Custom Foot Orthotics
Most often mechanical pathologies in the form of foot pain, knee pain and lower back pain are caused by abnormal mechanics of walking. Muscle flexibility, strength and optimal range of motion (ROM) at various joints are vitally important to walk normally, but foot function enormously influences mechanics of walking and must not be neglected at all. Custom Foot Orthotics is specifically designed to align an individual’s foot in STJ (subtalar joint) neutral position.
Every individual needs a support which is carved according to his/her individual foot requirement. It has been observed that foot function remarkably improves when it supported to function around STJ neutral position. The walk becomes energy efficient, tissue stress decreases and chances of developing any mechanical pathology reduces considerably.
How Custom Foot Orthotics Helps?
Custom Foot Orthotics has been found to be effective in the treatment of the following pathological/conditions:
- Flat Foot
- Diabetic Neuropathic Foot
- Plantar Fasciitis (Heel Pain)
- Heel Spur
- Bunion or Hallux Abducto-valgus
- Morton’s Neuroma
- Hallux Limitus or Rigidus
- Posterior Tibial Tendon Dysfunction
- Peroneal Tendonitis
- Achilles Tendonitis
- Corns and Callosities on plantar aspect of foot
- Cavus Foot
- Shin Splints
- Inflammation of Ligamentum Patallae
- Patellofemoral Pain syndrome
- ITB Syndrome
- Knee Osteoarthritis
- Mechanical Low back Pain
FLAT FOOT TREATMENT
Flat Foot, also called pes planus, is a condition of the foot in which the arch of the foot is collapsed. Due to this the entire sole of the foot touches the ground, the shock absorption mechanism of the foot gets disrupted and all the tissues of the foot, ankle, knee and lower back get subjected to overloading stress. This overstress can may cause foot , knee and lower back pain.
Mostly flat foot is a hereditary problem and it runs in families. But it can also be caused by injury to the foot, specifically to the tibialis posterior tendon. When developed through an injury to the of PTT (posterior tibial tendon) it is called acquired adult flat foot.
Flat Foot is of two 2 types: Flexible and Rigid. In case of flexible flat foot, the arch of the foot appears normal in non-weight bearing position but it flattens as soon as the individual stands or starts to walk. While, in case of rigid flat foot the arch of the foot permanently remains collapsed even while non-weight bearing condition.
At AktivHealth, we make anti-pronating insoles customized specifically to your foot. These customized insoles align your foot in neutral position, distribute weight evenly on foot and provides shock absorption. By doing so they remarkably reduce stress from foot, knee and lower back structures.
DIABETIC FOOT TREATMENT
The diabetes capital of the world with as many as 50 million people suffering from type-2 diabetes, India has a challenge to face. WHO estimates that diabetic population is expected to grow from 50 million in 2010 to 87 million in 2030. According to Doctors nearly 70% of all diabetics suffer from peripheral neuropathy- nerve damage in the peripheral nervous system, caused by high blood sugar level. Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream, and bacterial and fungal infections can break down the skin and complicate ulcers.
High blood sugar also interfered with the ability of nerve cells to transmit signals efficiently to the brain. This results in numbness, loss of sensation in the feet, loss of proprioception.
Poor blood circulation to the foot can lead to a significant amount of increase in the time taken for a wound to heal. This may also cause a wound to spread. A non-healing wound may require amputation of a toe, foot or even part of the leg.
This makes it extremely important for diabetics to take care of their feet on a daily basis. There should be a two pronged approach here: daily foot care and diabetic orthotic insoles. Here are some tips to keep in mind for daily foot care:
- Check your feet every day for red spots, cuts, blisters, calluses, swellings
- Wash your feet every day with soap and warm water, dry them well, completely
- Keep your skin soft and smooth by using a moisturizer on the top and bottom of your feet
- Keep your toe nails trimmed and filed
- Wear socks and shoes at all times
- Protect your feet from hot and cold as you might not be able to sense the temperature
- Keep blood flowing to your feet by putting your feet up when you sit and wiggling your toes
- Quit smoking as smoking can worsen heart and vascular problems reducing circulation to your feet
- Get your feet evaluated by a diabetologist or an orthotist regularly
Orthotics can be very useful in avoiding friction and pressure sores. They main neutral alignment of your foot, distribute weight evenly on the foot and provides shock absorption. All of these features are essential to prevent development of calluses, corns and ulcers.
PLANTAR FASCIITIS TREATMENT
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting.
Plantar Fasciitis can be caused by many reasons like:
1) Sudden change in activity
2) Walking on very hard surface like marble floor
3) Wearing unsupportive shoes
5) Excessive pronation due to flat foot or muscle weakness.
Custom Orthotics controls excessive rolling inwards of the foot, thereby reducing excessive stretching of the fascia and aids in healing of the micro tears in the fascia.
