Several years ago A Step Ahead Foot and Ankle care decided that to have more control of our patients outcomes we needed to make our own orthoses in house. Patients and often their referring doctors often don’t realise that many podiatrists in fact do not make their own custom made orthoses. While they can prepare a script they have trouble really making a device that is perfectly matched to the foot.
In our last article we described how orthoses should be prescribed. As you will see the process is fairly complex and requires a number of measurements using some specialised equipment and a great deal of clinical expertise. The junior podiatrists at A Step Ahead Foot and Ankle care who have already completed a university degree and 1000 clinical hours still are observed and work with one of our senior podiatrists for the first two years after graduation to make sure they have a strong knowledge base behind them when designing an orthoses for a patient.
Once a 3 dimensional scan and measurements are taken of both your feet, it’s time for our Podiatrist to design the orthotics. Designing each orthoses is done using Cad-Cam software and specific to each person, each person’s individual design takes approximately 15 minutes ensuring a complete match to your foot.
From here the design is sent to A Step Ahead Foot and Ankle care’s CNC mill for cutting on average this takes about 20minutes for each of the orthoses shell. As mentioned before, each orthotic is individual and subsequently there can be as little as 1 mm differences in measurements in the orthoses so ensuring we get the milling right is very important.
After the mill has finished its very precise job, the orthoses edges need grinding so they fit comfortably into a shoe. At this time we will add covers to enhance the comfort of the device and small additions which will tweak the way you walk, such as metatarsal domes and rocker bars and possibly even more cushioning! We will also look at any further adjustments needed to change the postural position of your feet and legs. This can all add up and takes about an hour’s worth of time per pair to finish.
As you can see making a custom made orthoses can really take some time they are very complex devices with a real “handmade” component to each of them. Each device is designed to meet each patient’s specific health needs. So when people rightly ask “How come your orthotics cost …….” You can tell them because my orthoses are handmade just for me!
So you have been told by your podiatrist that you need custom made orthoses…
Now we would assume these are to be made specifically for you, from a set of measurements taken from your feet and legs. Your Podiatrist will also have taken a video of your walking and or running pattern. They will have watched how you stand walk run and tested muscles and joints. Your Podiatrist will have also taken a cast or better still a 3 dimensional scan of both your feet – to be truly custom made this is essential! If your podiatrist or other practitioner has NOT done these things then frankly I would question if you were truly getting a custom made or true prescription orthotics!
These are all the things we do for our patients at A Step Ahead foot and ankle care. (Note NOT an outline and NOT a 2 dimensional or force plate measurement – you CANNOT make truly custom made orthoses from this)
Orthotics are costly, they are in the same ball park as prescription glasses and at times the same price as some mouth plates Dentists use to correct small alignments for your teeth. Thankfully NOT as expensive as braces though! I would suggest that they are this expensive because, if they are truly prescription custom made orthotics, the time that it takes to make a pair is reasonably extensive. Add to this the cost of your practitioner’s time taking the measurements then preparing the prescription and then finally check-ups fittings and etc and it will quietly add up. We have noted a few podiatrist tell people the cost of the device only. For example “orthotics cost $400” but be warned it is a good idea to ask about associated the cost of appointments.
How about check-ups? You know your feet are ok on the first check, but 4 months later your orthoses don’t feel right. We always give free check-ups for our patients for the life of your device – if its 2 years then so be it! We don’t believe you should have to pay for a check-up of your device if there is a problem. If your friend a relative or any type of patient of ours says they are not comfortable or not happy PLEASE send them back to our clinic – it’s free and we are ALWAYS happy to see them!! It’s included in the cost of the devices and appointments whenever we fit you with orthoses at A Step Ahead Foot and Ankle Care.
We guarantee our devices – if they flatten out, warp, the covers fall off or somehow otherwise your orthoses die an untimely death in the first 12 months we will replace your orthoses! Now you’d think this is common sense BUT if your dog eats them (don’t laugh has happened numerous times) that’s your responsibility, we will always be reasonable and we hope our patients are as well.
