Orthopedic Insoles

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Flat Foot
Flat feet (also called pes planus or fallen arches) is a medical condition in which the arch of the foot has fallen or collapsed because of which the entire sole of the foot cones into contact with the ground. When the arches collapse, the feet lose their shock absorption capability and this can add strain to the ankle and can cause foot pain, knee pain, lower back pain. A patient of flat feet is likely to get tired sooner when walking or running.

When the arches collapse, the ankle rolls inwards when the person stands or walks. This can add strain to the connecting muscles and ligaments as they stretch a lot more than what they normally do.

Some people have flat feet due to a developmental fault during childhood. Others develop flat feet due to a weakening of the muscles in the foot due to aging, pregnancy, being overweight, incorrect footwear.

At Physio Lounge , we design insoles that are anti-pronation. They have the right amount of arch support needed by your feet, medial rear foot postings and a heel cup for heel stabilization. They hold your feet in the neutral posture and provide support by holding up your arches. The Noene in the insoles absorbs shock and these insoles provide relief and comfort to your tired feet.

It’s very important for the orthoses to flex slightly under the feet of the patient as the patient walks. If the arch is too rigid, it will hurt. If it is too flexible, it will collapse with the patient’s weight and won’t provide support to the arch.

We have special insoles for children as well which are not very rigid. However, we do not recommend insoles for children up to 7 years old as their arches are likely to naturally develop. The child should be encouraged to step out and play and as this will exercise the feet and develop the arches.

Heel Spur
A heel spur or a calcaneal spur is an abnormal protrusion of the heel bone. There is a slight growth on the heel bone that protrudes and causes extreme pain in the heel especially while standing or walking. A heel spur is caused by calcium deposits formed due to the plantar fascia deviating from the heel area. The plantar fascia is a broad tissue located at the base of the foot, stretching from the heel to the forefoot. A lot of heel spur cases are associated with inflammation of the plantar fascia, also known as Plantar Fasciitis.

Heel spurs are mainly caused by excessive pronation of the foot. This leads to the plantar fascia getting stretched thus leading to calcium deposits on the heel bone. They can also be caused by running or walking on hard surfaces, excess weight and obesity.

Physio Lounge custom orthotic insoles help bring pain relief in heel spur cases by neutralizing the excessive foot pronation. This prevents the plantar fascia from getting excessively strained. These insoles are also designed to offload weight from the heels. The Noene in the insoles absorbs shock thus protecting the heels. The heel cup also has a socket for the heel spur to fit into thus reducing its impact with the ground. This reduces or even eliminates the pain associated with the heel spur.

Plantar Fasciitis
Plantar Fasciitis is described as an inflammation of the plantar fascia, the broad tissue which stretches from the base of the heel bone to the forefoot. This inflammation is caused by excessive stretching of the tissue and this leads to pain in the heel. It could also lead to a heel spur, which is a bony protrusion in the heel bone due to calcium deposits.

In Plantar Fasciitis, the patient feels a stabbing pain in the heel, usually as soon as you get off the bed in the morning or after a long period of rest because the plantar fascia contracts to its original shape. As you start walking again, the tissue stretches and this causes pain. As the day progresses and the plantar fascia continues to get stretched, the pain often subsides. The pain is caused mainly after rest!

Plantar Fasciitis is mainly caused due to excessive pronation of the foot. To be precise, it is caused when the calcaneus in the hind foot is stable but the forefoot is over-pronating. Thus the plantar fascia is repeatedly over-torqued, causing inflammation in the tissue. When the plantar fascia is repeatedly being stretched away from the heel bone, the calcaneus will eventually grow towards the plantar fascia in an attempt to re-attach itself. This bony growth is called heel spur.

Plantar Fasciitis can be treated with orthotic insoles that correct excessive pronation of the foot and elongate the arch. These insoles need to be rigid so that the plantar fascia is prevented from excessive stretching and the foot arch is dynamically held up. The patient can expect a complete recovery within 2 to 3 months.

A night splint can also be used for pain relief as it keeps the plantar fascia stretched during the night, preventing it from contracting back to its original shape

Metatarsalgia can be described as a condition in which you experience pain in the balls of your foot or under your metatarsals. This is common in sports people who run or jump a lot. It can also be caused due to abnormal weight distribution caused by a foot that pronates excessively. Another cause of metatarsalgia is ill-fitting footwear.

Metatarsalgia can be treated with ice and rest and orthotic insoles. Physio Lounge orthoses for metatarsalgia correct over-pronation in the foot and also have soft medical grade poron under the metatarsals to offload weight from the region. If shoes allow, we also fit a metatarsal bar that further offloads weight from the metatarsal heads and brings relief from pain and allows for healing.

