A prescription foot orthotic is an in-shoe brace which is designed to correct for abnormal foot and lower extremity function [the lower extremity includes the foot, ankle, leg, knee, thigh and hip]. In correcting abnormal foot and lower extremity function, the prescription foot orthotics reduces the strain on injured structures in the foot and lower extremity, allowing them to heal and become non-painful. In addition, prescription foot orthotics helps prevent future problems from occurring in the foot and lower extremity by reducing abnormal or pathological forces acting on the foot and lower extremity. A prescription foot orthotics is more commonly known by the public as a “foot orthotic”.
Podiatrists prescribe two main types of prescription foot orthotics for their patients, accommodative orthotics and functional foot orthotics. Both types of prescription foot orthotics are used to correct the foot plant of the patient so that the pain in their foot or lower extremity will improve so that normal activities can be resumed without pain. However, accommodative and functional foot orthotics are generally made using different materials and may not look or feel the same. Both types of prescription foot orthotics are nearly always prescribed as a pair to allow more normal function of both feet [similar to having both the left and right wheels of a car realigned in a front-end alignment.
Accommodative Foot Orthotics
Accommodative foot orthotics are used to cushion, pad or relieve pressure from a painful or injured area on the bottom of the foot. They may also be designed to try to control abnormal function of the foot. Accommodative orthoses may be made of a wide range of materials such as cork, leather, plastic foams, and rubber materials. They are generally more flexible and soft than functional foot orthotics. Accommodative orthotics are fabricated from a three-dimensional model of the foot which may be made by taking a plaster mold of the foot, stepping into a box of compressible foam, or scanning the foot with a mechanical or optical scanner.
Accommodative orthotics are useful in the treatment of painful callouses on the bottom of the foot, diabetic foot ulcerations, sore bones on the bottom of the foot and other types of foot pathology. The advantages of accommodative orthotics are that they are relatively soft and forgiving and are generally easy to adjust in shape after they are dispensed to the patient to improve comfort. The disadvantages of accommodative orthotics are that they are relatively bulky, have relatively poor durability, and often need frequent adjustments to allow them to continue working properly.
Functional Foot Orthotics
Functional foot orthotics are used to correct abnormal foot function and, in so doing, also correct for abnormal lower extremity function. Some types of functional foot orthotics may also be designed to accommodate painful areas on the bottoms of the foot, just like accommodative foot orthotics. Functional foot orthotics may be made of flexible, semi-rigid or rigid plastic or graphite materials. They are relatively thin and easily fit into most types of shoes. They are fabricated from a three-dimensional model of the foot which may be made by taking a plaster mold of the foot, stepping into a box of compressible foam, or scanning the foot with a mechanical or optical scanner.
Functional foot orthotics are useful in the treatment of a very wide range of painful conditions of the foot and lower extremities. Big toe joint and lesser toe joint pain, arch and instep pain, ankle pain and heel pain are commonly treated with functional foot orthoses. Since abnormal foot function causes abnormal leg, knee and hip function, then functional foot orthotics are commonly also used to treat painful tendinitis and bursitis conditions in the ankle, knee and hip, in addition to shin splints in the legs. The advantages of functional foot orthotics are that they are relatively durable, infrequently require adjustments and more likely to fit into standard shoes. The disadvantages are that they are relatively difficult to adjust and relatively firm and less cushiony.
The Process of Prescribing Foot Orthotics
In order to design and fabricate a prescription foot orthotics, the podiatrist must perform a biomechanical examination of the foot and lower extremities. Angular measurements are taken of the toes, foot, ankle, knees and hip to determine the amount and level of any structural or functional deformities. This examination is done while the patient is on an examining table and also while standing. The podiatrist will also do a walking and/or running gait analysis of the patient to determine how their foot and lower extremity functions during these activities. Abnormalities from the biomechanical examination and gait examination are noted in the patient’s chart for future consideration in the design and fabrication of the prescription foot orthotics.
The podiatrist then next must take a three-dimensional model of the patient’s feet in order to make a prescription foot orthotics. This is done by either applying plaster splints to the patient’s foot, by having the patient step into a box of compressible foam, or having the foot scanned by a mechanical or optical scanner. The resultant three-dimensional model of the foot is then used along with a detailed orthosis prescription from the podiatrist to have the prescription foot orthotics made for the patient. Most podiatrists have a specialty podiatric orthosis laboratory make their orthotics while some podiatrists make their own prescription foot orthotics.