Treatment Method: 6 StepsTM
Step 1. A shell is custom formed to the shape of the sole of the foot.
The effect of so forming the device is to create a Total Contact Foot Orthosis. This is best done by thermoforming a suitable material directly to the foot and in the footwear that will be worn. Neutral Subtalar position is approximated by having the centre of the patella aligned over the second toe. Total Contacts Orthoses provide Neuro Motor Facilitation and Mechanical Control.
Step 2. The Break-in Period.
The effect of a therapy is related to the adaptation of the patient’s body to the therapy. The patient uses the device in their shoes from 3 to 7 days. During this time the patient’s body adapts to the devices. The devices are slightly deformed, in accordance with the patterns of activity of the patient, to adapt to the patient’s dynamics. This break-in period is important and should not be omitted.
Step 3. The rearfoot is adjusted by Functional Posting
Wedges are used as a means of applying a force to the rear-foot (as in using a wedge to split a log of wood). The 6 Tests™ are repeated as a wedge is inserted to various depths under the medial and/or lateral aspects of the rearfoot portion of the device. Commonly, a medial or Varus wedge will yield the most improvement in alignment, balance and supination resistance. The improvement in function should be verified by the patient.
Step 4. The forefoot is adjusted by Functional Posting.
Wedges are used as a means of applying a force to the fore-foot. The depth of insertion and angle of the wedge determine the force that is applied. The 6 Tests are repeated as a wedge is inserted to various depths under the medial or lateral forefoot of the device (generally just proximal to the MTP joints). Commonly, a lateral (or forefoot valgus) post will yield the most improvement in Jacks Test and the Forefoot Stability Test. The improvement of function should be verified by the patient.
Step 5. In Shoe Testing.
The technology and structural characteristics of footwear effect foot and leg function. The functional effects of the devices should be assessed with the patient wearing them in the shoes. Orthotic Therapy may fail if there is conflict between the design of the devices and the structure of the shoe. The Supination Resistance Test and Jack's Test may be difficult to perform with the shoes on but the other tests can be done. Changing shoes can alter the functional effect of the devices.
Step 6. Ongoing adjustment
The patient's adaptation and functional response to orthotics varies over time and is effected by other therapies employed. The devices should be checked and modified at 3 to 6 month intervals. Modifications include the addition or reduction of wedges and also sometimes reforming the device. The end point of therapy occurs when the patient is able to perform his/her desired daily activities without pain or unacceptable restrictions of mobility.
Read on: The Duration of Orthotic Therapy
