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Posts for tag: orthotics

By contactus@rebyfootcare.com
December 21, 2014
Category: F.Y.I.
Tags: heel   orthotics  

CUSTOM FOOT ORTHOTIC devices can be used for many deformities and conditions that affect the foot and ankle.  Plantar Fasciitis or Heel Spur Syndrome, however, is one of the primary indications for using custom foot orthotic devices, and for any arch support or insole.  Plantar fasciitis is a totally MECHANICAL problem, where the arch is under stress and strain because of a tight plantar fascia.

  The plantar fascia is the thick, avascular (no real blood supply - hence it looks white and not red like muscle tissue) ligament that starts on the bottom of the heel, runs up through the arch into the ball of the foot, and ends as it sends off small slips into the toes.  There are many reasons that people suffer with heel and arch pain that comes from a tight or strained plantar fascia.  Long periods of standing on hard surfaces, excessive weight, sports activities, and functional/structural foot deformities such as flat feet and high arch feet are just a few of the things tha can cause the fascia to pull harder and result in the condition known as plantar fasciitis. 

A mechanical or functional cure often works as well as, if not beter, than other treatments such as injections, oral NSAIDs, physical therapy. or surgery.  Unlike a injection, which is often very beneficial for immediate or almost immediate short term reief, orthotic devices take time.  A cast or 3D image of the foot is made, almost always for BOTH FEET, even if one foot does not hurt.  This can be done using a plaster slipper cast of both feet, a fiberglass sock cast of both feet, or an electronic scan, where the patient stands and/or walks over a force plate connected to a computer which records high and low pressures when the bottom of the foot hits the ground.  A lab then takes the scan or cast and creates a device (often semi-firm to firm for heel and arch problems) which creates a more ideal position and weighbearing pattern for the foot. 

These can be full length (all the way to the tips of the toes), sulcus length (ending at the base of the toes), or 3/4 length (which ends near the ball of the foot, fits easier in the shoe, and is usually adequate if no toe or metaarsal head problems need to be accounted for).  The devices are then sent back to the doctor who ordered them, and they ae then dispensed to the patients.  Just like with contact lenses, there is usually a breaking-in period.  This may be a matter of a few days, or as long as a few weeks, and often depends on the age of the patient (children are usualy quicker to adjust), the hardness or rigidity of the device, any other lower extremity problems (like knee or hip problems) and how much correction is needed in the devices.  

Follow-ups and adjustments are sometmes needed, but in many cases, improvement is seen fairly quickly.  After wearing the devices for awhile, there is a tendency for many people to forget about their heel problem after a few months, and to eventually go without the devices.  There are many cases where patients "lose" the devices, and two or three years later, come back saying that the pain was gone for over a year, so they tought they "didn't need them anymore."  After 6 to 12 months without them, the pain came back.  If you have pain in either or both heels or arches, and other treatments have given only temporary or partial relief, consider orthotic devices.   They may just be the best investment in YOU that you have ever made! 

 

Richard S. Eby, DPM

(423) 622-2663