Do I need Custom Insoles? Hear from a Podiatrist, Dr. Alan Bass

Contrary to what some might believe, podiatrists treat more than the feet. While patients present to a podiatrist’s office to treat certain biomechanical problems, they look at how the feet affect the  ankle, knee, hip, and the rest of the body. While prefabricated orthotics, like Powerstep, may not be able to be adjusted to treat every biomechanical issue that your patients present with, they do provide the medial and transverse arch support that relieves the pain most patients describe when consulting with a Podiatrist.

Let us discuss the arches that are found in the human foot. While it is understood that there are three arches in the foot, the medial longitudinal arch, the transverse arch and the lateral longitudinal arch, the medial longitudinal arch is the primary area that patients need support. Healthcare providers also recognize the lateral longitudinal arch and the transverse arch, but they do not play a major factor in the biomechanics of the lower extremity. The transverse arch is formed by the base of the fifth metatarsal, cuboid, and the cuneiforms and incorporates the LisFranc joint and ligaments. The lateral longitudinal arch consists of the two lateral metatarsals and the cuboid bone and is mainly flat. That is the reason that it does not play a major place in foot biomechanics.

According to Kevin Wong, Doctor of Chiropractic, a member of the Foot Levelers Speakers Bureau for almost 20 years, podiatrists “are treating only the foot with little regard to the skeletal structures and associated joints above”. This cannot be further from the truth. Additionally, Dr. Wong states that podiatrists only use expensive, rigid “one-arch” orthotics or tell patients to go to the store and choose an off-the-shelf brand. This is also not true. There are chiropractors that believe that podiatrists are the experts when it comes to foot biomechanics and the proper devices needed to provide optimal support and function. While I would agree with Dr. Wong that there are three arches within the human foot, I would disagree with his assumption that podiatrists only worry about the medial longitudinal arch.

As described by Asghar and Naaz in their recently published article, The transverse arch in the human feet, "it is commonly understood that the transverse arch of the foot plays a role in midfoot stiffness and the transverse arch is a spring lever to provide stored energy that is used during propulsion." I would appreciate the opportunity to review studies addressing the lateral longitudinal arch and the benefits from the use of Foot Levelers over other well-constructed prefabricated orthotics such as the Powerstep ProTech in the treatment of biomechanical issues affecting the lateral longitudinal arch.

Custom orthotics can range from flexible, semi-flexible, rigid, semi-rigid based on the biomechanical problems that the patient presents with and can most definitely address the problems of both the medial and transverse arch. Additionally, most, if not all podiatrists perform gait analysis prior to prescribing prefabricated or functional foot orthotics.

Common Foot Conditions Than Can Be Treated With Powerstep Orthotic Insoles 

Mild to pronation, pes planovalgus, mild hallux abductovalgus are just certain conditions can still be addressed with a Powerstep prefabricated orthotic, that provides both medial and transverse arch support.

That begs the question, does every patient need a custom orthotic? While some Chiropractors and Podiatrists would say yes, I would say no. Not every patient has a foot type or biomechanical issue that would warrant the use of a custom orthotic. According to Spencer Hoffman, Doctor of Chiropractic, he believes that “every patient does not need a custom orthotic” Dr. Hoffman also believes that if price is a factor, then the use of a prefabricated device can be used. If a prefabricated device does not work, Dr. Hoffman also looks elsewhere in the kinetic chain and might move onto the use of a true custom functional foot orthotic. Using a device like the Powerstep Protech orthotic, with a medical grade foam and semi-rigid arch that can treat patients very well. Also, patients presenting with new biomechanical problems may not require a custom functional foot orthotic.

Additionally, why do patients need to wait for custom orthotics? They can get the benefit of using a Protech orthotic and get relief from a podiatric problem and control the biomechanics of the foot which also lead to other biomechanical problems of the lower extremity.

Most podiatrists also will scan or cast their patients for custom orthotics in an off-weightbearing, subtalar joint neutral position to hold the foot in its best biomechanical position. In my professional opinion, stepping on a scanner or stepping into a foam box will only transfer any poor biomechanics of the foot to the scan or foam. This will not allow the provider to treat the poor biomechanics of the feet, leading to other lower extremity problems.

Written by  

Alan Bass, DPM, FACPM, CPC, RPh

DR. ALAN BASS IS THE FOUNDER & MEDICAL DIRECTOR OF CENTRAL JERSEY FOOT & ANKLE CARE 

https://www.basspodiatry.com/our-foot-doctor

Citation

Asghar, A., & Naaz, S. (2021). The transverse arch in the human feet: A narrative review of its evolution, anatomy, biomechanics and clinical implications. Morphologie.