Philip

Plantar orthotics are used to enable subjects to maintain the best possible balance in static and dynamic situations. They have a major influence on the movement of the rear foot (pronationand supination) during running and walking.

Running is fundamental to all sports in physical preparation, and the runner population, in general very heterogeneous, will consult a podiatrist. Plantar orthotics have been shown to be extremely effective in lesions caused by running (Eggold, 1981; Kilmartin and Wallace, 1994). Furthermore, the wearing of orthotics is thought to increase shock absorption during initial contact (Redmond et al., 2000). The reasons for this population consulting a podiatrist can be categorised into two types: a desire for more comfort, particularly “cushioning”; and pathologies connected with the practice and/or age of the subjects. Two pathologies appear to account for the majority of consultation requests: gonalgia and calcaneal tendinopathies. It is in this context that we chose to evaluate the impact in terms of satisfaction, pain, perspiration and perception of stability of two types of thermoformed plantar orthotics. This technique is widely recognised in sports podology (Boissinot, 2007) and has a number of advantages: better stabilisation of the rear foot (Rodgers, 1999), better load distribution (Berger et al., 2005) and easier adaptation in athletes (Mündermann et al., 2003) have been demonstrated and are evidence of the positive influence of moulded orthotics on the running pattern. Moulded orthotics reduce the maximum overpronation of the rear foot and the maximum external rotation of the tibia.  

Materials and methods

133 patients (51 women and 82 men) were included in the sample for this analysis, with a mean age of 36.2 ± 12.9 years (9 to 61 years) and anthropometric characteristics of 1.70 ± 0.12 m, 64.85 ± 14.12 kg. The reasons for consultation were in connection with either gonalgia-type pathologies (60 patients) and calcaneal tendinopathies (50 patients) or with a request motivated by the desire to prevent injury (33 patients). The majority of these patients presented high-arched (40) or flat (25) foot morphotypes (Figure 1).

The method chosen to make the orthotics was thermopressure in the corrected position by thermoshaping. To make the orthotics, in the first instance we had to make an accurate mould of the foot using a vacuum bag. The orthotics were made malleable by heating them and then positioned underneath the subject’s feet in order to assume the foot shape. Using the windlass technique when moulding the thermoformed orthotics ensured that the rear foot and midfoot were naturally realigned (Aquino, 2003 – Photo 1 + Figure 4).

The thermoformed orthotics were made to measure based on two

criteria: the patient’s pathology plus a pogological examination comprising

several stages – questioning, palpation, static podoscopic

examination, dynamic examination (podometric and digital) – and an

analysis of the wear and deformation of the patient’s sports shoes.

Based on a summary of these findings, the practitioner was able to

make an effective and suitable tailor-made plantar orthotic. The

plantar orthotics chosen were of two types: the SPCT® Sport standard

(43 pairs of POs) figure 2 and the OPCT® Tonic standard TX

(90 pairs of POs) figure 3.

Each patient was asked to fill in a questionnaire after one month

to record their opinion regarding comfort, perspiration, weight of

the orthotics and perception of foot stability.

Pain was evaluated by the question “Has wearing your orthotics

had a positive influence?”.

The choice of responses was yes or no.

Survey results

The vast majority of patients were satisfied or very satisfied in

terms of comfort (90%), perspiration (93%), weight of the

orthotics (95%) and foot stability (95%). In 76% of cases the

orthotics appeared to have a positive influence on pain. (Figure 5)

27% of the orthotics were renewed after one year. But this

depended essentially on the intensity of practice.

Discussion of survey results

Wearing the orthotics appears to bring real comfort to the

patients. There is a close connection between sports footwear

and plantar orthotics in the practice of sports. The footwear has

to adapt as well as possible and in a neutral way to the movements

involved in the sport, but the thermoformed plantar orthotic

fulfils a compensating role in connection with pathologies.

The addition of a plantar orthotic does not appear to result

in unacceptable excess weight or excessive perspiration.

This survey confirms the results of previous studies: foot

orthotics are shown to be effective in reducing pain, particularly

in the knee (Eng and Pierrynowski, 1993; Springett

et al., 2007). Patient satisfaction in terms of perception of

foot stability may be partly explained by better plantar

pressure distribution (Berger et al, 2005).

CJ and BL

Bibliography:

Aquino A, Payne C. Function of the Windlass Mechanism in Excessively Pronated

Feet. J Am Podiatr Med Assoc2001; 91(5): 245 – 250.

Berger L, Calleja J. Effets des semelles thermoformées sur la répartition des

appuis plantaires. Revue du podologue,2005, 5: 24-26.

Boissinot P, Pierre F. Chaussures, orthèses plantaires et sports. Revue du Rhumatisme.

2007 ; 74(6): 608-611.

Eggold JF. Orthotics in the prevention of runner’s overuse injuries. Phys Sports

med1981; 9:181–185.

