Video on Custom Orthotic Devices in the World of Biomechanics (from Dr Richard Blake)

https://prezi.com/v/knup4p49iyp3/orthotic-devicespptx/?preview=1

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. 

Orthotic Stability: Check Placement of the Orthotic Device within the Shoe Itself

When designing custom made functional foot orthotic devices, the proper shoe fit is essential. The photos below demonstrate a common problem when placing an orthotic device on top of the already existing shoe insert. It is important that the orthotic line up perfectly with the outside edge of the foot (baby toe side). However the inserts in the shoes can force the orthotic medially (towards the big toe side). This will cause the orthotic not to match with the foot, and possibly cause problems. 

The shoe insert under the orthotic device directs the orthotic device away from the outside edge of the foot causing poor fit issues including irritation, and both medial and lateral instability.

In this photo, the lateral (baby toe side) side of the shoe insert is cut away of all but the part on the bottom.

This photo demonstrates how the orthotic device can be more easily seated laterally to line up with the lateral side of the foot. Patients should be reminded always to place the orthotic device into the shoe so that it lines up along the outside (lateral) (baby toe side) of the shoe. 

Designing Orthotic Devices from Afar

Hello,

I am  21 years old and i live in Egypt. I suffer from flat feet and i wanted to ask if i can custom a special steel orthotic matches my feet size, and if there are any other types of workout to help curing it.

thank you,

Dr Blake's response:

 I would be happy to work with you. I do not work with Steel but have found 3/16 inch (4.7 mm) polypropylene work great and gives some spring to the arch. The best is to buy a Biofoam box and try to make an impression of your feet. Then mail the box to Dr Rich Blake, 900 Hyde Street, San Francisco, Calif, 94109, and I will try to make something. It will take 2 -3 tries due to the long distance, but based on the feedback you give me on the first set, we should be able to figure out where to make changes. The link to buy the box is below. Probably sending me a video of you walking back and forth in a 15 foot area will give me better idea what you need. Rich Hope it works. 

http://www.mooremedical.com/Index.cfm?Ntk=all&No=0&Search=Search&Ns=Searchorder%7C0%7C&Ntx=mode+matchpartialmax&Ntt=Biofoam&x=48&y=11

Also, it is extremely important to do daily foot and ankle strengthening exercises. Never exercise through pain, but you should be able to gradually strengthen your flat feet. Here is a video to get you started. Rich