Custom functional foot orthotics are made through a precise process that begins with a biomechanical evaluation to determine the orthotic's prescription. Dr. Hoy at Seattle Foot and Ankle Center then casts the patient's feet in plaster, manually holding them in the medically recognized "subtalar joint neutral, midtarsal joint maximally pronated" position, which is the proper method described in medical literature. These precise casts are sent to an orthotics laboratory for scanning and fabrication, a process that typically takes approximately one month before the devices are dispensed and fitted.
One of the biggest parts of our practice is the production of custom functional foot orthotics. Custom orthotics are like eyeglasses for the feet. Functional orthotics change the way ground reactive forces hit the muscles and joints of the feet, much like how eyeglasses change the way light rays enter your eye. During consultation appointments, Dr. Hoy will assess your condition and determine if custom functional foot orthotics are needed. Sometimes a trial of over-the-counter orthotics can be used to see if they help for the condition, although imprecisely. Some conditions will require custom functional foot orthotics for more precise control. Once it is determined that custom functional foot orthotics are necessary and the patient wishes to proceed, we go through the process as shown in the above illustration.
A biomechanical evaluation is performed to measure some critical angles needed to determine the prescription of the orthotic. The prescription of the orthotic is then discussed with the patient, taking into consideration the types of shoes the patient wears, activities and pathological condition. The feet are then casted with plaster with Dr. Hoy holding the foot in the proper position, known as subtalar joint neutral, midtarsal joint maximally pronated. This is the proper method of making custom functional foot orthotics described in the medical literature. Oftentimes orthotics are made by choosing a number from a kiosk, stepping over a force plate or stepping into a sandbox. These are improper methods of making custom functional foot orthotics.
Once the proper casts of the feet are made with the foot in the correct position, the casts are then sent to the orthotics laboratory. The casts are scanned into the laboratory’s computer so that the shell of the orthotic can be fabricated. If additional pairs of orthotics are needed in the future, the casting in the proper position is stored in the computer. Sometimes the prescription may change but the casting position does not change. It takes approximately one month for the orthotic devices to be made. The devices are then sent back to Dr. Hoy’s office for dispensing, fitting and instruction appointment.
The process of fabricating custom functional foot orthotics is documented in the scientific biomechanical literature. Our office uses best practices in the prescription of custom functional foot orthotics. Dr. Hoy graduated from the medical school where the science of orthotic therapy began.
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