CODG Blog

We are often asked which is better; custom made foot orthoses or ready made ones from the drug store?  Like anything in life, it is dependent on the proper use at the proper time.  In some cases a ready made insole is appropriate to help with foot and leg conditions; other times they are not and  custom made foot orthoses are necessary. 

Ready made insoles are made to fit everyone, usually in small, medium and large and fit according to shoe size.  They offer some support for the medial longitudinal arch (along the inside of the foot) and often provide cushion to the heel.  For people that have mild foot conditions and only need a little bit of support or cushion with regular shaped feet, the ready made insoles will work fine.  Often they are used as a first treatment option.   The advantage of the ready made insoles is that they are easily available and the cost is about $40.00 - $100.00.  They are not usually covered by insurance.

Custom made foot orthoses or orthotics are usually made from plaster impressions of the feet while held in a corrected position.  The casts are then used to make the orthoses with specific criteria for the individual foot.  The support, cushion, correction and/or accommodation is designed into the orthoses based on the particular condition of the person.  Each foot orthosis is unique.  The advantage of the custom made foot orthosis is that they are made according to the medical requirements and can address the exact need of the individual which provides for better fit and function.  They can also be adjusted if there are minor changes to the medical condition.  For more information on Custom Made Foot Orthoses, click here.

If you have questions, speak to your medical doctor or schedule an appointment and we can provide you with further information.  There is no charge for the initial assessment.

The United Nations International Day of Persons with Disabilities is a day that “aims to promote a better understanding of disability issues with a focus on the rights of persons with disabilities and gains to be derived from the integration of persons with disabilities in every aspect of the political, social, economic and cultural life of their communities”*.  The day is consistent with the UN message and commitment to social justice and equity for all people and helps to raise awareness of barriers to access to everyday life for persons with disabilities and to improve participation in all areas of mainstream society.

Today we celebrate the contributions and participation of persons with disabilities in our lives and our communities! We will work towards a better tomorrow for all.

For more information on the UN International Day of Persons with Disabilities go to:  *  http://www.un.org/disabilities/default.asp?id=1540

After twelve years, our good friend and colleague, Geoff DeGuzman R.T.O.(c) moved on to another workplace to continue his professional career as a Registered Orthotic Technician.  Geoff has worked at CODG since finishing the Orthotic/Prosthetic Technical Program at George Brown College in 1999 and then completed his two-year Internship with us.  Geoff worked on many of the orthoses for our patients over the years and got to know many of you - he was "the guy in the back". 

We wish Geoff and his family the best of luck!

On November 2, I had the privilege of attending the Canadian Disability Hall of Fame Induction Ceremony where the Canadian Foundation for Physically Disabled Persons (CFPDP) recognizes remarkable Canadians who make exceptional contributions to the lives of people with physical disabilities.  The truly inspirational list of previous inductees include: Jeffrey Tiessen, Jeff Healey, Linda Crabtree, Dr. Geoff Fernie, Lauren Woolstencroft, Steven Fletcher, Chantal Petitclerc, David Lepofsky, Clifford Chadderton, The Hon. Lincoln M. Alexander, David Onley, Jeff Adams, Vicki Keith Munro and Rick Hansen among many others.

Rick Hansen was the dynamic guest speaker who captivated the audience with his stories and dreams.  He also shared pictures and anecdotes about the 25th Anniversary Relay - a relay that marks the 25th year after his Man in Motion World Tour.  His message about inclusion and the potential of every person is something that we try to remember each and every day.

The new 2011 inductees of the Canadian Disability Hall of Fame include:

Brian McKeever and Robin McKeever - Athletes

More information on the Canadian Disability Hall of Fame can be found at: http://www.cfpdp.com/cdhf/default.html

Custom Orthotic Design Group Ltd. and The Orthotic Centre are pleased to announce the opening of our new location within The Credit Valley Hospital.  We have moved across the Emergency Entrance foyer to the new place.  This move coincides with the beginning of our fifteenth year working in partnership with The Credit Valley Hospital.  Our services remain the same:

• Foot orthoses (orthotics or insoles)
• Treatments for people with neuro/musculo/skeletal concerns who need support, correction, protection or alignment of body parts using orthoses such as AFO's, knee braces, back braces, wrist braces and other orthopaedic appliances 
• Orthopaedic and comfort shoes
• Compression Stockings
• Medical supports

Professional Care, Professional Service - Helping You Find the Freedom to Move!

