Q & A

What sort of examination should I expect?

Before any physical examination commences, you should be encouraged to describe your problems, clearly and extensively. A complete medical history should be completed, followed by a physical exam which should include vascular and neurological and musculoskeletal status.  An essential biomechanical examination should be done, involving both non-weight bearing and weight bearing (standing) component. Ideally you will be observed walking as well.

Why should I be questioned regarding my general and systemic health?

Many conditions effecting the structure and function of the lower limbs are as a direct result of systemic illnesses or medications, some connections are more obscure like nutrition, social habits or environmental variables.  Quite frequently, the condition you present with, can be the precursor or warning of a systemic illness that if detected early would be of obvious benefit. (common examples of these are diabetes, peripheral vascular disease, congestive heart failure, liver disease, cancer, HIV, renal disfunction, deep venous thrombosis)

How will i understand what is happening?

Don't worry, if you are being cared for by a licensed practitioner they are obliged to explain what they are doing to investigate your problem, and subsequently ensure that you fully understand the findings. If there is a reluctance to share this information you are advised to discontinue the process immediately and seek an alternative opinion.

What technology should be used to diagnose my problem?

If there is some concern regarding your circulation, a simple non invasive Doppler examination will be performed, and perhaps a blood pressure cuff may be placed on your ankle and upper arm for comparison. With regards neurological testing the technology will likely be simple to determin impairment, involving perception of heat, cold, vibration,sharp and blunt.

Examining gait and function using pressure mats requiring the patients to stand on or walk over them, this offer very little useful information and most certainly can not diagnose a structural condition. They are often utilized in the retail environment with futuristic screen displays indicating a suitable prefabricated, or customizable orthotic device. Most professionals will not utilize computer aided gait analysis equipment, those that do are often highly skilled biomechanical specialists/ researchers and such examinations, require the placement of numerous sensors and a large amount of time to both collect the data and then analyze the subsequent implications.

Video gait analysis is an excellent diagnostic tool often used in conjunction with a tread mill. It is also particularly useful in helping the practitioner explain to you the details of your structural imbalance or disfunction and re-evaluating the effects of orthotic and footwear interventions.  Various imagining techniques such as x-rays, ultrasound, MRI, bone scans and CT scans can in many circumstances be invaluable but not always essential.

What if i don't understand the diagnosis?

Once again with a licensed professional you must be fully informed of your condition before consent to treatment can be given. The license this professional holds is through a college, whose sole purpose is to protect you the patient while under their care. This being the College of Chiropodists of Ontario, they actively police and ensure the conduct of their chiropody and podiatry registrants. www.cocoo.on.ca

Does every foot problem require custom functional orthotic devices?

Yes! .......No I’m kidding! 

Very frequently if a mild underlying structural problem is identified, simple changes can be recommended in footwear design, shoe wearing habits, and activities to produce significant improvements in control, function and comfort. Two groups in which this is often the case are, retirees (spending considerable time in their homes) and young developing children.

What is a custom functional orthotic device?

Simply put, it is a custom made device from either a 3Dimensional digital or plaster mould of your foot, the shell and angled base of which are specific to your body weight, activity and structural misalignment. They can be rigid, semi-rigid, and semi-flexable; with decreasing rigidity, the devices become less functionally active. They may be made from thermoplastics, graphite, cork, leather and in the past even made from steel.

How does a functional orthotic actually work?

The goal of the functional orthotic is to work in conjunction with appropriate footwear, so that you can be supported in such a way as to enable the muscles controlling your foot structure to regain their mechanical advantage, enabling shock absorption, improved stability/balance, control load distribution and even have a significant influence on overall body posture and alignment.

What will custom orthotics Not do?

They will not fix backs, hips, knees or enable us to play the piano!. As stated before they can, if properly prescribed and utilized, have a very positive influence in shock absorption,  improve stability and overall postural alignment. This will most certainly decrease some of the inflammatory influences in disabling knee, hip and back pain. Beware of unrealistic expectations and promises.

Will it work in every shoe for me?

No!, some shoes are not suitable for any orthotic, and depending upon orthotic design they can be restrictive or versatile. It is a great idea to have a sample of your shoes present when deciding upon appropriate orthotic design versus function.

Do I need several devices?

Often times not, but it depends upon the variety of footwear worn, and the lifestyle you lead. Simply put, playing tennis and wearing dress shoes for the office require very different skills and orthotic design, ideally.

How should it be made?

The shape of the foot should be captured, non weight bearing, in either 3D digital scanning or plaster/fibreglass contact casting. The shell must be of a rigidity necessary to produce functional change relative to your body weight. Simply put once again, if the shell of the device is soft it will have very little effect, positive or negative. To the exterior of the shell the corrective prescription is added and/or ground to a prescribed degree. In dress devices these surfaces may be smaller and more subtle, but should be obviously present in true custom functional orthotic device.

How long should a custom orthotic last?

There is no fixed lifespan for an orthotic device.The best gauge of orthotic function is the return of symptoms or perceived lack of control. Semi-rigid functional devices often will last 3-4 years, this will vary greatly with design, activity and changes in body mass. Any suggestion of annual or set periodic replacement should lead you to question the motivation and expertise of the provider.

Will I need to come back to the office once I get my orthotic?

Yes most certainly, follow up visits are vital to ensure the best possible outcome of the custom prescription. Many modifications are possible although often not necessary. The followup visits will likely be unlimited and be included in the fee charged for your devices so as not to deter you from returning to achieve satisfaction.

Do I need custom footwear?

Very rarely is custom footwear required unless the degree of structural deformity is very significant in one or both feet. An orthotic designed to fit in custom made footwear will likely not fit in most other shoes thus restricting your options. In most cases where custom orthopaedic shoes are suggested, they are most likely not custom made, rather off the shelf models with the insole removed and an orthotic device in its place. This is generally offered at an exorbitant price versus buying the same shoe in a retail outlet, the anticipation being that a third party insuring company will cover the fee. Fortunately more and more shoe manufacturers are now aware of the increasing demand and are offering more diverse and attractive footwear in varying widths, depths, fabrics, and many with removable insoles.

Will my insurance company cover the cost of the orthotic?

Each insuring company is different, and within each company there are variances in the degree of coverage. If you have any reservations or questions regarding The best thing is to make sure before proceeding with ordering an orthotic device, unless you are committed regardless of the insurance outcome. The insurance companies have a very clear list of criteria regarding qualifications of the individual provider, method of casting and laboratory used to fabricate the orthotic. They will also want a physical examination, gait analysis, diagnosis and will want to ensure that the device was properly dispensed. In short your provider should show a willingness to assist you in ensuring your paperwork and receipts are appropriate for consideration by the insuring company. With regards to custom footwear, most insurance companies are now identifying this as a major area of insurance fraud and as a result will scrutinize all applications for custom footwear to ensure the legitimacy of the request.