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| Description |
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| Accommodative
Foot Orthoses |
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| Functional
Foot Orthoses |
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| Foot
and Lower Extremity Biomechanics |
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| The
Process of Describing Foot Orthoses |
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| Advantages
and Disadvantages of Prescription Foot Orthoses |
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| Your
condition may be treated by the use of a specially fitted
orthotic device. When worn, this device will allow you
to walk normally and relieve you of most abnormal foot
and ankle stress. Our doctors also specialize in designing
and fitting orthotic devices for daily and athletic
use-helping to keep you competitive in your activities.
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Description
A prescription foot orthosis is an in-shoe brace which
is designed to correct for abnormal foot and lower extremity
function [the lower extremity includes the foot, ankle,
leg, knee, thigh and hip]. In correcting abnormal foot
and lower extremity function, the prescription foot
orthosis reduces the strain on injured structures in
the foot and lower extremity, allowing them to heal
and become non-painful. In addition, prescription foot
orthoses help prevent future problems from occurring
in the foot and lower extremity by reducing abnormal
or pathological forces acting on the foot and lower
extremity. A prescription foot orthosis is more commonly
known by the public as a "foot orthotic".
Podiatrists prescribe two main types of prescription
foot orthoses for their patients, accommodative orthoses
and functional foot orthoses. Both types of prescription
foot orthoses are used to correct the foot plant of
the patient so that the pain in their foot or lower
extremity will improve so that normal activities can
be resumed without pain. However, accommodative and
functional foot orthoses are generally made using different
materials and may not look or feel the same. Both types
of prescription foot orthoses are nearly always prescribed
as a pair to allow more normal function of both feet
[similar to having both the left and right wheels of
a car realigned in a front end alignment].
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Accommodative
Foot Orthoses
Accommodative foot orthoses are used to cushion, pad
or relieve pressure from a painful or injured area on
the bottom of the foot. They may also be designed to
try to control abnormal function of the foot. Accommodative
orthoses may be made of a wide range of materials such
as cork, leather, plastic foams, and rubber materials.
They are generally more flexible and soft than functional
foot orthoses. Accommodative orthoses are fabricated
from a three dimensional model of the foot which may
be made by taking a plaster mold of the foot, stepping
into a box of compressible foam, or scanning the foot
with a mechanical or optical scanner.
Accommodative orthoses are useful in the treatment of
painful callouses on the bottom of the foot, diabetic
foot ulcerations, sore bones on the bottom of the foot
and other types of foot pathology. The advantages of
accommodative orthoses are that they are relatively
soft and forgiving and are generally easy to adjust
in shape after they are dispensed to the patient to
improve comfort. The disadvantages of accommodative
orthoses are that they are relatively bulky, have relatively
poor durability, and often need frequent adjustments
to allow them to continue working properly.
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Functional
Foot Orthoses
Functional foot orthoses are used to correct abnormal
foot function and, in so doing, also correct for abnormal
lower extremity function. Some types of functional foot
orthoses may also be designed to accommodate painful
areas on the bottoms of the foot, just like accommodative
foot orthoses. Functional foot orthoses may be made
of flexible, semi-rigid or rigid plastic or graphite
materials. They are relatively thin and easily fit into
most types of shoes. They are fabricated from a three
dimensional model of the foot which may be made by taking
a plaster mold of the foot, stepping into a box of compressible
foam, or scanning the foot with a mechanical or optical
scanner.
Functional foot orthoses are useful in the treatment
of a very wide range of painful conditions of the foot
and lower extremities. Big toe joint and lesser toe
joint pain, arch and instep pain, ankle pain and heel
pain are commonly treated with functional foot orthoses.
Since abnormal foot function causes abnormal leg, knee
and hip function, then functional foot orthoses are
commonly also used to treat painful tendinitis and bursitis
conditions in the ankle, knee and hip, in addition to
shin splints in the legs. The advantages of functional
foot orthoses are that they are relatively durable,
infrequently require adjustments and more likely to
fit into standard shoes. The disadvantages are that
they are relatively difficult to adjust and relatively
firm and less cushiony.
