Why Podiatrists Should Be Administering More Custom Orthotics

Posted on: Monday, April 29th, 2013

While sources vary, most statistics show that well over 90% of the population over pronates. Thousands of articles directly link excessive pronation to several musculo-skeletal pathologies and syndromes of the kinetic chain. More importantly, many of these conditions are biomechanical in nature. Therefore, it can be said that correctly made foot orthotics make for great patient care.

It is therefore easy to see why DPMs should be administering more custom orthotics. So many people need them! However, there are barriers to overcome. Inconsistent results and overadjustment of orthotics does not qualify as good patient care. Neither does sending the orthotics back to the lab countless times. All of these result in unhappy patients. And that means wasted time and extra, unforeseen costs.

Supination & Pronation

A very simple overview of the gait cycle is given below.

Gait can be divided into stance and swing phase. Each approximately equates to 60% and 40% of the cycle, respectively.

Stance phase could be divided into 3 phases: heel strike, midstance, and push off (or propulsive phase). Although midstance is longer than heel strike and push off, each phase is roughly about one third of the total stance phase.

As the heel strikes the ground, it ideally should be supinated or inverted. Supination means the bones are locked and stable. This is the opposite of pronation, which means unlocked and relatively unstable bones. When the heel strikes, one should be landing on a solid, steady foundation. This is why striking the ground in some supination is desirable.

As you progress through heel strike and enter midstance, the foot naturally begins to pronate. This initiates the unlocking of the joints to provide shock absoprtion. It also allows for adaption to uneven terrain. Some pronation is not only good, but is in fact a necessity to ensure proper function.

Near the end of midstance, the foot should begin to supinate again in preparation for the push off phase. This begins when the heel comes up off the ground.

What Happens When Over Pronation Occurs

When a patient’s arches excessively collapse or “over pronate”, two major things occur.

Pronating excessively can cause the joints to remain unlocked much too long in the stance phase of gait. The foot does not then have a chance to re-supinate. In essence, this results in the patient “pushing off” an unlocked and unstable foot. This allows the ground to manipulate the entire foot adversely.

A) If uncorrected, over pronation will lead to pathologic boney damage from abnormal shearing forces. This will result in osteoarthritics in both the forefoot and the rear. Stretched and torn ligaments, bunions, hammer toe, heel and arch pain and other conditions are the result of kinetic chain issues.

B) In many patients, a significant and excessive internal rotation of the entire lower extremity is generated. When the arch drops, the talus rotates medially. This then medially rotates the tibia. This excessive internal tibial rotation can place undue stress and therefore create torque at the knee. This causes ligament and meniscus tears, various knee compartment syndromes, and patella tracking problems. In many cases, internal torque can be transferred to the femur, consequently inducing an anterior pelvic tilt and increased lumbar lordosis.

How DPM Practice Solutions Can Help

With our unique technology, Structured Biomechanics, we provide a system that makes casting and fitting a patient with orthotics a simple task. More importantly, we are treating the cause of a host of conditions which have their root in an improperly balanced foot which over pronates. Once you understand the importance of properly aligning the bones in the feet to ensure exact supination and pronation occurs, you will see how powered our technology really is.

DPM Practice Solutions has partnered with Icon Orthotics, an orthotics lab in Florida. Icon Orthotics brand inserts are custom made, based on your exact casting of the patient. The ingredients used to manufacture the orthotics are of the highest quality and will retain their shape much longer than regular cheap plastics. Furthermore, they can be readjusted using a simple technique when performing followup examinations.

To learn more about our online course, read about our Structured Biomechanics Basic Course.