HEEL SPUR TREATMENT
A heel spur or a calcaneal spur is an abnormal protrusion of the heel bone. There is a slight growth on the heel bone that protrudes and causes extreme pain in the heel especially while standing or walking. A heel spur is caused by calcium deposits formed due to the plantar fascia deviating from the heel area. The plantar fascia is a broad tissue located at the base of the foot, stretching from the heel to the forefoot. A lot of heel spur cases are associated with inflammation of the plantar fascia, also known as Plantar Fasciitis.
Heel spurs are mainly caused by excessive pronation of the foot. This leads to the plantar fascia getting stretched thus leading to calcium deposits on the heel bone. They can also be caused by running or walking on hard surfaces, excess weight and obesity.
Custom orthotic helps bring pain relief in heel spur cases by neutralizing the excessive foot pronation. This prevents the plantar fascia from getting excessively strained. These insoles are also designed to offload weight from the heels. The insoles absorb shock thus protecting the heels.
Sesamoiditis is a common forefoot ailment that typically affects young people who engage in a physical activity like running or dancing. It is an inflammation of the sesamoid bones, small bones just behind the great toe. These sesamoid bones are not connected to other bones but are connected to tendons. Like the kneecap, the sesamoids function as a pulley. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. Every time you push off against the ground with your toe, the sesamoids are involved.
The sesamoids in the forefoot also assist with weight-bearing and help elevate the bones of the great toe. Like other bones, sesamoids can break (fracture). Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis. It is very common among ballet dancers.
Sesamoiditis doesn’t need any invasive treatment. Normally it heals with a long period of rest and insoles custom moulded and fortified with a sesamoid cut out (also called as dancer’s pad). This is a metatarsal pad that takes the weight off the sesamoid bones by redistributing it in the surrounding areas and allowing the inflammation to heal.
A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint (1st MTP joint). Bunions are often referred to as hallux abducto-valgus. Bunions may be caused by wearing ill-fitting footwear or having an inflammatory condition like rheumatoid arthritis but mostly it is a hereditary problem and runs in family. Basically, through heredity, a specific foot type is inherited, called Metatarsus Adductus, foot type. This foot type has a tendency of developing bunion but the tendency only becomes a reality if the metatarsus adductus foot type also over-pronates. Foot Over-pronation shifts the direction of action of some muscles which start to exert an outwardly directed force on the 1st MTP joint, thereby pulling the toe outward and causing bunion.
Bunion is a progressive problem, meaning that the level of damage keeps on increasing overtime. It has four stages. Progression from one stage to another brings about a permanent irreversible damage.
With custom orthotics, over-pronation of the foot is controlled. By controlling the over-pronation of the foot, the outwardly directed muscle force can be controlled thereby outward movement of the toe is stopped. Hence progression of bunion is stopped by wearing custom foot orthotics.
In order to prevent friction of the bony bump with the shoe a bunion protector can be used.
Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot. This region is also known as the ball-of-the-foot. This problem is common in sports people who run or jump a lot. It can also be caused due to abnormal pressure distribution caused by over-pronation or high arch foot.
Orthotic Insoles with metatarsal pad helps control the over-pronation and distribute weight evenly on the foot, thereby reduce the symptoms.
MORTON’S NEUROMA TREATMENT
Morton’s Neuroma is a common foot problem associated with pain, swelling and maybe inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. Symptoms include sharp pain often radiating to the corresponding toes. The next most common locations are the second, fourth and first interspaces.
Morton’s neuroma is caused when the interdigital nerve is subjected to abnormal pressure and becomes swollen and inflammed. This abnormal pressure may be caused by tight shoes or abnormal walking pattern. Morton’s neuroma is often associated with flat foot, high arches, bunions or hammer toes.
Using custom foot orthotics with metatarsal pad normalises the walking pattern and creates more room between the metatarsals heads so as to offload the inflamed nerve. This offloading in turn helps the nerve to heal thereby reducing the symptoms.
TIBIALIS POSTERIOR TREATMENT
Tibialis Posterior muscle has a very important role in supporting the arch. By doing so it plays a vital role in our walking. Tibialis Posterior Tendinitis or Tendinosis is nearly always caused by an overloading of the tendon especially where it curves around your ankle bone.
Some of the common causes of Posterior Tibialis Tendonitis are:
- Over-training or unaccustomed use – “too much too soon”
- A period of under-training, then moving back to previous training loads
- A sudden change in training surface – e.g. grass to bitumen
- Flat (over-pronated) feet
- Tight hamstring (back of thigh) and calf muscles
- Toe walking (or constantly wearing high heels)
- Poorly supportive footwear, or a change in footwear (even to new shoes!)
