What are Custom Orthotics?

At Vaughan Physiotherapy Clinic we are proudly partnered with Orthotic Energy - a dynamic Toronto-based Custom Orthotic manufacturing Lab to design and manufacture quality custom orthotics that make a difference. Custom orthotics are custom molded inserts which are designed to treat foot, lower limb, and back problems. They may be paired with Orthopaedic footwear for greater efficacy.

Typically we will recommend a custom orthotic if an off-the-shelf device or other treatments, such as exercises at home, haven’t proven effective. These may be partially or completely covered by health insurance

What do Orthotics do?

Walking is essential for daily life, and feet play an important role in supporting the body and maintaining balance during walking.

An Orthotic supports a balanced weight distribution in the plantar area and arch, and aids in efficient shock absorption, including the ground reaction generated during walking or running, thus reducing pain and unstable joint motion. proper insoles and orthotics could reduce muscle activity, provide comfort, and increase exercise ability.

Research and analysis have been conducted with use of functional foot Orthotics in walking, and on the resulting performance and effects on kinematic functions.

It is important to note that careful assessment and prescription is required for orthotics. It is true that Orthotics are often over prescribed for any foot impairment. Many sports medicine physicians, physiatrists, orthopaedic surgeons, and physical therapists are in agreeance in that orthotics require a global assessment to determine if they are appropriate for you.

Conditions that may benefit from custom orthotics

You may be prescribed orthotics to treat a number of medical conditions. Examples include:

How much do orthotics cost?

How much are custom orthotics? Custom Orthotics can be expensive. On average to assess, cast, order, and then fit orthotics in Ontario the price may range anywhere from $400 to upwards of $800 CAD. This may include the multiple steps required to create orthotics which include an orthopaedic examination of the foot, gait assessment, taking a mold of the foot, and manufacturing the custom orthotic. This cost may be reimbursed if you have access to health insurance. Please check with your health insurance provider to see if your benefits cover orthotics. Some companies will cover all of the cost, whereas other companies will only cover a percentage. For example "Company A" may cover 100% of the cost of the Orthotics up to a maximum of $200, whereas "Company B" may cover 80% of the Orthotics price up to a maximum of $550.

How long do orthotics last?

How do I know that I need to replace my orthotics?

A worn out pair of orthotics may do more harm than good. The durability of an orthotic will depend on a wide variety of factors however most Orthotics will last at least 2 years. It is important to inspect your orthotic insoles on a regular basis (i.e. once a month) to look for signs of wear and tear.

The top surface of an orthotic may often become worn and will be required to be resurfaced. If the plastic or EVA foam used in an orthotic is worn it may no longer provide the benefit it once did. This orthotic will need to be replaced.

Some factors that may require you to replace your orthotics:

Age of Orthotics: Usually a well made, quality orthotic will be good for at least 2 years before there are obvious signs of wear. This may vary with an individual's daily activities and frequency of use for the orthotic.

Lifestyle Changes: If you have recently had changes in your lifestyle such as a hip replacement, knee surgery, or perhaps you have lost a significant amount of weight, or have recently become much more sedentary and gained weight. All of these lifestyle changes may require you to reassess your footwear to accommodate for the changes in your body.

Pain: If you are experiencing significant discomfort and or pain while wearing your orthotics it is important to have a health professional assess your feet, lower limb mechanics, footwear, and orthotics in order to understand the origin of your problem. If deemed neccessary it may require you to replace your current orthotics

Visible wear and damage: Damaged orthotics

How are Custom Orthotics made?

Step 1: Evaluation

When you see your podiatrist for custom orthotics, you can expect to start with a thorough examination that includes:

1. A Range of Motion Test- Your podiatrist will measure the motion of all your lower-extremity joints (such as your hips, knees, and ankles) in order to identify any irregularities in joint motion like excessive flexibility or extreme limitation. Your doctor will also establish the weightbearing and non-weightbearing functional positions of these joints by testing them while you're standing and walking on them, and when you are lying down.
2. A Muscle Examination- Your podiatrist well test the lower-extremity muscle groups like the quadriceps and calves to identify any overly weak or tight areas. This will show if your muscles are adding to your injury, symptoms, or biomechanical problems.

You can also expect your doctor to take measurements, ask about your lifestyle and inspect your shoes for a specific wear pattern to better understand your gait mechanics. Your specialist will look for the following patterns:

1. Symmetry- Is the wear equal and in the same location on both shoes?
2. Tipping at the Heel- If you place the shoes on a table and look at them from the back, do the shoes tip in at the heel (pronation) or out (supination)? Does one shoe tip in a different direction than the other? That can be indicative of leg-length discrepancies.
3. Toe Wear - Are there holes in the mesh part of the shoe where your toes have popped up? Do the toe creases run straight across the front of the shoe? If not, it could be a sign of poor fit.

Step 2: Casting the foot

Your specialist will cast the foot with a specific methodology as to ensure a proper fit and mold for the manufacture.

1. Non-Weightbearing Neutral Position Mold of the Foot- Your specialist will cast your foot to provide a model for the orthotic laboratory. A speciifc method for creating a mold of the foot is imperative as if it is poorly cast it may over or under correct foot mechanics.
2. Place your foot in a neutral position. Your specialist will need to see your knee in relation to your foot and set your foot into the desired position.

The most common method of taking this cast is by using plaster. Wet plaster strips are wrapped around the foot. The hollow, “negative foot mold” is then sent off to the orthotics lab. The lab will fill in the cast and discard the shell. The resulting “positive cast” looks like your foot.

While the plaster hardens (it usually takes 5-10 minutes), your podiatrist will watch your foot position to make sure it doesn't change. The plaster usually takes a full 24 hours to harden completely, so after your podiatrist removes the cast, it will be stored before being sent to the lab.

Step 3: The lab

After your specialist takes the proper non-weightbearing cast of your feet, the negative foot mold and your custom prescription are sent to an orthotics laboratory.

Your prescription will include not only the materials, dimensions, and accessories to be used in the orthotics' manufacturing, but also the specifications for the correction of the cast. These measurements are taken from the in-depth exam your podiatrist conducted before casting your foot.

Once the positive cast has been constructed, the lab constructs the orthotics through the following steps:

1. Under extreme heat, your individual cast is pressed against a sheet of graphite or plastic material.
2. A cover made of comfortable yet durable material is attached to the harder heel and arch structure.

Step 4: Materials

For your custom made orthotics to provide optimum results, they must be constructed from materials that can resist the various forces and motions you put on your feet. Materials need to be rigid enough to control for irregular injury-producing motion, while still flexible and comfortable enough to be compatible with your activities.

There are two main types of materials used for the rigid foundation of your orthotic:

Cushioning materials such as Neoprene and open- and closed-cell forms are often used to complement the harder plastics or graphite and provide added comfort. Remember, these softer materials should never form the core structure of your orthotic.

The most common materials used to cover the plastic or graphite arch-support and heel cup come from the polyethylene foam family. These are closed-cell forms best for total-contact, pressure-reducing orthotics. Individual materials include:

- Ethyl-vinyl cetates (EVAs)
- Crepes/neoprenes
- Silicones
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Your individual foot requires individual attention. Materials that work well for one person might not be good for another.