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Foot
and Lower Extremity Biomechanics
The study of the mechanical nature of the foot and lower
extremity is called biomechanics. It is a specialized
branch of science that uses the mechanical principles
of physics to study the motions and forces on the human
body. Podiatrists receive specialized, in-depth training
during their four years of medical training on how the
movements and forces in the foot affect the movements
and forces in the rest of the lower extremity, and how
the movements and forces in the lower extremity affect
the movements and forces in the foot. No other medical
specialty has this in-depth training, which is necessary
to understand lower extremity pathology as it relates
to the biomechanics of foot function. Therefore, the
podiatrist is the most qualified medical specialist
to diagnose and treat foot pathology.
Understanding the biomechanics of the foot and lower
extremity is of critical importance when the mechanism
of an injury must be determined to decide on a appropriate
treatment plan for the patient. In addition, biomechanics
plays an important part in the planning for corrective
surgery for injuries, such as tendon ruptures or bone
fractures, or for the surgical correction of deformities
of the foot, such as hammertoes, bunions, or heel spurs.
As a result of the podiatrist’s training and expertise
in biomechanics, they will often prescribe either functional
or accommodative orthoses as part of their treatment
plan. In many instances, an orthosis will be all that
is required for the successful treatment of foot or
lower extremity pathology. In most instances, however,
an orthosis will be prescribed along with other therapies,
such as stretching or strengthening exercises, oral
or injectable medications, and specific types of shoes,
in order to insure the fastest healing for the patient.
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The
Process of Prescribing Foot Orthoses
In order to design and fabricate a prescription foot
orthosis, the podiatrist must perform a biomechanical
examination of the foot and lower extremities. Angular
measurements are taken of the toes, foot, ankle, knees
and hip to determine the amount and level of any structural
or functional deformities. This examination is done
while the patient is on an examining table and also
while standing. The podiatrist will also do a walking
and/or running gait analysis of the patient to determine
how their foot and lower extremity functions during
these activities. Abnormalities from the biomechanical
examination and gait examination are noted in the patient’s
chart for future consideration in the design and fabrication
of the prescription foot orthosis.
The podiatrist then next must make a three dimensional
model of the patient’s feet in order to make a
prescription foot orthosis. This is done by either applying
plaster splints to the patient’s foot, by having
the patient step into a box of compressible foam, or
having the foot scanned by a mechanical or optical scanner.
The resultant three-dimensional model of the foot is
then used along with a detailed orthosis prescription
from the podiatrist to have the prescription foot orthoses
made for the patient. Most podiatrists have a specialty
podiatric orthosis laboratory make their orthoses while
some podiatrists make their own prescription foot orthoses.
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Advantages
and Disadvantages of Prescription Foot Orthoses
The advantages of prescription foot orthoses are many.
First of all, they are custom made for each foot of
each patient, so that each foot orthosis will only fit
one foot correctly. In addition, since they fit so exactly
to the persons foot, they can be made with relatively
rigid, durable materials with a minimal chance of discomfort
or irritation to the patients foot. Prescription foot
orthoses also have a much greater potential to effectively
and permanently treat painful conditions, all the way
from the toes to the lower back, since they are designed
specifically for an individual’s biomechanical
nature.
For example, in children, prescription foot orthoses
are used to prevent abnormal development of the foot
due to flatfoot or intoeing or outtoeing disorders.
In athletes, prescription foot orthoses are used to
allow the athlete to continue training and competing
without pain. And in most adult patients, prescription
foot orthoses are used to allow more normal daily activities
without pain or disability.
One disadvantage to prescription foot orthoses is that
they are relatively expensive when compared to store
bought over-the-counter foot inserts. Even though the
over-the-counter inserts do help some people with mild
symptoms, they do not have the potential to correct
the wide range of symptoms that prescription foot orthoses
can since they are made to fit a person with an "average"
foot shape.
In this fashion, prescription foot orthoses may be considered
to be analogous to prescription eyeglasses. Over-the-counter
eyeglasses may work for some people since they are made
to correct for the average eye. However, over-the-counter
eyeglasses will almost never work as well as prescription
eyeglasses. Prescription foot orthoses, since they are
custom made to each foot of a patient, are almost always
more corrective and comfortable than over-the-counter
foot inserts, even though over-the-counter inserts do
work for some people.
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