Shin Splints
The term “shin splints” refers to a condition where one experiences pain along the shinbone (tibia) — the large bone in the front of your lower leg. Patients complain about a dull aching pain on the medial side of the shinbone and once it starts, any physical activity tends to aggravate it. “Medial shin splits” is medically known as medial tibial stress syndrome.

Shin splints occur during physical activity and result from too much force being placed on your shinbone and connective tissues that attach your muscles to the bone. When the foot over-pronates, the tendon of the tibialis posterior is pulled upon excessively. Due to this excessive stretching, the small pain fibers of the periosteum are torn away causing pain and inflammation.

Shin splints are common in runners and in those who participate in activities with sudden stops and starts, such as basketball, football or tennis.

Physio Lounge orthotic insoles correct excessive pronation of the feet and thus reduce the excessive stretching of the tibialis posterior, the central of all leg muscles. They also reduce stress on tibialis anterior thus providing relief to patients of anterior shin splits as well.

Achilles Tendonitis
Achilles Tendonitis is a condition wherein the Achilles tendon, the large tendon in the back of the ankle, becomes inflamed and causes pain. Patients complain of severe aching or burning pain felt in the back of the heel, which increases when the toes are flexed upwards.Although the largest tendon in the body, the achilles tendon is also the weakest. It is injury prone and slow to heal.

Achilles Tendonitis is an injury caused by overuse to the muscle and usually occurs in middle-aged athletic people. Excessive pronation of the foot leads to excessive strain on this tendon. When the foot arch collapses upon weight bearing, the achilles tendon is strained.Not have an adequate warm up prior to athletics, improper shoe fitting, heel bone deformity are other causes of achilles tendonitis.

Other factors that lead to Achilles Tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short Achilles tendon, direct trauma (injury) to the tendon, and heel bone deformity. The inflammation of the tendon can worsen if not treated in a timely manner.

Achilles Tendonitis is treated with plantar orthoses and light stretches. A heel cup elevates the heel to reduce the stress on the achilles tendon. Physio Lounge orthotic insoles can be used to control over-pronation and thus eliminate excessive stress on the tendon. Athletes, especially runners, should have an adequate warm up session before they start running. The warm session should comprise light stretches on the calf, ankle and shin. Reducing the duration of your walks or runs is advised until the tendon heals

A corn (heloma) is an area of thickened skin tissue on the foot or on top of the toes usually caused due to irritation and friction from a bony prominence. Corns become inflamed due to constant friction with shoes. Corns that form between toes are called soft corns and could get infected. Corns can press on a nerve below and cause pain.

Corns form when the pressure point against the skin traces an elliptical or semi-elliptical path during the rubbing motion, the center of which is at the point of pressure, gradually widening.

Corns are caused when pressure points against the skin are created by abnormal friction (instability or over-pronation) occurring between a bony prominence and the soft tissue between the toes. Over-pronation causes hypermobility of the foot which can cause the skin to get trapped between bony areas of the foot and the footwear. If not checked for a long time, this can lead to the skin thickening itself for protection against irritation and that’s how the corn develops.

Physio Lounge orthotic insoles stabilize the foot and correct excessive foot pronation thus reducing the friction between the corn and bony prominence acting on it. With specialized medical poron to offload weight in the area of the corn, our insoles will bring relief from pain and help the healing process. Physio Lounge insoles can also be further customized to completely offload pressure under the corn and redistribute it to the surrounding areas. They are an excellent rehabilitation aid for post-surgery patients who have got their corns removed.

A callus is an area of thickened skin tissue on the bottom of the foot due to irritation and friction, typically under bony prominences. The patient feels pain in the area of the callus, especially when there’s direct pressure.

The integrity of the protective barrier the skin provides the foot is critical in maintaining weight bearing function. Callus formation occurs in areas of high vertical and shear loads and defends against blistering and ulceration. However, this process itself can cause symptoms and predispose patients with poly-neuropathy to deep infection. Even when considering a ‘healthy’ foot, poor foot function can lead to callus formation. During over-pronation, the foot rolls across the metatarsal heads – one at a time – instead of distributing the weight equally. This happens because the foot is a “loose bag of bones” during pronation causing hypermobility of soft tissues. When the “loose bag of bones” phase goes on too long and the skin is trapped between the bones in the foot and the ground, the friction of individual metatarsal heads bearing all the weight can cause inflammation.

