Custom-made orthotics: the complete guide

    Auteur: Podiatre Montreal

    On this page, we will try to provide you with the most complete guide to custom-made orthotics, including all the information you will need to make an informed decision about custom-made orthotics. Whether you are considering getting your orthotics from us or elsewhere, we recommend that you read this page and the links it contains before making an appointment to have them made. We will answer, among others, the following questions:

    • Are foot orthotics for you?
    • Who should make them?
    • What is the best way to take a mold of the foot?
    • What problems can be treated with orthotics?

    Leaders in podiatric treatments

    The Montreal Podiatric Clinic is one of the first podiatric clinics to be established in the Montreal area. The unique credentials of our podiatrist makes him some of the most talented in the country to design custom orthotics that meet your exact needs. We specialize in custom orthotics, biomechanics and gait analysis, and are the leading reference in podiatry in the Montreal area.

    Why we are the best choice for custom-made orthotics

    There are several possible places to buy your custom-made orthotics.

    When you choose to come to Montreal Podiatric Clinic, you will find more effective symptom relief and more comfortable orthotics than at other clinics. Find out why your orthotics will be more effective if they are designed by our podiatry doctor.

    Contact us today to book an appointment in our clinic for an evaluation.

    A number of our patients have come specifically to see us for their orthotics. If you come to see us, please let our receptionist know so that she can make an appointment that is convenient for you.

    What are orthotics?

    The term “orthosis” can refer to almost any device that can be worn in a shoe. Items designated as “orthotics” can be found in infomercials, retail stores, and even fairs. There are three very different types of orthotics: custom, personalized and over-the-counter. An informed customer should be familiar with each type.

    There is a lot of information available on orthotics. For many clients, it is difficult to make an informed decision. A key to better health is knowing how to recognize the sales pitch and the facts. The information in this section will help you make an informed decision.

    What are custom-made orthotics?

    Custom foot orthotics are prescribed medical devices that are designed from a cast or scan of your feet when they cannot support your weight. They are designed to control the alignment and function of your feet to treat or prevent movements that cause injury, such as pronation (inward rotation) and supination (outward rotation). They also help make walking, running, and even standing more efficient. Finally, they can redistribute pressure on the soles of the feet to relieve pain caused by excessive pressure or calluses.

    How do custom-made orthotics work?

    Most foot pain is the result of a poor relationship between the bones and muscles of the foot. Even a slight misalignment can cause great discomfort. This abnormal function can cause problems such as bunions, hammer toes, arch and heel pain, horn, knee pain, and even back pain.

    The function of custom-made orthotics extends beyond the plantar support. Orthotics realign the structures of the foot and leg to prevent misalignment of bones and fatigue of muscles, tendons and ligaments. They are often used after surgery to prevent the recurrence of foot deformities.

    When you wear the brace, your foot is gently but constantly put in the right position when walking, running and standing.

    Your foot functions normally, muscle pain and pressure points are released and the progression of the deformity is stopped or slowed down.

    Design of custom-made orthotics

    Custom-made orthotics is a demanding process that determines whether or not you will receive quality devices to treat your condition. As with all things, there are well-made orthotics and poorly-made orthotics. The ability of an orthosis to eliminate your pain depends on its quality.

    The quality of orthotics depends on the three initial steps:

    1. The moulding of your foot
    2. Your doctor’s prescription (based on the examination and the doctor’s knowledge and experience)
    3. The work of the laboratory that makes your orthotics.

    How should your feet be molded for custom orthotics?

    Laser scanning for orthotics:
    There are several possible ways to obtain an image of the foot to make custom-made orthotics. In fact, some are much more effective than others.

    Fiberglass molding:
    Unfortunately, not all practitioners are using the methods that have been shown to be the most effective. This may be because they are unfamiliar with the literature, because they are looking for a less expensive method of taking a picture of the foot, or because they have purchased a contact mat system that is impressive to see, but does not work very well. The most important criteria are the practitioner’s experience and skills, but some techniques have been shown to be more effective than others.

    The only method that has been shown to be effective in producing a quality custom-made functional foot orthotic is a three-dimensional casting without weight support or laser scanning of the foot. For this technique, the foot is held in a precise position – the position in which it should be in order to function properly. The image of the foot can be obtained using laser scanning or a plaster or fiberglass cast. All of these methods achieve the same image quality if the foot is held in the correct position when the image is taken.