So there is much more than just a custom orthoses that’s in your shoe… it’s a long process of getting this very specialised device right. As we have discovered they are very specialised devices made from very specific measurements. What we have not spoken about is the very detailed equipment which makes up the mill that manufactures the devices and how that works. That I thought we would speak about next time.
Lisa had pain from an ingrown toenail for several months. She felt she had tried everything including trying to remove the ingrown nail herself. A friend of hers told her just to cut a V into her toenail – which sadly didn’t work. She tried a shopping centre nail salon but they turned her away saying they could not help her.
By this time, the nail had become a little pustulent, Lisa then also visited her GP who was some help and prescribed some antibiotics. While this cleared up the infection that had occurred, it did not take away the pain for more than a day or so and she found that her problem returned shortly after her antibiotics ran out.
When Lisa visited our clinic her toe was red around the area that the nail meets the skin on the side of the toe. It became obvious that what had happened was that Lisa’s toe nail was quite ingrown and that the answer was to remove the offending piece of nail. By this time Lisa was quite upset and was worried about how painful it was going to be to remove the nail.
We offered Lisa the option of having a local anaesthetic injection but we assured her that when you know what you are doing and have seen as many ingrown toenail as the podiatrists at A Step Ahead Foot + Ankle Care, you get very good at removing these with little or any pain.
In this instance Lisa opted to try without the anaesthetic injection. Within a couple of minutes the ingrown nail was removed from the infected area with little if any pain, yes as many people are Lisa was surprised at how painless and easy it was – she’s wondering why she had waited so long?
We asked Lisa to keep a small bandage on the toe for another four days, simply to keep the area dry and free of nasty bugs and bits getting into the area as it was already red and inflamed when she arrived.
A check up in two weeks found Lisa to be pain free! She reported it took about 24 hours to calm down and has been completely pain free since and she can now go back to wearing her high heels… hmmmmm
Mary decided to visit us at A Step Ahead Foot + Ankle Care because after starting walking in an effort to lose weight and get fit again, she was getting quite a lot of pain in her right foot. Mary explained that she’d been walking for about 3 weeks, 3 to 4 times a week for about an hour at a time.
Mary is a 49 year old mum of three children she leads a busy life; she works full-time, still runs the family home, volunteers at her husband’s footy club and is trying to get fit!
Mary noticed that she started to get a little bit of pain after each of her walks but put it down to just ‘getting used to walking’. After another week she noticed the pain became more intense and noticed it started very quickly after she began to walk. The week following she noticed the pain began to increase over time it went from hurting when on her walks to eventually hurting when she was not walking at all and all through the day. Mary swears she also has noticed that the arch of her right foot was falling.
After taking a detailed history we began to palpate (push and prod in non-doctor talk) around Mary’s ankle to find the area under the inside of her ankle bone (Her medial malleolus in doctor talk) was very swollen and painful to touch. Using our specialised digital video walk and run analysis equipment we discover that Mary had quite rolled in (over pronated) feet and she was correct, her right foot was more rolled in than her left. We sent Mary off to a radiologist with a referral for an ultrasound to confirm our suspicion that Mary was suffering Posterior Tibialis tendon Dysfunction. She returned that afternoon with exactly that!
Custom made orthoses from a 3d model of your foot
Having confirmed our diagnosis, we began looking after Mary with the best quality care available. Firstly before leaving we strapped Mary’s foot to take pressure off the overused tendon, we ordered her a specialised brace for the short term again an immediate relief in pain and after a discussion we also prescribed a pair of custom made orthoses. These will stop the overuse of the tendon by reducing the excessive pronation.
Mary’s results have shown that unlike some people who wait too long, Mary came in quickly and has avoided the need for surgery, which can be necessary if this is left too long and not caught quickly. Her orthotics were manufactured in A Step Ahead’s own orthoses laboratory using our custom made milling system and hand finished by our technicians. After a fitting and wearing her orthoses for several weeks we also began a series soft tissue therapy sessions with our team to help rehabilitate the damaged muscle.
