Much has been said about what constitutes a good pair of foot orthotics.  The answer to this question for the most part is rather straight-forward…a fine balance between biomechanical foot correction, shock absorption and of course patient comfort.  To successfully reach this end goal of attaining the fine balance between these 3 very important orthotic qualities, it is the process that requires the most detail and focus.  What constitutes a good pair of foot orthotics begins at the steps taken to properly assess the patient for the need for such a corrective device.   The art and the science of correctly assessing a patient for custom foot orthotics is multi factorial and critical in producing the most suitable orthotics for the patient.  Without the complete and proper execution of this “Process”, results as to the success of treating the patient’s condition may be compromised.

The Process:

1.  The History:  A clinical history of the patient is conducted to take into account all health and lifestyle factors that may be contributing to the complaint.  The history is designed to gain an understanding of the patient/the patients’ condition and is an essential prelude in guiding a comprehensive examination.  In addition the practitioner should also investigate and take into account patient body type, patient activity and patient shoe type.

2.  Non Weight- Bearing Examination:  The initial foot examination first in a non- weight bearing position will allow the practitioner to assess:  the overall condition of the superficial areas of the feet  (ie. caluses, bunions, plantar warts etc.), the integrity of the arches of the foot in the non weight-bearing position,  and the  non weight bearing ranges of motion of the joints of the foot and ankle.

3.  Weight Bearing Examination:  This part of the exam allows the practitioner to assess the patient while standing and while in the different phases of the gait (walking) cycle.  Foot and body biomechanics are assessed as they pertain to the patient’s complaint.  It is during this part of the examination that the practitioner is able to observe the biomechanical patterns that develop while the patient is on their feet and correlate them to how they are contributing to the patient’s complaint.

4.  Impression:  A casting of the patient’s foot in a neutral, non weight-bearing position or a 3 D digital scan of the foot while in its normal gait (walking) phase must be taken.

5.  Integration:  The findings in the first 4 phases of the Process are integrated by the practitioner and sent to the lab to produce a custom foot orthotic to the individual specifications of the patient.  Once produced the patient is fitted and reassessed with the foot orthotics  Patient education as to the proper use of the devices and any other pertinent  body/foot home care advice is explained to the patient to achieve the best results in the treatment of their condition.

Dr. Raminder Badyal  B.Sc., D.C.  (Vancouver Chiropractor) is the founder of the Downtown Wellness Centre in Vancouver  BC.  If you have any questions with regards to this article please feel free to contact  Dr. Badyal at 604.687.5712 ext 1.