With summer around the corner, we will be spending more time outside and most of us tend to be more active.  Now is the time to make sure that we are ready for more activity by making sure that our bodies ares ready to go!  When starting a new exercise or activity plan, some of us may need to check with our doctors first to make sure that we are physically ready.  All of us need to make sure that we have the right equipment and you are ready to go when all of the rainy, cold weather ends!  Here is a check list:

Check your shoes

• Are they in good condition?   Shoes that are worn out do not provide proper support and cushion and they may contribute to injuries. 
• Are they appropriate for your activity? Shoes are made for different activities.  For example a court shoe would provide more side to side support than a shoe made for walking.  Hiking shoes offer a more rugged sole for off-road.
• Are they appropriate for your feet? Shoes are made for different foot types.  If you are someone who overpronates or has flat feet, a motion control or stability shoe that has extra support along the inside may be the best for you.  If you have a high, rigid arch, a cushion shoe may be best.  Talk to your foot wear supplier - they should be able to guide you.

Check your foot orthoses

• Are they in good condition?  Make sure that there are not any tears or splits in the orthotic.  It is often possible to repair minor defects in an orthosis, often at no charge.  If the defect becomes significant, it may be difficult to repair and cost you more.
• Are they comfortable? If your orthotics are not comfortable, you may change the way you walk or function - that may cause new problems or exacerbate the old problems - you should be comfortable!
• Are they worn out?  Foot orthoses often last three to five years but in some cases may wear out sooner.  If you are no longer getting good support, if your symptoms have returned or if they do not feel "right", book an appointment for a check-up.  At Custom Orthotic Design Group Ltd. and The Orthotic Centre, we do not charge for a check up of foot orthoses that we have made for you in the past. 

Be ready for summer - book your check-up now!

In December I had the opportunity to attend the Canadian Association of Wound Care (CAWC) Institute Levels 1-3 which works to support and educate health care professionals regarding wound prevention and management.  Some people ask, "Why wound a Certified Orthotist take a wound care course?"

My two thought processes involved in the answer are:

1. Certified Orthotists provide treatment to people with wounds on a regular basis.  We do not change dressings or apply medication, however we protect, support and offload the area of a wound to allow for better healing.  In a wound care team, the Certified Orthotist is one of the members who treat the cause of a wound and help prevent further damage.

One of the most common causes of wounds is due to peripheral neuropathy (loss of sensation) due to complications of diabetes mellitus and we see many patients on a daily basis who have diabetes.  Ideally we would treat a patient who has diabetes before complications arise to educate regarding proper foot care and proper foot wear.  If the person does have complications such as ulcers or a Charcot foot, the Certified Orthotist, offloads, or reduces pressure in the area to allow for healing.  Foot orthoses, orthopaedic shoes, ankle foot orthoses, removable cast walkers and CROW walkers are all different types of treatments that may be used based on the needs of the individual person.

2. The Canadian Association of Wound Care (CAWC) Institute is designed for the multidisciplinary team.  Doctors, nurses, occupational therapists, physiotherapists, dieticians and many other health care professionals take the course to learn about wound care and how we all fit together as a team to treat the whole patient.  As a Certified Orthotist, I play a very small part in the treatment of a wound, however as part of a team that includes all the disciplines, my small contribution helps to reduce the length of time a wound is present and treats the cause of the wound to prevent further damage.

The CAWC Institute was an excellent course where I learned more details about wound care and which also reinforced what I know and how I treat wounds. 

We have now been in our new office in the Medical Arts Building at 1 Young Street for two full months after our move from St. Joseph's Healthcare, Hamilton and as I sit here on this cold winter's day in a room full of sunshine, I can't help but think that it has been a good move.  Our new office has many windows with views to the north, east and south with much more space than our small location inside the hospital.

