Icon Orthotics’s Competition:

1. The “Functional” Orthotic
2. The “Step In The Foam Box Full Weight Bearing” Orthotic
3. The “Computer Generated” Orthotic
4. The “Milled” Orthotic
5. The “Pre Fabricated” Orthotic
6. The “Icon Orthotics” Orthotic

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The “Functional” Orthotic

The “Functional Foot Orthotic” is the majority of my competition. This technology, which is not only extant today but is in fact the “status quo” in foot orthotics, is in my opinion an antiquated technology mainly because of more recently developed modern day plastics and materials that were not available in the 50’s and 60’s when this technology was developed. To fully understand the rational of “modern day orthotics”, you must first learn of its history. A brief history is as follows:

The corollary between unstable feet (hyper pronation, over pronation, collapsed arches, fallen arches, flat feet, flexible flat feet, pediatric flexible flat feet etc…) and orthopedic pathology up into the kinetic chain were known and documented way before the 1950’s and 60’s. However, in the 50’s and 60’s great advances and awareness of the detrimental link between a mal aligned foot and the rest of the kinetic chain were definitely advanced and strengthened through relentless documentation in the literature and from wide spread teaching of this school of thought to the various medical professions.

And as the physicians in this era understood this, their first “modern” attempts at correcting the entire body through the feet began naturally with the most stable, strongest and well aligned position; that is they put the foot in a slightly supinated “high arched” position and they maintained that position with a “total contact arch support”. The problem was that this position maintained, while it creates great alignment, posture etc…, it is not functional because if this stable “supinated” position was maintained throughout the gait cycle, you would literally “rattle someone’s teeth” as there would be no shock absorption what so ever. So why exactly did they fail?

They failed because they did not have the dynamic materials that we have today. Schaffer tried to use stainless steel. His “Schaffer Plates” offered great correction, as did the Whitman plates, the University of California Biomechanics Lab or UCBL (is a type of high flanged, very deep heel cupped total contact “high arch” orthotic), and the various high flanged and deep seated “heel stabilizers” that were made out of thick, inflexible thermo plastics, steel and fiberglass laminates. And the one thing all of these materials have in common is that they are not flexible to any significant degree due to the sheer nature of the materials. On top of that, the “I beam” created by the very deep heel cup and high medial and lateral flanges dramatically increased the stiffness of the devices as well.

So they found out very quickly that although you could immediately affect and straighten alignment problems, that you cannot “lock up” people’s feet into even a great alignment and have them tolerate it because the foot is Dynamic machine, not a Static one. So these “total contact arch supports” were to a greater extent abandoned. They were, in the 1960’s, supplanted with the concept of the “functional foot orthotic”. This brief history is of course over simplified, but factually speaking this data is accurate and correct.

The “Functional” Orthotic

So with the above in mind, a new breed of biomechanics minded physicians attempted to create a device which controlled the foot but allowed normal foot “function”; hence the name “functional orthotic.”

In order to create a device which limits pronation but yet allows foot function, several modifications called “cast corrections” are employed to in essence make the devices less efficient as these devices are traditionally made of the same hard and unyielding materials that they used in the 50’s and 60’s with a few modern day wonders such as Rohadur (more recently called Polydur) and carbon graphite composites. And even though “carbon graphite” rolls off your tongue very nicely, it is nothing more than a hard, relatively inflexible material.

As previously mentioned, going full arch height and making a UCBL type “total contact device” with these materials is still not possible for the same reasons we ran into 60 plus years ago. So to make them work they lower the arches and in essence allow the mid tarsal joint to pronate to some degree but limit the amount of gross pronation or arch collapse with the orthotic shell itself. There are two major detriments to this theory:

1. If the arch recovers in swing phase and it naturally returns to the more rigid, high arched or supinated position to prepare itself for heel strike as it ideally should, the arch will progresses swiftly down from this high ideal position and ultimately SLAM down into the flat, hard orthotic shell. If the shell were not there the arch would continue down past the level of the shell and the torque would be generated up the chain as previously mentioned, but now you are substituting that problem for a new one; the potential aggravation and injury to the foot from slamming down in an uncontrolled fashion into a hard and relatively flat (compared to the normal arch contour), orthotic device. Or…
2. If the arch does not recover to an ideal arch height in swing phase and simply “lazily” rests on the low, hard orthotic device, it functions in one single position (which is a problem in itself covered in the cause section of this web site) and it obviously remains in some degree of pronation, which in many cases is a significant degree of pronation. So in essence, they allow a compromised position to “reign supreme” during the entire gait cycle.

Yes there are various modifications like the famous “first ray cut out” which supposedly allows the medial column to planterflex and “allows a more normal foot function etc…” and as a Podiatrist and an ABC Certified Orthotist who was trained in such techniques and “modifications”, I can tell you that those modifications are not widely utilized, but that the previously mentioned cast correction is in fact the status quo, even though almost nobody is pouring their casts anymore. The “modern” cast corrections are done digitally and incorporated into the milling machine’s programming.

