How We Do Custom Orthotics?

History Taking

The process we undertake in order to prescribe custom orthotics starts with an in depth dig into your history of pain and injuries. Creating a picture of your past experiences with everything on the pain spectrum, from back pain to shin splints and plantar fasciitis,  is an essential step in establishing whether you need custom orthotics in your life or not. 

What we find is that many people have patterns of pain, misalignment and weakness through their bodies that they often carry with them from an early age. These patterns of weakness frequently cause different pains and different injuries during different periods of their life. Establishing a solid working theory about possible connections between your different pains and then testing it with a combination of gait analysis, and a  physical exam is a 3 step diagnostic process designed to gather as much information as possible for the purpose of a valid orthotic prescription. 

Physical Exam 

Our physical exams that we apply to our orthotic prescription process are usually quite straight forward and focused, once we have taken your history. Our examinations are a simple combination of well established ‘functional tests’ and orthopaedic testing. Theses tests are basically movement tests, mostly targeted at joints and muscles in your legs and lower body. These tests can be easily performed on a pair of shorts and t-shirt or shirt  with your modesty well preserved. 

The results of our physical exams  are often more or less ways of us testing the questions posed by your history. They enable us to continue building a broader picture of how, why and exactly where you have pain. 

Gaitscan 

Gait analysis is basically an in depth look at how you bear weight through your feet when you are walking and running. The location and timing of where your centre of gravity is in relation to your heel when it strikes the ground is measured. The path that your centre of gravity takes as you transition your weight along your foot to your forefoot is measured. The exact point of leverage that you use your toes and forefoot from to propel yourself forward is measured. There is also a pressure graph that shows which parts of your foot bear the most weight. 

In one sense your gait pattern is not unlike your fingerprint, it is unique to you, it is partially something you are born with and it is fundamentally very similar to everyone else’s. In another sense your gait pattern is nothing like your fingerprint, because as far as we know your fingerprint cannot become wildly dysfunctional over time and cause you untold amounts of pain. 

Our detailed images of your foots behaviour give us deep insight into the overwhelming majority of stubborn lower body pains. The information on the scan in most instances ties a neat bow around the theory of your pain that we have developed throughout the history and exam.

In any case, gait analysis is usually the final word on foot pain, ankle pain, knee pain and hip pain. The reason for this may be that your walking and running is by far the single biggest source of mechanical strain in your lower body.

In some instances however your gait does not explain your pain, then we go back to the drawing board. Maybe you have a weakness on your core, are lifting with poor technique at the gym or you sit funny at your desk.. but those are topics for another day. 

Prescription 

Making the correct prescription for your custom orthotics is absolutely vital, they will determine the alignment of your lower body for years to come. The primary thing that guides the prescription is the Gait Analysis report, this is however substantially supported by your history and the findings of the physical exam. 

One very broad aspect of the decision making process with custom orthotics is what style of orthotic you actually choose. For many people with varied lifestyles 2 pairs of orthotics is necessary, the most normal trend being to have an active or sport orthotic in combination with a casual or dress orthotic. 

When we are engaged in activities like running we exert far more force upon our orthotics than we do during less active times, this calls for a stiffer and more corrective orthotic. An active orthotic can also be more substantial and more corrective as there is generally plenty of room for it in your trainers.

Casual or dress orthotics are smaller in order to be able to fit more easily in fashionable footwear, they can also be thinner and more flexible for additional comfort and because they won’t be compressed as forcefully. 

There are of course also those individuals who live in fashion trainers, never have to dress up and never go to the gym. Many of these individuals do get away with a single ‘all rounder’ type of orthotic. 

Once we have figured out what style of custom orthotics you need we can work on the more detailed aspects of the prescription. The prescriptive aspect in making custom orthotics is where we make a determination of arch height, width, material thickness, length, heel control and contour. We also often add layers of customisation into the additional materials that are added to the orthotic. Metatarsal pads to help spread the foot bones, heel pads to protect the plantar fascia and forefoot pads to help with the propulsion phase of your gait are all commonplace ‘options’.

Materials 

The most challenging part of developing a custom orthotic is identifying materials that will withstand being stomped on 3 million times per year for 5-10 years without breaking.. without being more than 3mm thick .. while still not being too stiff. That combination of qualities is not easy to achieve, takes a lot of trial and error and a lot of testing. 

The tradition with custom orthotics and insoles is that they are either very strong and much too stiff to provide natural flex, or they are far too flexible to actually support your weight when it comes onto the arch. The sweet spot is found in a material that can act both flexibly and durably for a long period of time. This long search for us, ended with the discovery of the ideal exotic plastic for the job.. it was a surprisingly difficult task but well worth the effort. 

Wearing In

The process of ‘wearing in’ custom orthotics can be a very delicate one indeed. Making changes to the alignment of your feet can create a great deal of pain in the short term, if it is not done with appropriate patience, care and attention. 

Broadly speaking there are 2 ways in which a new pair of orthotics can cause you pain. The first is by creating muscles spasm in muscles that are shocked by the changes in alignment and the change in muscle recruitment patterns. The second way that custom orthotics can cause you pain is by aggravating old tracts of scar tissue in the body, especially in the feet.

We’d love to receive a dollar for every time we met someone who had a past failure with orthotics due to irritation of scar tissue that they took as a sign custom orthotics just weren’t comfortable. In these instances all they would have needed was a small amount of treatment to assist with the scar tissue remodelling, and they would have felt fine. Instead the orthotics had gone into a bin or a drawer in most instances. At our clinic we prevent this type of thing from happening by keeping a close eye on you,  to make sure you are successfully wearing your custom orthotics in without a problem. 

We would love to receive an additional dollar for every time we gave someone clear instructions to wear their orthotics in gradually ( 1 hour the first day, 2 hours the second day, no hard runs in them for first 2-3 weeks etc. ). Only to have a very sad person call us a week later asking for an emergency appointment.  

Some of us can get away with going gung ho into a custom orthotic prescription without any reaction whatsoever. Others find that this policy lands them with severe short term knee pain, ankle pain, back pain and even headaches as the bodies struggles to re-calibrate itself to new movement patterns. 

Maintenance 

Orthotics generally last a very long time and probably only need replacing as often as a mattress.. if that. Orthotics do lead a fairly hard life though and that obviously includes the top covers. Top covers can become frayed, can eventually crack at the edges and if they get wet often can ultimately break down. Bear in mind what trainers start to look like if you wear them all day every day for years on end. 

We do on average receive requests to replace the top covers on people’s orthotics every 3 years or so. Replacing top covers is a reasonably inexpensive process and it’s quite nice to feel like you have a brand new pair of orthotics once it’s done. 

Support

As we have discussed there are most definitely occasional challenges adapting to custom orthotics, it’s a big change for many of us. In the same way that we don’t literally feel our muscles grow after gym work,  we don’t feel the adjustments the body makes in the days, weeks and months after orthotic prescription. The changes are real through and having the right support to see you through any challenges is essential.

An additional,  and hugely important dimension to the support we offer with custom orthotics is  ‘rehabilitation’. By using carefully prescribed and executed balance and strength based home exercises, we give a boost the newly formed ‘alignment’ and greatly increase the benefit of your orthotics in the longer term. This approach honours the fact that ‘alignment’ is not solely about support (orthotics) it is also about muscle  strength (exercises). 

Orthotics are a powerful tool for many people who suffer with lower body pain, they are not a super duper one size fits all cure-all magic bullet. This is sometimes where appropriate and diligent care a support comes in, both in the long and short term. The basic forms our support takes are exercises prescription, hands on treatments and advise based on the benefit of experience.