- Hill running
- Poor eccentric strength
As with most soft tissue injuries the initial treatment involves rest, ice, compression and elevation. After that it becomes vitally important to restore eccentric and concentric muscle strength as well as normalise foot biomechanics. Using custom foot orthotics normalises the biomechanics of walking and helps in unloading of the injured tibialis posterior tendon. By doing so it helps in healing of the injured tissue.
ACHILLES TENDON TREATMENT
Achilles Tendon attaches the calf muscle to the heel bone. It plays a very significant role in walking, jumping, running and standing on the forefoot.There are two types of Achilles tendonitis: insertional Achilles tendonitis and noninsertional Achilles tendonitis.
- Insertional Achilles tendonitis affects the lower portion of your tendon where it attaches to your heel bone.
- Noninsertional Achilles tendonitis involves fibers in the middle portion of the tendon and tends to affect younger people who are active.
Achilles Tendonitis is an overuse injury and can be caused by many factors like exercising without proper warm-up, playing sports such as tennis that require quick stops and changes of direction, sudden changes in activity level, wearing old and poorly fitting shoes. One of the most important reasons of achilles tendonitis is poor mechanics of the foot due to over-pronation.
Normalising the biomechanics with the help of custom foot orthotics and providing heel wedge in the foot orthotics reduces the strain from the tendon thereby helps in healing of the tendon.
CORN & CALLUSES TREATMENT
Corns and calluses are thick, hardened layers of skin that develop because of excessive pressure over any part of the foot. Basically, it is a protective mechanism of the body wherein it is trying to prevent higher amounts of pressure to reach innermost structures. Initially a thick layer of skin develops over the area where the foot is getting subjected to extra load. This stage is not painful and it is called callus. But if the process of overloading continues then inner layers of the skin start to become thickened but it happens in such a way that the a cone starts to become form inside the skin with its pointed part inside the skin. At this stage the calluses turns into a corn and becomes very painful. Corns can easily turn into ulcers in case of diabetic neuropathic foot. So it is very important to treat them.
As calluses and corns develop due to uneven pressure concentration at a particular point of the foot. This pressure concentration in turn develops due to poor biomechanics of the foot or faulty footwear. Using custom orthotics normalises the biomechanics of the foot and offloads the area of corns and calluses thereby treats the problem.
CAVUS FOOT TREATMENT
Cavus foot, also known as pes cavus, is a condition of the foot in which the arch of the foot is abnormally high. Due to this the ball of the foot and heel is subjected to abnormal weight during walking and standing.Cavus foot is often caused by a neurologic disorder or other medical conditions such as cerebral palsy, charcot-marie-tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot the high arch may represent an inherited structural abnormality.
The following problems are more commonly associated with cavus foot:
- Hammertoes (bent toes) or claw toes (toes clenched like a fist)
- Calluses on the ball, side, or heel of the foot
- Pain when standing or walking
- An unstable foot due to the heel tilting inward, which can lead to ankle sprains
Using custom foot orthotics distributes the weight evenly on the foot and considerably reduces pain and discomfort.
SHIN SPLINTS TREATMENT
Shin splints is a common complaint, especially among participants of running sports. The term ‘shin splints’ is colloquially used to describe shin pain along the inside or front edges of the shin. Shin splints are the most common cause of painful shins.
There are two regions where you can suffer shin splints:
- Anterior Shin Splints
- Posterior Shin Splints
Anterior Shin Splints
Anterior shin splints are located on the front (or anterior) part of the shin bone and involve the tibialis anterior muscle. The tibialis anterior lifts and lowers your foot. It lifts your foot during the swing phase of a stride. Then, it slowly lowers your foot to prepare your foot for the support phase.
If your anterior shin pain increases when lifting your toes up while keeping heels on the ground – you are likely to suffer from anterior shin splints. Medically anterior shin splints can also be referred to as anterior tibial stress syndrome (ATSS).
Posterior Shin Splints
Posterior shin splints are located on the inside rear (or medial/posterior) part of the shin bone and involve the tibialis posterior muscle. The tibialis posterior lifts and controls the medial aspect of your foot arch during the weight bearing support phase. When your tibialis posterior is weak or lacks endurance your arch collapses (overpronation), which creates torsional shin bone stresses.
If you feel pain along the inside rear of your shin bone – you are likely to suffer from either posterior shin splints or tibia stress fractures. Medically, posterior shin splints and tibial stress fractures can also be referred to as medial tibial stress syndrome (MTSS).
What Causes Shin Splints?
Shin splints are caused by overstraining of your muscles where they attach to your shin.
The most common cause is overuse or overtraining associated with poor foot and leg biomechanics. Shin splints can be caused by a number of factors which are mainly biomechanical (abnormal movement patterns) and errors in training.
Treatment for Shin Splints
Initial treatment involves rest, ice and NSAIDs. Restore normal flexibility and strength of muscles specifically calf, tibialis anterior and posterior and glutes. More importantly normalise the foot biomechanics of the foot with the help of custom foot orthotics is extremely vital for the treatment of this condition.
