A Perspective on Current Orthotics
Based on the current status of orthotic technology, all orthotics for hyperpronation are based on mid- and rearfoot correction. Methods for determining the optimal orthotic dimensions vary from plaster casts and foam box imprints of the foot to fancy electronic gadgetry which many believe adds little information, but dazzles patients. The discussion of what is most appropriate, weight bearing or non-weight bearing cast is ongoing, and seems driven by proponents of different orthotics suppliers.
Forefoot or rearfoot posting is sometimes incorporated to support a “Roots forefoot varum” or to force the heel to become perpendicular to the ground if arch supports seem insufficient. In most cases the measurements are static in nature, and even if the measurement is dynamic (walking over a pressure plate) the orthotics that are produced provide static support only, and become useless as the body weight shifts to the forefoot.
To contrast Dr. Rothbart’s simple and different methods, let us first take a look at current static technology.
Arch supports are so common today that people expect to see them in their shoes. Interestingly, most arch supports found in shoes are merely cosmetic. Material softness and position causes most people to have little or no sensation of its presence (does not support the Navicular). Some shoes incorporate functional arch support, and many people find them uncomfortable because all of a sudden they feel pressure under the arch; a sensation they are unaccustomed to and that most people do not need or want.
Functional arch supports are very important for people with near or completely collapsing arches (flat feet). Their arch may look functional when the foot is not weight bearing (patient sitting), but it collapses fully to the ground when standing naturally on the foot. These people need functional arch supports.
A majority of suppliers of orthotics recommend arch supports for everyone - low arches or high arches. This is a disservice to the patient. Arch supports immobilize the foot. Would you leave a neck brace on a patient for an indefinite time? Only if their neck muscles were incapable of holding the patient’s head. For normal active people, you should only provide arch supports to patients who do not have functional arches. Without arch support, the foot will be free to move naturally, strengthening the muscles controlling it. If a patient has suffered an injury that needs a temporary arch support, think of it as a neck brace and remove it as soon as possible to allow the patient’s muscles to recover and strengthen.