How are My Custom Orthotics Made?
How are Custom Orthotic Insoles Different?
There are many types of insoles available to people with foot problems, they can be bought for $40 in a pharmacy, or even bought on a cruise for several hundred dollars!
So what sets custom foot orthotics apart from other insoles, and how are they actually made?
In this article I’m going to show you the whole process we undertake to make a pair of custom orthotic insoles for a patient with foot related problems.
Do You Have a Generic Foot and Body to go with that Generic Orthotic? Of Course Not!
The generic foot orthotic is what I call a blunt tool.
It is made using an “average foot shape.”
What is an average foot shape?
Does one even exist?
I’ve seen and assessed thousands of feet in my years as a podiatrist and I can honestly say that I have never looked at a foot and thought, “Wow, this is the average foot type!”
Plus, it’s not just the shape of the foot that matters.
It’s also what’s going on above the foot in your ankles, legs, knees, hips, lower back. And what activities you perform with those feet.
Every single person will do different things with their bodies once they leave our practice.
From the sports they play and activities or work they do, through to the intensity they do it at and the body weight that they carry around, everyone has a different life experience.
Our job as Podiatrists is to take all of this information into account and come up with a solution that suits you the best.
That solution may include orthotics, but it will also include footwear advice, stretches and exercise, to make sure we are covering as many factors as possible to keep you active and pain free.
We Built Our Own Custom Orthotics Laboratory
Several years ago Dynamic Podiatry joined forces with two other leading podiatry practices to build Quantum Orthotics Laboratory Pty Ltd, to ensure that we could provide the highest quality custom orthotic devices to our patients within a week.
We had two main purposes in mind:
- Highest quality custom orthotics available
- Fast turnaround so patients were in pain for less time.
After putting together all our resources, knowledge gathered over 40 plus collective years of podiatry practice, and 18 months of research and development, we had a product and service that we are very proud of, and that provides our patients with an excellent product that will last them for years.
Biomechanical and Gait Assessment
Before we do anything of course, we go through an in-depth assessment and diagnosis of your condition.
This already sets custom orthotics apart from generic orthotics as we make sure first that they are an appropriate treatment.
After we conduct the patient and practitioner interview and physically examine any areas of aches and pains, some type of test treatment is often tried for a few days.
Once we have determined that custom orthotics are suitable for you, that’s when a detailed investigation of your running and walking gait and biomechanical makeup is begun.
- a thorough examination of the range of motion in the joints of your feet, ankles, knees, and hips
- strength testing of all muscle groups involved, especially how equal they are from left to right.
- Visual and video gait assessment
- Gait assessment using our state of the art Sensor Medica Treadmill (in photo above) which has a 1.2 metre pressure plate inside, measuring the pressure going through each part of your feet during gait.
This pressure data is then synchronised with a super high speed camera to give us incredibly detailed information about what’s actually happening when you move (I will cover this is more detail in an upcoming article).
Capturing a 3Dimensional Image of Your Feet.
In years gone by, Plaster of Paris was used to take a cast of your feet.
This would then be filled with dental plaster to create a positive cast.
As you can imagine there would be plenty of room for error in this process. E.g. whilst the plaster is setting around the feet some patients will move to some degree changing the shape of the cast.
The Age of Digital Scans Using Laser & Light.
Digitisation has transformed almost every profession and industry in the world, and Podiatry and the making of custom foot orthotics is no different.
These days scanners using a combination of laser and white light are used to capture an incredibly accurate representation of the feet.
Laser gives pin point distance information whilst the white light creates a real life picture of the foot.
Put the two together and you have a truly reliable and accurate 3D representation of your feet within a few seconds, reducing the amount of movement significantly.
Pictured to the right is the laser pass of a three dimensional scan in progress.
Once we have captured and checked the scans of your feet, the podiatrist is ready to write a prescription for your orthotics based on all the data gathered during the biomechanical examination.
A Patient Specific Prescription is Written
Here is another part of the process which is crucial in making genuinely custom made foot orthotics.
The Podiatrist takes into account all the information they have gathered during the interview of the patient, the physical examination, and the data collected to help them write a prescription for custom foot orthotics.
The prescription tells the custom orthotics laboratory how the scans should be positioned, what angles to apply, and what materials should be used to make the custom foot orthotics.
The scans and prescription are now sent to the orthotics laboratory for maunfacture.
Custom Foot Orthotics Designer Takes Over
Once the scans and prescription arrive at our laboratory at Acacia Ridge, our designer imports the scans into state of the art computer aided design software.
They then apply settings to the scans according to the Podiatrist’s script.
Sometimes the rearfoot needs to be set to a different angle to the forefoot because of problems caused by the foot tipping one way or another.
This computer aided design allows incredible accuracy unable to be achieved using traditional methods.
Milling Your Custom Foot Orthotics.
Once the design work for your orthotics is complete, the “job” is sent from the design computer over to the CNC mill.
This mill basically takes the orthotics design and carves an orthotics shell out of the materails that your podiatrist has prescribed.
The materials are most commonly either:
- polypropylene, a hard type of polymer material that has flexibility, but an incredible “shape memory.” This means that for years your orthotics will hold the original shape required to hold your feet in the best position.
- Or EVA (Ethylene-Vinyl Acetate) A softer material that comes in several densities depending on the patient and the demands they will be placing on their feet. EVA also holds it’s shape extremely well, but can be a little more gentle on older (or younger) joints.
Below you can see a short video of the CNC milling machine in action.
Finishing by Hand
After the milling there is still a fair amount of work to do.
All the rough and scrap pieces of the shell need to ground by hand to get a nice neat product that will fit into your shoe.
We have the shell based on exactly your foot, but there are often some soft tissue additions to be made.
Some patients will require a “well” of cushioning right at the heel for acute plantar fasciitis.
Some might need a soft metatarsal dome at the forefoot to help restore the transverse arch at the front of the foot.
Covering materials also come in all types of thicknesses, colours, and cushioning properties. Something to cater for every patient!
Once the finishing has been completed and the coverings and accommodative pads have been put in place, the custom foot orthotic is finally ready to leave our laboratory and head to the clinic for dispense to our patients.
Fitting Your Custom Foot Orthotics
A dispense appointment is very important to make sure that your orthotics are fitted properly to the shoes you most commonly wear.
Your Podiatrist will also watch you walk, run and stand in your orthotics to make sure that you appear stable in them, and that they are doing what they were prescribed for.
They will also get feedback from you on how comfortable they are.
If you’ve never worn orthotics before, they can feel very weird, but they shouldn’t make any part of you sore.
Your Podiatrist will then explain to you how to wear them in slowly to make sure that the muscles in your feet and legs get a chance to adapt to the adjusted patterns of use.
A three week review is necessary to make sure that you have been able to wear your orthotics as often as required, and that you are starting to get relief from pain.
So there you go!
Who’d have thought making something as “simple” as a custom foot orthotic would be so involved?
Once you realise how much goes into making a custom foot orthotic that is designed just for you, using your foot shape, and involving extensive testing and assessing by our experienced podiatrists, I think you’ll agree that they leave all generic foot orthotics behind in the dust.
As mentioned above, you don’t have generic feet, so why settle for generic orthotics?