Handle with care…your feet are for life

When your feet hurt, you hurt all over. Ever hear that? Ever say that yourself? Most people don't give their feet a second thought…that is, not until they hurt. And once these feet are hurting, most people have no idea how to relieve the pain. They'll try just about anything to relieve the pain.

What causes this pain?
Most foot pain is the result of a faulty relationship between the bones, muscles and ligaments of the foot. The foot is a highly complex organ which produces the balance and propulsion of the body. The feet are the foundation for the rest of the body; its function affects every other motion in the body.

Main functions of the foot:
Locomotion is the most important function of the foot, getting you from point A to point B to point C and back. In order to be able to do this the foot must function as a flexible adapter. It must initially be a loose 'bag of bones' capable of providing accommodation for uneven ground and absorbing the shock of the body weight, yet be able to maintain the equilibrium of the leg and the body above. In addition, it must be a rigid lever, capable of locking itself into a rigid structure so that it can stabilize, lift the body's weight and then propel the body forward.

It's all in the timing

Timing is of great importance. Obviously, if the foot is a rigid lever at a time it should be a flexible adapter or vice versa, then it could not possibly perform its specific function for that particular phase. In the normal foot, the sequence of adapter-lever proceeds uninterrupted and on time. All bones remain in their proper positions and go through a minimal amount of motion; and muscles and ligaments work effortlessly. Consequently, no symptoms generally arise.

Faulty adapter-lever function
Now consider the foot in which there are factors that prevent or retard the normal sequence of going to and from the flexible adapter phase and the rigid lever phase. Mechanical symptoms experienced by the foot and structures above may be as follows: ankle pain; foot and leg cramps; heel pain; knee and hip pain; low back discomfort; neck spasms; plantar callouses; and the list goes on.

These are just some of the mechanical symptoms of faulty mechanics of the feet and legs. These symptoms occur when the body's weight is applied to the foot at a time when the foot is not prepared to receive the stress. The foot is unstable and consequently the bones move in abnormal directions and through abnormal ranges of motion so that they cannot be fixed against the ground nor be efficient help to propel the body's weight.

Under these circumstances, muscles and ligaments which stabilize the foot are now called upon to work harder, stronger and longer. The result: muscle fatigue and tiredness. Twisting and shearing of bones may result in internal inflammation of tissues, which produces the lesions (callouses) we see in the feet. Rotary stresses transmitted through the legs to the pelvis and spine produce the postural complaints. Finally, because the bones of the feet and the skeleton are being subjected to more stress than they can physiologically tolerate, they actually change their shapes in an attempt to bear these pathologic stresses better.

So what can we do to solve and prevent these problems?

Prescription custom-made foot orthotics
Almost anything that fits into a shoe has been called an orthotic. This includes parts of the shoe themselves, commercial inner soles, and pads often referred to as arch supports. Orthotics that are prescribed and custom made for your feet should not be confused with over the counter products. Over the counter items may be of help with minor problems and discomfort but often do not provide foot control or fit properly. Be wary of individuals with no or inadequate training who present themselves as foot experts. Your medical doctor can refer you to a reliable specialist who can evaluate and treat faulty foot mechanics.

What are foot orthotics?
Foot orthotics are custom designed and custom-made medical devices that are worn inside of footwear to control, support and align the foot. They also provide protection, correction and prevention of various foot deformities and improve the functions of the foot. Everyone's feet are different, and because imbalances between the muscles and bones are so varied, a precise prescription for each individual is required. An exact understanding of where the problem lies is very important in order to obtain optimal results. You and your neighbor may have a similar foot problem, but remember…your feet, like you, are unique.

How do they work?
Custom-made orthotics are designed for 'dynamic motion' and control the biomechanical functions of the foot. As your foot rests on the orthotic, it is supported and consistently directed into the correct positions for standing, walking and running. With a pair of custom orthotics, improper rotation of the foot and leg, painful muscle strain and pressure areas are relieved because the foot is allowed to function properly.
Please note: the foot orthotic is only as good as the footwear which accommodates it. This will be discussed later.

What can I expect from an evaluation?
The specialist must evaluate the client and their feet thoroughly in order to understand the problem completely. In order to design the orthotic most suited to the person's requirements, the following factors must be considered: age, gender, motivation, lifestyle, medical history, social and vocational history; and in the physical examination: muscle power, joint range of motion, stability, deformity; sensation, pain, proprioception; peripheral circulation, clinical gait assessment.

Foot Orthotics
Custom-made foot orthotics can be made from a wide variety of materials over a large range such as various densities of foams, rubbers, cork, thermoplastics, carbon fibre composites and leather, to name a few.

Depending on the specialist's evaluation of the foot problem, she/he will determine the type of orthotic required, the amount of control and support needed, the types of materials to be used, and the modification required. By utilizing updated techniques for impression molding/casting of the foot, state of the art material combinations, and advanced methods of construction, the specialist can create a very customized device suited to the patient's needs.

Types of foot orthotics
Custom-made foot orthotics are fabricated from a mold taken from your foot. The mold is a replica of the sole of your foot, reflecting your foot's particular shape, contours and bony profile. This is the basis from which the device is fabricated. Based on the evaluation the specialist will modify the mold accordingly.

Foot orthotics can be grouped into three classifications:
1) Accommodative: Generally a soft orthotic, designed to provide cushioning, protection of sensitive sites (such as an ulcer site) and accommodation of various deformities (such as claw toes and dropped metatarsal heads). Little or no correction is provided.
2) Semi-rigid: Depending on material used, which is based on the evaluation of the foot, the degree of rigidity can vary. The combinations for control, support, cushioning are limitless!
3) Rigid: Generally made out of a high temperature thermoplastic or carbon-fibre composite. More often than not, orthotics made from these materials are fit into 'dress' shoes where room in footwear is limited.

How long will I have to wear them?
Orthotics will not change the underlying structures of the foot; they work on the same principle as eyeglasses…vision is improved when the eyeglasses are worn but they won't cure your vision problems.

The orthotics modify and improve the function of your foot as long as you continue to wear them. They can ensure that the problems do not develop further or reoccur.

Will the orthotics cause any discomfort?
Initially, when foot orthotics are dispensed, a wearing schedule will be recommended. Some people when they first wear orthotics may experience some discomfort in the foot, leg or lower back. This is a common occurrence and is due to the realignment of the lower extremities and the body. The new alignment creates a situation where muscles and ligaments will need to adjust to work more efficiently. This period of discomfort/body realignment will usually resolve itself in two to three weeks. Persistent discomfort will require adjustments to the orthotics. Follow-up appointments with the specialist at regular intervals are imperative to ensure the devices are providing what they were designed to do.

Ask questions

Be sure your specialist explains and you understand clearly your condition, what the problem is, the causes and its consequences, how she/he plans to solve it, with which device, and what to expect once you wear them.