From immobilization to controlled mobility

The primary stabilization for the foot's three arches comes from proper bony alignment, supported by the plantar fascia and other ligaments. Secondary stabilization depends on healthy, coordinated muscular control. When the ability of these structures to respond to stress is overwhelmed, pain often develops in the foot or lower extremity.

Some providers have found that immobilizing the foot and ankle can effectively allow the body to heal at a rate that keeps up with the trauma. However, just as a cast, crutch, collar, or brace is only helpful while the body heals, a rigid orthotic used beyond the recovery period can create a new set of problems. This information will help you determine when to upgrade a patient to flexible orthotic support and help you make this transition a smooth one. Rigid orthotics are often prescribed for the acute phase of plantar fasciitis, achilles tendonitis, and shin splint therapy. In addition to providing the foot with a "crutch", the provider will likely give activity or lifestyle modifications. Unfortunately, when the pain is relieved, patients are often less inclined to return for continued care or to comply with the doctor's orders. Furthermore, rigid orthotic systems can cost between $350-$500. As a result, many patients are hesitant to discontinue wearing the rigid orthotics in which they have invested and risk having the pain return. Unfortunately, the body will often experience disuse atrophy and structural compensations, as the patient becomes truly dependent on the rigid orthotics.