Where do we begin with this topic? Even though you probably use functional foot orthotic devices for many reasons, there must be a main reason or two or three that comes to mind. I am looking here for the major categories of reducing stress and helping gain stability. So, why do you use custom made functional foot orthotic devices, functional since they change function, and custom since you have made a unique impression of their foot and sent it to the lab?
One of the primary reasons that we use custom made functional foot orthotic devices is to make a patient more stable. By hugging the foot, if we can avoid hot spots, we are increasing the surface area of the foot that is in contact with the supporting surface. This will give the patient great comfort and they will feel the added stability, proprioception and balance. Ideal positions of stability can be set slightly inverted from the patient's maximally pronated position to slighly inverted to the ground. This gives a 8-10 degree of range where you can make a patient make and feel more stable. This incredible range of is hard to miss with the way custom made orthotic devices are made. The medial arch should pull the patient off their maximally pronated position of the subtalar joint, and the heel cup and posting should help them not supinate past 2-3 degrees inverted. Try to take a good image and the laboratory should be able to do the rest (with you picking the bells and whistles for style, flexibility, softness, sport, etc).
Yet, another one of the primary reasons we use custom made functional foot orthotic devices is of course to reduce pain. A patient presents with pain, and just the appointment made implies that they want you to do what you can to fix that pain. So, what are you doing with your custom insert to help this pain? How are you going to change the forces through the foot? You need to lessen the stress on the injured area, but still allow the most motion/activity for the patient. Custom made functional foot orthotic devices are a huge way to immobilize an injury while still allowing high levels of activity in rehabilitation. And yes, many injuries you treat with your custom inserts, probably will get better over time anyway. Why bother in the first place if the patient was just going to get better in the long run anyway?
The "Why Bother" has to do with the enhanced speed of rehabilitation and the natural correction of a patient's weak spots. And yes, we all have some weakness spots from birth, and some that develop over time. I will get on my soap box in Hyde Park and proclaim that the appropriate insert will not only be helpful faster in a particular injury than just waiting, but by removing weak areas from patients you are helping prevent injury reoccurrence. This injury prevention can go a long way in an athlete's career of 40-60 years or more. Each weak spot a patient has that you can correct like biomechanical faults, weak or tight muscles, short leg syndrome, poor shoe selection (definitely a mental weak spot), poor training habits (weak spot!!), poor bone health, can help athletes and all patients live healthier and more active lives. This is the "Why bother" to encourage you to get better at this modality of treatment.
I always practiced biomechanics in a way that made patients more stable. That was my mantra. Always make your patients more stable. Err, if you need to, on gaining more stability for the patient as you treat them. Even if the treatment was not for a considered biomechanical issue. Always ask "how can I make them more stable, or am I making them more stable"? Ask the patient the same thing. "Do you feel more stable?" with the inserts you prescribed, the taping you applied, the exercises you give them, the shoes you recommended. Listen to what they say. And, they may actually be quite impressed that you care about this!!
I talked above about how a typical functional foot orthotic device typically helps the typical patient gain stability. I believe this to be true in hundreds of thousands of patients that receive a version of common orthotic devices. The device alone, if comfortable, will add some stability to the patient. I have always called this insert the Doctor's Goal Standard. This is the insert she or he most goes to in treating patients. The doctor prescribing knows what this Gold Standard will do, and it typically makes the patient more stable. Since we can have 10 doctors taking their impressions differently, ordering different prescriptions off those impressions, and all 10 saying that the patients they work with feel more stable and more comfortable, then we must conclude that there is great importance for a doctor to have their own Gold Standard. I recommend everyone define their Gold Standard, and no one is every going to compare your's with mine or someone else. But, I think you can do better, as I can do better.
How do we get better? In Part 2, I will start the discussion over ways of advancing your prescriptions for greater stability. I will have separate posts on improving pronatory stability, supinatory stability, and medial-lateral stability. You need to go from your Gold Standard and know when to change. Yet, true knowledge of the process will come as you differentiate from your Gold Standard. I will define my Gold Standard (Type A). The 3 points of stability modern man uses are 2-3 inverted from Maximum Pronation, a Vertical Heel, and a Neutral Subtalar Joint. Therefore, we can still have a meaningful discussion if you do not measure anything, but I love RCSP, MPP, NCSP, and OCSP. Do not worry if you do not know how these are made. You can go to my recent post on RCSP measurement. No time in practice: there is always time to observe and listen. I will hit this subject from many angles since is so darn important. Can't wait to see how Part 2 starts out!! LOL