KNEE OSTEOARTHRITIS TREATMENT
Osteoarthritis of the knee is caused by deteriorative changes happening over a period of time. Age is one of the main factors causing OA but other factors like trauma, overweight, heredity, gender and repetitive stress injuries, RA etc can also cause it.
Symptoms of OA includes pain, stiffness, swelling and crepitus in the knee joint.The pain usually increases with activity and improves with rest. It’s treatment involves weight-loss, exercise, NSAIDs, knee braces and in adverse cases surgery.
Giving outer wedge in insoles offloads the medial compartment of the knee joint (medial compartment is the most commonly affected part) and thereby reduces the symptoms.
ITB SYNDROME TREATMENT
The ilio tibial band runs from the hip to the lateral side of the proximal end of the tibia. Its function is to resist internal rotation of the tibia as well as to maintain the lateral integrity of the leg. Ilio tibial band “friction syndrome” is a condition wherein the ilio tibial band is stretched and torqued and the distal end rubs across the lateral condyle of the femur. Patients complain of pain on the lateral side of the knee often extending up the lateral side of the thigh as high as the hip.
Overstress of the ilio tibial band. During a normal gait cycle, the femur and the tibia rotate in unison (i.e. internally during pronation and externally during supination); however, when a person overpronates, the tibia is locked into the talus by the saddle joint and therefore continues to rotate internally past the end of the contact phase while the femur begins to externally rotate with the pelvis during midstance phase. The resulting counter rotation of the femur and the tibia causes a shearing force to occur in the ilio tibial band is torqued and stretched. The result is that the distal end of the band rubs across and is irritated by the lateral condyle of the femur.
Massage and stretching of surrounding muscles to help ease the tightness and ice to reduce inflammation. Since the problem is the abnormal pronation, the patient should be fitted with functional orthotics to correct the prolonged pronation thereby reducing the counter rotation between the femur and the tibia, alleviating stress off of the ilio tibial band.
INFLAMMATION OF LIGAMENTUM PATALLE (Patellar Tendonitis)
Patellar Tendonitis is an overuse injury to the tendon connecting the kneecap to the tibial tuberosity. It is also known as jumper’s knee, is most common in athletes whose sports involve frequent jumping- such as basketball and volleyball. Also overpronation of the foot causes excessive tibial internal rotation which in turn causes a strain on the patellar tendon. Repeated strains cause microtrauma and injury to the tendon.
Pain is the first symptom of patellar tendonitis, usually at its attachment point on tibia. Initially the pain is felt only at the beginning of physical activity or just after an intense workout. Overtime the pain worsens and starts to interfere with the sports activity. Eventually the pain interferes with daily movements such as climbing stairs or rising from a chair.
Its treatment involves icing, resting, maintaining flexibility and strength of the thigh muscles. Using custom foot orthotics reduces overpronation of the foot, thereby reducing stress from the patellar tendon and hence helps in its healing.
PATELLO FEMORAL PAIN SYNDROME (PFPS)
Patello femoral pain syndrome is a broad term used to describe pain in the front of the knee and around the knee cap. It is also known as Runner’s knee because it is common in athletes who participate in running activities but it can also occur in non-athletes as well. Females and young adults are more prone to develop PFPS. The pain and stiffness it causes make it difficult to climb stairs, kneel down and perform other everyday activities.
PFPS is mostly an overuse injury caused by vigorous physical activities that put repeated stress on the knee- such as jogging, squatting and climbing stairs. It can also be caused by a sudden change in physical activity. Abnormal tracking of the patella due to excessive foot pronation can also PFPS.
Its symptoms include pain during exercise and activities that require repeated bending of the knee such as jumping, squatting, running and climbing stairs; pain after sitting for a long period of time with bent knees; popping or crackling sound during climbing stairs. Its treatment involves rest, ice, compression, elevation, NSAIDs. Physical therapy exercises to improve range of motion, strength and flexibility specifically for quadriceps and core muscles are very important to treat the condition. Using custom orthotics to control excessive foot pronation is important in cases in which PFPS is caused by abnormal foot alignment.
MECHANICAL LOW BACK PAIN TREATMENT
Vast majority of low back pain are mechanical in nature. Mostly it is caused by sprains and strains, intervertebral disc degeneration, herniated or ruptured discs, radiculopathy etc. Our foot biomechanics also plays a vital role in the loading pattern of our back muscles. Excessive foot pronation causes the lower extremity to undergo excessive internal rotation which in turn causes excessive anterior pelvic tilt. Anterior pelvic tilt increases lumbar lordosis which in turn puts extra strain on back muscles. Back pain caused because of the overpronation of the foot can be treated by using custom foot orthotics.