Orthotic Insoles

Things you need to consider…

An Orthotic is a device used to support, align, prevent, or correct deformities or to improve the function and mobility of the body. “Insoles” typically refers to custom made foot orthoses that are worn in a persons shoes. By definition, any time you combine any two items together to form a new object, it can be considered custom made. This means that a pre-made insole with a new top cover glued into place may be labeled as a “custom made“ device, when in reality it is just a modified pre-existing support. There is a significant difference between a custom made device and a custom molded one, and without knowing what questions to ask, you may end up with the wrong device!

Some people are content to just pick a provider out of a phone book, and that’s fine. Sometimes they get lucky and find a provider who can make a device that will address their needs. Sometimes they wind up with a ‘custom made’ item that they could have purchased at a fraction of the cost elsewhere.

There are a number of companies and practitioners out there who use computer gait scan systems to make orthotics for their clients. They certainly are fast, and while these machines can tell you where the pressure points are under a foot, along with the length and width of the foot, most of these systems lack the ability to measure the actual height of a persons arch. Further, most of these systems are operated as a mail order operation. Often, the computer style orthotics are made of site by a 3rd party, off site. There is more potential for errors when the orthotic is being produced by another party who has never seen your feet.

Another reason to be cautious is the fact that some professionals who are selling these devices are only trained for a few days on the system, and have little to no training on the actual manufacturing of the orthotics. This means that if you need an adjustment to the device, they might need to be sent back to the factory.

When considering who to see for orthotics, clients should check with their insurance company to make sure the provider is recognized and what documentation is required. They should also keep the following questions in mind:

Finding a Provider

Finding an orthotic provider is easy. Finding one who will fulfill you orthopedic needs properly can be difficult.

Some people are content to just pick a provider out of a phone book, and that’s fine. Sometimes they get lucky and find a provider who can make a device that will address their needs. Sometimes they wind up with a ‘custom made’ item that they could have purchased at a fraction of the cost elsewhere.

There are a number of companies and practitioners out there who use computer gait scan systems to make orthotics for their clients. They certainly are fast, and while these machines can tell you where the pressure points are under a foot, along with the length and width of the foot, most of these systems lack the ability to measure the actual height of a persons arch. Further, most of these systems are operated as a mail order operation. Often, the computer style orthotics are made of site by a 3rd party, off site. There is more potential for errors when the orthotic is being produced by another party who has never seen your feet.

Another reason to be cautious is the fact that some professionals who are selling these devices are only trained for a few days on the system, and have little to no training on the actual manufacturing of the orthotics. This means that if you need an adjustment to the device, they might need to be sent back to the factory.

When considering who to see for orthotics, clients should
check with their insurance company to make sure the provider is recognized and what documentation is required. They should also
keep the following questions in mind:

WHO is the practitioner?

​You need to be comfortable with someone… if they are going to properly assess you they should be touching your feet… (some people are a little squeamish about this)!

WHAT are the practitioners qualifications?

There are a number of different professions that are qualified to make orthotics but some locations only have ‘in-house training’… (anyone can print off their own certificates, in fact,
here, print your own!).

WHERE are the devices manufactured?

Are your orthotics being made at the same place where your assessment is being done, or are they being mailed out to a 3rd party to be manufactured? What are the qualifications of that 3rd party?
​
WHEN will they be ready? What is the turn around time?

Are the orthotics going to be ready in just one hour? Chances are they are computer made devices, or pre-made adjusted devices. Are they being sent away for 2 – 3 even up to 4 weeks?Keep in mind that if the location you are buying from can’t make their own adjustments, those devices are going on another trip back to the lab!

WHY are the orthotics needed? Is there a diagnosis?

Did you get a prescription (Rx) from your family doctor/specialist, or are you being told by the person who is selling the orthotics that’you really need these’? Remember, If you are going to claim for services through your insurance most companies NEED A Dx (diagnosis) ON YOUR Rx (prescription)!

HOW much? Is there a fee for the initial assessment and/or follow up?
​
Orthotic devices can have a wide verity of prices; OTC orthotics and computer generated devices should NOT be as expensive as fully molded 3D cast orthotics. Some places charge extra money per visit to have adjustments done and some are ‘travelling shows’ that move on to the next city… good luck even getting an adjustment done!

Pros & Cons

A brief review of the of the pros and cons of the 4 most popular methods for measuring for orthotics

Gait Scan
These are typically produced from a 2 dimensional pressure readout. A client will walk across the pads and a computer readout will display where the foot is hitting the ground. Often produce with pre-made shells and custom modifications. PROS: Quick, clean, inexpensive, thin design, digital storage CONS: Not custom molded – some practitioners have as little as 3 days training with the system – clients often change their gait to hit the pads ‘correctly’ – 2 Dimensional picture lacks arch height for accurate measurement
Contact Scan
3 dimensional laser scan of the foot or a total contact mapping via a computer controlled contacts. PROS: Repeatable results, cost effective, quick turnaround time, digital storage of scans CONS: When casting in a full or semi -bearing position the computer may capture the foot in it’s ‘bad’ position. Without proper training on how to manipulate the image on screen, proper correction is difficult – Limited material for manufacturing
Plaster of Paris Cast
Gauze wrapping with Plaster of Paris is wrapped around the feet while the foot is held at neutral, capturing a 3 dimensional negative mold of a foot. PROS: Tight contact cast, familiar method throughout industry CONS: When cotton gauze dries it tends to shrink. This creates a tight cast, however the cast must be ‘dressed’ to accommodate arch collapse and fat-pad displacement. This can lead to errors in manufacturing – finding the ‘neutral’ point is not the same for all disciplines, causing errors in manufacturing – Messy – Slow
Foam Box Cast
A full weight bearing or semi weight bearing cast is taken of the foot at neutral. PROS: Fast – Clean – High rate of repeatability – Cost effective – Often does not need to be `dressed` CONS: When casting in a full or semi -bearing position a practitioner who does not ‘pre-correct’ a foot will capture the dis-functional foot – Easy to damage – not always having a positive cast made, some practitioners are sending out for the computer scan orthotics, leading people to believe it’s a molded orthotic.

So WHY choose US?

How is Custom Orthopedic Ltd. different?

Here at Custom Orthopedic we don’t just focus on the orthotics alone. We take into account the whole story, including what footwear you are using, and what they (the footwear itself) is doing to your body and orthotic. We also consider what activities you are planning on doing, as they may significantly change the design of your device.

For our orthotics, we have chosen to use the Foam Box method for most of our castings. We have found that the Foam Cast, if taken properly at neutral, yields the best results because a pre-corrected, semi-weight bearing cast will take into account the arch collapse and fat pad displacement that occurs when people are standing.

There are some situations that require that we use the Plaster of Paris method, however we do this sparingly, as it is messy, time consuming and does not take into account the change in position that a foot experiences when weight bearing. When Plaster Casting, a technician must ‘dress the cast’; that is, add plaster to the cast to mimic those weighty changes. Depending on how much or how little the cast is changed, the results will vary greatly.

Our Canadian Certified Pedorthist ( C.Ped(C) ) also performs a gait analysis and a range of motion test before casting a person’s foot. It is important to know what the foot is actually capable of doing, before a custom device is made to `correct`someones position. A ‘flat-footed’ person may not have the available range of motion to wear an arch support. Doing an assessment helps to guide us in designing the correct device for each client.

We manufacture our own orthotics ON SITE. We use durable materials that can be adjusted easily, often in the same visit; (no need to send the device back to some remote lab and wait for weeks for an adjustment).

We’ve been “Keepin’ Edmonton on it’s feet for more than 25 years!”