Prescription Custom Orthotics

BY DR. BOB WEIL

Hey Sports Parents & Coaches- Hard to believe that I’ve been prescribing custom orthotics for sports kids over the BY DRp.aBstO40ByWearEs I(give or take a few weeks). Young boys & girls, from teenagers to others commonly under the age of 12, as young as 5 or 6 in all sports. Sports like soccer, baseball, football, basketball, tennis, figure skating, hockey, running, dance, etc. I often tell sports parents sitting with their young athlete, “Overuse injuries & problems are similar– all that changes is the uniform your kid’s wearing–the sports they play!” Their concerns and challenges both physically and mentally are many times the same. Quite often their overuse problems or discomfort is related to their foot type or mechanics. Almost always the reasons were persistent or ongoing pain or discomfort, not an acute injury. Their feet hurt, heels hurt, ankles, shins or knees hurt. Especially with aggressive schedules and playing demands! More and more, however, especially in skating sports like figure skating & hockey, orthotics can improve balance, stability, edging and performance. This is exciting!

Orthotics in growing kids might be changed every year and a half to two years. Once their foot growth is over, (girls about 14 and boys about 16), they might use the same orthotics for the next ten years! Rarely is larger shoe or skate boot needed for these inserts.

We’ll get more specific with foot type, foot mechanics and joint position and alignment later this article.

Prescription in shoe orthotics, properly done, ideally by podiatry, but also by well qualified physical therapists & pedorthists have really proven to be a major weapon in the treatment and prevention of foot related ankle, lower leg, knee, hip and back overuse problems. Yup, like the song, the foot bone is connected to the ankle bone is connected to the knee bone… All the way up the weight bearing chain. In running, jumping, skating sports–that’s where it’s at. The feet affect all areas above.

Orthotics are made from various materials. Often the demands and specifics of the sport can determine these materials. I have always liked flexible unbreakable polypropylene plastic for youth sport orthotics. Flexibility is determined by the athlete’s weight and their sport.

Orthotics do much more than support the feet. They help properly position and align the foot, ankle and lower extremity. Optimal joint position is the goal as is structural integrity. Often the prescription is made using plaster cast molds, (messy but still I believe the best method), of the feet in non-weight bearing measured neutral positions. Orthotics have various uses and indications. Examples could be to redistribute weight away from painful areas, to control excessive or abnormal motion, or enhance alignment of the lower leg. Dissipating and reducing shock might be another important reason. A common misconception is that custom orthotics are arch supports. Although support is important, it is not the only function – proper alignment & joint positioning are also key. There are definitely uses and indications for over the counter inserts or supports– often I’ll recommend them for temporary initial use while we’re waiting for the custom orthotics. But these are generic inserts by shoe size, having not much effect on foot function or joint alignment correction.

Custom orthotics main role is usually controlling the positioning of the feet and lower leg during the different phases of gait. Basically, the foot has three jobs in walking and running–shock absorption when the heel hits the ground, ground accommodation or shaping to the ground, (imagine walking on the sand), and then pushing off the foot like a spring lever. Each of these actions demands particular motions of the foot and rotational motions of the lower and upper legs, pelvis and spine. The terms used to describe these foot motions are pronation and supination. These are complex motions taking place in the joints of the foot and lower ankle, three motions in three directions simultaneously.

Hey–it’s complicated! Only our hands are as complicated but we don’t walk on our hands! (Mentioned that once in a talk I was giving to young gymnastics kids & their parents & coaches & one of them said. “yes we do!” I stood corrected).

Pronation and supination are normal motions. Problems can arise when the timing, velocity, or amounts of these motions are excessive or limited. Pushing off a loose hyper pronated foot is inefficient and can strain the supporting tendons and muscles.

Various inherited foot types and leg shapes create problems with these motions. Examples are flat feet, high arches, bowed legs, knock knees and leg length differences. Each of these imbalances (quite common), can cause excessive pronation or supination leading to overuse injuries, wear and tear and problems like arch and heel pain, shin splints, knee pain ETC. Yes–foot type and leg shapes are commonly inherited! Blame your parents and grandparents! National health statistics and surveys show that over 75% of us exhibit some minor to major foot or leg imbalances. It’s not surprising then with so many young athletes “pushing the envelope” that so many overuse and repetitive motion injuries have exploded around youth sports! When these overuse problems become ongoing, repetitive and persistent, look at foot type and mechanics!

Many sports Parents will ask, “Does my son or daughter need orthotics”? Better questions are “would they benefit with them? Will my young athlete be less susceptible to overuse injuries? Will they help performance?” Often the answer is yes to all the above questions!

Once it is understood what the role of custom orthotics is–to capture the optimum alignment and functioning position of the feet and lower legs, to enhance the normal motion and position of the joints of the foot and ankle and that these devices are not crutches or arch supports– sports parents & coaches will pay lots more attention.

Although not a cure-all, custom orthotics are really a step up for both prevention of overuse injuries and enhancing sports performance–the two things we’re all looking for!

DR. BOB WEIL is a sports podiatrist in private practice in Aurora, Illinois. He hosts “The Sports Doctor,” a live weekly radio show on bbsradio.com. For more information, go to sportsdoctorradio.com.

Leave a Reply

Your email address will not be published. Required fields are marked *