What are orthotics?
Custom orthotics are an insert for your shoes that are molded to your foot to help maintain a neutral foot position. Neutral means that the forces going through your joints are equal, and this helps to keep an upright position. Muscle function can change with change of joint position. Malalignment decreases normal functioning of joints and soft tissue biomechanics. Joint malalignment alters muscle functioning resulting in muscular imbalance, which can lead to injury. Sometimes our joints are misaligned due to loose joints and laxity. Orthotics help give an outside force to correct joint laxity that cannot be rehabilitated.
Examples of reasons to get a custom orthotics:
Over-pronation or over-supination due to joint laxity. This can cause premature wear and tear to our knees, hips, and back if not corrected.
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Leg length discrepancy.
Over time, our joints and muscles can acquire damage if not corrected. Custom orthotics can include a built in heel lift while still supporting the arch and forefoot position, unlike a standard heel lift that may negatively alter the forces through the arch and forefoot.
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A metatarsal pad combined with arch support can relieve nerve pressure.
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An extension of supportive material can protect a sprained toe joint.
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Supporting a hypermobility of the 1st tarsometatarsal joint can improve weight bearing through the big toe and reduce pressure from torsion.
Custom orthotic versus over-the-counter:
Over-the-counter orthotics correct for a lack of arch support only. This may be very helpful for someone who has a mild to moderate amount of pronation without malalignments of the heel. If your heel is angled inward or outward (everted or inverted), posting of solid material around the heel can be built into a custom orthotic. If your arch and heel position cause excessive weight bearing on the outer foot, a custom orthotic with heel posting can re-position the heel inward while maintaining arch support. If you can collapse an over-the-counter arch support with the weight of your hand, chances are that your body weight will not be supported. Custom orthotics can be made of much harder material that will last for years.
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How is a custom orthotic made?
When a physical therapist performs and evaluation of a patient and determines the patient could benefit from custom orthotics, the therapist will cast a mold of the patient's foot. The therapist then sends the evaluation and mold of the patient's foot to a lab that specializes in making custom orthotics. The lab will work with the therapist in determining the composition of the orthotics, including materials, rigidity, size and shape, depending on the type of activity the orthotic is designed for. The orthotic is then sent to the therapist, who helps the patient fit the device in their shoe and gives parameters for use.