Eng JE, Pierrynowski MR. Evaluation of soft orthotics in the treatment of patellofemoral

pain syndrome. Phys Ther1993; 73: 62–70.

Kilmartin TE, Wallace A. The scientific basis for the use of biomechanical foot

orthoses in the treatment of lower limb Sports injuries: a review of the literature.

Br J Sports Med1994; 28:180–184.

Mündermann A, Nigg B, Humble R, Stefanyshyn D. Foot orthotics affect lower

extremity kinematics and kinetics during running.

Clin Biomec2003, 18(3) : 254-262.

Redmond A, Lumb P, Landorf K. Effect of cast and non cast foot orthoses on

plantar pressure and force during normal gait.

J Am Podiatr Med Assoc2000; 90 (9) : 441-449.

Rodgers MM, Leveau BF. Effectiveness of foot orthotic devices used to modify

pronation in runners. J Orthop Sports Phys Ther 1999;4:86–90.

Springett K, Otter S, Barry A. A clinical longitudinal evaluation of pre-fabricated,

semi-rigid foot orthoses prescribed to improve foot function. Foot, 2007,

17(4):184-189

Article SIDAS auteurs
Laetitia Berger
et Julien Calleja svp.

For over 30 years SIDAS has been the leader in designing, developing and producing technologies and solutions for every foot, every sport, every day. Its custom orthotics directly moulded to the foot and a very much appreciated concept amongst the sportive elite.

The SIDAS concept is all about using thermo-mouldable materials shaped to the feet, to support or correct them and alter your gait or posture. Moulding directly to the foot has been proven to be the right approach as it respects the foot’s anatomy. 

Sidas Bike

I worked at SIDAS for seven years and have used their concept for over twenty years. During that time I have dealt with countless feet, injuries and conditions. My work involved Research & Development. Working with the world’s and Olympique’s top athletes to create the unique, highly effective orthotics that they required. 

The principle/concept/theory/logic are key to making these custom moulded orthotics specifically to your requirements. To choose the right materials combination; we need to select the suitable material with the correct density, thickness and design to have the desired impact on your biomechanics. 

I do not agree with some school of thought who says that orthotics will make you feet lazy. 

I designed and craft orthotics to help your body to be pain free and stop compensating to counter attack the problem. The orthotics are designed to rest some muscular groups and stimulate and engage others to coordinate and balance your body. 

Sidas Run

This approach can be applied to all sports needing footwear and also to problems encoutered in your everyday life. Your feet are the foundation of your body. If they are not stable and mechanically sound, they can affect your whole body, in particular: 

Your Knees. 

The muscles, tendons and ligaments in your lower limbs. 

Your lower back. 

Your hips. 

Your ankles. 

REMEMBER, YOUR FEET ARE UNIQUE 

SO LOOK AFTER THEM! 

Photos courtesey of Sidas  

If your current ski boots are uncomfortable it’s probably due to poor foot stability and lower limb alignment. A new set of ski orthotics will refresh your current boots and transform your skiing.

Most boots problems can be resolved by making customised orthotics, specially designed for skiing, fitted precisely to your feet and your boots.

Once the orthotics are fitted your boots will become an extension of your legs and pressure points around your feet will disappear.

Improved skiing, with real comfort, becomes a reality.

ifyou’re not sure that orthotics will work for you, then please come along, bring your own boots for a free 1/2 hour consultation.

I have been fitting ski boots to the French ski teams for several years.

My expertise and knowledge about ski boots fitting is unique.

New custom orthotics will be your great skiing experience.

• New Resolutions
• New Goals

You have decided to step up your profile and set your eyes on a specific race or distance.

To prevent or solve lower limb problems or mechanical issues, orthotics are ideal.

To assess skeletal mal-function or soft tissue niggle, Foot Factor offers you the opportunity to get closer to your new goal by checking your gait, biomechanics and footwear.

Just call reception on 020 7436 8960 to book a Free 1/2hour consultation.

Bring you current running shoes along (don’t buy new ones for that occasion ).

START THE NEW YEAR ON A GOOD FOOTING!

HAPPY RUNNING!

This has given me invaluable and unique experience. I have always worked with patients/clients “on the spot”,

treating them and making orthotics while they wait. This means that:

• No time is wasted.

Only one, one and a half hour appointment is needed.

You present with a particular problem/injury.

I assess it, understand it and determine what is required.

I find, design and provide you with a solution.

• Common sense

Most injuries have a logical and chronological explanation.

What seems to be a new problem often has for a long time waited to happen.

• A thorough assessment

Assisted by computer reading and analysis, some empiric observations and a complete questionnaire, a rigorous assessment will be conducted to determine the causes of the problem.

• Find a solution

Finally but most important, I will design and produce an orthotic that will help you to get over your problems,

This is what matter to you. The value of an assessment is as good as the solution you can provide.

The orthotics will be produced in a half weight bearing procedure with your best foot and ankle biomechanical alignment.

ouI think that is very important that the practitioner who assesses your problem makes the ultimate custom orthotics while you wait.

