Welcome to Foot Talk Fridays!
For orthotics, what we do here in the clinic is examine the foot first. For example, say you come in here with a foot problem and the original issue is your foot leaning and its collapsing the arch. Well, everybody’s feet lean in different angles and that is why we want to know what the degree of every patient is between the left and right foot.
So, this cast is zero, it is absolutely straight. What I’ve done is I’ve made lots of little angles from 45 degrees (40, 35, 30, 25, 20, 15, 10, 5, and 0) just to show you the angles that we use to determine the amount that the foot leans in.
Now, why it is important to discover how much the foot leans in is because someone’s foot leans in only about 10 degrees the arch will collapse. The arch will also collapse if someone’s foot leans in 45 degrees. We want to determine how many degrees your foot leans in because usually, for example, if you are an adult male your foot will align 5 degrees every 6 weeks. Or, if you are a growing child about the age of six or seven it will take 5 degrees in 6 months to get the ankle straighter. So, there’s a big difference between children, adult males, adult females and the angle so that’s why it’s important to determine how much your foot leans in.
Say for example, does your foot lean in 45 degrees or does it lean in only 15 degrees? Of course, a straight foot doesn’t lean at all so that’s a zero degree angle. We have to be scientific about it and instead of just making you an insole exactly the shape of your foot (that won’t correct the angle of your ankle if it leans in which is normally the underlying problem of a collapsed arch). That’s why we like to find out why the arch is flat – is it because you truly have a flat foot which is extremely rare, we might only see a couple of cases a year, or is it because your foot leans in. If your foot leans in then we make something exactly the shape of your foot and we use the angle measurers to determine how many degrees it takes to get the ankle straight. Then, we would divide it by 5 as well as considering your age and if you are male or female. It does make a big difference between a male and female.
Male ligaments are stronger and less flexible so they will take about 6 weeks to get 5 degrees. Adult females take 6 to 12 weeks to get 5 degrees straight. A young growing child with growth hormones will take about 6 months. Older children (17 and 18 years old) that’s a little different – we treat them as adults because their growth hormone depletes around those ages significantly. That’s why it’s very important to measure the angle of the ankle. We call this hyper pronation, we hear a lot of the time when somebody had hyper pronation of their feet or of their ankle – what that means is that their foot leans in.
Now, we have hyper supination which is where the feet leans out, if your feet leans out you’ll get a very high arch and almost like bow legs and easy sprained ankles but most of the time we see flat feet and feet that lean in.
Every 5 degrees determines a new orthotic, so the arch changes, the foot changes phenomenally with the difference in the ankle alignment. As you straighten the ankle, the arches develop and you don’t have just one arch in the foot there are three (the medial, lateral, and the forefoot arch).
The forefoot arch is a little curve underneath the front of your foot here. The lateral arch is on the outside of the foot, and then the medial foot arch is along the medial aspect. The inside aspect of the foot is normally stronger, so that’s why we also address all three arches of the foot because if you were like a little ant underneath the foot and you were standing here, when you look up the ceiling should be dome-shaped across the way, it’s not just one arch here. That’s why when we start to tilt and align the foot, the whole foot (muscular wise and bone structure wise) changes.
Now, we get a lot of questions about “can flat feet be fixed?”
We have to determine what type of flat feet you have, so if you have a hyper pronated flat foot, of course it can be corrected and that’s the most common one that we see.
So, as we tilt the foot back to straight and engage all the arches and get the alignment of the ankle back to straight. Perfect! No more flat feet, so it’ a myth that flat feet cannot be fixed and actually in adults it’s faster to fix flat feet than it is for children. It is a misconception that flat feet can’t be fixed.
It’s just like braces for your teeth, your teeth have already formed but it doesn’t mean you cannot get braces to align your teeth. It’s the same with feet, just because your bones have grown and stopped growing, it doesn’t mean you cannot manipulate the position of the bones. The bones are held together by ligaments and the ligaments are the things that determine where you bones sit.
The muscles can hold and move your foot but you can’t actually hold your foot in a position for more than 20 minutes because the muscle will fatigue and you’ll start to vibrate and shake and then you will have to relax your feet. But, the ligaments can’t hold your feet in place, like you cannot push your teeth in to position – you need an orthodontic brace for that. That’s why we make the orthotics to tilt the foot and keep it position for 6 weeks – 6 months, then we change it again to get another 5 degrees corrected.
So I hope that is more useful information in determining what a flat foot is – what a hyper pronated foot is, what do the angles mean, what the foot leaning in means, how does that interrupt the arches of the foot and how it can be corrected.
Enjoy your Friday!
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