Thursday's Biomechanics of the Week: Orthotic Devices: A Cure for many Problems

I am honored and humbled by the comments below. I love biomechanics. I thank this nice patient from sending in this compliment. Orthotic devices can do so much to help patients. I make my own orthotic devices, not only because I love that work, but I love to experiment. I love to see the process from start to finish-- from taking the impression cast to dispensing the devices. 

Dear Dr Blake: Recently I saw a podiatrist at Kaiser to just learn more about what their podiatry department has to offer. The podiatrist I saw told me that he followed your career and that you are the best orthotics person in the country.  We, your other followers, already know that of course!  But this is also to say again thank you for your dedication and helpfulness to your patients.
I am trying to work with my flexible hammer toes.  Will come in for visit as my old orthotics are getting worn out. Thanks.

Regards,

Dr Blake's comment:

     Foot orthotic devices can be used for many functions. It is the attempt to understand what you are trying to accomplish, and what the limitations are in the devices you prescribe, that experimentation is often needed. Health care providers that prescribe and dispense orthotic devices are trained to know how to work with these inserts. The common checklist that is worked off of in prescribing is:

• Amount of Pronation Control Needed
• Amount of Supination Control Needed
• Amount of Motion Needed
• Amount of Shock Absorption Needed
• Amount of Limb Length Shortness Correction Needed
• Amount of Metatarsal Arch Needed
• Amount of Flexibility/Rigidity Needed
• Amount of Foot vs Leg/Knee Correction Needed

This is a terribly complex equation at times. And, at times, each foot need very different support. And, at times, corrections are contradictory (i e. the need of flexibility and rigidity at the same time for different reasons). As I exam my patients, it is often after I give them an initial orthotic device, and get their feedback, that it is apparent  that major changes are needed. What I thought was important initially was incorrect or just must take the back burner to a more important issue. This is the Art of Biomechanics that I live in, and love. 

When you are making orthotic devices, you need to know how to work with your lab to have 3 or 4 levels of change in each of the categories above. That will make you successful with 95% of your patients needs. For Example, your initial "standard" orthotic device has a certain amount of shock absorption qualities. But, could you improve on that shock absorption in 3 more layers of complexity: more motion, more cushion, more support. Yes, the better the foot contacts the orthotic device, the better the plastic absorbs the stress away from the body and on to the device. The vertical ground reactive force gets transferred less up the leg and more out the end of the shoe. We can go on and on about all the modifications to biomechanical support that can be made to improve someone quality of life. I hope this gets everyone thinking in these terms. "We are truly limited by our Imagination in this field", and sometimes I have a good imagination.