Custom orthotics can help in various ways. They can address foot mechanical issues, alignment issues, joint dysfunctions, or soft tissue functions, and the list goes on and on. When being assessed by a Certified Pedorthist, or Podiatrist, the devices dispensed are not the only way we help. Knowledge is power, and the more we can inform our patients of their pathology, the better we can find the path to recovery.
“How have custom orthotics helped you live a better life?”
This is the question we asked three different patients after we assessment them for a pair of custom orthotics. In this blog we will give you their answers to this question, give you a brief overview of each patients profile, review the reasons for the initial visit, what key aspects were found during their assessments, and what treatment goals were achieved; as well as a brief testimonial of the patients successes.
Patient one was suffering from daily pain which increased greatly even from light activity. Her pain was focused on the outsides of both feet, and within the ankle joints. These pains were occurring because of severe angles of her hind feet were naturally positioned in during weight-bearing. Because of the severity of the angles of her hind feet, surgical intervention was needed. She had her right subtalar joint fused, and a year later, her left subtalar joint was fused. The surgery was successful in drastically reducing her pain, but subsequently, range of motion was lost.
There were a number of issues to note during her assessment after surgery. She was suffering from bilateral bunion pain, pain on the top of her 3rd and 4th toes (due to hammer toe positions), weak flexor muscles of the feet and lower leg, and high medial longitudinal arches.
The purpose of using custom orthotics after surgery was meant to decrease the pressures on her ankle joint and return as much normalcy to her gait as possible. We coupled the custom orthotic treatment with a number of shoe modifications in order to achieve a gait pattern that would not cause an increase in pressure on other joints. She was also given an exercise routine to help with her weak flexor musculature.
To date, patient one has been able to return to her daily walks pain free!
“I feel like I’m walking normal again. I’m able to walk as long as I used to when I was young. It feels good to go for walks, and I feel like I’m not damaging things for doing something I love to do.”
Patient two was suffering from plantar fasciitis pain in both heels. He has had multiple bouts of this over the years. He found in the past that the pain would subside on its own with time. This time, however, the pain was gradually worsening. The most significant hurdle this patient was having, in regards to his pain, was his job; he is a mail carrier. You can imagine the amount of time he would spend on his feet on a day to day basis, and if he has pain in his feet, his life can be seriously disrupted.
Custom orthotic therapy was utilized for this patient in a number of ways. We first reviewed a number of stretching and anti-inflammatory techniques to reduce the pain he was getting in his heels. Custom orthotics made for his feet in order to support his medial arches, reduce the strain on his plantar fascia, and help with the velocity at which his subtalar joint pronates. What was contributing to this patient’s issue was the function of his big toe joints; specifically the loss in range of motion. We utilized a technique to help with his gait pattern because of this loss of function. He was also given a night splint for the right foot in order to keep a stretch on the plantar fascia throughout the night as his right foot had significant pain in the morning when he got out of bed.
On review of this patient, his plantar fasciitis pain was completely gone, and his gait has returned to a more normal function. He is back to work pain free, and able to increase his activity level, specifically, his favorite sport squash.
“The pain is gone! I’m not having any issues anymore. My plantar fasciitis pain is gone! I will continue to wear my custom orthotics, and use the forefoot plate, for work every day.”
This patient was suffering from pain in her right forefoot. The pain was the result of a Morton’s Neuroma – a compression neuropathy of the common digital nerve. This patient had tried custom orthotics in the past to resolve the issue, but had always been met with constant flare ups of her sciatica.
Her assessment determined a number of contributing factors to her pain. She has a series of anatomical misalignment’s which had been causing an increase in pressure to the area of her condition. Over time, and without intervention, a Morton’s Neuroma will most often progress in severity of symptoms. We developed a set of custom orthotics to help with structural realignment, and we included a metatarsal pad designed to redistribute pressure away from the metatarsal heads. The placement of this pad is important, and sometimes will initially be done temporarily before finding the correct location.
After reviewing patient two’s gait, it was determined she had very weak hip abductor muscles, most concerning were her gluteus medius muscles. We worked on a number of exercises to help with these muscles, and she was referred to physiotherapy to continue development and strength.
Her follow-up appointments showed a great improvement of her neuroma pain, and she continues to work on her physiotherapy-appointed exercises at home.
“I am a nurse and on my feet all day. The pain was getting to the point where I had to take time away from work. After using my custom orthotics, even for a short amount of time, I am able to spend a full day at work without discomfort.”
There you have it! Three different patients, suffering from three different issues all coming to the same conclusion. With the proper assessment, follow up, sometimes in combination with other conservative treatment pain management can be achieved through custom orthotics.
Russell Cattoor, Certified Pedorthist
Arthritis & Injury Care Centre
Olivia Northrup, Business Administration Manager
Arthritis & Injury Care Centre