What are Custom Fabricated Orthotics?
"Orthotics" are custom fabricated in-shoe devices that support and correct the alignment of the feet, lower limbs and indirectly the entire skeleton. They are used to control, guide, limit and/or improve the body alignment for a particular physical benefit. Orthotics mostly assist and promote movement, thereby reducing abnormal weight bearing forces. They also aid the rehabilitation from fractures and correct the shape and/or function of the entire body starting in the feet, providing easier movement patterns while reducing pain.
Custom fabricated orthotics are not to be confused with over the counter orthotics (OTC) or custom fitted orthotics, arch supports or shoe insoles which are largely cushioning devices. Custom fabricated orthotics are durable medical corrective devices, usually made of stronger materials, which improve the function of the entire foot and create a more symmetrical and efficient walking and/or running stride. A chain reaction of interdependent actions occur during walking and running. These begin at foot-strike and cause torquing and pulling sensations throughout our body involving all 206 bones, 600 muscles and tendons and 1,200 ligaments. The vertical forces applied to the ground at each foot strike radiate upward and equate to 3 to 8 times a runner's body weight. This translates to absorbing more than 440,00 lbs on each foot per mile and why 85% of repeat marathon runners use orthotics.
What Causes the Need for Orthotics?
FOOT AND LEG PAIN PLAGUE MILLIONS OF AMERICANS. Foot and leg pain inhibit us from living normal active healthy lives, prevent us from exercising and pursuing our hobbies and special interests, sap our energy, and can be torturous for those who have to be on their feet all day. For younger athletes, foot and leg pain slow their development and progress, cause them to lose practice time and fitness, keep them from performing up to their full ability and stymie the pursuit of their goals.
The average American logs 250,000 miles in a lifetime on his or her feet and could easily have twice that mileage if an athlete. Walking is usually one and a half times our body weight with each step taken. Plantar fasciitis, shin splints, achilles tendinitis, plantar fasciitis, knee pain, low back pain, hip pain and even headaches can be some of the most common eventual resulting pain symptoms originating in the feet. The most significant revelation during my 40 years of specializing in sports injury treatment and prevention has been the tremendous contribution that custom fabricated orthotics can have on preserving and maintaining our musculoskeletal alignment. I've also discovered that two major structural flaws are inherent in our body's genetic framework:
1. Approximately 95% of people have a significant right to left leg length difference - 1/4 inch difference on average.
(Leg Length Measurements)
How to Diagnose
Orthotics usage with my philosophy combines many disciplines of study within the health and physical sciences. These include chiropractic, orthopedics, physics, mathematics, materials, engineering, gait analysis, anatomy, physiology, pathophysiology, neurology, biomechanics, and even psychology. My current understanding of the cause-and-effect of sports injuries came from many years of study, licensing, practice, and working with professionals from many different disciplines including chiropractic, physical therapy, athletic training, acupuncture, massage therapy, sports psychology, and podiatry.
As a licensed DC, CCFC, I began creating orthotics with a Bachelor's Degree in Science, followed by a Doctorate in Chiropractic, and postgraduate Podiatric Certification of "CCFC," Chiropractor Certified in Foot Care. This specialization in foot care provides me with additional training in the assessment of the body's lower limb anatomy and biomechanics, special education and training in design, manufacturing, fit and modifications of custom foot orthotics, including footwear and shoe knowledge to help alleviate pain, abnormalities and debilitating conditions, not only in the lower limbs and feet, but throughout the entire skeleton.
How To Treat Using Orthotics
The best long-term solution to prevent and treat potentially all walking and exercise-related conditions is with a pair of custom fabricated orthotics made with a special correction for the anatomical short leg. Such orthotics create a more symmetrical and efficient walking and running gait, preventing the usual physical breakdown of the human frame most people eventually experience.
(Abnormal Foot Alignment), (Corrected Foot Alignment With Orthotics)
These realities cause biomechanical imbalances which are accentuated 5 to 20,000 times daily with every foot strike causing a cascade of twisting/pulling actions on muscles, tendons, and ligaments from the bottom of our feet to the base of our skulls.
(Foot Alignment- Abnormal vs. Normal)
2. There is a predisposition to lose the arches in our feet due to the continual stretching of the ligaments on the inside of our ankles and on the bottom of our feet as we log 1,000s of miles every year on them.
(X-Ray Side View of the Feet)
Custom Fabricated Orthotics are created by first making non-weight bearing sub-talar neutral position plaster cast molds of both feet. These are sent to the manufacturing lab, where positive casts are made and from which custom-made functional orthopedic orthotics (durable medical equipment) are constructed. The construction of these devices includes my detailed 15-point prescription, developed after prescribing 5,000 pairs of custom orthotics. This includes a correction for the longitudinal leg-length discrepancy, an extremely integral and effective detail, especially when only one side of the body, back, leg, hip, knee, foot or even head is experiencing symptoms and/or pain. These symptoms may develop when the leg length is not equal, causing more weight to be placed on the long-leg side of the body than the short-leg side. My custom orthotic prescription will also include control and functional corrections of the gait cycle leading to the remission of symptoms and resolution of articular and soft tissue abnormalities. Many times the orthotics will include special considerations for heel spurs and metatarsal (ball of foot) pain. These orthotics are made of a semi-flexible plastic material (polypropylene), giving a special "spring-like" effect with each step taken, which benefit the entire skeleton starting in the feet by improving movement, providing support, stabilizing gait, reducing pain, correcting biomechanical deformities, and probably most importantly, preventing the progression of physical degeneration and eventual need for surgery. With basketball and volleyball athletes, as well as high jumpers, these orthotics will produce a minimum of 1" vertical increase up to 4" vertical improvement. With runners and sprinters, count on a 1/4" to 1/2 " stride length increase. This special polypropylene material enables me to modify the orthotics with a special 1250 degree industrial heating gun and some additional tools to perfect them for each patient's ever-changing needs and abilities for optimal overall body performance from toe to head, starting with optimal foot alignment. Thousands of my patients continue to function successfully and thrive today using the same pair of orthotics for more than a decade.
Studies Show Custom Fabricated Orthotics End Foot/Leg Pain and Improve Athletic Performance
A 1992 study by Michigan State University showed that custom fabricated orthotics improve foot speed and vertical leaping ability. There are reams of testimonial evidence that orthotics enable athletes to run faster, run further, and recover faster from the physical stresses introduced in training and competition.
U.C. Berkeley published in it's June 1992 Wellness Newsletter that most people (at least 80%) have a difference in their longitudinal leg length and most peoples' physical problems start on their long-leg side, as it absorbs more shock than on the body's short-leg side. In fact, Dr. Friberg, M.D. published in Lancet in 1984, the first of multiple studies referencing the long-leg syndrome (in 86% of the population) and the likelihood that the grandparent's long-leg femur breaks first after walking 100,000s of miles which causes him or her to subsequently fall, not vice versa. I agree with Dr. Friberg's studies, U.C. Berkeley's findings, and both of their recommendations that the best correction of this leg-length inequality is with custom fabricated orthotics and a leg-length correction.
Dr. Paul R. Copeskey, DC, CCFC
I routinely use X-Rays of both feet, a Scanogram, a special X-Ray/CT bone scan of both legs, including the femurs and tibias. Of the 5,000 leg-length images I have measured, the average difference in 98% of the population is approximately 1/4 inch.
(X-Ray Scanogram of the Legs)