I hadn't heard from my high school chum Laura in years, but it didn't take more than 20 minutes of catching up on the phone to discover that we still had a lot in common. In particular, back pain. "Bodies fall apart," she stated. "That's just what happens when you get older.""And spend all day chasing, carrying, and caring for kids," I reminded her.
"Either way," she answered.
Her chiropractor had suggested the possibility of arch supports, or orthotics. "You're the shopping lady," said Laura. "Why don't you find something out for both of us?"
Dr. Jack Reingold is a podiatrist. He's also the owner of the Active Foot Store in UTC (858-453-5057). "We're often born with less-than-ideal body function," said Reingold, "and over a lifetime, we put great demands on our bodies. People may have certain postures or foot shapes that aren't ideal for certain activities, ranging from shopping to standing at work to running a marathon. So when our bodies don't cooperate with our desires for function, we need to function better."
That's where an orthotic comes in. "It's a very broad term. I've had patients who went into their garages, took out chunks of rubber and slabs of felt, and fabricated wedges that changed the function of their feet. There's that, and there's a custom, individually molded, very scientifically measured, vacuum-pressed device." All that customization is crucial, said Reingold. "Sometimes, the wrong orthotic can cause problems. It requires a little bit of detective work to find out what's needed."
Reingold begins by administering "a bio-mechanical exam. We try to figure out where the pain is. Is it a specific muscle or an arthritic joint? Do you have nerve entrapment or is the problem structural? If it's a structural problem, then, due to the way you walk, you're putting abnormal stress on your body, and your body is reacting. We watch the way you walk or stand, and we look at the wear patterns in your shoes."
If your problem is minor, you might get off cheap. "Sometimes, we suggest an over-the-counter arch support; you can get them in most sporting-goods stores. The Active Foot Store has them -- $30 innersoles. We also talk to the person about proper shoe gear. Nike makes zillions of models, and each has its own characteristics. I can say, 'You need a shoe with a deeper toe box,' or, 'One with more heel stability.' Things like that. But I might say that you would really benefit from a truly custom, functional orthotic." (He compares it to buying reading glasses in a drugstore versus getting custom eyeglasses.)
In that case, Reingold starts measuring. "I use a tractograph to measure things like rotation in your foot to your heel. Then I take an impression of your foot; it can be done in plaster, in foam, or electronically with a laser scanner." Electronic imaging is still fairly rare, but Reingold believes it's the wave of the future. "Instead of wrapping plaster around the foot and making a statue from the mold, I take a digitalized laser impression with 20,000 pixel points of shape in about eight seconds. Then I go to a mill, where they carve a block of either paraffin or wood into a statue of the foot."
The manner of the impression depends on the patient. "For a diabetic, or someone who is a bit older, I might take a semi-weight-bearing impression in a foam box. There, we're doing more skin protection. For a marathon runner, where we want to control tremendous forces on the foot, I might do a plaster impression with no weight bearing or do it electronically. The key is to capture the contour of the foot in a certain position, adjusted, and with all the joints lined up. Then you can make the orthotic around the foot just the way you want it. If somebody has a short heel cord, like a toe-walker, I may want to put a little lift in the back to change the stress."
The particular condition of the foot also determines the material used. "I have to match the person, the shoe, the function, and the pathology. I think about which part of the foot I want to control, how much the person weighs, and the type of shoes they're going to wear -- will the orthotic be for a dress shoe or an athletic shoe? I pick from a combination of semirigid thermal plastic and graphite materials -- both are heat sensitive and moldable. Once the outer shell is made, I decide on a cover. If you're a runner and you just want support, you may not need anything more than a vinyl strip. If you have an issue with shock absorption, a soft cover would be best."
Orthotics from the Active Foot Store take around ten days to make and cost $299 a pair. "I wanted to bring the science and ethics of medicine to retail. In a podiatrist's office, custom-made orthotics can run $400 to $600 . When you come to the store, you're not necessarily seeing me. You could be seeing my trained staff -- they're all certified pedorthists. They've gone to school and taken exams. And I'm always there to troubleshoot and give backup advice. The idea is that you don't necessarily have to have a doctor to put an orthotic in a shoe; you just need somebody who can look at you and say 'I think we can get you to walk better.' However, we do a lot of health screenings where we end up telling people they need to seek other medical care. If they have tendinitis, they have more than just a shoe issue."
Reingold estimated that orthotics last about three to five years, depending on body weight and activity. He keeps the mold on file and offers a $50 discount on a second pair. "I suggest that people start with one pair for their walking shoes. Then people can come back and say, 'I love these, and I need a pair for my dress shoes.'"