Orthotics
The Role of orthotics (foot support) in back care
Why has my chiropractor suggested orthotics for me?
It is well recognised that foot problems, including pronation (flat feet), cause postural problems, through the mechanism called the kinematic chain. This mechanism transfers forces from the feet and legs to the pelvis, the vertebral column, the shoulders and the head and neck, and also the other way around, thus from the neck trough back down to the feet.
When we walk, automatically repeated movements are produced activating the kinematic chain from the foot to the head. The effect of the foot structure translates to the alignment of every part of the chain, therefore being implicated in problems like disc hernia, neck pain and headache.
The patient with excessive pronation (flat feet), exaggerates medial rotation of the entire leg when walking. These rotational forces are transferred to the sacro-iliac joints of the pelvis. This rotates the whole pelvis forward, or it may become rotated forward on only one side. A scoliosis may develop as a compensatory result of unequal flat feet or unequal leg length. Scoliosis often begins in the lumbar spine but may involve the entire vertebral column. In young patients, the curves may disappear when they are seated or lying down. With advance of the years, the curves of the column become more rigid and the scoliosis become structural.
The excessive pronation should be corrected with orthotics, if possible individually made for each patient, in order to improve the posture and to avoid future problems of the young patient. Poor walking stance, poor posture, neurological imbalance and the asymmetric forces, that are the normal consequences of flat feet, are lessened with good orthotics. Without the support, the patient will compensate by contracting the large muscles of the dorsal and lumbar spine and the shoulders. Sooner or later they become chronically painful.
When patients start to wear orthotics some pain may appear. Most patients can relate to the changes associated with moving teeth. However, everyone realizes that a temporary discomfort leads to a healthier bite and an improved smile. If the orthodontic appliances were removed at the first instance of discomfort, patients would never achieve lasting benefits. In a similar fashion, chiropractic care makes significant structural changes, and adapting to them sometimes requires patience.
Flexible, custom-made orthotics combined with chiropractic adjustments often will improve the adaptation period, but nothing will guarantee a totally pain free transition during this natural process. Because supporting the feet affects the whole body, it is not uncommon for some patients to experience mild but temporary discomfort as the knees, hips, pelvis and spine adjust to the improvements.
Orthotic break-in time varies from patient to patient. Some patients accept them immediately, while others need up to four weeks to get used to the feel of their orthotics. If you have a lot of foot pain you can do the "golf ball" exercise. Sit on a chair and place a golf ball on the floor. Put one foot over the ball and rotate it for about five minutes with a firm, comfortable pressure. Repeat with the other foot. This exercise should be performed in the mornings and evenings until the fixations in the foot are broken up, and adaptation to the orthotic is complete.
You should understand orthotics are designed specifically to work only in certain shoes for maximum support and benefit. It is always best to remove the original innersoles from the shoes, so the orthotic sits on a flat base. Many patients can tolerate full-time use of their orthotics immediately. However, most patients should limit their use to 1-2 hours the first day, and then add an additional hour each day. Most importantly, book your chiropractic check ups during the first 2-3 weeks while you adapt to your orthotics. Chiropractic adjustments improve the transition and help muscles, ligaments and joints adjust to more healthy positions.
You should also check your children for foot problems that may lead to future spinal dysfunction. The use of proper orthotics helps avoiding many future problems, and to grow healthier. Older patients find improvement for persistent or chronic problems of the spine. After the fitting of your new orthotics, chiropractic therapy will help the spinal structures to adapt to the newly acquired posture. Together with personalised exercises the chiropractic treatment promotes more durable relief from pain and will help you remain healthier.