Is An Orthotic Necessary?
The Process a Doctor of Podiatric Medicine performs to Determine This
The patient presents to the office and the Podiatrist discusses the chief complaint. Following that a history of the issue and physical exam. The physical exam includes- dermatologic, vascular, neurologic, and biomechanical examination.
The biomechanical exam includes foot type, stance appearance, stance position, gait analysis, lower extremity examination static, muscle testing. A biomechanical sheet is filled out which includes- gait/stance analysis, also sitting/lying evaluation of position and range of motion of hip, knee, ankle, feet.
A diagnosis is then made and treatment plan is instituted. Xray, bone scan, CT, MRI to help determine the diagnosis. Various treatments may include, but not limited to shoes, exercises, taping, rest, immobilize, medication, OTC inserts, custom orthotics, surgery.
If orthotics are decided upon as the treatment of choice, the patient is casted for the orthotics. This is performed as a 3D Volumetric Mold of the feet. It isa neutral suspension cast non weight bearing. This is accomplished by doing a slipper cast made from plaster or fiberglass or a laser scan. Non 3D impression of the feet is mat scan, pictures, or tracing of the feet.
A prescription is written for the orthotics. Custom Orthotics written on a prescription pad is no a prescription. The prescription written by the Podiatrist includes the cast correction of how many degrees, shell material, shell flex, angulation of rear and fore foot (post), width of orthotic, cover, accommodation. Also the shoe type and activity the orthotic is used for.
The orthotic lab is offsite from where the mold is taken. The orthotic fabrication process is hand crafted or computer automated. Orthotic is fabricated based on the Root technique. The orthotic is custom and not prefabricated.
Once the orthotic is fabricated it is then sent to the Podiatrist’s office for dispensing to the patient. The patient returns to the office for orthotic fitting and explanation of breaking in the orthotic. Patient is reappointed in one month for follow up or if a problem the ASAP. If all is ok the patient is reappointed in 4-5 months. If patient still has pain then the orthotic is modified and or other treatment modalities are instituted.
If orthotic treatment is chosen the Podiatrist needs to be able to justify the orthotic, make quality of cast and write a correct prescription. Podiatrist needs to be able to modify to help the patient.
Orthotic treatment is based on;
- Evidence based medicine of orthotic/biomechanical therapy.
- Results in optimal clinical outcomes.
- Orthotic treatment is best for the patient.
- Treatment of lower extremity pathology.
- Podiatrist needs to make a diagnosis and proper treatment plan.