Winter 2011

By Bryan Anderson, ATC

Stretch Winter 2011

Orthotics for Foot and Knee Pain

By: Bryan Anderson ATC

Anatomy of the foot and plantar fascia.

Plantar fasciitis medical illustration.

Orthotics are rigid or semi-rigid inserts placed into
your shoe or on your foot to help correct biomechanical
dysfunction in the foot, ankle, or knee. These inserts
range in variety from very expensive rigid and semi-rigid
orthotics to low-cost gel inserts found in any sporting
goods store. Both can be useful in relieving a number of
lower extremity conditions and injuries.
Custom orthotics are inserts that are fabricated by a
health care professional with expertise in lower extremity
biomechanics. This typically involves molding your foot
in plaster or scanning the foot with a special device while you are walking. This also includes a
biomechanical assessment by our clinician in both weight bearing and non-weight bearing to help
determine the exact issues present in every area of your foot and ankle. Custom orthotics are tailor
made for you, and are usually the most effective type of orthotic.
Off-the-shelf or generic orthotics can be found at most sporting goods or running stores, and can
sometimes be a cost effective way to treat lower extremity pain. These are generally used “as is” from
the package, and should be available in several different forms, depending on foot type and problem.
The store associates at a good running or sporting goods store can typically aid in helping you pick the
type of orthotic needed.
The two most common types of foot dysfunctions are known as pronation and supination. Both
affect the shape and mechanics of the foot in weight bearing activities and can also cause issues up the
kinetic chain into the shins, knees, and even hips and low back.
Pronation occurs in an overly flat foot generally including a very low medial longitudinal arch, and
external rotation of the foot. This causes your ankle to roll as you begin to walk on the inside of your
foot. This can lead to many issues in the ankle, including foot and ankle pain, stress fractures, and can
increase stress on the medial knee. In general, to correct this, a semi rigid orthotic providing support to
the medial arch and correcting the rolling in of the ankle is recommended.
Supination occurs in a hyper rigid forefoot and arch, characterized by a high arch, and internal
rotation of the foot. This can cause a person’s ankle to roll out and walk on the outside their foot. This
condition decreases shock attenuation in the lower limb, and increases stress on the ankle and shin.
Also, the general position of the supinated foot can increase the instance of lateral ankle sprains. To
correct this, a more cushioned semi rigid orthotic is typically recommended to help attenuate shock in
the foot and transfer forces from the lateral foot to the medial arch.


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