The skin thickens in the inflamed area to protect the sore spot. This thick build up of skin so close to the nerve endings in the bottom of the foot is what causes the pain. This callus formation is our body’s defense mechanism to protect the foot against excessive pressure and friction. Calluses are normally found on the ball-of-the-foot, the heel, and/or the inside of the big toe.

Many people try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. This is not the way to properly treat calluses. This is very dangerous and can make the condition worse, resulting in unnecessary injuries. Diabetics especially should never try this type of treatment.

In order to relieve the excessive pressure that leads to callus formation, weight should be redistributed equally with the use of an orthotic insert. An effective insert transfers pressure away from the “hot spots” or high pressured areas to allow the callus to heal. The insert should be made with materials that absorb shock and shear (friction) forces. Women should also steer away from wearing high-heeled shoes.

Physio Lounge orthotic insoles are customized to redistribute weight away from the callus partially or fully. We have special module for corns and calluses that have medical poron as one of the layers, a material that is excellent for weight offloading.

Bunions are a very common condition, mainly affecting the female population due to improper footwear. If your big toe looks distorted and protrudes from the side of your foot, you may have a Bunion. A Bunion is a bony protrusion of the big toe joint that can cause friction and pain when wearing shoes. The condition in which the big toe deviates inwards is called Hallux Valgus.

With the continued movement of the big toe towards the smaller toes, a bunion can result in the big toe resting under or over the second toe. This placement causes a common forefoot condition called overlapping toes.

In medical terms, a bunion is a medial deviation and inflammation of the metatarsophalangeal (MTP) joint of the big toe. The capsule of the joint is subluxed (displaced), thickened and enlarged, and the cartilage of the joint is damaged. There are three degrees of bunions: mild, moderate and severe. Bunions are not hereditary, although the tendency to over-pronate, which is the cause of bunions, has a hereditary component.

Patients complain of pain in the MTP joint and have a deformed (medially deviated) big toe. Often, they are only able to wear very wide shoes.

Prolonged pressure against the medial aspect of the first MTP joint can lead to thickening of the medial capsule and bursa, resulting in severe valgus deformity of the great toe. Normally “toe-off” occurs from the plantar surface of the big toe. Over-pronation can cause the propulsion phase of stance to take off from the medial aspect of the phalanges of the big toe instead of the plantar surface. As a result, there is a retrograde force into the joint which pushes it out medially and stretches the joint capsule. This tearing and stretching of the joint capsule as well as the wear and tear on the cartilage causes the pain.

Since the problem is the over-pronation, the patient should be fitted with orthotics and can expect a slow recovery over a period of months. Physio Lounge orthotic insoles for Hallux Valgus are moulded to offload pressure from the first metatarsal head. Toe separators should be used with orthotic insoles to prevent worsening of the condition.

However, orthotics will not cause the physical deformity to regress, but will simply arrest any further progression and likely stop the pain. It is important to note however, that when bunions are severe and require surgery, the bunion can be corrected, but will develop again unless the root cause of over-pronation is corrected. Since overpronation is the root cause, orthotics are still necessary.

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability.

Many people with cavus feet have no problem at all. Sometimes it can be difficult to find shoes to fit, or the feet may ache, especially around the ankle, the outer edge of the foot or in the ball of the foot. Curled-up toes may rub on shoes.

Cavus feet tend to be stiffer than normal and may not take pressure as well as normal feet, so they may ache if you have been on your feet for a while. Some people with mild cavus feet don’t notice them until they take up running or other sports, when the cavus may limit their exercise tolerance.

Some people complain that their ankles feel weak and they get ankle sprains easily. A few people who have reduced feeling in their feet as part of the condition that caused the cavus, find that their skin rubs raw in areas of high pressure.

Physio Lounge orthotic insoles provide shock absorption to patients of cavus feet. Our custom orthoses significantly increase midfoot pressure and decrease rearfoot and forefoot pressures for patients of cavus feet. This threefold improvement in pressure distribution with Physio Lounge custom foot orthoses can be attributed to the to the orthoses being moulded to the exact physiological features of the patient’s foot.

Hammer Toe
If your toes appear crooked or misshaped you may be a patient of hammertoes. Having the toes bent can cause muscles to shorten causing the hammertoe deformity and pain. Patients may feel pressure against the shoe and under the metatarsal head, particularly the second toe, which is often caused by the retrograde pressure on the big toe.

A hammer toe is a toe that is contracted at the PIP joint (middle joint in the toe), and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. Hammer toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe.

