Thursday, March 27, 2014
Thursday's Orthotic Discussion of the Week: Asymmetry in Orthotic Control is Best
When you take impressions of patient's feet, there will always be differences in the overall foot structure. Study the casts and appreciate these differences. Decide if these differences, like more or less forefoot deformity, is important to correct fully. Orthotic labs overall love to even out the tilts, but these tilts may be important. Work with your lab on making sure they only even out when you prescribe, not routinely. Most of the time I see totally symmetrical orthotics, even when both feet look totally different, so I know this evening out occurs (and possibly not for the patient's best interest).
The true reason for this post is the asymmetry in the correction that so many feet need. Correcting asymmetrically, like the photo above, is needed often. This occurs since one foot may pronate more than the other, supinate more than the other, require more forward pitch than the other. The photo above shows more pronation (arch) support on the right, and more supination (outside) support on the left. Be critical of your orthotics, work with your labs, dare to be more asymmetrical in your Rx.
The goal really is to make both feet function close to symmetrical, and stable, no jerking, very smooth. With asymmetries, just make symmetrical orthotics will not feet function even. This is an old theory from the 1970's. Perhaps it worked more in rigid rohadur orthos and oxford or wingtip shoes. But, not in 2014. Think asymmetry for RX to make the feet function more symmetrical.