Sport Podiatry
What are 'podiatrists'?
Podiatrists, among other things, are specialists in the biomechanical assessment of feet. Biomechanics is the study of force and its' control and distribution in the body. The foot is a complex collection of bones, ligaments, muscles, tendons, nerves and blood vessels, and podiatrists have spent a minimum of four years at the university level learning about the interaction between these structures, as well as how the foot relates to the alignment and function of the rest of the body. Podiatrists have their 'Doctor of Podiatric Medicine' (DPM) degree, and are foot specialists as this is the only area of the body they deal with. Podiatrists commonly use prescription orthotics to aid in the treatment and prevention of injuries, but also may perform surgery on the foot in certain circumstances.
What are prescription orthotics?
Prescription orthotics are custom made devices that are inserted into your shoes. They enhance your function by maintaining the anatomical angular relationships between the segments of the feet and legs. Orthotics control abnormal foot and leg motion, and are very useful at preventing and treating overuse injuries of the lower legs and feet. They also play a big role in managing many causes of low back pain.
Who makes orthotics?
In Ontario, pretty much anybody! The prescription of orthotic devices in Ontario is not a regulated act like many things in medicine, so you do not need any special accreditation to prescribe orthotics. Because of this, many different practitioners and businesses make these devices. There is a wide continuum of training, ranging from weekend courses all the way up to university degreed podiatrists. Many shoe stores offer this service, as do many health care professionals, all with varying degrees of understanding of foot biomechanics. The important thing to remember is, as with anything, the more training and experience a particular individual has, the more likely positive results will be obtained. Orthotics are no exception, and without a doubt, podiatrists are the most highly trained foot practitioners in the Ontario system.
How should my orthotics be made?
Currently, there are four common methods used to make orthotic devices: off the shelf, force plate, foam box and plaster cast.
Off the shelf orthotics are prefabricated devices, typically store bought. Store bought orthotics can provide hit or miss pain relief because they are not specifically designed for your individual foot. Foot structure and function can vary tremendously from person to person, so this is the least desirable approach, much like one pair of glasses being used for many different people who have varying corrective eye prescriptions.
Force plate involves walking on a pressure sensitive mat, which scans the foot in two dimensions during weight bearing. The scan information is then usually used to modify pre-fabricated orthotic devices to fit your foot-not exactly custom made. The foot is a three dimensional structure, so using two dimensional information to modify a prefabricated device is obviously less than ideal. Virtually anyone can use this method due to its simplicity, and this system requires minimal training and understanding of foot biomechanics to use it.
The foam box method is used by many health care professionals (except podiatrists) to make orthotics. The patient steps into a foam box, which takes a mould of the foot. The mould is then manufactured into a custom orthotic device. While this method is probably better than the prior two, it is still less than ideal in terms of accuracy, as much research into the topic confirms. The appeal of this method is it is relatively less messy and less costly than the next method.
The last method is the plaster cast method. This method has been proven over and over again with good research to be the most accurate method used today. With this method, a plaster cast of your foot is taken while lying down, so that no weight is exerted on your feet during the process. Your feet are held in 'neutral position' (the foot position most ideal to be in) while the plaster dries. This enables the cast to most accurately represent your ideal foot position, and the orthotic is then manufactured from this plaster impression. Virtually all podiatrists use the plaster cast technique due to the superior features of this process.
Why is there such price variability in orthotics?
The price of an orthotic, like anything else, is dependent on who makes them, and what method is used in the manufacturing process. The more educated and experienced your practitioner, the more they will charge, meaning podiatrist prescribed orthotics are usually more expensive than those made by other practitioners. In addition, a truly custom device requires a series of angles be built into your orthotic to maximize control of your foot (your foot prescription), and your podiatrist will direct the manufacturing lab how to do this for your particular situation, much like a medical doctor directs a pharmacy with a prescription for medication. Adding angles to your orthotic increases the manufacturing cost. You can be sure that with less and less training, your practitioner is less and less likely to actually direct the manufacturing lab as to what angles to build into your devices, as this is an area requiring substantial levels of education and experience to fully understand. Also, any prefabricated device will naturally be less expensive (off the shelf and force plate technique) because these methods don't produce custom devices, and therefore are less expensive from a manufacturing standpoint. As it turns out, the manufacturing process for the plaster cast technique is on average a 20 step process, and, as such, is generally a more expensive, albeit much more accurate, method of manufacturing.
How long do orthotics need to be worn?
Once an orthotic is prescribed, it is likely they will be worn for the rest of your life. Think of orthotics in the same way you think of eyeglasses. While orthotics are often used for rehabilitation from an injury, they are most often utilized to maximally control abnormal foot and leg motion. Therefore, they will likely be worn forever.
Will a foot orthotic improve athletic performance?
An orthotic device prescribed for an individual's needs should improve the efficiency of athletic performance. Stress on the feet and legs can be minimized with added foot stability and certain injuries can be prevented, while simultaneously improving efficiency of power transfer from the foot to the legs. This is especially important in running/field/court sports, cycling and figure skating.
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