Additional modifications can be made to the shell of the orthotic. The amount of contact and support desired in the arch has to be communicated to the lab that fabricates the orthotic. We start with simply identifying whether the orthotic should contact the arch fully (more corrective and more aggressive), slightly, or if it should be slightly lower than the arch impression in the cast. For patients with a lower arch structure as well as those with issues in the big toe joint, the inside aspect of the orthotic may be cutout to allow better function through the arch and big toe joint. This modification is called a first ray cutout. Some patients who have no motion in their big toe joint or the motion here is the cause of pain, the hard shell of the orthotic can be extended under the big to joint. This is called a morton’s extension. The heel portion of the shell can offer more control of the motion in the foot if it is made deeper, and if this modification is ordered it is called a deep heel seat. These are just a few of the possible modifications that can be considered based on your foot condition.
The bottom of the orthotic can slide in the shoe or make squeaky sounds while walking, so we often recommend what is called a bottom cover. This is when a thin material is adhered to the entire bottom surface of the orthotic. It often times helps to reduce noise that the orthotic makes in the shoe and is also helpful to reduce the wear of the orthotic when it is moved from one shoe to another frequently. This bottom cover can most often be made out of microcell foam or suede.
On top of the plastic shell of the orthotic, most patients prefer to have a continuous feel to the device and also some extra cushioning. For this reason, we often request that the lab apply what is called a topcover. The topcover provides some shock absorption and when made the full length of the orthotic it lessens the stepoff you may feel when standing on the orthotic. For a more athletic style orthotic, neoprene is a great topcover. It provides a rubberized cushion and has a more fabric type material that is closest in contact with your foot/sock. Microcell provides some shock absorption, but tends to bottom out (or squish down) sooner. For patients who wear their orthotics in casual or dress shoes, they may select a topcover made of Naugahyde (like leather) or suede, in order to save some room in the shoes. Microcell or a foam may be recommended for younger athletes who may experience more foot sweating and have excessive activity as it doesn’t tend to develop holes from rubbing as neoprene sometimes can. Also, additional foam padding can be added so that we don’t lose the shock absorbing properties offered by neoprene.
Padding is another customization available. Here are a few of the more common types. In the heel, for those who have experienced a loss in their natural fat pad (our built- in shock absorbers), a portion of the shell itself can be removed and a gel or foam can be inserted to this area, reducing the hardness felt in the heel of the orthotic. Patients who suffer from forefoot pain may benefit from an MT – or metatarsal pad. This is a tear-drop shaped pad that is placed just behind the ball of foot area and helps to offweight the forefoot area when walking and standing. Extra arch padding can also be applied under the topcover, which allows a more streamlined device but with a little extra boost of support.
We aren’t kidding when we say these are ‘custom’ orthotics! As you can see, custom orthotics can be built in a great variety of ways. Our goal is to make an orthotic for you that you like so much you don’t want to go without it! We consider not only the foot condition you are being treated for, but we also take into account the types of activities you will be doing in your orthotics and the shoes you are most likely to wear them in. Padding modifications can often be trialed prior to having these added to the orthotics to assess how well you may have tolerated padding. Custom orthotics are the more aggressive form of conservative treatment for musculoskeletal conditions in the feet and are critical in preventing future flare ups of pain. We often have patients who believe that surgery is the only solution to their foot problem and are delighted when they can avoid surgery and recovery due to the comfort offered by their custom orthotics. In cases where surgery is needed, the orthotics assist in reducing post-operative pain or the need for additional surgery later. Please make an appointment today if you think you could benefit from custom orthotics or if you have foot pain you’d like to get better!
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