Shame on me. I realized that I have been writing this blog for a little over 2 years and I have never once taken the time to show you how I make custom foot orthotics. It’s only the number one thing that I do. I am going to correct that error right now.

In my opinion, foot orthotics are very often the most successful and un-invasive way to correct bad body alignment, allowing patients to recover from and prevent many kinds of overuse injuries.  Custom foot orthotics are made from scratch for each individual patient. The materials and techniques used to make foot orthotics can vary widely depending on the needs of the patient and the skills of the practitioner.

I am going to walk you through the step-by-step process. The pictures in this blog are just snap-shots I took while at work one day – sorry for the low quality.

Step 1:  Take a mold of the patient’s foot.

BioFoam molds

BioFoam molds

This mold is a box full of crushable foam into which the patient’s foot has been pressed. Another type of mold is made from plaster casting material which is wrapped around the foot (See below).

Plaster cast

Plaster cast

This plaster type of mold is messier and takes a little longer, so it is usually only used for more complicated cases.

Step 2: Make a replica of the patient’s foot

Plaster is poured into the footprint or plaster mold and allowed to harden into the shape of the patient’s foot. It is removed from the mold and cleaned up to smooth out all the rough edges. When it is ready it looks like this:

Model of Patient's Foot

Model of Patient’s Foot

Step 3: Mold material to the model of the foot

The material that foot orthotics are made from comes in large flat sheets of various thicknesses. A blank of suitable material is cut to fit the patient’s foot size.

Cut out a blank

Cut out a blank

Next, the material is heated in an oven until it becomes soft and pliable. The model of the patient’s foot is placed in a vacuum press which will be used to shape the material around the plaster cast. The hot material is removed from the oven and draped over the cast while a powerful vacuum suctions the rubber membrane of the press against the model. There are no pictures of this step because it is so time sensitive that I couldn’t do it one-handed.

This is a picture of the model of the patient’s foot inside of the vacuum press with the hot material being molded to it. I am using my thumb to smooth out any air bubbles that form underneath the rubber to ensure a good mold.

In the Vacuum Press

In the Vacuum Press

Step 4: Finalizing the Orthotic

Once the material has finished cooling in the vacuum press it can be trimmed down to its final shape. The molding process has created wrinkles and left excess material that has to be removed. Here is what it looks like when I take it out of the press.

After the Vacuum Press

After the Vacuum Press

Posterior View After Vacuum Press

Posterior View After Vacuum Press

At this point, the sides of the orthotic material wrap around the mold too far and would create a lot of unnecessary bulk inside the patient’s shoe. It is trimmed down with the use of a grinder. Sorry, there are no pictures of me using the grinder for what I hope are obvious safety-related reasons.

Once it has been ground down it looks like this:

Side View After Trimming

Side View After Trimming

See how the material exactly matches the contour of the patient’s arch?

Here is a view from the heel:

From the heel

From the heel

Step 5: Fit the orthotic to the patient.

At this point, the patient returns to the office with a pair of appropriate shoes. The final touches are added to the orthotic while the patient is present. This might include attaching a full-length top cover or grinding off additional material to tailor the orthotic exactly to the patient’s needs. It is very important for the practitioner (that’s me) to watch the patient walk with his or her new foot orthotics. This ensures that the foot orthotic can be properly adjusted to the patient’s individual needs. It pays to be very picky at this point. The patient should be able to give feed-back as to how the orthotics feel underfoot. And the practitioner should be able to see a marked improvement in the way the patient is walking. In my office, the patient doesn’t leave their fitting appointment until we are both satisfied that the orthotics are the best they can be.

Things you should know:

Custom foot orthotics are great when they are made well, but they can also be pure torture to the patient if they are made incorrectly. It is a big responsibility. Many offices do not make their foot orthotics themselves; instead, they send all foot orthotic molds out to a central fabrication facility. This means that every time the patient requires some sort of adjustment the orthotics have to be sent back to the fabrication lab. This can be costly, frustrating and time-consuming. I recommend to all patients that if they have complicated foot issues they should get their foot orthotics from someone who makes them in-house.

One other thing to be cautious of is to make sure that if you are paying for custom foot orthotics – they actually are custom foot orthotics. Look back at step 1. If you don’t have a mold of some sort taken of your feet, then you should decline treatment and go somewhere else. FYI: There are some facilities that use a 3D scanner to capture the shape of your feet – this is sort of like taking a mold, it is acceptable. **Note: The little electronic platform that some stores have you stand on only shows the high pressure areas of your feet and does not count as a mold-taking process.** That is just technologically advanced smoke and mirrors. Don’t be too impressed.

My advice is to do your research before you buy any type of foot orthotic. Know how much they cost. If you are wondering, the industry average for a pair of custom made foot orthotics is in the neighborhood of $400. Most insurances do not cover the cost of foot orthotics. For this reason, many people try to purchase off-the-shelf foot orthotics to save money. Sometimes this works. Actually, if you have a pretty average foot shape and your problems aren’t too severe – then I say go ahead and try it. But, if you have unusual feet then I can already tell you that it isn’t going to work.

Here is a picture of that same patient’s foot mold sitting on top of an off-the-shelf foot orthotic:

Off-the Shelf = Poor fit

Off-the Shelf = Poor fit

And just for comparison, here again is the newly made custom orthotic for the same foot:

Side View to show arch contour

Side view to show arch shape

See what’s going on here? All that gaping between the patient’s arch and the prefabricated foot orthotic means that the foot will not be getting enough support. Whereas the custom foot orthotic follows the arch of the foot exactly, supporting it evenly and completely. That support can be the difference between sore feet and happy feet.

Well, that concludes this little back-stage glimpse into the magic that happens in an orthotic lab. I hope you have enjoyed it! If you have any questions, feel free to comment below and I will do my best to clear things up for you.

Walk Well!

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