Orthotics, or as I prefer to say, Custom Orthotic Therapy, is appropriate when the biomechanics are such that the knee is thrown into too much valgus or varus.
Custom orthotic therapy modifies a shoe's internal structure so that the foot, ankle and leg are better aligned for efficient movement and force dispersion. Orthotics are custom made because each patient has different biomechanical problems in his or her feet. When orthotics are installed the biomechanics of the lower extremities are altered so that impact loading and movement become more efficient. Athletes can improve their quickness and balance and reduce risk of injury because orthotics improve the energy absorption characteristics of the lower quarter during impact loading activities.
There is a significant difference between off the shelf devices and custom built devices. Custom orthotics therapy is not simply “putting an arch support in the shoe.” Orthotic therapy is a biomechanical solution to a biomechanical problem. We find that in conjunction with good physical therapy rehabilitation strategies, especially hip muscle training, custom orthotics therapy is often the key intervention that helps a person recover fully.
Biomechanics: The Physics of Movement
We live in an environment that forces our bodies to react to gravitational forces. With every step we take, our skeleton's alignment and structure influence the process of absorbing and releasing the energy that motion and gravity create. The feet have two functions in life. The first is be a mobile adapter. And to do this job, our feet are highly adaptable. As they hit the ground and begin to absorb load, the motion they undergo is called pronation. The structure and alignment as well as the flexibility of our joints determine just how much energy the lower extremity chain (foot-ankle-knee-hip-pelvis-lower back) can absorb. Should the foot be restricted, the energy is absorbed higher up the chain. For different reasons, both flat and high-arched feet channel a large amount of energy to skeletal structures high in this chain—especially the knee and the hip—making those structures more susceptible to injury.
For example, it is common for the kneecap (patella) to develop pain because a flat foot forces the patello-femoral joint to absorb more energy. Running sports add "impact loading" to the equation. Running and jumping amplify the effects of failed biomechanics. Sprains and strains are likely to occur when joints are poorly aligned or when they absorb forces that should be directed to another part of the body.
A Real life example: As a down hill skier, our 30 year old male patient discovered that he had a very difficult time trying to make long carving turns. Instead his turns were short and sharp. Our patient presented with a high arch foot that had several other technical structural deficits. The biomechanical consequence of his foot mechanics was that he was unable to easily use his forefoot to control the inside edge of the ski. Instead, he had to roll his knee in to get his inside edge down. He presented in the clinic with knee pain. Manufacturing custom orthotics for his ski boots and exercise shoes that corrected the biomechanical deficit enabled him to use his forefoot to control his inside edge. The result: Long C-shaped curves and more controlled skiing, no more knee pain. Custom orthotics were the solution for his mechanical deficits.
Who benefits from Custom Orthotic Therapy?
While the medical literature does not support the idea that we all need orthotics, in our experience, anyone who is active on their feet can benefit from custom orthotic therapy. Those who stand, walk or run frequently—whether in sports,
at work or at home—will see improved performance and comfort with the aid of custom orthotic therapy. At the Sports Reaction Center, we make custom built orthotics for all types of athletic footwear, dress shoes and working shoes. If you suffer from foot, ankle, knee, hip or back pain, custom orthotics therapy could be the biomechanical solution for you. We make the devices as follows: First we evaluate the mechanical alignment of your foot. Next we cast the foot, placing the foot in a sub-talar neutral position. This position of the foot lets the pod-orthotist construct a cast of your foot in a known position. The cast is sent to a lab we use (Biomechanical Services, in Brea, California). Together with the pod-orthotist, we construct a cast with corrections that will adjust your biomechanics to optimize your function. And from that cast, the orthotics are manufactured. It takes about 3 weeks to get the finished products back, and then there is a break in period to consider as well.
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