Orthotic Therapy

A foot orthotic is a device that is worn under the foot, inside appropriate footwear, that alters the gait pattern or re-distributes weight in order to provide symptom relief of the target area. A pre-fabricated orthotic is one that is found commercially at drug stores and shoe stores that are already made and can be purchased in one size or simply the size of your foot. Many people can benefit from these appliances, as long as the patient is aware of their condition and which appliance to get. It is best to consult with your Chiropodist. A custom made foot orthotic is one that is made especially for you. Precise measurements are taken of your feet as appropriate for your condition. There are several ways you can take these measurements:

PLASTER CASTING

There are several ways that a patient's feet can be cast in plaster of paris, the traditional method of gathering the information needed for the orthotic. The way the patient is cast, i.e. standing, neutral, semi-weight bearing, etc., depends on the patient and the condition being treated. Foot specialists rely to this day on plaster casting for the accuracy of information it captures which determines the success of the orthotic. The Kingston Foot and Ankle Clinic exclusively uses plaster casting techniques for all orthotic appliances.

COMPUTERIZED PRESSURE/GAIT ANALYSIS

There are several computerized gait analysis programs on the market today that try to capture the patient during standing and/or walking. The measurements taken, however seem to differ somewhat depending on how many times the patient walks over the mat or the posture of the patient while standing, etc. Most foot specialists do not use computerized gait analysis as the only method in obtaining the measurements for their orthotics, but the software and equipment's effectiveness will depend on the qualifications of the practitioner. If you are thinking about this method, make sure you are seeing a Chiropodist/Podiatrist to determine if weight-bearing measurements can work for you. It is our opinion that, in our experience, these orthotics are not aggressive enough to treat many of the conditions we see on a regular basis.

OTHER METHODS

There are ink pads and foam boxes that have been on the market for many years that provide a rough measurement for orthotic devices. We feel that there is too much of a margin of error if you are trying to get the patient's foot in a specific position and decreases the effectiveness of the therapy. However, we have found for patients who require only a light prescription, this method has been proven to be successful.

WHY IS ORTHOTIC THERAPY SO POPULAR?

Many people today are not willing to give up their profession or their sport simply because they have developed some back pain, or knee pain, etc. They want to find a solution and they are not satisfied with the traditional medication of anti-inflammatories or surgical options. Foot orthotic therapy works for a large section of the population.

A biomechanical exam from a Chiropodist/Podiatrist is required to determine if orthotic therapy can help you and to what degree.

Currently in Ontario, foot orthotics are not regulated. This means that when you choose a clinic to go to, you may not be seeing a Chiropodist/Podiatrist simply because they have orthotics in their advertising. There are many commercial labs that manufacture foot orthotics for chiropractors, family doctors, nurses, physiotherapists, and others with staff that have little or no medical training.

Only a Chiropodist\Podiatrist has the proper intensive training and continuing education in orthopaedic materials to offer the correction of biomechanical dysfunction through the use of orthotic therapy.

Some of these commercial labs, in order to keep orders high, offer one-day and weekend training seminars to get anyone interested in orthotics. Many health professionals can be seen advertising that they offer orthotic therapy on the side. Our clinic regularly sees patients that have obtained orthotics from less qualified commercial clinics only to be told that nothing could be done when the therapy was not working. Protect your investment: check the qualifications of the practitioners at the foot and ankle clinics- make sure that there is a registered Chiropodist/Podiatrist on staff!

HOW DOES AN ORTHOTIC WORK AT OUR CLINIC?

After the cast is taken of the foot in the desired position that is going to help the patient the most, the hardened plaster cast is then filled with liquid plaster and set to dry. After the cast is dry, the outer shell (the part that came off your feet) is removed to expose a positive impression of your foot in that position. The technician will then apply the prescription to the cast. This is done by adding or removing plaster and by measuring the different areas of the foot to achieve the desired shape.

For example, if the patient had a severe corn under his big toe joint, we will have to look at what is causing that corn. The metatarsal arch may need to be raised, the area itself will need deflection, the position at the ankle may need to be corrected, etc.

After the plaster work is done, the cast is set into a vacuum former. This machine will take the heated material that is going to be molded to the foot exactly.

The materials chosen for a patient are as important to the whole treatment as the casting technique. A soft comfortable orthotic, for example, may not be beneficial for a 300 lb man that has rolling ankles and knee pain - everyone must be treated individually!

When the material has cooled and the desired shape of the molded material is set, it is removed from the cast and taken out of the vacuum former. The "shell" which this material is now called is then ground on a machine to form it into the shape that will fit into the desired footwear.

After this is done, a top cover is then chosen to be applied to the shell. Again, the selection of materials used depends on the success of the orthotic. Once this is adhered, the final product is buffed and is ready for a fitting.

One benefit of a clinic that has it's own orthotic lab, is that there is short turn-around times before you get your new appliances and that all repairs and adjustments can be done in house, rather than sending casts or orthotics out for adjustments. It can take weeks before they return to the clinic and then you are waiting for an appointment to get them again.

The staff at our clinic actually see and know the patients that they are making custom made appliances for, so all of the criteria that goes into the orthotic are gathered, such as activities of the patient, types of footwear worn for dress, sport, work and hobbies, weight, problems they are experiencing, etc.

OUR ORTHOTIC LAB

We take great pride in our orthotic appliances and choose our materials very carefully at the Kingston Foot and Ankle Clinic. New materials are introduced into the marketplace all the time and we test their effectiveness thoroughly before we add them to our list of over 40 different orthopaedic materials. We only use non-caustic glues which are healthier for everyone. We offer a full range of services for any type of orthotic from any lab.

FOOTWEAR

Footwear itself can, to some degree, determine the success of the orthotic appliance. The greatest orthotic in the world, may not be able to reach it's full potential in an ill-fitting shoe or boot. Our staff can give advice regarding the many different types of footwear that would be suitable for each patient depending on their prescription. Today, many of the orthotic appliances are not as bulky and thick as they once were, and most have thinner shapes that can be accommodated in existing footwear. Today, we stock many materials that are rigid enough to provide the support over the long term, yet have some 'bounce' to avoid a 'hard' feeling when there is no give to the material. Of course the actual characteristics of any patient's orthotic will depend upon the prescription. However, the orthotic is the most important part of the equation. If a patient requires a special top cover that will be thicker, i.e. to defect pressure from a corn or an arthritic joint, there are still many choices today to choose from in footwear that does not appear as 'orthopaedic' looking as was the case in the past.

PRIVATE INSURANCE COVERAGE

Private insurance companies are doing their part in trying to regulate orthotic therapy by requiring a prescription for orthotics that include a biomechanical assessment, materials used, and so on. A Chiropodist/Podiatrist has full prescription rights and is usually preferred by insurance companies. The Kingston Foot and Ankle Clinic will provide the patient all the necessary documentation that is required for your insurance coverage.

PROVIDER INFORMATION

We are a provider for the following government programs:

• Veterans Affairs Canada
• Workman's Compensation Board
• Department of National Defence
• Indian Affairs

HOW CAN YOU GET SEEN AT OUR CLINIC?

The simplest way is to click on our Contact Us main menu item at the top of every page. Alternatively, the clinic telephone number appears at the bottom left of every page. There is no referral required. Usually we can provide appointments within 2 weeks of booking. Appointment times run from 30-45 minutes in length.

You will be provided all of the information that you require for insurance company reimbursement at the completion of your treatment. You will also have the option of sending a copy of the information of your condition/results to your family doctor, if desired.