When you hear the term “orthotics”, most people immediately have a negative connotation. We run into this problem daily at Chiappetta Shoes. Customer after customer walks in with a bag full of orthotics, all of which are either uncomfortable, too thick, or are made poorly. This bag usually represents thousands of dollars and is completely worthless. Not only are they out big bucks, but they are now feeling hopeless, desperate, frustrated and still in pain. The bottom line, and probably a question you may be asking yourself, why is it difficult to get a well-constructed orthotic that works?
Molding and Impression Process
When making a custom orthotic you must first take an impression of the foot. From the negative impression the manufacturer creates a positive mold. Fairly simple, right? Wrong. Like us, most places use a foam box for capturing the negative impression. However, most do so using a poor method which results in a poor orthotic. A common and incorrect way of taking an impression is using a weight-barring method with the patient standing and stepping into the foam box. This allows room for too much user error. For example, you might lean forward too much or land heavy on your heel thus creating a poor impression. Another poor way to take an impression is using a non-weight barring method having the patient sit on a table with no weight on the foot. This creates an impression that is often too high in the arch. Simply, having a misshaped impression leads to a misshaped orthotic. This is an important part of the process and if not done properly will lead to an orthotic that will have no chance of working well for you. The most effective way to take an impression is in a semi-weight barring position allowing the patient to sit in a chair and pressing his or her foot down into the impression foam box. The person taking the impression should be locating your foot in the most neutral and natural position, therefore creating the best starting point for an orthotic. This is considered an accommodative methodology.
Pictured: A customer’s impression having used the semi-weight barring position correctly.
Surprisingly, where an orthotic is made is a big deal. Here at Chiappetta Shoes, we pride ourselves on creating custom orthotics that are Wisconsin made and done entirely in-house. Very few orthotics are manufactured in-house these days and most are outsourced to central fabrication businesses. Commonly, you may be sent with a prescription to one of these fabrication businesses instead of seeing or interacting with the professional directly. In addition, when going through an outsourced process, the prescribing professional typically does not have the grinding machines or materials to make continual adjustments therefore modifications are made preemptively. This is considered the corrective methodology. These changes are made to the positive, plaster molds to “correct” your problem. The problem with this is that the professional sees corrections as subjective and therefore makes changes to the foot molds before the orthotic is even made, much less worn. These subjective changes in the plaster mold are then baked into the orthotic and if the orthotic doesn’t feel right when initially tried on, you’re out of luck. Another common occurrence with outsourced fabrication businesses is that they often only make the orthotics and that’s it. Once you pick up your orthotics you are on your own to find shoes that fit. Although one-stop-shops are often a dying breed, they usually offer the best possible solutions to your foot problems. Chiappetta Shoes is the holy trinity of shoe stores: real customer service, full Pedorthic services including manufacturing custom orthotics in-house, and shoe repair services. Our depth of knowledge in all aspects of footwear allows us the best perspective for solving different foot problems with real solutions.
Pictured: The grinder, a machine that allows us to do adjustments on custom orthotics.
Here’s something you should find appalling. Most professionals that prescribe custom orthotics put absolutely no thought into the functionality, i.e. what type of footwear you are going to wear them with, what you do for work, and what the fit will be like with the types of shoes you currently wear. Most orthotics we see brought into our shop are rigid plastic, cut extremely poorly, and far too thick for most shoes in your wardrobe. It really is a shame. This reason alone is the main reason most orthotics do not work. The problem is that most professionals that prescribe orthotics don’t consider your lifestyle and how you would use them. They are satisfied with you wearing the orthotics regardless if you are getting real relief. To get properly made orthotics that function well, solve a problem, and enable you to live your life to the fullest – you must first realize that orthotics are only a part of the solution. Your shoes, wardrobe, and daily activities are equally important in creating a properly functioning orthotic. Functionality can be broken down into two different aspects: materials and fit.
Pictured: Pete, our Master Cobbler, working on a custom orthotic in-house.
Orthotic Materials and Fitting Qualities
Most orthotics we see are made with a material called Subortholene, a plastic used in many orthopedic applications. Plastics offer great support but in most cases are far too rigid to use with shoes. Remember, orthotics are only a part of the solution and they must work in unison with your footwear. When discussing custom orthotics with our patients, the type of shoes you wear is extremely important. Men’s footwear is fairly simple in that most men’s shoes have about the same depth to the inside so that when making a custom orthotic, the thickness should be kept around 5 mm. Women’s footwear on the other hand varies greatly in depth and thus requires the proper thickness of materials to fit the shoes you wear regularly. A functional orthotic has two objectives: it is an insert you can move from shoe to shoe and a medical solution that solves your problem. At Chiappetta Shoes, we identify what types of shoes you are wearing and what a typical day is like for you; we learn about you and listen. Starting with the general concept of creating proper weight distribution, material selection is important when determining how an orthotic is going to feel in your shoes. In most cases, a “semi-rigid” construction is preferable for two main reasons. First, semi-rigid orthotics tend to sit inside of shoes much more naturally. However, firmer plastics can be a problem because the internal structure of each shoe is different. With a rigid insert, often shoes and orthotics do not function collectively and it “feels like you are wearing an orthotic”. With a more flexible base, the insert basically becomes a part of the shoe and creates the proper weight distribution needed. Secondly, using more flexible materials allow us to make continual adjustments to increase or decrease the amount of support. When it comes to feet, even the most seasoned professionals can never say they have seen everything because not one pair of feet are the same. Not to mention, people have different bone structures and life circumstances.
Pictured: Different orthotic materials offered that are later combined to create a custom pair of orthotics, all while keeping that individual’s needs in mind.
The Wrap Up
Starting with an accommodative impression, a well-made orthotic should begin with a neutral amount of contour and support. Using this methodology typically requires a few follow-up appointments for adjustments, but does not over-correct a problem out of the gate. It is a much easier transition to wear a pair of orthotics made using the correct method compared to a corrective approach where adjustments are made before you even wear the orthotic. What makes Chiappetta Shoes special is that we take an incremental approach to adjustments because we have the equipment, time, materials, and knowledge to make these continual changes.
For another visual of our orthotic process, see video below.
Thanks for reading! Leave any questions or comments below. If you’re experiencing foot pain and are looking for real solutions, give us a call at 262.657.9142 for an initial consultation.