This way, no data can be interprated differently or lost.

You can wear the orthotics instantly, starting your recovery immediately.

Hyperpronation causes an internal rotation of the lower extremities. If one foot hyperpronates more than the other, the asymmetrical internal leg rotation causes colatteral hip to be pulled forward and down more than the other causing an un-leveled pelvis and a functional leg length discrepancy.

As these displacements cascade up the axial framework, scoliotic and kyphotic curves are exaggerated. The thoracic cage usually twists, one shoulder usually protracts more than the other, and the opposite shoulder drops. The head moves anteriorly causing a neck over-loading.

This gravity induced collapse as significant health consequences. These changes also result in an anterior shift in the body’s center of gravity which causes an increased load on the forefoot and increased muscular activity of the back muscles to maintain balance and stability.

What causes Shin Splints?
The biomechanics and your physiology factors. I mean the way you are. Your feet biomechanics and the degree of mobility you have in the foot and all his joints will determine how much at risk you are from the problem.

How can you help it?
Whether you are a pronator, supinator or neutral runner, your weight, your weekly mileage, you must choose the correct pair of running shoes to suit your needs.
Like with any other injuries a sudden increase in mileage can also trigger Shin Splints.

Treatment
There are many things you can try to remedy this problem.

• Immediately after completing a run, ice the shins for 10 mins. Respect that time, as icing for too long will slow down or stop any natural healing reaction from the body. Repeat two to three times a day.
• As with all overuse injuries, try to rest or slow down yoe training.
• Consult a physiotherapist who is accustomed to runners problems.
• If you have had the problem for more than six weeks, or you suffer from recurrent Shin Splints, it is likely that you have a biomechanical problem that will require biomechanical and gait analysis. Custom made orthotics will provide you with the required correction.

Plantar fasciitis is inflammation of the thick, fibrous band of tissue that reaches from the heel to the toes, supporting the muscles of the bottom of the foot. “Plantar” refers to the bottom of the foot; “fascia” is supportive tissue. When the plantar fascia becomes overly stretched, tiny tears can riddle its surface. The band of fascia can ultimately swell and become quite painful. While some people have attributed this type of pain to bony growths called heel spurs, it is now believed that heel spurs are usually just a coincidental finding in people with plantar fasciitis.

plantar fasciitis

Plantar fasciitis is a painful inflammatory condition caused by excessive wear to the plantar fascia of the foot. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition.

Treatments
Many different types of treatment have been effective, and though slow to respond plantar fasciitis has a generally good prognosis. Custom orthotics, preventing excessive pronation of the foot and stress to the fascia. Weight loss if necessary.

Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, and flip-flops.

Local injection of corticosteroid often gives temporary or permanent relief, but may be painful, if not combined with a local anesthetic. Recurrence rates may be lower if injection is performed under ultrasound guidance.

Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. Patients should be encouraged to lessen activities which place more pressure on the balls of the feet.

What is Runner’s Knee?
Patello-Femoral Syndrome refers to pain behind or around the knee cap (patella). The condition is characterized by the kneecap rubbing against the thighbone (femur) when moving.

The patella is embedded in the common tendon of the quadriceps muscles and forms part of the knee joint by articulating with the femur. There is a groove at the bottom of the femur that allows the patella to move through it as a pulley when the quads are in action. However, should the pull of the quadriceps be unequal, the patella will deviate to one side, rubbing painfully along the patellar groove.

What causes runner’s knee?
Runner’s knee may be caused by a structural defect, or a certain way of walking or running. Other causes may include the following:

• a kneecap that is located too high in the knee joint.
• weak thigh muscles.
• tight hamstrings.
• Walking or running with the feet rolling in, while the thigh muscles pull the kneecap outward. This is the most common cause in running.
• Biomechanical abnormalities such as over pronation of the feet can also result in incongruity between the direction the patella is pulled by the quadriceps muscle and the shape of the patellofemoral groove through which it travels.

What are the symptoms of runner’s knee?

• The following are the most common symptoms of runner’s knee. However, each individual may experience symptoms differently. Symptoms may include:
• pain in and around the kneecap that may be felt with activity ( running ), or even after prolonged sitting with the knees bent, occasionally resulting in stiffness and soreness at the front of the knee.
• rubbing, grinding, or clicking sound of the kneecap that can be heard at times when the knee is bent and straightened.
• It is usually aggravated by hill running. The symptoms may quieten down during running, only to recur at the end of a run or later on in the day.

Treatment for runner’s knee:

• Stretching exercises for the tight lateral structures of the thigh.
• strengthening exercises of the medial quadriceps and gluteal muscles will help.
• Custom made orthotics specifically designed for you needs. The orthtoics will correct or stabilise the foot in the appropriate manor in order to affect your general gait. They will improve patellar tracking by affecting the foot and the knee biomechanics.