Hammer toes can be caused by improperly fitted shoes or a dropped metatarsal head. Some other causes are arthritis, diabetes, neuro-muscular disease, polio or trauma. They can also be caused due to muscular imbalances that cause the ligaments and tendons to become unnaturally tight.

Hammer toes are classified based on the mobility of the toe joints. There are two types – flexible and rigid. In a flexible hammer toe, the joint has the ability to move. This type of hammer toe can be straightened manually. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

To treat a hammer toe, first push up on the plantar surface of the metatarsal head and see if the toe straightens out. If it does, then an orthotic insole could correct the problem, usually with a metatarsal pad. If the toe does not straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotic insoles are required post-surgically.

Morton’s Neuroma
Morton’s neuroma is characterized by pain located in the third interspace. It is a common foot problem associated with pain, swelling and maybe inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot.

The next most common locations are the second, fourth and first interspaces. A burning sensation is present in the interspace and typically radiates to the adjacent digits.

Morton’s Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads. Symptoms of Morton’s Neuroma often occur during or after you have been placing significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. Footwear with pointed toes and/or high heels can often lead to a neuroma. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

The first step to treating Morton’s Neuroma is to get the right kind of footwear with a wide forefoot that does not constrict the toes. Next, use custom made orthotic insoles to correct your foot posture and offload weight from the respective metatarsals. Physio Lounge uses a metatarsal dome insert in between the layers of the orthotic insoles to take the pressure off the nerve and bring pain relief to the patient. Ilio Tibial Band Syndrome The ilio tibial band runs from the hip to the lateral side of the proximal end of the tibia. Its function is to resist internal rotation of the tibia as well as to maintain the lateral integrity of the leg. Ilio tibial band “friction syndrome” is a condition wherein the ilio tibial band is stretched and torqued and the distal end rubs across the lateral condyle of the femur.

Patients complain of pain on the lateral side of the knee often extending up the lateral side of the thigh as high as the hip.

Overstress of the ilio tibial band. During a normal gait cycle, the femur and the tibia rotate in unison (i.e. internally during pronation and externally during supination); however, when a person overpronates, the tibia is locked into the talus by the saddle joint and therefore continues to rotate internally past the end of the contact phase while the femur begins to externally rotate with the pelvis during midstance phase. The resulting counter rotation of the femur and the tibia causes a shearing force to occur in the ilio tibial band is torqued and stretched. The result is that the distal end of the band rubs across and is irritated by the lateral condyle of the femur.

Massage and stretching of surrounding muscles to help ease the tightness and ice to reduce

inflammation. Since the problem is the abnormal pronation, the patient should be fitted with functional orthotics to correct the prolonged pronation thereby reducing the counter rotation between the femur and the tibia, alleviating stress off of the ilio tibial band.

Knee Osteoarthritis
Osteoarthritis of the knee is also known as wear and tear arthritis. It is a slowly progressive and degenerative condition in which the cartilage of the knee wears away. The cartilage functions as natural cushioning between the joints. When this wears off, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage. This friction results in pain, swelling, stiffness, decreased ability to move and, sometimes, the formation of bone spurs.

While age is the major factor that contributes to osteoarthritis as the ability of the cartilage to heal decreases as we grow older, it can affect younger people as well due to being overweight or getting an infection, repetitive stress injuries (certain occupations that make you do activities that puts a lot of stress on your knees like kneeling, squatting, lifting heavy weights) or even due to athletics. If the muscles around your knee are weak and you are into long distance running or football or tennis, you may be at a higher risk for developing osteoarthritis of the knee.

Physio Lounge orthotic insoles help in such conditions as they have shock absorbing Noene pads in insoles made for such conditions. These absorb and disperse the shockwaves from hitting your knees. Also, the ankle and knee are better aligned with the insole which reduces the load bearing on the knee. Besides insoles, braces help provide support to the knee and take away from the side of the knee that is affected.

Sesamoiditis is a common forefoot ailment that typically affects young people who engage in a physical activity like running or dancing. It is an inflammation of the sesamoid bones, small bones just behind the great toe. These sesamoid bones are not connected to other bones but are connected to tendons. Like the kneecap, the sesamoids function as a pulley. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. Every time you push off against the ground with your toe, the sesamoids are involved. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the great toe. Like other bones, sesamoids can break (fracture). Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis. It is very common among ballet dancers.

Sesamoiditis doesn’t need any invasive treatment. Normally it heals with a long period of rest and insoles custom moulded and fortified with a sesamoid cut out (also called as dancer’s pad). This is a metatarsal pad that takes the weight off the sesamoid bones by redistributing it in the surrounding areas and allowing the inflammation to heal.