Are Your Feet, Knees, Hips, or Back Sore?
An Orthotist May Be Helpful
by Arnold Finan, C.O. (c)

An orthotist is one who, by referral from a medical doctor, designs, assesses for, fabricates, and fits orthoses (arch supports and braces) for feet, ankles, knees, hips, and the spine. Orthotic training involves in-depth clinical and technical programs, followed by an intensive internship and a national certification exam required by the Canadian Board for Certification of Prosthetists and Orthotists.

Orthotics are needed for a variety of reasons: to eliminate posture problems; to protect the body from the shock of running and walking; to relieve foot, knee, hip, and back pain; to distribute weight evenly over both feet; or to relieve conditions such as leg length discrepancies, heel spurs, plantar fasciitis, arthritis, or diabetes.

If you experience any of the latter, then an othotist, such as myself, may be helpful. During the first visit I assess the conditions of the lower limbs and complete a gait analysis to determine the best treatment for a person’s particular needs—this is free of charge. As a certified orthotist, I am qualified to advise if the condition requires a specialist to provide a more suitable type of brace, or to see a physiotherapist for muscle stretching or strengthening, and/or gait training. Also some diabetic problems may need to be referred to skin care specialists.

My custom-made biomechanical foot orthotics are more than just arch supports. They are fabricated in-house, with a choice of different materials fitting most flat shoes. The construction of orthotics starts with casting of the feet. This method provides a three-dimensional model of the feet positioned in subtalar neutral (i.e. normal standing position). The use of plaster of Paris is preferred because this method picks up fine details including soft tissue areas and points needing relief. The choice of materials for these othotics depends on the individual’s age and activity level. For example, a jogger with normal feet would require a softer material extending the full length of the soles, and a person who has ankle or knee instability would require a firmer material to give more side support.

Not as effective, in my opinion, are other methods which are used: tracing and ink impression, which doesn’t capture the three-dimensional shape or insure that the feet and ankles are in neutral position; or the computer generated orthotics (CAD/CAM), because they do not insure good gait alignment, as the patients are weight-bearing when they are standing on the scanner, which doesn’t hold the ankle in a correct position.

The practice of orthotics also includes orthopaedic adaptations to the shoes, whenever needed to accommodate unstable foot ankle problems and leg length discrepancies. Such modifications can be internal (inside the shoe), inserted (between the shoe and the outsole), external (sole of the shoe), to the shoe’s upper construction, systemic (affecting the entire shoe construction), cosmetic, or simply for a better fit (without permanent modifications).

To accommodate the orthotics, functional footwear (suitable shoes) would preferably have firm rocker soles and removable insoles, as well as very few seams and firm enough soles and heels to limit side movement. Cushion soles and heels, which are popular nowadays, are more suitable for people without gait problems. In the case of diabetic feet, softness is required, however it should be on the inside of the shoe over top of the orthotic form to cushion any sore areas.

Orthotics provided by my services are locally made. Adjustments and follow-ups are provided free of charge. The Saskatchewan Provincial Health Insurance covers most orthotics with the exception of arch supports and shoe adaptations, but most private or group insurance plans reimburse such expenses. For people who do not have a private medical insurance please contact me for further information.

Arnold Finan is a Certified Orthotist (C.O. ©) with 35 years experience, and is a Member of the Canadian Association of Prosthetists and Orthotists. For more information contact Finan’s Custom Orthotics in Saskatoon, phone (306) 227-2864, email: catnfiddle@sasktel.net. Also see the Classified ad under Foot Orthotics on page 34 of the 13.2 July/August issue of the WHOLifE Journal.