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Orthotics
Strictly speaking any device used to straighten or support a body part is an orthotic; however, in general usage it is an under-foot brace to make the motion of the foot more true or correct. I tell my clients that it is “a front end alignment” on the foot!

Ordinarily this device slips inside the shoe, replacing the molded foam footbed that came with the shoe, and typically transfers from one pair of shoes to another. Not only is more aggressive orthotic therapy more effective in successfully dealing with structural foot problems, but surprisingly it is, in my experience, usually more comfortable, than less aggressive devices. It does not work out to half fix a foot problem.

Orthotics for feet have only been in common use for 40 or 50 years. Originally they were called “arch supports.” Now they have a more descriptive name. Prior to the use of orthotics, this work for feet was primarily done by alterations to shoes and boots, and back then you saw all kinds of alterations to the heels and soles of shoes, that required the expertise and equipment of a shoemaker. When orthotics came into common usage, it was deemed “easy” work, because all the practitioner needed to do was to have the client step into impression foam, make plaster positives and shape leather over them. The heavy, dirty equipment previously needed to make shoe alterations was no longer needed. This new work could be done in a lab, not a workshop: make impressions, make plaster positives, shape the leather (later plastic), slip the devices into the shoes and collect your fee. Easy as that.

No, not as easy as that! If the practitioner has the client step into the impression foam, he is simply replicating the motion that has been causing the pain or problem. The practitioner needs to evaluate and understand the erroneous motion of the foot, see the chain of compensations being made, and then capture the foot making the correct or needed motion. In most cases this is all about faulty (less-than-perfect) skeletal structure that is genetic, times the thousands of steps taken in any given day.

Actually what I described is very old-fashioned technique. Now the same thing is done, except it is all done digitally. The desire is to make possible a low level of training to solve foot problems. We all know that there are “professionals” that know exactly what they are doing and those that are clueless.

And, only in rare cases are the orthotics built “in-house.” There are all kinds of professionals dispensing foot orthotics: podiatrists, pedorthists, chiropractors, family physicians, ski shops, physical therapists, occupational therapists, sports trainers, and more. In nearly every case they send the impressions (be they plaster, foam or digital) to a central fabrication facility for the making of the devices. The individual constructing the orthotics has never seen the feet–he is only working from a spec sheet and the impressions.

Increasingly common, here at Merrell FootLab, I am having clients come in with no symptoms in the feet, but who complain of ankle pain, knee pain, or pain up the side of the thigh, or hip or back pain, saying something like: “I don’t really understand, and I have been to see...(and they will name a couple of practitioners) and that has not really helped. As I said, I don’t understand, but I really think that it has something to do with my feet.” Sure enough, we will then find excessive pronation or a leg-length issue, or some imbalance—and once the offending imbalance is compensated for, the pain will usually go away.

I do things differently. I spend a lot of time with our clients listening and asking questions. I still use old-fashioned impression foam. I capture the foot making the beneficial motion—the motion that it needs to be making—not the motion that has been causing the problem and pain. My attitude is different; I desire to fix things the best way possible, not just get by. Nothing is sent out to be fabricated some place else. We have all the materials and equipment here to not only fabricate the devices new, but to do the alterations needed to tune up and adjust as needed. When I first put the devices in the shoes, I watch the client walk to see if the orthotics are doing the best that they can. I expect my clients to come back after two or three weeks, after the “dust settles,” for a checkup/tuneup.

Typically in other clinics when orthotics are dispensed, the receptionist simply hands them to the client. Seldom is there an evaluation as to how the devices are working, and less seldom is there a follow-up. Rarely does the facility even have the tools, materials, equipment nor skill to make alterations were a deficiency to be found. Understood, this is strong talk—but the usual reality.

Unfortunately, all too often an individual with foot pain finds himself in the care of a pedorthist or podiatrist practicing “simple” pedorthics, or pedorthics as taught 30 years ago, and finds little or no benefit. So the client concludes that orthotics are not the answer, when in reality they are the perfect answer. He just needs a practitioner who knows his stuff, and is bold enough!

