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Orthotics
" I no longer feel open hostility towards others due to my
wonderful orthotics"...Seriously, not having aching feet is such a relief. It's
amazing how much better my whole body feels, and how much better my overall patience level
is, all due to these orthotics". ... Stephanie H., Agoura
"I
am a very satisfied patient of Dr. Zapf who just got a pair of orthotics for my
heel pain. The transformation from sore feet to happy feet has been terrific!. I
recommend a pair of orthotics for anyone who is experiencing heel pain. You will
be a changed person" ...
Lisa G., Thousand Oaks
What Are Orthotics
An orthotic device (orthosis) is an individually designed custom foot brace that
changes the function of your feet.
How Do They Work?
An orthotic changes the way
your foot functions. Dr. Zapf will first determine why your foot function is causing your
symptoms of pain or disability. Then, by using an orthotic that changes the way your foot
works, the symptoms may be relieved. Flat feet, high arches, hammertoes, neuromas,
calluses, bunions and heel pain are common foot problems that may be helped with an
orthotic. Orthotics are designed to not only support your feet, but to control excess
motion and accommodate areas of high pressure.
Orthotics are frequently used for post-operative foot control. Many foot problems
requiring surgical correction and caused by abnormal function. Frequently following
surgical correction of the deformity, an orthotic is used to reduce the possibility of its
recurrence.
How Much Of The Time Do I Need To Wear My Orthotics?
Orthotic devices are analogous
to eyeglasses. While you wear them the function is improved. Ideally, you should wear them
every time you are on your feet. If your symptoms are related to only a particular
activity, such as running or skiing, you may choose to wear them only for that activity.
But it only makes sense that if your feet feel more comfortable wearing your orthotics
then you would choose to wear them as much as possible. Certainly you can occasionally
wear your shoes without an orthotic.
"I am a
50-something Scottish dancer with heel pain. I received my orthotics about 2
months ago and I must say that they dramatically reduce my heel pain. It took a
little while for me to get used to them. At first they hurt a bit in the arch.
After 2 weeks, however, they are comfortable to wear all the time. They are indispensable."
...Margaret S.
Types of Orthotic Devices
Dr. Zapf uses many types of orthotic devices. Activities requiring "straight-ahead
activities" like running or walking require a rigid orthotic. Graphite materials are
frequently used for rigid devices. They are strong and thin and fit into a variety of
shoes. "Side-to-side" sports like tennis and racquetball are better served with
a semi-flexible orthotic such as polypropylene. Sensitive feet usually do better with a
leather or rubber device. Typically these are more of an "arch support" than a
functional device. Another type of orthotic is made for high heeled shoes. This device is
a compromise from a fully functional orthotic. Sometime a second orthotic type is required
for full time control of symptoms. A final type is designed for feet that have collapsed
due to severe arthritis and hurt with every step.
Types Of Shoes
Some type of orthotic will work in nearly every shoe. It is important that both the
orthotic and the shoes be appropriate for your activities. A woman's foot obviously needs
to be in a different position in a high heeled dress shoe than in her running shoes. Often
it is necessary to compromise on the type of shoes to insure the best control of foot
function.
It is important that you discuss with Dr. Zapf the types of shoes you will be wearing.
Women who anticipate wearing an orthotic in a dress pump should bring a representative
sample (or two) with them. Sometimes Dr. Zapf will send a pair of pumps to the lab to
assure proper fitting of the orthotic in the shoe.
How Long Will I Need My Orthotics?
Most often an orthotic device will change the way the foot works only so long as it is
worn. It does not change the function permanently. If daily activities cause the symptoms,
then there is a chance orthotics will be needed so long as these activities are performed.
Dr. Zapf tells the story of his own need for orthotics. Years ago in podiatry school
(well, not that many!) he commented to himself that maybe he made a mistake in his choice
of profession. He never had any foot pain and he didn't know anybody who ever needed
podiatry care. How, he wondered, will he ever pay off his student loans? As another
example of being careful what you pray for, within a month he developed heel pain!
Fortunately the pain responded to orthotics and quickly went away. Despite wearing the
orthotics for 15 years, if he fails to wear them for more than 8 hours, the pain returns.
This is in contrast to many of his patients who 'get over" their heel pain and are no
longer required by their pain to wear their orthotics.
Children's feet are an exception. Here the primary purpose of an orthotic is to help
prevent the development of a deformity or abnormality during growth. In this case Dr. Zapf
usually recommends wearing the orthotic until growth is complete and then as needed if
symptoms persist. Controlling abnormal function of a growing foot allows more normal
structure to develop, limiting future symptoms. As a rule-of-thumb, new orthotics are
needed every time the feet grow three half-sizes (one and a half full sizes).
How Long Does It Take To Get The Orthotics
Our laboratory usually takes two weeks to fabricate a pair of orthotics when they are
not busy or when they are not backlogged. Unfortunately Dr. Zapf has chosen a very popular
orthotic laboratory and they are always backlogged and always busy. Sometimes it takes a
little longer (sorry!) Dr. Zapf really likes his current lab and would change to one a bit
more prompt if he felt they could do as good a job.
How Long Does It Take To Get Used To A Pair of Orthotics?
Dr. Zapf instructs patients to wear their new orthotics one hour the first day, two
hours the second and so on. You should be wearing them all day in a week or so. At this
point you can begin athletic activities.
Evaluation 
To make a proper orthotic
device, Dr. Zapf will need to make an extensive biomechanical evaluation. He will measure
the range of motion of your hips, knees, ankles and feet. He will evaluate your muscles,
posture and he will watch you walk. Above is an example of a Halloween gait :-). Many time
X-rays are needed to evaluate the position of joints and to rule out abnormalities not
properly treated with orthotics.
We ask that you wear shorts or other garments that will allow Dr. Zapf to see
your knees while you are walking.
Impressions
In order for the laboratory to construct your orthotic device, it is necessary for Dr.
Zapf to make a plaster impression of your foot. He will hold your foot in the
"neutral" position while the plaster sets. Making this impression is the most
critical step in the fabrication of the orthotic device.
Lab Process
Your impressions will be sent to the laboratory. The lab makes a positive model of your
foot. Any corrections are prescribed by Dr. Zapf. The specified materials will be formed
to the positive model. Covers, extensions and other additions are made by the laboratory
before they deliver the orthotics to our office. Fabrication time by the lab takes usually
one week.
To learn more than you ever wanted to know about orthotics
click the link below to read the Medical Practice Guidelines on Orthotics
published by the American Board of Podiatric Orthopedics"
http://www.acfaom.org/pg1103.pdf. <---- click this hyperlink | 