New 3d scanners create perfect models of your foot
The good news – Mary’s ankle and foot is now back to normal and she has started back to walking slowly! After we designed a ‘return to exercise’ program for her to follow, she has reduced the chance of re-injuring her foot. Rehab took quite some time but was made easier by Mary’s compliance and her willingness to work hard at getting better.
Its always rewarding for our team to meet people like this who are striving to get back to health!
Sam is 10 and loves his footy! He plays once a week, trains twice a week and you can’t stop him from playing at school and in the backyard with his brothers. He plays cricket in the summer he is a typical Australian boy – loves his sport, and loves getting in and getting dirty.
Of late something has stopped Sam being as active as he would like to be. He has recently developed a pain around the back of his heel that occurs after he has been active, particularly such as after playing or training for football. Sam’s dad is worried because it means Sam sometimes starts to limp during a game and has had to come off the field once because it became too painful. This worries his parents more now because Sam would like to play reps this year and his dad thinks if this wasn’t a problem he may have a chance.
So how did A Step Ahead Foot +Ankle Care get to meet Sam?
Sam’s dad found us through the internet after reading one of the articles Brenden had written, talking about dealing with foot pain. We checked Sam’s walking and posture using our Dartfish gait analysis equipment. We also undertook a series of muscle tests and palpated the muscles and tendons around his heel and ankle. After some more questioning we diagnosed Sam with Severs Disease – which sounds rather horrible, however, while painful this should really be called a condition rather than a disease.
Heel pain in children
In very basic terms Severs Disease is an irritation of the growth plate. During growth spurts, the heel bone sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. This is more common than people realise and often parents are told that their child needs to rest or that there is nothing that can be done. Worse still, parents can sometimes be told this is simply growing pains.
There are many things that can relieve pain in children affected by Severs Disease. In Sam’s case we designed some stretching for him to undertake, started on a series of deep massages to help stretch out Sam’s very tight muscles. We also gave some heel raises to Sam to take the load of the growth plates. We contacted Sam’s football coach and gave him some details of the condition and went through a warm up program with the coach so Sam would be able to play at his best.
The good news is Sam made the rep side!
After a couple of sessions of massage and Sam being very good at warming up as we had instructed him, things began to improve. Sam had 5 sessions of massage and we continued with his stretching at home and before sport for the whole season. Sam is now pain free and still loves sport and getting dirty! (Apologies to Sam’s mum, the getting dirty bit we can’t fix!)
James is a 7 year old boy who is reasonably active loves to ride his bike and play with his little brother and older sister. He comes from an active family that enjoy doing some kind of activity most weekends – a little bike riding some weekend sport or some time at the park. James is otherwise a healthy bright young boy.
James’ mother brought him to see us because he often wakes at night crying complaining of pain in his feet and his legs. James’ mum was quite frustrated and looking for answers, as after seeing at least two other well-meaning health professionals she had not found an answer. On both occasions when seeing other health professionals she was told that this was ‘normal’ and it was ‘just growing pains’. Not knowing what to do and getting the same answer twice, James’ mum was given no choice but to watch James wake at night crying – they tried heat packs and ic
Growing pains in children can be debilitating for them and also stressful to parents.
e on his legs, they also tried rubbing his legs and paracetamol but with little relief. This pain continued off and on for many months, almost a year. A friend told James’ father about A Step Ahead Foot + Ankle Care which lead them to visit us.
After a thorough history and examination including watching James walk using our specialised gait analysis software we established that James had flat feet and that it was in fact this that was leading to a large amount of his pain.
A 3d scan of the foot is taken to develop a model of the foot.
We decided to fit James with some custom made orthoses (insoles) as these are designed to fit his foot exactly and are able to be custom designed – like prescription glasses – to assist him with his pain. We took a laser 3D scan of his foot to ensure a perfect fit and designed these for him on our computer aided design software.
A month after fitting, at James’ complimentary check-up there were beaming smiles all around! Mum reported
James had not had any episodes of waking up in pain. James said his orthotics were comfortable and he enjoyed wearing them so much he was wearing them every day and swapping them between his school and sports shoes. Another free check-up the following month revealed the same.
Happy Parents and a happy pain free James!