics may be extended by repairing replaceable components, such as top covers, extensions, cushioning, posts, and metatarsal pads. Fees for repairs vary according to amount of material and labor required.

What shoes can I wear my orthotics in?
Your orthotics are only as good as the footwear you put them in. Proper footwear selection and fit is vital to the success of your orthotics.

Can I Wear Orthotics With Any Shoes?
Orthotics can be designed for virtually any shoe type but are usually designed with a particular shoe type in mind, depending on your needs, and as such should work well with shoes of similar style. If an orthotic is designed for running shoes, it will not fit properly into a heeled shoe. Sandals also restrict orthotic use, as the orthotic is not secure without a closed shoe unless it was designed for a removable insert.

Do They Transfer From One pair Of Shoes To Another?
Yes, they are removable and transfer nicely between similar pairs of shoes. On occasion you may require a second pair to use in some footwear, such as high heels, loafers, and ski boots, for example.

Will I Have To Wear The Orthotics For The Rest Of My Life?
Chances are that when your pain is resolved, you will be able to go without them, but once you are accustomed to the great support they provide you may miss them! Some individuals are advised to wear them indefinitely because the orthotics correct their gait and prevent problems from recurring.

HOW MUCH ARE THE CUSTOM-MADE ORTHOTICS?
Prices are competive and available upon request. There are no taxes on custom-made devices.

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Casting

Patient Assessment to Fitting

Julie's clinical assessments take approximately 45 minutes. If she determines orthotics can help she creates a three-dimensional cast of the patient's feet. From this cast, Julie creates orthotics from her London Lab. Once finished she meets with the patient again for a follow up appointment and fitting. Julie will also lend her expertise on over the counter (O-T-C) orthotics for those who do not require custom orthotics or do not have insurance coverage to cover the cost of custom-made. Julie will offer consultation regarding O-T-C Orthotics and their modifications.

After a thorough physical, biomechanical and gait assessment, a casting technique must be used to capture the foot. The method of casting is critical to the success of the orthotics. There are various ways to accomplish this. There are many different casting techniques used to obtain a 3-D image of a foot. Each casting method has advantages and disadvantages and your pedorthist will determine the best method for you.

Once the total-contact orthotic has been fabricated, a detailed fitting takes place to assure that it meets all prescription requirements. This fitting is also important to make sure that the orthoses is comfortable. At this time, a follow-up visit is scheduled and any necessary adjustments are performed. Our Certified Pedorthist uses years of experience and pedorthic knowledge to provide the best fitting, most accommodative device possible.

Casting/Moulding

custom casting orthotic

At Sole Decisions we fabricate custom-casted orthotics by 3 methods: plaster slipper, fiberglass slipper and impression foam box.

  1. Hands cast using a slipper plaster casting technique with the subtalar joint in neutral. By capturing the correct foot position in the cast this technique is superior to all others. This is usually taken non-weight bearing. When done weight bearing or semi-weight bearing you get more tissue deformation and may lose rearfoot to forefoot alignment. Plaster slipper casting involves applying plaster directly to the foot in order to capture the contours and shape of your foot. The casting will be done with you lying down on your stomach or seated with your foot in the air. This is a non-weight bearing technique and takes 5-7 minutes.Foam box impression

  2. Fiberglass slipper casting is similar to plaster except that it is less messy and time consuming as it is in a sock not fabric roll format and leaves no residue on the client's foot since a bag is placed over the foot first.

  3. Foam box impressions involve pushing the foot into a foam box either from a standing or seated position. This can be a semi-weight bearing or full-weight bearing technique often used if someone cannot get on a table for plaster casting or if a less aggressive (more accommodative) shell shape is desired such as for severe arthritics or diabetics (sores on foot). This technique is used for clients with no forefoot to rearfoot misalignment.

What about computer-generated or "Dynamic Orthotics"?

"Bells and Whistles" Although to the general public these high-tech systems may look impressive, all they are really doing is playing on their perception of what a computer can do these days. Some methods do not give a 3-dimensional image of the foot in a non-weight bearing subtalar neutral position in which to manufacture a corrective device. If the information is based on a two dimensional image of a foot that has already failed biomechanically there is no mathematical equation in existence that will take this data and transform it into a three dimensional image of the foot in a non-weight bearing subtalar neutral position. It is this neutral position that is the essence of a truly corrective custom foot orthoses. Therefore some computer-generated orthotics are not always custom moulded.

There are some systems that are contact digitizing such as the Amfit, CAD-CAM system which is used full-weight or semi-weight bearing a 3-D presentation of the foot is captured from elevated sensors against the foot in a static situation. This can work well since modifications to the mould can be made and evaluated for success prior to manufacturing. There are some limitations to material types that can be used though since the mill is limited by what it can grind down and it is not a complete total-contact due to spaces between sensors. The use of laser scanning with multiple lasers, a newer invention to create an electronic 3-dimensional image, is evolving and will likely be capable of equaling the flexibility of slipper casting in the coming years. This system eliminates messy plaster and removes the need to modify models by hand prior to orthoses fabrication.

Some computer generated orthotics use an injection moulding method to mass-produce a variety of prefabricated shells such as orthotics made for you from inkblots at Home Shows. These prefabricated products may then be slightly modified or "customized" to mimic the look of a custom moulded orthotics. These orthotics may well help alleviate mild symptoms and feel generally comfortable. But you should be cautioned on the expense of these devices as they are not a truly custom device and may have the same therapeutic affect as a much less expensive off-the-shelf arch support. These types of arch supports are generally made of a fairly flexible rubber-like material and claim to be custom to your feet. They are however, massed produced products providing little more support or benefit than a non-custom insole. All the modifications and adjustments will never make them a truly custom moulded orthotic. Some insurance companies will not cover these types of devices - check your policy.

Dynamic orthotics are usually produced from the information produced when you walk across a pressure sensitive pad such as when using the Footmaxx system. This means that the images are taken in a weight bearing position and therefore captures an image of your foot when it is already compromised in function - already pronated or supinated - the position that may be contributing to your symptoms. Ultimately this is a 2-dimensional image derived from where you foot makes contact with the mat. The computer uses algorithms to best estimate the actual shape of your foot. It does not in fact know whether the arch of your foot is 1mm or 10mm off the ground. Though sometimes the orthotic made from this system is sufficient enough.

While several methods exist for making orthotics, including some that are computer generated, the majority of foot care professionals consider the plaster slipper cast taken with the foot in a non weight bearing position, to be the gold standard. However a poorly taken slipper cast is not superior to a well-taken cast of other means. Any casting method can be satisfactory in skilled hands however, and alternative casting techniques are often superior in specific conditions.

Position Statement on Casting Techniques for Custom Foot Orthoses

Advantages of slipper casting in non-weight bearing are:

  1. The non-weight bearing foot does not capture its structural defects: for example if the arch flattens excessively (hyperpronation, pes planus) then this occurs when the weight is on the foot. This is why most of us believe that our arches are fine - we look at them when there is very little weight on them, for example when we are sitting.

  2. Precise positioning of the foot: the pedorthist can hold the joints including the ankle, subtalar (below the ankle), midtarsal (bones in the middle portion) and the forefoot. Positioning the forefoot up or down can increase or decrease the height of the arch and the overall correction of the foot. Most other casting methods cannot provide this degree of flexibility of "intrinsic " cast correction.

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