TECHNOLOGY
The OrthoGait System refers to the way in which the devices can be used fitted and modified by a Podiatrist or other qualified Medical Professional (Foot Specialist) to treat musculoskeletal problems related to dysfunction of the feet and legs.
By Definition, A foot Orthosis is.
1. An in-shoe medical device.
2. Shaped to match the plantar surface of the foot.
3. Used in the prevention and treatment of injury, pain and disability.
4. A means of optimizing lower extremity function.
Foot Orthoses in Lower Limb Overuse Conditions: A Systematic Review and Meta-Analysis
Natalie Collins, B.Phty. (Hons 1)1 ; Leanne Bisset, B.Phty., M.Phty (Sports and Musculoskeletal)1 ; Thomas McPoil, P.T., A.T.C., Ph.D2 ; Bill Vicenzino, B.Phty., Grad. Dip. Sports Phty., M.Sc., Ph.D1
“Based on evidenced published to date, we would propose the following definition for foot orthoses: in-shoe devices shaped to match the plantar surface of the foot and used in the prevention and treatment of injury, pain, and disability through the optimization of lower extremity function.”
Prior to 1980, Foot Orthoses were constructed a variety of thermoplastic materials of various types. The materials were moulded on a plaster cast replica of the patient’s foot, which had been taken with the foot in an ideal posture or “neutral subtalar position” and then adjusted with wedges or posts under the heel and forefoot.
From a technical point of view, a foot orthotic consists of 2 parts.
1. The orthotic shell, which is moulded to match the plantar surface of the individual patient’s foot.
2. Functional posts, which are wedge shaped additions to the shell that apply forces to parts of the foot to alter its biomechanical function.
These principles of foot orthotic fabrication are still considered to be valid.
Since the early 1980’s there have been many products of a class called “Prefabricated Foot Orthotics”. Most of these products are mass produced insoles made by compressing sheets of heated thermoplastic foam material to a shape that has a contoured upper surface and some wedging effect under the heel and/or forefoot.
Several scientific studies have compared various brands of prefabricated foot orthotics to custom devices made by the traditional method on casts of the individual foot. The findings of these studies tend to suggest that both types of devices have very similar effects on symptoms and foot function and that the prefabricated devices may be more cost-effective.
The most compelling studies have used prefabricated devices in which the thermoplastic material has been milled rather than compressed to different thicknesses under specific parts of the foot. These devices can also be re-heated and re-moulded by the therapist to the contours of the wearer’s foot in the footwear in which they are to be used and some evidence suggests that this enables superior effectiveness.
While we at OrthoGait do not wish to debate the relative merits of prefabricated vs custom casted foot orthoses, we do believe that any devices used for therapy should.
1. Be compatible with the definition above.
2. Incorporate a shell that matches the contours of the wearer’s foot.
3. Incorporate posting that is appropriate for the patient and problem being treated.
4. Relieve the patient’s symptoms.
5. Significantly improve the function of the lower extremity.
In some cases, a mass produced shoe insole might co-incidentally satisfy these criteria in relation to a particular patient’s foot or feet but it is much more probable that a devices, which have been custom fitted and adjusted by a skilled therapist will consistently provide satisfactory patient outcomes.
In our opinion, the emphasis should be more on Foot Orthotic Therapy than Orthotic Insoles.
Therapy is a process by which the therapist utilizes his/her knowledge, skills and experience to:
1. Assess the patient’s problem and function.
2. Derive a diagnosis of the structural and functional specifics of the problem.
3. Prescribe appropriate therapy to solve the problem.
4. Reassess the outcome achieved by the treatment.
On this basis we consider our Foot Orthoses to be Semi-Fabricated in order to enable the therapist to efficiently finish the fabrication by customizing them to suit the individual patient. What we are aiming to do is spare the therapist the tedious work of cutting and grinding a chunk of raw material into a shape that can fit the foot and the shoe.
By supplying an adequate range of sizes and shapes of Semi-fabricated devices in various densities and combinations of densities and with a range of intrinsic design features we hope to assist the therapist to be able to cost-effectively relieve the pain and suffering of more patients.
We trust and rely on the therapist to use the products in the way which is most beneficial to his/her individual patient and think that this will generally follow the following sequence.
1. Select the appropriate device in terms of size, density, shape and design features from the products in the three ranges (Control, Support, Comfort).
2. Ensure that the size and shape of the product securely fits into the shoes and provides adequate room for the foot. Sometimes the innersole supplied with the footwear may have to be removed.
3. Compare the pre-moulded shape of the OrthoGait device to the plantar surface of the foot (with the foot in the desired alignment) to see if they match.
4. Place the devices in the shoes and heat them appropriately and thoroughly if re-moulding is required to match the contours of the device to the plantar surface of the patient’s feet.
5. Put the shoes with the soften inserts onto the patients feet with the patient seated and non-weightbearing.
6. Supinate the feet and press the arch and heel cup parts of the devices up against the soles of the feet by using the hands while the patient is seated.
7. Keep the feet in a supinated posture as the patient stands up and then guide the feet into a posture in which the alignment of the foot and leg are as desired. Generally the centre of the patella will be aligned over the 2nd toe and the Talo-navicular joint may also be in a desired alignment.
8. Maintain this foot posture for 30 to 60 seconds as the material cools and sets to maintain the new shape of a custom formed shell.
9. Reassess the patient’s mechanical alignment, function and comfort after custom moulding the devices.
10. Further customize and modify the devices by re-moulding, grinding, posting or by other adjustments or additions as required.
11. Institute additional therapies that are appropriate for the condition being treated.
12. Follow-up the patient’s progress and revise the devices and other therapies as required.
By supplying an adequate range of sizes and shapes of Semi-fabricated devices in various densities and combinations of densities and with a range of intrinsic design features we hope to assist the therapist to be able to cost-effectively relieve the pain and suffering of more patients.
If you would like to receive more information or have suggestions as to how we can improve our products or the way in which we recommend them to be used, please feel free to contact us.