    Who should do the molding?

    The position of the mold is crucial to a good final product; it is our opinion that only a doctor, not a staff member, should scan or mold your foot. Before making an appointment to have your orthotics made, the first question to ask is “Who will make the cast of my foot? The doctor or an assistant? “If the answer is not the doctor, go elsewhere.

    Are there other ways to take a cast of the foot to make orthotics?

    There are three other methods used to make custom-made orthotics, which have been shown to be ineffective in making orthotics that improve foot function, but can be used to make simple plantar supports. These techniques are:

    1. Make a plaster or foam cast: the Patient sits down and the foot is placed on the floor to produce the cast.
    2. Walking on a punch plate
    3. Standing on a digital image of the foot

    Several studies have shown that these methods are less effective in producing well-functioning orthotics.

    A 1989 study at Northern Arizona University showed that placing a weight on the foot during casting or imaging led to an orthosis whose shape caused pain in the big toe joint and pressure on the plantar fascia.

    A 2002 study from the Joiner Center for Sports Medicine at the University of Delaware showed that a cast taken when the foot was bearing weight caused abnormal pressure under the big toe joint. This leads to an orthosis that does not effectively reduce the pressures that cause common problems such as bunions, pain in the big toe joint, heel or arch, plantar fasciitis and others. Casting without weight-bearing is recommended as the most effective method of making custom-made plantar orthotics.

    Summary of Custom Foot Orthotics Casting Information

    1. Only a laser scan in which the foot does not support any weight should be used.
    2. The ineffectiveness of casts and images of the foot taken when it is supporting a weight has been proven in the medical literature: these methods do not produce functional foot orthotics.
    3. It doesn’t matter whether you are standing or sitting. If your foot touches the ground during casting, you may not have an orthosis that offers optimal function.
    4. Medical literature indicates that walking on a contact mat does not provide enough information to produce a quality functional orthotic. The doctor, not an assistant, should take the cast of your foot.

    The problem with computer-generated orthotics

    If you (or your insurance company) are going to spend money on a custom-made brace, make sure you get what you pay for.

    Unfortunately, many devices are sold as custom-made orthotics when they are not. They are often the product of a computer-generated system in which the Patient has to walk on a plunger punch plate that then shows the pressure distribution on a computer screen. Generally, the orthosis is made by adding parts to a prefabricated insole. They are then sold as custom-made orthotics, and the price is just as high.

    Several studies have shown that it is impossible to manufacture an effective custom-made orthosis by measuring pressure. This computer-generated orthosis process has been in use for several years. You can consult our list of preferred over-the-counter foot supports by clicking here. Computerized gait analysis and orthotic manufacturing systems are sold to practitioners with little orthotic training.

    How can you tell the difference between semi-custom and custom-made orthotics? If you receive real custom-made orthotics, there must have been a three-dimensional cast of your foot. Your foot must be held in place without supporting any weight and the doctor can make this cast in three ways:

    • Plaster
    • Fiberglass
    • Laser scanning

    It is possible to use a punch plate to evaluate certain aspects of the foot’s function, but it cannot be used to obtain the three-dimensional impression of your foot, which is necessary to obtain the best possible results. Remember, it is essential to have a three-dimensional scan or cast of your foot while it is not supporting weight to make a custom functional orthotic.

    If a practitioner suggests these computer-generated orthotics, go elsewhere or buy a quality, inexpensive prefabricated orthotic.

    Buyers, beware of radio, television and web advertising.

    You may have seen or heard advertisements for “custom-made” orthotics in shoe and orthotics retail stores. While these devices are not bad in themselves, they are prohibitively expensive. Our advice: the buyer should be on his guard. You should never pay more than $70 for an “orthotic” unless it is made from a cast of your foot by an experienced professional.

    You may also have seen websites that sell “custom-made” orthotics based on a foam impression of your foot. A foam impression can be used to take a cast of your foot to make custom-made orthotics (but this is not a very effective method), but a thorough examination by an experienced practitioner is necessary to write the correct prescription and to optimize results. It is possible to see improvement with these devices, but the chances of achieving the best possible result are low.

    Again, never spend more than $70 unless you have a complete exam and cast by an experienced practitioner.

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      Podiatre Montréal
      1826 Sherbrooke O,
      Montreal, QC H3H 1E4