With the change in geography and surroundings, we have also refocused our services back to the original roots.  As Certified Orthotists, we specialize in the treatment of people who have muscular, neurological or skeletal injuries or disease.  We support, align, correct and protect the different parts of the body with different types of orthoses, braces or splints.  If you still need special shoes, we can still help you - we just don't have the fancy shoe store anymore.

So if you need your orthoses replaced, repaired or a new assessment, call us for an appointment - (905) 540-9600.  Or if you just want to see where we have gone, come on over, we are happy to show you around!

The Orthotioc Centre is having a huge week long sale to clear out all of our overstocks to make room for new shoes and boots.  Join us this week to take advantage of the savings!  Click here for more information.

We have finally unpacked everything and set up our new office in Hamilton.  We moved at the end of October from St. Joseph's Healthcare after working there for ten years.  Our new place is two blocks down the street at the corner of James and Young in the Medical Arts Building at One Young Street, Suite 705.  Our new offices offer a great view of Hamilton to the north, east and south!

We will continue to provide the best care in orthotic treatments and speciality orthopaedic shoes.

Please call for an appointment at (905) 540-9600.

After ten years at St. Joseph's Healthcare in Hamilton, The Orthotic Centre is moving to a new location!  In our new office at 1 Young Street, Suite 705 in Hamilton we will have an expanded patient care area and focus on our speciality - caring for people who need orthoses to support, align, correct or protect their body parts.  We will continue to provide some speciality orthopaedic shoes, however the retail side will be scaled back and an appointment is necessary.

Our move will take place on October 29 and we will be ready on Monday, November 8th to look after you once again.  Please call us for an appointment!    

Our feet are one of the most spectacular feats of engineering – although composed of only 26 bones, some muscles, tendons and ligaments, the structure of each foot works to accept forces up to two or three times the weight of your body, and act as shock absorbers and adaptors to uneven surfaces.  All of the structure and mechanics of the foot is then covered with skin – a living tissue that can withstand all the forces and then sense the tiniest of touch of a tickle. 

The bony structure of the foot is designed to allow for force to load down the body on a small pillar (your leg bone – tibia) into the small stacked bones of the foot, the talus and calcaneus.  Weight and forces are then transmitted to the smaller bones of the ball of the foot.  The bones act like the frame of a house – the big solid beams that hold things up.  But the bones are not static like the beams in the house. They move small amounts like a spring compressing to allow for shock absorption when your foot hits the ground and then move further to work like a lever to propel you forward when your foot pushes off to take the next step.  The pattern is repeated often thousands of times a day.

We all need to look after our feet – wearing proper shoes, caring for the skin and nails, gentle massage and stretching and just everyday pampering will help us keep our feet healthy and strong. However, when something goes wrong with the foot – take care and look after it right away; see your doctor or foot care specialist – we can help you keep the Freedom to Move!

When you get a prescription from your doctor foot orthoses, orthotics or insoles (usually all the words mean the same thing) often people wonder what the next step would be.  Here is a check list of the steps of the process of obtaining the orthoses. 

1. Set up an appointment.  Sometimes your doctor will advise you on where to go or if not, talk to your friends and family.  Find a clinic that is convenient for you.  It is also important to make sure that the person that will be treating you is qualified.  In Ontario, there is no regulation on who can provide orthotics, so ask questions such as:

             - Is the person who will be treating me a Certified Orthotist C.O.(c) or Podiatrist or Chiropodist?

             - Are the orthoses made on site or sent away?

             - Can adjustments be made while I wait?

             - Does the cost of the orthoses include any follow-up and adjustments?

2. The first appointment provides an opportunity for the Certified Orthotist to assess your needs.  This session of gathering information will include a personal history (complaint/problem, age, activities, past medical history), a gait assessment (how you walk) and a physical examination (range of motion of joints, muscle strength, identification of deformities, abnormalities).  The Certified Orthotist will also discuss with you your goals and expectations.  You will then set up a plan together which may include foot orthoses and education regarding other factors such as footwear that you may need to take into consideration.  If orthoses are indicated and you choose to proceed, a cast impression of your feet is taken. The cast material is put on your feet (it feels nice and warm) and your feet are held into the appropriate position until the cast material sets (about 10 minutes).  A return appointment is then set up.

