A Caution About Orthotics

We live in the New Jazz Age, as it were - everything is shiny and new and digital. This includes the various methods of making foot orthoses. Today, you can have your feet laser digitized. Totally WOW! And for most people, this is a really fast and effective approach. But - there's always a "but" - if your post-club feet have a very limited range of motion, or you've had fusions, this is not, in my view, the best approach. Allow me to explain.

There are currently two primary types of digitizers - static position scanners, and expert-positioned scanners. Static scanners are precisely that - you place your foot on a platform or within an enclosure while in a seated or standing position, and click! your feet are scanned. Unfortunately, this means your feet are most likely in their most problematic position, and the resultant orthotics are most likely to maintain your feet in or near that position.

The expert-positioned scanner requires a trained technician or biomechanist to position and hold your foot in what is called its neutral position while the scanner captures your feet in that position. Orthotics made on such digital parameters are far more likely to allow your feet to operate from this neutral position, and thus allow your joints their optimum ranges of motion. This leads, in most instances, to reduced pathomechanics during the entire gait cycle.

But with post-club feet, most trained technicians and biomechanists, in my view, don't see in their careers enough people with post-club feet. This means they are less likely to 1. successfully capture the true neutral position of our feet, whose neutral position is quite different, in many cases, from less "altered" feet. I know this from many years of working with both plaster molds and digital data of all types of feet, including post-club feet. And 2. Making the required modifications to the resultant images based on that same limited experience with feet like ours.

Before the advent of digital laser image capture, all orthotics were made from a plaster mold derived from either a plaster casting technique, or the step in the foam box technique. The foam box technique is fine if the orthotics are to be made from soft materials, because such materials will compress and collapse fairly rapidly, and can't have too much negative impact if they aren't well positioned and properly modified. But devices made of firmer, longer lasting, and more controlling materials offer less room for error. If a device made from polypropylene, for example, is made incorrectly, you are going to know about it fairly quickly. There is some, but not much, room for error. More rigid materials offer many advantages - more positional and functional control, longer life, greater resistance to compression and collapse, and more resistance to the acids in our sweat. But if made improperly - through casting or digital capture, and subsequent modifications of the resulting image or mold, then such materials can cause reactions ranging from aches to outright new and painful, and the odds are high such a device will be rejected.

I realize this doesn't seem very hopeful or upbeat, but again, I am trying to move the bar as high as possible for us clubbys. The precision required to both capture the proper position, and the skills necessary for proper mold or image modifications as applied to post-club feet require much experience. Unfortunately, and while I am willing to be corrected on this, I believe that I am the only post-club footer to have ever done this kind of work, and to have done it with more than twenty people with post-club feet (believe me, that's actually a lot.) This made me pay very close attention to how post-club feet vary from other types of foot deformities. The one foot type that most resembles post-club feet are those on people with Charcot-Marie Tooth's Disease. And I made shoes and orthotics for many such folks, as well.

So, to not be a total downer here, let me offer a few suggestions:

1. Find someone who understands and is well-practiced at neutral position casting technique. Podiatric biomechanists, especially ones trained at the California school, are better trained at this than most, but there are a few certified Pedorthists out there that really understand this technique. Question your practitioner on this, whether they use plaster casting, or laser digitizing.

2. Question as well who will be doing the actual modifications and manufacture of the devices. If you can't get that information from your practitioner directly, insist they put you in touch with the people who will be doing this. Speak to them directly about your feet - you are the best teacher on the subject of your own feet. Some of us, for example, have "fatter" soft tissue, especially around our heels. Some have some part of that soft tissue (also known as fat pad) that is laterally displaced - it doesn't stay under our heel when we put our foot on the ground - it "squeezes" out to the side. This soft tissue needs to be accounted for in the modifications to image or mold, or the devices will pinch or press that soft tissue in a painful manner. The height of the heel cup may also require increasing to account for this issue, as well. (If you are having problems explaining these issues to the practitioner or technicians, contact me with their contact information, and I'll be happy to "translate" for you.)

3. Break-in. Properly. Or risk failure of the devices.

4. Beware those who tell you "this" is the best/better/newest/coolest way. There are many gimmicks aimed at foot comfort. They only really work for a narrow slice of the foot-wearing public. An example: you might remember Earth Shoes? These shoes tried to sell buyers on the concept of the "negative-heel shoe." That is, the heel of the shoe was lower than the ball, causing the foot to fall harder at heel strike. The sales pitch used pictures of a bare foot in wet sand, citing this as a "natural way to walk." Unfortunately, both the pitch, and the shoes, were way off base: how often do YOU walk barefoot on the beach, compared to how often you walk on concrete, wood, tiles, etc? And, when you do walk on wet sand, how long does it take before your feet, legs, back get tired? As for the shoes? They ended up causing a large number of knee injuries, because (and I really shouldn't have to even say this, but what the heck) this position causes the knee to hyper-extend, which can lead to meniscus tears, torn HCLs, etc. Oh, lots of lawsuits ensued. So question all such claims - it may save you another trip to the doctor. And quite a bit of money, to boot (shoe pun:-)

Of course, I DO have a bridge to sell.