Workers whose jobs require frequent, prolonged standing commonly experience foot pain. place. Based on your evaluation, the doctor will write a prescription detail-ing the choice of materials (rigid or flexible), the proper biomechanical alignment or tilt of the orthotic, any cushions or modifications, and take into consideration the patient’s complaint, occupation, sport and preferred shoe. Advances in plastics and materials science have significantly improved the design and manufacture of foot orthoses over the past couple of dec-ades. Novel composites and hybrid plastics will offer lighter, stronger and more customizable devices. Practi-tioners and fabricators already have a dizzying array of materials at their disposal, including thermoplastic polyolefins (poly propylene, polyethyl-ene and copolymer combinations of them); polyethylene foams (e.g., Plas-tazote, Nickelplast); open-cell polyu-rethane foam (Poron); ethylene vinyl acetate (EVA); closed-cell neoprene foam (Spenco); ther moset carbon-fiber composites; and others, such as natural and artificial cork. Now this may seem overwhelming, but why prescribe an orthotic device if you don’t know which material is used for a particular condition? Have you ever noticed that the orthotic you order from a company is made of the same material? Do you know what it is? Does the company offer different material options? This is a great op-portunity to call your fabricator and ask questions or ask for an in-service learning session. If you live near the lab, attempt to check out the fabrica-tion process. The main construct of the orthotics is typically classified into shank-de-pendent (i.e. various foam products) and shank-independent materials (i.e. thermoplasts and carbon composites). The shank-independent type is what we see in most chiropractic orthotics. This type of stiffer material applies a higher reaction force, which in some circumstances might be beneficial; in others, it might not. The two biggest considerations when selecting the right orthotics for a patient are weight – more thickness in millimeters for a heavier patient – and activity level. EVIDENCE-BASED MANAGEMENT Podriatrists and pedorthists claim there are four common conditions that they treat, and for which foot orthotics have the most potential to help pa-tients. These include: plantar fasciitis, arthritis, diabetes and metatarsalgia. 1. Plantar fasciitis. The patient will typically complain of pinpoint pain at the medial tubercle of their calcaneus, which is worse upon walk-ing in the morning. There are three modifications that I typically add to every patient with plantar fasciitis. The use of a semi-rigid polypropylene shell with a standard heel cup, and valgus extension will help to support the lateral forefoot, decreasing plantar fascia tension October 2015 Canadian Chiropractor 31 Photo: fotolia www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor October 2015: Page 31