The bottom line:

When you have a very minor pronation or unlocking problem in the foot, the degree of rotation and torque created in the upper kinetic chain is likewise relatively minimal unless pushed to the limits as in your long distance runner and the like. But concerning your average public who do not push the envelope, this is when the supermarket arch supports may suffice and when people may have big wins with the typical “functional” type arch supports. However a moderate to severe pronator will quickly overpower these types of arch supports and these patients will experience varying degrees of relief to the extremes of not helping at all to the unfortunate incidence of actually injuring themselves while wearing these devices.

And in the case of the patients who over power the devices, some physicians quickly abandon their inefficient arch supports and insist that their patients must be placed into a much more substantial lower leg brace that actually has the capacity to handle and control the arch. I will agree that the very severe over pronator with a concomitant non reducible valgus ankle deformity must resort to this type of bracing, but I believe that this is an over utilized modality and only “required” in many cases because the inefficient “functional” or typical orthotic just could not get the job done.

On a final note, while this “solve” is not without any merit, it is in my opinion far from the ideal scene and subsequently what I can create with my orthotic technology.

The “Step In The Box Full Weight Bearing” Orthotic

This section is relatively short as I don’t have too much positive to say about this type of orthotic. The casting technique employed to create a foot orthotic with this technology is as follows:

1. Place the foam casting box in front of the patient
2. Have them stand and step into the foam casting box full weight bearing.

The Problem with the “Step In The Box Full Weight Bearing” Orthotic

This technique obviously captures the most fully pronated and pathologic position that the patient can obtain.
Now I may be missing the boat here completely, but as someone who has literally personally fabricated thousands of foot orthotic devices and other body orthotic devices designed to support the various joints and appendages of the entire body, I cannot see the logic behind this casting methodology that clearly gives you nothing but a pathologic and mal aligned foot position.

Stepping full weight bearing into a foam casting box may be sufficient to take an impression of the foot if perhaps the foot is literally so rigid that it cannot be manipulated to any degree or if you just want the basic outline shape of an severely arthritic or Charcot type foot that you would make a completely accommodative “pillow type” plastazote and poron insert for. Accommodative, maybe. Functional, I don’t think so.

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The bottom line:

As I have heard the rational to any lab that uses such a technique, all I will say is that it is an interesting theory. It also does not surprise me that the dozens and dozens of practitioners who have used such devices for their patients in the past have said one for one “if you place 10 sets of these devices on a counter top, you would not be able to tell them from one another if they did not have the patients names on them.”

I would suspect that such a device that would come from this casting methodology would be very generic in nature and as such will have a severely limited ability to control the foot, never mind the kinetic chain. However, just like in the case of the supermarket inserts, when you have a very minor pronation or unlocking problem in the foot, the degree of rotation and torque created in the upper kinetic chain is likewise relatively minimal. So in this case, even minimal correction can, and in some cases does afford some degree of relief.

However a moderate to severe pronator will quickly overpower these types of arch supports and these patients will experience varying degrees of relief to the extremes of not helping at all to the unfortunate incidence of actually injuring themselves while wearing these devices, again because of the following two reasons:

1. If the arch recovers in swing phase and it naturally returns to the more rigid, high arched or supinated position to prepare itself for heel strike as it ideally should, the arch will progresses swiftly down from this high ideal position and ultimately SLAM down into the flat, hard orthotic shell. If the shell were not there the arch would continue down past the level of the shell and the torque would be generated up the chain as previously mentioned, but now you are substituting that problem for a new one; the potential aggravation and injury to the foot from slamming down in an uncontrolled fashion into a hard and relatively flat (compared to the normal arch contour), orthotic device. Or…
2. If the arch does not recover to an ideal arch height in swing phase and simply “lazily” rests on the low, hard orthotic device, it functions in one single position (which is a problem in itself covered in the cause section of this web site) and it obviously remains in some degree of pronation, which in many cases is a significant degree of pronation. So in essence, they allow a compromised position to “reign supreme” during the entire gait cycle.
   

The Computer Generated Orthotic

The Problem with the “Computer Generated” Orthotic

The type of methodology that I am talking about here is the computer image generated from walking over a flat mat that has sensors in the mat that sends pressure readings to the computer when someone strikes the mat while walking in stride. This type of technology is similar to the Tech Scan product “f-scan” which is utilized in our very own clinic to aid us in gait analysis when we get a more involved and subsequently difficult case.

The question then becomes “how does one take a two dimensional computer generated image and create a functional foot orthotic from that data?” This is in fact a great question to ask someone who uses this type of orthotic.

Visual comparison to other brands

The bottom line:

When I questioned a vice president of one of the big orthotic labs who utilize this technology how they do it, his answer after a few minutes was to confess that they utilize a pre fabricated shell and they customize it with various posts etc… based on the data they receive from the mat sensors that the doctors provide them from their office computers over the internet.

An interesting concept but at least this company uses pre fabricated shells which are then dressed up and modified to be called and classified as a custom product. I personally think that a product created in such a fashion is in fact not a custom device, but unfortunately many people do.