3. For second appointment it is important to bring in the shoes that you usually wear - even two or three pairs if you need to.  The Certified Orthotist fits the orthoses into the shoes and checks for proper alignment.  You will then try on the shoes with the orthoses.  The Certified Orthotist will check your standing position and have you walk to recheck your alignment and gait once more.  The orthoses will feel strange at first but should never be uncomfortable.  Sometimes based on your gait or how you feel, the orthoses will be adjusted.  You will be given instructions on wear times and care of the orthoses and sent on your way to try them.

4. The third appointment is arranged for a follow-up to check and see if everything is going well and that the goals that were set at the initial appointment are being met.  Often the symptoms are not completely gone by the second or third week of wearing the orthoses but there should be noticeable improvement.

5. At any time if there is any discomfort or if the orthoses are not helping, you should be encouraged to book an appointment for a recheck.  There should be no charge for the follow-up appointment.  If the orthoses are comfortable but not reducing the symptoms sufficiently, sometimes other interventions such as physiotherapy are required and your Certified Orthotist will suggest them to you and your doctor.

For more detailed information please check Foot Orthoses - What Should you Expect?

To arrange an appointment for a free assessment click here.

Plantar Fasciitis, also known as heel pain syndrome, can cause mild, moderate and even severe pain of the heel and/or the arch of the foot.  The plantar fascia is band of tissue that starts at the heel and blends into the tissues around the ball of the foot.  When there is excess tension around the plantar fascia, it may get inflamed and irritated.

Signs and Symptoms- Often with plantar fasciitis, there is a gradual increase in pain at the heel and sometimes into the inside arch of the foot.  The pain will be worse first thing in the morning when getting out of bed and then after resting during the day.  Sometimes the pain can continue all of the time.  It may be in one or both feet.  If an x-ray is taken, there may be a spur on the heel bone.  Plantar fasciitis can cause significant pain.

Treatment- Since plantar fasciitis can be caused by many factors all together, there are many things that should be done to treat it and since it often takes a long time to seek treatment, it may take sometime to cure.  See your doctor for a proper diagnosis and to rule out other possible underlying medical conditions.

• Proper footwear - A good supportive pair of running shoes or molded sandals should be worn at all times - NO BAREFOOT
• Biomechanical assessment to see if foot orthoses (or orthotics) are necessary
• Roll your foot over a frozen bottle of water to ice the area (make sure to protect the skin from frostbite and do not do this if you have loss of sensation in the feet)
• Daily exercises to stretch the calf muscle - must be gentle and slow - hold 30-60 seconds several times a day
• Sometimes your doctor will prescribe medication
• A night-splint  will hold the foot into a position to stretch out the Achilles tendon
• Physiotherapy may be necessary for ultrasound, proper stretching and other modalities

 Since plantar fasciitis is affected by so many factors and often develops over time, many factors and some time are involved in resolving it.  See your doctor and follow the instructions carefully!

We often have parents coming in for an appointment with their children wanting foot orthoses or insoles for "flat feet".  The big question is: Do children need foot orthoses? 

In everything that we do, we need to make sure that each situation and each person is assessed properly to determine if there is any treatment that should be provided.  Children are often hard to treat - they do not always act and perform the same as adults or even adolescents and it is difficult for them to verbalize their complaints (if they do at all).  The first line of treating a child with flat feet is to visit the physician for a good diagnosis and to rule out any possible underlying medical conditions.  The child can then be assessed by a Certified Orthotist where a complete history, a physical examination and a gait examination would be performed. 

In some cases, foot orthosesare beneficial and advised for young children and in some cases, we watch and monitor the child's growth and development.  It is important to remember that as a child grows and develops, they do go through a range of body alignments that are completely normal.  For example, very young children look like thay have completely flat feet due to the normal amount of fatty tissue in the feet - once the child grows a little, the feet thin out and do not look as flat. 

As a parent, the best thing to do is remain observant, listen to the children and educate yourself about the condition of your child.  Physicians, therapists and Certified Orthotists are all excellent resources for parents to use and learn from.  If you are concerned, have your child assessed and like any medical intervention, foot orthoses can and should be used but only when appropriate and only by qualified healthcare providers such as a Certified Orthotist in collaboration with a medical doctor.

The final answer: Sometimes!