I find using footwear sole modification applications to have more impact than a typical plantar foot orthotic on re-alignment aims and goals.
Someone with a chronic ankle pain from a condition such as arthritis or CMT (Charcot Marie Tooth), Posterior tibialis syndrome or motor vehicle trauma can be realigned and stability controlled with this. If it is inoperable then this approach provides conservative treatment and great long term benefits.
I’m not saying for all occasions but for many bio-mechanical and offloading issues, a well designed individual change to the sole unit of each shoe/boot/sandal to dictate gait can be far more effective than any orthotic used within a shoe.
Most people and practitioners are familiar with prescribing a rocker sole and for good reason.
What is a rocker sole as we normally know it.
It is a change to the side profile (sagital plane) in order to achieve an aim to improve or benefit motion in the sagital plane and or displace pressure by restricting motion or flexion.
It can slow or speed up the weight transition across the length of the foot. It can aid or hinder either the hinging of the ankle or the hinging of the forefoot/toe .
This is rocker sole in its basic form.
I remember being shown the USA Pedorthic Association’s manual. It had pictures and descriptions for five or six ‘type of rocker sole modifications to an existing shoe.
A rocker for instance can rocker analysischange the gait alignment in all three planes of motion if you design it to.
Most practitioners will think a rocker is for sagital plane only. That is the aim of the majority of the referrals I receive.
When I design a rocker sole I have an array of fulcrum positions for both the foref
oot rocker and the heel rocker. However we are sometimes adding in another fulcrum to control more of the gait alignment in three planes.
Or a radical change to a fulcrum angle can make an awesome difference to realigning the gait as it progresses from Heel strike to Toe-off phase.
Heel flairs and floats, buildups, wedges, side raises, buttresses, fulcrum positions and angles etc all have control over gait immediately on ground impact. Orthotics can’t do that. The sole unit takes the initial crush load first and before the orthotic can impact the gait has progressed approximately 15%.
However orthotics when used alongside footwear changes can make the difference between a 60% solution and a 90% solution.
Orthotics are a great benefit and always provide stability and control points throughout the weight bearing moments of foot within the shoe. In other words they can make the difference between a 60% solution and a 90% solution. Orthotics on their own sometimes do not provide the desired strong influence on immediate control at ground impact or throughout the weight bearing cycle of the gait.
Pedorthic modifications of the sole unit in all its possible material and designs choice provide instant impact and importantly instant patient sensory feedback and response.