With the onset of so many infomercials on television about shoe inserts and orthotics, we’ve had a rash of confusion among our patients about when to use orthotics and if it’s appropriate for them.

To understand orthotics, it’s important our patients have a good understanding of normal foot mechanics because that’s what orthotics do — change foot mechanics.

In a normal foot, the arch is both taunt and rigid while also being flat and flexible. When our heel hits the ground, the foot needs to accommodate the surface — flex like a shock absorber to dissipate the force of impact and provide a stable wide platform to accept the body weight (think about walking barefoot on an uneven lawn).  Our foot will naturally pronate to allow all the midfoot joints to become loose and accomplish these goals.

To walk on uneven ground, our feet need to be flexible

Once our body weight is completely loaded on top of our foot, the arch must tighten to provide a rigid lever so our muscles can propel us forward for the next step.

In normal mechanics, the foot needs to be both flexible and rigid for effective propulsion.  However, when we suffer from an injury in the body (lower back, hip, knee, ankle) the normal mechanics are disrupted.  We walk with a limp or we put abnormal forces across our limbs to hide a limp or guard ourselves from pain.  Now the foot and arch can no longer function normally.

The purpose of an orthotic is to intervene in these injured states and try to restore normal mechanics.

Many times, when we hold the heel of the foot straight up and down, the front portion of the foot is not aligned.    Looking straight on, the inner border of the foot can be rotated upward or downward.  The purpose of orthotics is to compensate for this rotation by building up the “floor” to meet the foot.

In some orthotics, the floor is built up to meet the foot

Another way of accomplishing this same goal is to have a person walk across a computer force plate.  By analyzing areas of high pressure, an orthotic can be precisely made to dissipate and transfer pressure from one area to another.

Computer force plates help with other types of orthotics

Since the foot is the very foundation that we walk on and because all the joints above the foot are affected by the forces of weight bearing, orthotics can be critical for anyone who suffers from an injury.

Malalignment at the foot can cascade upwards

In older patients with arthritis, orthotics are effective in relieving foot fatigue.  In athletic individuals, sports activities result in a great deal of movement and pressure on the foot.  Slight imbalances in the foot that aren’t harmful or even detectable under usual circumstances may make one more vulnerable to injury with the extra stress of sports.  By eliminating the need for one’s muscles to compensate for imperceptible imbalances, orthotics can reduce fatigue and promote efficient muscle function to enhance performance.  With enough functional correction, the foot structure can be aligned to give more propulsion and make walking, running and cycling more mechanically efficient.

In plantar fasciitis, orthotics support the arch so it’s less likely to collapse.  In addition, the support along the inner border of the foot helps control pronation of the foot. These two effects take pressure off the plantar fascia and the Achilles tendon to give relief.

In bunions and hammertoes, orthotics will help support the balls of the feet so the tendons across the toes are better balanced.  Hammertoes and bunions occur when the natural balance of the tendons across the toes, which act like the reins of a horse, is lost and one rein starts to over pull compared to the other.

For anyone who has had braces on their teeth, you know how important the retainer is after correction.  The same is true of surgical correction of the feet.  To insure maintenance of the correction and relieve pressure from the surgical site, orthotics are used to protect the time and effort invested in the surgery.

And, like eyeglasses, orthotics are an effective tool in attempting to restore normal function.  The best ones seem to make little immediate difference and only with prolonged use and persistence do we realize many of our previous complaints have lessened or even disappeared.  Like eyeglasses, orthotics are sometimes not covered by insurance and require an initial investment.

The bottom line is this: orthotics can make a difference to people who have been injured.  Orthotics are effective in changing abnormal mechanics.  Normal mechanics of the foot are essential to having normal mechanics of the entire limb.

A surprise in surgery!

A woman vacations in Costa Rica 6 weeks ago.  When she returns, she notices an itch on her ankle which won’t get better.

A 6 week old itch thats infected

Since it was almost 6 weeks, we got concerned and decided to surgically debride what we thought was an infection.

Within the incision, we found what we thought was a unique abscess or boil.

We thought it was an unusual boil or abscess

As we explored closer, what a surprise! Here’s a close up.

Thomas H. Lee, M.D.

A quiet rural mountain village of Vietnam

In addition to research and education, OFAC is committed to our humanitarian mission. In 2006 and 2008, we had the opportunity to work in the rural mountain villages and fishing villages of Vietnam. We operated on victims of land mines, childhood deformities, and polio.

Until recently, there were more land mines in Vietnam than anywhere else.

The challenge of surgery with no running water and only battery electricity

Take a look at the video produced to promote this mission. In the end, join us in giving back. Ask us when we’re going again. Ask us about our great stories. Ask us about our commitment.

Sprains, Strains, and Contusions

With the weather getting cooler and the fall sports seasons starting, there are a lot more injuries. Confusion remains over sprains, strains, and contusions. Excellent resources for these injuries can be found on the internet.

The bottom line is this: if you get injuried, immediately rest and immobilize, ice, compress, and elevate (RICE). Perhaps the most important is to immobilize. As a boy scout (or girl scout) we all recall using a rolled up magazine to splint a sprain. Pain arises as the injured tissues continue to be exposed to movement. By immobilizing a limb, the injured flesh is allowed to rest and begin healing.

Ice, compression, and elevation all help with the swelling but the immobilization is the only intervention that actually begins to help with healing. Contrary to what your buddies may say, dont try to walk it off. It may aggravate the injury.

If the pain is severe or its not improved with time, always seek medical opinion. Urgent care centers, emergency rooms, or a quick phone call to your primary care physician is never wasted time.

95% of all sprains and strains heal without any specialized treatment.

Sprains and strains always involve soft tissue structures such as ligaments or tendons. Contusions generally involve an impact injury and involve bruising of fleshy tissue and in severe cases involve bone bruises.

If the injury hasn’t resolved in a week, medical attention is definitely important. At this point, specialized immobilization may be required. Physical therapy may be required. X-rays at this time are important. Though unusual, there can be subtle fractures, broken bones, or even hairline stress fractures.

With modern advances, the rare 5% that do not heal now have opportunities for advanced sports medicine techniques. Ankle arthroscopy can heal ligaments through small minor punctures in the skin. Lasers and more advanced thermal probes can literally weld ligaments together. What used to take almost a year of recovery can now be repaired in just a few short weeks.

But the most critical time period is the first day after the injury. Remember, Rest and immobilize, Ice, Compress, and Elevate. RICE.