July 2017

Orthotics, or arch supports, are typically prescribed to control the act of over pronation, or flattening of the medial longitudinal arch of the foot during the gait cycle.  Walking and running places approximately 3-10x the force of body weight through the arches of the feet respectively.  Over time, the excessive pronation can lead to common problems of the lower extremity to include:
• Plantar fasciitis
• Heel spurs
• Bunions
• Morton's neuroma
• Achilles tendonitis
• Posterior tibial tendonitis
• Shin splints
• Knee pain
• IT band pain
• Hip/low back pain
The feet are comprised of 26 small bones, 33 joints, and over 100 muscles which all have to function properly to ensure healthy, pain-free running.  Problems happen when the arch of the foot repeatedly over pronates and places excessive stress and strain on the muscles, ligaments, tendons, nerves, and joints of the foot.  Over time, the excessive forces transmitted through the foot can lead to the following dysfunctions:
• Fibrotic adhesions in the muscular and tendinous structures
• Loss of structural integrity of the ligaments
• Degeneration of the joints
• Chronic irritation to the local nerves: tibial nerve, medial/lateral plantar nerve 
• Reactive bone formation: bone spur

The goal of orthotics is simply load management.  Orthotics will provide increased support to the medial longitudinal arch and take excessive stress off of the soft tissue and osseous structures during the gait cycle.  The increased support will help break the cumulative trauma cycle and enhance the healing process.



It is important to note that all orthotics are not created equal.  Examination, diagnosis, and implementation of the proper orthotic for the specific condition will yield the best results.

Soft orthotic: used to restore balance and absorb shock
Rigid orthotic: non-flexible provides maximum support
Semi-rigid orthotic: moderately flexible and most often used with athletes

Just as there are different types of orthotics, there are different methods that orthotics are casted.  There are arguments for both the non-weight bearing and weight bearing casting methods.  

Non-weight bearing: orthotics casting method of foot in unloaded/neutral condition

• Plaster casting
• Crush boxes: seated

Weight bearing: orthotics casting method of foot under loaded condition

• Crush boxes: standing
• Computer scan

If you are suffering from a chronic lower extremity condition it may be due to the functionality of your feet.  The following steps are the logical order for resolving your issue:

• Physical assessment and accurate diagnosis for your condition
• Restore proper functionality of the soft tissue structures 
          • Active Release Techniques ®
          • Self myofascial release
• Functional rehabilitation
• Professional consultation regarding which type of orthotic may be necessary 

As you can see, orthotics are listed last since you do not want to jump right from painful lower extremity condition to an orthotic correction.  Many times with proper assessment, treatment, rehabilitation, and shoe selection orthotics are not needed.  Often people have issues with orthotics when they become a first line of defense and correction.  You never want to put a good orthotic into a poorly functioning foot.  Restoration of normal foot function will greatly enhance the outcome of your orthotics and lead to faster resolution of lower extremity conditions.

Active Performance Chiropractic focuses on the diagnosis, treatment, and rehabilitation of athletic-related injuries.  Treatment is a unique blend of Active Release Techniques, traditional chiropractic therapy, and physical rehabilitation designed to match each patient's goals and lifestyle.