Part 2: Progressing out of orthotics.

another Facebook Q. Is there a point during, or post treatment when the foot intrinsics perform and maintain their function without the exercises? Is it shuffle gait and moonwalk for life? and…. Are there any foot conditions that require ‘orthotic therapy’ to be maintained long term?

The Gait Guys answer:

Over time (about 3-6 mos avg, sometimes longer in our experience) the neural pattern becomes ingrained through neural adaptation and collateralization. As long as the exercises become a habit and ingrained into the motor pattern, then it is automatic; but think about how many layers of compensation are present and how long the problem took to occur. It takes time to restructure the nervous system and those pathways. The key here is adaptation of a new motor pattern; then life becomes rehab. There are many other exercises as well; keep an eye out for our new site launch and watch for some of them there. We have a DVD on the works as well.

When a person is UNABLE to function normally (ie they lack the ROM, muscle capacity, anatomy, neural drive IOW an anatomical problem) they MAY require an orthotic to make up for those ROM’s or mechanics they lack. An example may be an uncompensated FF varus where they lack the ROM in the 1st ray, or the individual with a loss of ankle rocker due to trauma, an arthrodesis, or some other anomaly.

The key is, if you are doing your job, their prescription should change and become less and less. This is one reason we sometimes use orthotics constructed of EVA, because they are easier to modify.

Believe it or not (LOL), some people won’t do the exercises you prescribe or aren’t willing to make the changes to be independent of them; these individuals will often need to wear them indefinitely.