Q: We’ve been hearing a lot about foot orthotics in recent years – why are they suddenly a trending topic?
Dr. Fergus: I often hear this question in my clinic. Patients come to me with pain in the knees, ankles, and low back, and they often ask me why I recommend orthotics for their pain. The crux of gait pain issues is the change in surfaces on which we walk. Our ancestors did not need custom foot orthotics, but they weren’t spending all of their time on modern hardened flat surfaces.
Q: How do modern hardened flat surfaces affect foot function?
Dr. Fergus: Most of the history of our bipedal ancestors involves walking, running, and standing primarily on variable surfaces. Our feet are wonderfully adaptable to changes in terrain. There are 30 joints and more than 100 muscles and ligaments in the feet that allow them to adapt to different surfaces, absorb shock, and stiffen to transmit force for running and jumping. All of those moving parts are there to allow us to customize our body to surfaces and loads and enjoy a wide variety activities.
The 2-dimensional flat surfaces we walk on force our 3-dimensional feet to conform the same shape with every step. If you’ve ever followed an animal’s tracks in the wild, you’ll notice that they avoid the hard types of surfaces on which we spend most of our lives. Animal instinct leads us towards softened and variable grounds. Hardened, flat grounds, however, are a requirement for modern living, so we need to be aware of what demands come with that and how we can avoid or overcome injury. Sidewalks, paved roads, wood and tile floors, etc. all demand a repetitive sameness of our feet in gait. They require our feet to work perfectly or bear the consequences of repetitive impact stress.
Q: How do custom foot orthotics help the body move in a more natural way?
Dr. Fergus: Custom Foot Orthotics restore a more natural foot function by taking stress off the body. I encourage most patients to spend a few hours each week barefoot on soft surfaces like beaches or yards. Soft ground is the original orthotic. Soft ground is nature’s orthotic to stimulate our feet and nervous system. As the heel and ball of the foot sink into softer surfaces, the broader arch is filled and supported by the ground to help absorb shock and slow down rotation of the ankle and knee. It’s not always practical for everyone to spend hours barefoot on soft ground weekly. So, when we build a Custom Foot Orthotic for you at Cornerstone Health, we take a mold of your foot in neutral position. This mold will then create a plaster positive of your foot that we will use to make your orthotic specific to you. The main heel and arch support in the orthotic mimics the feel and effect of soft ground supporting the foot. In a good orthotic, the arch support is not rigid or uncomfortable, instead it is a perfect fit to your foot and is a little springy to work with your foot muscles for shock absorption and keeping the foot in a neutral range. There is a common misconception that orthotics are rigid and prevent the foot from moving. If you see an orthotic like that – throw it out and give us a call!
Q: How do Custom Foot Orthotics fit into Cornerstone Health’s mission of eradicating chronic pain?
Dr. Fergus: When feet become deconditioned to varied types of movement, the body has a hard time adapting to change. When your joints are able to move and tendons able to stretch, they send a barrage of wonderful sensory information to the brain. This is termed afferent stimulation, and it lights up the sensory cortex of the brain. The more diverse sensory information the brain receives from an area the better it can move and control that area of the body. These healthy movements can also reduce the sensation of pain – think of how good it feels to get up and stretch after a long plane ride! A well-made Custom Foot Orthotic starts from the ground up to improve therain’s relationship with the body. They’re a natural choice for many of the patients I see, who suffer from pain in the lower body as a result of repetitive movement on unnatural, hardened surfaces.
Q: Why is it important to use a well-made Custom Foot Orthotic that takes anatomical variation into account?
Dr. Fergus: Many of us have what are considered “foot deformities”. These may be as mild as having a toe that is abnormally shorter than others, or the angle of how our heel or forefoot hit the ground being out of sync. These are not major deformities and they are very common – we call them ‘anatomical variants’. On soft ground, these minor deformities are neutralized by the ground conforming to meet the foot. On our hard surfaces, our foot must conform to meet the ground. This often leads to aches and wear in the feet or up the kinematic chain in the knees, hips, or spine. By having Cornerstone Health build you a custom orthotic, we can make some mild modifications that neutralize foot deformities and actually allow your foot and walking gait to function much more naturally and comfortably. This is closer to natural foot function than walking barefoot on hard surfaces, but is not a perfect replacement for being barefoot on soft surfaces. A well-made custom foot orthotic can help you maintain a natural gait and healthy feet, despite spending the majority of your time on hard surfaces.
Q: What about more major issues?
Dr. Fergus: Some patients are born with bigger deformities or develop them over a number of years. Club foot deformity, ankle equinus, pes cavus, hallux abducto-valgus, hallux limitus, hallux ridgidus, bunions, neuromas, adult acquired flatfoot deformity, posterior tibial tendonitis and other foot deformities can all benefit from a well-constructed custom foot orthotic. These
conditions require a skilled doctor and orthotic lab to evaluate the patient and determine how each element of the orthotic needs to be built to provide a great outcome. At Cornerstone Health, we focus on detailed evaluation of walking mechanics and work closely with the best orthotics lab in the country, Xtreme Footwerks, to build a Custom Foot Orthotic that helps you overcome your foot issues while still feeling light, natural, and comfortable. In fact, we provide
a consultancy to educate other doctors and orthotics labs internationally world to help them provide the same great care and custom foot orthotics that we offer right here in downtown Evanston!
Q: What is the process for ordering a Custom Foot Orthotic?
Dr. Fergus: We start each orthotic exam with an evaluation of your issues and goals. The exam portion continues with a Harris Mat pedograph to map out foot pressures in gait – a simple step-through device that creates a map of your foot. The exam concludes with a unique specialty of our practice: video slow-motion gait analysis. By watching real-time gait in detail
with an expert eye, we identify how your walking gait affects the entire body, not just how the foot and ground interact. This helps us solve that nagging shoulder problem or pain in the hip, etc – a more global view of the body. While most orthotics are built from a scan of your foot, our approach looks at how your entire body needs to function in relation to your walking gait. Finally, we mold an impression of your foot in neutral position to build your orthotic. When the orthotics arrive from our lab, we have a thorough, in-office fitting process including ‘Posting’ of extensions and wedges as needed to help your foot work more naturally with the ground. With these methods, we create a perfect Custom Foot Orthotic for you that can be worn walking, standing, and exercising and will last for up to 6 years.
We are in-network with Blue Cross Blue Shield and Aetna insurances, and many of our patients are surprised to discover that most plans cover Custom Foot Orthotics. Our front office staff can help you check your insurance benefits.
Benjamin Fergus, DC, DNS
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