This is of course only a “survey of one”, but I would like to know how exactly do they generate the actual shape of the arch from two dimensional data and readings. For example, they obviously can capture, just like the step full weight bearing into the foam casting box technique, the fully pathologic foot as it strikes the mat during gait. But how do they know where the arch began and what shape the arch was in before it flattened out while striking the mat? In other words, ten different people may strike the mat and flatten out to the same degree, but they all may start from different arch heights because they all may have different ranges of motion.

Although I do not know this for a fact with the exception of the one company I asked, I don’t see how this type of technology could generate anything other than a prefabricated orthotic. If you are using this type of technology, I would be curious as to the response that you would get if you asked your rep these questions.

The Milled Orthotic

The Problem with the “Milled” Orthotic

Traditionally, milled orthotics were limited exclusively to essentially blocks of medium to firm density foams, which are “carved” from a computer generated model obtained from a unique “casting or impression” methodology. There are many different systems that include digital “painting” systems to digital photographs to a system that involves placing your foot over a series of blunted plastic rods which, when you hold your foot still over them, lift up until they encounter a resistance at which point they stop. In any event, you get a sort of topographical “negative” foot impression that is linked to a computer to create a three dimensional computer generated model. This model can usually be manipulated and “corrected” while in the computer and then the finished image is sent to a c and c machine which “mills” the block of foam or what ever materials to the specks set in the computer program.

In more recent years, soft plastics such as blocks of poly ethylene or similar type plastics can also be milled to offer the obvious advantage of strength and resilience over the traditional foam based type of orthotic that was the only option at one time.

Visual comparison to other brands

The bottom line:

A definite disadvantage to this type of orthotic is the somewhat limited materials that can be milled, but more importantly, the positioning and maintaining the foot in a correct and ideal position during what ever scanning technique can become compromised before you obtain your scan.

Additionally, different modifications such as an extra deep heel up, and various flanges cannot be employed in the devices as the c and c machines have a somewhat limited ability to extend past the traditional trim lines. Traditionally these devices have been very bulky and accommodative in nature but this has been changing over recent years.

And although the future may well be heading towards scanning and milling, in present time this technology cannot or is not producing a total contact device as the programs generally contain and manipulate the computer models with the traditional “cast modifications” which are utilized to create in essence the status quo “functional” orthotics. This is to say, arch supports that do not completely or efficiently support the arch.

The “Pre Fabricated” Orthotic

Pre fabricated kind of says it all but there is a valid point of discussion here as the “functional foot orthotics”, the “step full weight bearing into the foam box” orthotics, the “computer generated” orthotics and the “milled orthotics” all have the detriment of not being full and total contact, they all lack a significant amount of control and efficiency and therefore effectiveness.

This may make one wonder how do these various types of orthotics compare in effectiveness and control when compared to pre fabricated orthotics? And that would certainly be a great question to ask. The answer however is a bit unfortunate, but factually speaking the answer is that in many cases there is no significant difference.

This is in fact the major problem with this industry and the cross that the custom labs, my lab included, have to bear. This is to say that certain parties have a vested interest to only reimburse us for only those things that can be proved to be necessary, essential and that which has proven efficacy. And yes I am talking about the insurance companies proper.

Are you starting to see why more times than not that the insurance company doe NOT reimburse for foot orthotics? When custom orthotics are not much more, if any more at all effective than prefabs, why would the insurance companies reimburse us? And again, most times they do not!

We do what the pre fabricated can’t do; we fit total contact into the arch and we therefore control the foot which controls the entire kinetic chain. We know what we do and we do it day in and day out. We make great custom arch supports. Read some of our most recent success stories in the testimonials section of this web site.

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The Icon Orthotics Orthotic

Although there is a very thorough explanation in the Solution Section of this web site, we do little more than to allow the foot to function the way that it naturally would have if it did not become permanently injured and compromised because of the concrete type surfaces that we encounter with virtually each and every step we take.

By maintaining the bones in the foot in a very congruous position just before the initial impact at heel strike, we simply allow the inherent stability of the foot’s bony architecture to do what it was intended to do which is in essence:

1. 1. To initially protect the foot from the forces generated at heel strike by being in a relatively supinated and stable position.
2. To maintain and allow the natural shock absorptive mechanisms of the body (which commence with the initial movement of the bones in the foot), to function naturally (and subsequently correctly and free of injury), by ensuring that the foot’s natural range of motion stays intact so that the arch can in fact move through a range of motion.
3. To realign into the supinated and stable position after the bodies weight and center of gravity moves over the foot through midstance to once again create the stable and injury free rigid platform for us to propel ourselves forward with each and every step we take.
4. To be able to do this free of injury for an entire lifetime despite the surfaces or obstacles that we may come in contact with on a day to day basis.

In short, we do in fact accomplish all of this with our technology as our orthotics initially maintain the bones in the foot in a near ideal alignment and then they gently cradle the foot’s arch down into some degree of pronation to allow the normal and necessary function described above. And since the bones of the foot are not allowed to disarticulate to any significant or pathologic degree, our orthotics subsequently help the bones of the foot to once again attain maximal congruity and stability to allow for a non pathologic push off and to adequately prepare our entire musculoskeletal system for our next step.

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For further details, please see the “our solution” section of this web site.