Ok, so you think you could benefit from having custom orthotics made for you. But how do you know who you should see? What are some of the different factors you should consider in choosing a practitioner? I have put a list of 5 questions together that can help you navigate the world of orthotics.
- What are your credentials?
In Ontario, the orthotic industry has a number of different providers with different credentials. These come with different educational backgrounds and differing levels of training. Certified Orthotists, Certified Pedorthists, Chirpodists and Podiatrists are the most common providers of foot orthotics, while you may also see chiropractors and physiotherapists also making the offer.
The type of education that the provider has will determine a few things, with the most important being is this a side business to their main product or service or is this their reason for existence? Many providers will offer orthotics as a way of increasing their sales while they may not have the thorough educational background to support this decision. But how does the consumer know? This leads me to the next question you should ask.
- Are the orthotics made onsite or at a lab?
This is the fastest way to answer the question about whether or not it is a side business. In other words, a practitioner who does not know how to make orthotics will send the orthotics away to a lab. This is the biggest give-away that the clinician is not fully trained in dispensing custom orthotics. But this is not just a question of whether or not a practitioner knows how to design custom orthotics but also a question of quality control. I know that when my hands have been on a patient’s feet that they also need to be the hands that modify the cast and I want to oversee the fabrication of the orthotic. An additional benefit to having orthotics made onsite is that we can also make adjustments onsite. I have heard horror stories of orthotics being shipped back and forth to labs 3 and 4 times each time taking two weeks to get them back. And all of this was to make adjustments that would take 5-10 minutes if they had the proper set up.
- How is the shape of my feet captured?
Traditionally, there are three main methods to capturing the shape of someone’s feet. (1) Hand Casting (suspended subtalar neutral casting), (2) foam box impressions (3) digital scanning.
Hand casting has been around the longest and in my opinion is still the gold standard (it is what all methods are compared to in research). This method enables the practitioner to hold the foot in the ideal position while the cast hardens. It also gives the clinician an exact knowledge of what modifications they will need to make to the mold after it has been poured.
Foam box impressions are the quickest and easiest method however are also the most prone to error. In this method the foot is pressed into compressible foam but this invites the possibility that the foot is pushed into a position that is not wanted.
Digital scanning is a newer form of shape capture. The shape capture accuracy is excellent (very close in accuracy compared to hand casting). The limitations are more in the modifications after the fact. As practitioners we have to modify the molds after they are created from the cast. When using a digital scanner these modifications are done on a computer. There are set modifications that the software uses and there is some ability to customize them. However, it is not always straightforward. Have you ever tried to write your name using the paintbrush in Microsoft paint? It never seems to come out as neatly as your handwriting. This is because digitization lacks a sense of tactile feedback and this is my experience with digitally scanning for shape capture in orthotics.
- What different designs do you make?
You may hear different answers to this question. For example, “I make a dress design, athletic design and an everyday design”. This however is not an appropriate answer. If the orthotics are truly custom made, then patients will not be slotted into different categories. When I am asked “can you make an orthotic to fit in these shoes?” or “can you make them with padding in a specific area?” the answer should invariably be yes since I am making them from scratch each and every time.
- What is involved with the assessment?
Unfortunately, the assessment is an area that is often of poor quality within the orthotic industry. If all the assessment involves is someone quickly watching you walk and taking an impression of your feet then this is not nearly thorough enough to create a proper pair of custom orthotics. The foot should be carefully examined using proper physical assessment techniques, clinical tests, observational gait analysis and if possible some sort of instrumentation for objective data collection. We use each of these techniques including applying the Fscan system to every patient. Sometimes it provides us with new information that is critical to the design of the orthotics and other times it simply confirms what we already thought but either way the addition of this system to our assessments is invaluable.