Proper Orthotics Fitting

Running Shoes/Running Gear Shoes

14 years ago 11/18/2009 1:43pm EST

A runner of mine was recently sent to the doctor to get fitted for orthotics. I realize the debate about whether to wear orthotics or not has been on here before and I am still not sure if it is ultimately a good idea or not but we are going to give it a try. While I appreciate any feedback on other options than orthotics, my question is in regards to how they fitted her for the inserts.

They had her lie down and her foot was up behind her. They then took a mold/impression of her foot in a neutral position. I was recently reading Keith Livingstone's "Healthy Intelligent Training" book (page 101-102, very good so far by the way) and he had a section on this subject. He stated that they should have the molds or scans done in a standing, weightbearing position and not seated or lying down. He states that "the plaster cast neutral position may bear no resemblance whatsoever to your true weight-bearing position and need for stabilization." It makes sense to me that you would want your foot this way but I wanted to see what others thought. Any running podiatrists out there who can comment?

14 years ago 11/18/2009 3:56pm EST

re: Ortho Man

Ortho Man wrote:
A runner of mine was recently sent to the doctor to get fitted for orthotics. I realize the debate about whether to wear orthotics or not has been on here before and I am still not sure if it is ultimately a good idea or not but we are going to give it a try. While I appreciate any feedback on other options than orthotics, my question is in regards to how they fitted her for the inserts.
They had her lie down and her foot was up behind her. They then took a mold/impression of her foot in a neutral position. I was recently reading Keith Livingstone's "Healthy Intelligent Training" book (page 101-102, very good so far by the way) and he had a section on this subject. He stated that they should have the molds or scans done in a standing, weightbearing position and not seated or lying down. He states that "the plaster cast neutral position may bear no resemblance whatsoever to your true weight-bearing position and need for stabilization." It makes sense to me that you would want your foot this way but I wanted to see what others thought. Any running podiatrists out there who can comment?

My experience is only as a user. Intuitively I would agree with what is stated in Livingstone's book however having been through 5 or 6 pairs using plaster casts and various scanning systems both weight bearing and not, the ones that actually worked for me involved a scan being taken of my feet while I was lying down. I had to have them adjusted 5 or 6 times before they fitted properly but after that they worked perfectly for about two years when I had to get another pair.

Two asides:

- the guy who produced a pair that worked for me is a full time orthotist who spent four years getting a degree in orthoses and prosthetics. He knew what he was talking about.

- the orthotics I got were pretty hard. I've read suggestions that soft ones (gave me pains in my hips) don't work very well because they're not stable enough.

14 years ago 11/18/2009 4:17pm EST

re: Echinacea

If you are going to take a mold of what the foot is already like in a weight-bearing position, what would the point of the orthotic be anyway? I understand there would be more weight taken in a running stride vs just standing, but how much more good can an orthotic do if it is molded to the weight-bearing position?

In other words, if you have a foot issue which shows up when you bear weight, and you take mold of your foot in that position, how is the orthotic going to address it?

14 years ago 11/18/2009 4:18pm EST

re: Ortho Man

It sounds like her casting was OK but perhaps not perfect. A vacuum cast with the subject seated, the foot held in neutral, would probably be the most comprehensive.

Remember, getting the foot to neutral at toe-off is what we're trying to achieve. The orthotic should be correcting the "crooked" foot into that position. That's why they take some time to get used to. If you cast or scan a "crooked" foot weightbearing, you'll end up with a "crooked" orthotic.

It's probably also important the podiatrist -- which I am not -- knows what the orthotic is going to be used for, i.e. a running shoe, so the proper materials can be specified for making it (some podiatrists/PTs make their own orthotics, some send the molds to labs to be made).

If the orthotics aren't working out for her, she should not be afraid to go back and have them adjusted a couple of times.

Good luck to her.

14 years ago 11/18/2009 5:19pm EST

re: ExCoastRanger

Fit on orthotics is always more of an art than a science.

If you are a serious runner, you should try to get to an orthotist. The idea of having the molds made by one guy who actually sees the patient's foot and then having another guy who never actually sees the patient's foot make the orthotic just isn't right.

That being said, orthotists are not necessarily experts on running. But, if you tell them what you want, they can do a much better job of customizing things for you.

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