The feet are of primary importance in reducing pain and optimizing function throughout the entire body. They support the weight of the body, and when the feet are not in proper alignment, they can cause gait alterations and other compensation patterns along the kinetic chains of the body. These compensation patterns can lead to increased pain and decreased function/performance.
Basic Mechanics of the Foot
The foot is made up of 26 bones that are uniquely shaped to create 3 arches:
1 Medial longitudinal
2 Lateral longitudinal
These arches act as shock absorbers for the shearing and torsion forces created during weight bearing and the gait cycle. The arches of the foot are supported by ligaments and muscles that work in tandem to maintain proper positioning of the foot during weight bearing and walking.
Relationship to Pain
When the arches of the feet are not maintained, it causes weakness in the muscles of the foot that attach to those various bones of the feet, thus causing synergistic muscles to become over-contracted and hypertonic in an effort to compensate. In the same way, if the arches are “too tight” and do not allow for adequate motion, you end up with rigidity of the foot and leg leading to chronic pain.
For example, if the navicular bone in the medial longitudinal arch of the foot begins to “fall”, it causes a reflexive inhibition of the tibialis posterior muscle–a major plantar flexor and stabilizing muscle of the foot. Similarly, a weak tibialis posterior muscle may cause the navicular bone to lose proper alignment. This in turn will lead to over-pronation of the foot (decreased shock absorption), tenderness of the deltoid and anterior talofibular ligaments of the foot, and may also cause medial knee pain and hip pain.
Also, when the transverse arch is not maintained it not only leads to major compensations in the kinetic chain, but can also produce numbness in the feet when the common plantar nerves are squeezed between the metatarsal heads, and makes “toeing off more difficult”, which leads to more problems along the kinetic chain.
Several other examples of bone/muscle relationships have the same type of effect on other joints of the foot as well, but are too numerous to mention here.
Relationship to Gait
Healthy feet are essential for proper gait mechanics, and proper gait mechanics are essential for eliminating pain and dysfunction from the body. When the foot strikes, it begins to pronate and the arches begin to flatten slightly in order to cushion the weight of the body through the mid-stance and toe-off phases. This causes certain muscles of the body to reflexively disengage to allow for proper/smooth gait.
Example: Dropped Medial Longitudinal Arch
It follows then, that arches of the foot that have been weakened and have “fallen” will cause these muscles to be more permanently down-regulated, thus leading to compensation patterns; which—you might have guessed—leads again to pain and dysfunction in the rest of the body.
If you are an athlete, consider that you have just lost a significant amount of power, right off the bat.
Alternatively, some patients may have the opposite problems, and may under-pronate, causing the foot to become a rigid lever, also leading to increasing pain and discomfort. Proper diagnosis and an accurately designed orthotic can correct these conditions and their resultant consequences.
The Role of Orthotics
Orthotics are used both to correct movement patterns of the feet and also support the arches of the feet while the ligaments heal and the muscles are strengthened (via light home care exercises). How much you use your orthotics is specific to your condition(s) and your needs.
Who Is a Candidate for Orthotics?
Obviously, not every patient is a candidate for orthotics. Furthermore, not every patient is in need of custom orthotics. Depending on your condition, your age, your activity level/demands and your budget, we have several different options to meet your particular needs ranging from a less expensive generic orthotic to a pair of customized orthotic inserts.
In addition, orthotics can be customized in a variety of ways to suit your preferences, be it for casual, sport, industrial or dress purposes.
Are You An Orthotic Candidate?
Do you have:
1 Sore ankles? Y/N
2 Sore heels? Y/N
3 Sore ball of foot? Y/N
4 Dropped arches? Y/N
5 Bunions? Y/N
6 Calluses? Y/N
7 Achilles tendonitis Y/N
8 Knee pain while working or afterwards? Y/N
9 Hip and low back pain when walking or afterwards? Y/N
10 Abnormal shoe wear Y/N
If you answered yes to any of the above then you should consider having your feet and gait assessed in relation to orthotics.
Orthotic Check List
Because each insurance company has different requirements for Orthotics re-imbursement, please complete this check list to avoid having your claim rejected.
____ 1. Does your plan cover Orthotics? YES/NO
____ 2. Coverage Amount $_____ or percentage ____%
____ 3. Do you require an MD’s referral? YES/NO
____ 4. Which casting methods are approved? Circle all that apply.
- 3-D Contact Digitization
- Non Weight Bearing 3D Volumetric
- Slipper Sock cast
- Plaster Cast
____ 5. What type of practitioner can dispense the Orthotic?
Chiropractor / Chiropodist / Podiatrist
We will provide you with the following documentation to be submitted with your claim form.
- Prescription with a diagnosis and treatment
- Bio Mechanical Assessment
- Proof of manufacturing. This will give a detailed description of the materials and casting technique used to make the orthotics.
- Confirmation that it has been made for the patient.
- Receipt of payment.
If you have any questions please contact your insurance provider.