Chapter 13: Custom Made Functional Foot OrthoticDevices
Introduction
Welcome to the world of custom inserts. Since most professional laboratories have ample information on materials that can be used, modifications available, etc., I will focus on function. What are the mechanics that we are trying to achieve with our inserts? What patient function are we trying to change, or what functionality should the orthosis have? Typically, these functions are 6 in number in this industry: balance and support, primarily pronation control, primarily supination control, medial/lateral instability control, shock absorption or plastic insensitivity, and sagittal planefacilitation.
Practical Biomechanics Question #529: What are the 6 main functions of custom-made functional footorthoses?
Accomplishing the goal of matching function to symptoms will require a lot of learning pain syndrome patterns related to abnormal motion. Some of these pain patterns are discussed in Book 3 Chapters 9 (pronation and supination), Chapter 10 (limb length discrepancy), Chapter 11 (weak and tight muscles), and Chapter 12 (poor shock absorption). Some are obvious like the need to give better shock absorption to a patient with multiple overuse stress fractures or joint arthralgias. Some are more subtle as placing less pronation support than necessary for the pronation due to a history of recurrent ankle sprains (called Medial Lateral Instability). However, there is logic in what we can order from our laboratories based on the functionality that we want to achieve. It is my job to help you with thatlogic.
Practical Biomechanics Question #530: In a long-distance runner with multiple recurrent tibial and femoral stress fractures, what would be the number 1 functionality that you would want to achieve in a custom foot orthoticdevice?
I want to list 12 common types of orthotic devices that will fit into this schema that I prescribe on a weekly, or at least monthly basis. I hope you will be closer to knowing when to use these 12 types of devices when you have read the chapter completely, with its challenging questions. I will also place the type of orthotic device symbol next to it. I will be going over these types in detail. I do not expect that you would know the indications of any of these now. The 12 typical orthotic devices I prescribe in my practiceare:
- 35-degree