Orthotic therapy is a wonderful thing. It can be incredibly effective, relatively painless, and relatively inexpensive. Unlike surgery, the procedure can be undone by simply taking the orthotics out of the shoes. AND, it is a simple matter for the devices to evolve over the years as the body and feet evolve.

The definition of Pedorthics as offered by the Pedorthic Footcare Association, and the American Board for Certification in Orthotics and Prosthetics is: “The design, manufacture, modification and fit of footwear, including foot orthosis, to alleviate problems caused by disease, congenital conditions, overuse or injury.”

With very rare exception, the practitioners are only dealing with the orthotic. The part of the definition of “pedorthist” that says “the design, manufacture, modification and fit of footwear” is ignored—yet it is an integral part of successful pedorthics. This is not only referring to custom or made-to-measure footwear. There are dozens of techniques to modify “off-the-shelf” shoes and boots to allow them to work far better for a foot with bio-mechanical issues. Our roots here are in the making of footwear, so I am very practiced in the “design, manufacture and modification” part of being a Pedorthist! Only a small percentage of Pedorthists across the U.S. are equipped and practiced at making or modifying footwear.

To understand the word “pedorthist” I prefer to dissect it: “ped” means step (like pedal, which you step on, or pedestrian). “Ortho” refers to straight, regular, proper, or correct. “Ist” is a suffix noun which means “one who practices or is occupied with.” So, I am occupied with making steps regular, straight, proper, or correct!

We would all like to think that our bodies are perfect, or nearly perfect. Yet if you go someplace like a mall and watch people walk, you will see large numbers of people limping, gimping or otherwise exhibiting an abnormality in their gait. Statistically at least 83 percent of Americans have structural anomalies with their feet and/or lower extremities. The “vigor of youth” can override much, but in time problems (pain) start to develop. Frequently we have “40-something” clients who have developed a painful condition such as plantar fasciitis, Morton’s Neuroma, metatarsalgia, or posterior tibial tendonitis only to ask: “How did this happen–I’ve not had trouble before, I have not had an accident?” The faulty structure that created the problem was there all along—it’s just that the years finally caught up.

It is our view, here at the Merrell FootLab, that a Pedorthists is trained and practiced to look at the foot and ankle as though it is a machine. I think of the foot in terms of cables, pulleys, hinges, levers, fulcrums and so forth—how the energy is flowing through it.

When you go to a physician for an examination, typically he will sit or lay you on his exam table. A Pedorthists must do his work differently. He must evaluate, at least in part; the feet and their function on the floor, because it is that interaction between the feet and the ground that must be right. An evaluation of gait and the motion of the feet is an integral part of a productive pedorthic evaluation. The feet are the foundation of your body—yes, a mobile foundation, but nonetheless a foundation. In a building if the foundation settles unevenly, the floor slopes, walls crack, floors creak and doors won’t close. Often problems with footwear, pain in the feet, ankles, lower legs, knees, even thighs and hips, low-back and the neck, can be traced to malfunctioning feet.

One of the most common structural anomalies is a verus deformity of the foot. Simply explained–a pair of verus feet are more comfortable walking on the peak of a roof (an exaggeration) than on a sidewalk or floor. Nearly every step taken requires the verus foot to make an exaggerated motion—excessive pronation. Pronation is a normal, natural, necessary part of gait–however, there are dozens of symptoms that often can be traced to excessive pronation. Here are a few:
- plantar fasciitis
- bunions
- bunionette’s or tailor’s bunions
- hammer toes
- shin splints
- ankle pain
- heel spurs
- leg-length discrepancy
- back pain
- hip pain
- posterior tibial tendinitis/dysfunction
- metatarsalgia
- general foot pain/discomfort

I could go on, but you get the idea. And a Pedorthist sees much more of feet than simply excessive pronation. We are asked to deal with trauma, Post-Polio Syndrome, Charcot Foot, the diabetic foot, congenital issues, Charcot Marie Tooth Disease, the club foot, and other structural issues. Again, I could go on. I never get bored with my work.

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