July 2004

Benefits of using orthotics

by Dr. Chris Akey

We know that addressing the subluxations of the spinal column can unlock the body's own ability to heal itself. Is correction of subluxations, however, the only approach to utilize in the care of patients? What supplemental devices exist that can enhance the power of subluxation correction?

It's a pattern seen in many chiropractic offices. Some patients respond quickly, while others do not. The question posed by this variance becomes clear: What's preventing the correction of the subluxation from having its strongest possible effect?

One approach is the use of pedal support (specifically, custom‑made orthotic support) as a supplement to the chiropractic adjustment. A large number of clinics have utilized orthotics as successful adjuncts for a wide range of patients. Numerous articles and research programs have also worked to track the effects of pedal imbalance on the correction of subluxations.

At least 75% of the population has some degree of leg length inequality. (1) This inequality can be anatomical in nature (from bone fracture or surgery) or can be the result of excessive and/or asymmetrical pronation, a functional problem.

Excessive foot pronation, whether in one foot or bilaterally, interferes with carefully orchestrated movements and can cause pathology throughout the musculoskeletal system. (2) It is, therefore, appropriate to apply the orthotic approach in many patient cases.

Determining need

If a patient is not responding to corrections of the subluxations as expected, there are several simple methods for determining if orthotics could be of benefit.

The easiest method is to inquire whether the patient has experienced foot discomfort, pain, or injury either recently or sometime in the past. Since any problems that are causing pain in the feet can contribute to pathologies in the spinal column, it would be to the patient's benefit to utilize orthotic support to reduce or eliminate these problems.

Another simple technique is visual examination of the feet and footwear, looking for what are known as the "five indicators." Look for:

*** uneven shoe heel wear

*** outward rotation of the feet

*** low medial arches

*** inward bowing of the Achilles tendons

*** internal knee rotation

The presence of one or more of these indicators strongly suggests the need for orthotics.

Another technique commonly utilized is to measure the amount of navicular drop on each foot and determine the difference in drop between left and right foot. Measurements can first be taken from a seated position, then a second set of measurements from a standing (weightbearing) position.

By comparing the level of drop between the two sides (a drop difference of more than 3mm can indicate functional leg length inequality, potentially contributing to a challenging subluxation) or excessive bilateral navicular drop (more than 5mm can also contribute to subluxation challenges), you will be able to make a determination as to whether or not orthotics should be recommended to your patient.

Getting started

Once you've decided to begin offering orthotic support to your patients, it's advisable to begin slowly and build at a comfortable pace. Select several patients who show signs of need for pedal support and recommend orthotics for them.

When making your first selections, I recommend patients who are younger and therefore more adaptable to the changes that the orthotics will cause to their feet and the above structures. Keep in mind that a person who pronates excessively or asymmetrically has likely been doing this for a considerable period of time and will need some time to adapt to the orthotics.

By starting with patients who adapt quickly and positively to these first pairs of orthotics, you can establish a 'comfort zone' for working with orthotics. From there you can work outward from your comfort zone to include patients who may require more time and effort to adapt to their new corrections.

Another great help to your efforts will be to network with other doctors in your area who have utilized orthotics in their patient care.

There are any number of possible combinations of patient conditions that can lead to occasional challenges in using orthotics for certain patients. For example, older patients often require an extended adaptation period. Numerous research studies and articles are also available to assist in particularly challenging cases as well as offering ideas on alternative methods of orthotic application.

Conclusion

The decision to utilize orthotics as a means of supplementing the care of particularly challenging subluxations is one that can open a new area of patient care for your clinic. You'll find you can finally address many difficult cases that in the past yielded disappointing or inconsistent results.

References

1. Yochum TR. "The short leg," (revised). Practical Research Studies 1994; 4(5):4.

2. Hyland JK. "Recurring subluxations linked to pronation." Practical Research Studies 2003; 13(4):1.

(Dr. Chris Akey is in private practice ‑‑ Life Family Chiropractic ‑‑ in Farmington, Arkansas.)

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