Chief complaint or diagnosis that may be helped by prescription orthotics
PROBLEM	SYMPTOMS	CAUSE	SOLUTION
Achilles Tendonitis	Inflammation of the sheath surrounding the Achilles tendon; pain behind the heel, ankle and lower calf.	Counter rotation of the tibia against the femur as a result of the excessive pronation causes the two heads of the Achilles tendon (gastrocnemius and soleus) to torque against each other and over stretch the tendon.	Orthotics to correct the excess biomechanical imbalance. Reduce activity until inflammation subsides.
Shin Splints Anterior Shin Splints Medial	Inflammation of the tendons and muscles in the front or inside of the lower leg.	Excessive pronation combined with overuse causes pulling of the tibialis anterior or tibialis posterior muscle with damage done to the insertion of these muscles on the tibia.	Orthotics should be used to restore normal foot and leg biomechanics to reduce excessive pronation. Reduce activity until inflammation subsides.
Bunions (Hallux Valgus)	An unsightly, sometimes painful bump at the base of the big toe.	Excessive pronation combined with a hypermobile first metatarsal ray segment causes toe-off to come off the medial side instead of the plantar surface of the big toe. The retrograde force stretches and distorts the joint.	Orthotics will control pronation and eliminate further angling of the big toe joint and jamming of the joint.
Calluses	Hard, dry masses of yellowish or grayish skin on the plantar surface, often surrounded by a red, inflamed rim that is swollen and painful.	Excessive pressure on the weightbearing segments of the foot. Microtrauma due to hypermobility associated with excessive pronation.	Although calluses can be removed, they will return unless weight distribution is balanced with orthotics.
Chondromalacia Patella (Runner’s Knee)	A degenerative inflammation of the cartilage covering the underside of the patella; knee pain and medial soreness.	Excessive pronation counterrotates the tibia against the femur creating undue stress that prevents the knee cap from tracking in its proper groove on the femur bone. The femoral condyles irritate and damage the back of the patella.	Orthotics are necessary to control abnormal pronation and prevent counter rotation of tibia against femur.
Hammer Toes	The distal joints of the smaller toes bend down, while the proximal joint bends ups. Corns form where they bend up.	Muscle imbalance and dropped metatarsal heads.	If not corrected with orthotics, the joints may stiffen in this awkward position. Also need to treat the associated corns.
Iliotibial Band Syndrome	Pain on the lateral side of the knee often extending up the lateral side of the thigh, as high as the hip.	Caused by excessive counter rotation of the tibia and femur as a result of over-pronation. The ilio tibial band is torqued and stretched resulting in the distal end of the band rubbing across the lateral condyle of the femur.	Apply ice to decrease inflammation. Orthotics to correct the over-pronation and eliminate excessive counter rotation between the femur and the tibia.
Low Back Pain	Pain in the lower back.	The shock of heel strike is transmitted up the leg, through the pelvis, and to the lumbar spine. Over-pronation causes stress and misalignment of the kinetic chain, affecting the alignment of the spinal column, facet joints, and possibly alignment of the discs.	Along with localized physiotherapy, manipulation, exercise, etc., orthotics to correct abnormal pronation and reduce shock to the heel.
Neuroma (Intermetatarsal Forefoot Pain)	Pain in the ball of the foot and/or numbness in the toes. Usually between 3rd and 4th toes.	Chronic irritations of the Intermetatarsal nerves due to the shearing of the metatarsal heads.	Orthotics to provide the forefoot with proper balance, spreading the metatarsal heads to allow a clear passage for the nerves.
Peripheral Polyneuropathy	Dulling of the sensation of pain, temperature and pressure especially in the lower legs and feet.	A symptom of long term diabetes (> 6 years); on occasion appears early. Cause is uncertain, being researched extensively.	Orthotics to properly distribute body weight (pressure along the plantar surface of the foot) to reduce the risk of ulceration.
Peripheral Vascular Disease (P.V.D.)	Poor circulation causing hands and feet to feel cold and wounds (ulcerations) to develop and heal slowly. Pain in the legs when walking, relieved by rest.	Ability of arteries to carry blood is reduced due to diabetic peripheral vascular disease.	Orthotics to properly distribute body weight (pressure along the plantar surface of the foot) to reduce the risk of ulceration.
Plantar Fasciitis (Heel Spur Syndrome)	Pain directly beneath or in front of the heel; chronic inflammation of the plantar fascia, sometimes accomplished by a bones spur where the fascia inserts at the calcaneus.	Excessive abnormal pronation stretching the plantar fascia over and over with every step. The origin at the calcaneus in the hindfoot is weakest and generally where fibres are torn.	Orthotics to control pronation and eliminate repeated elongation of the foot.
Plantar Ulcers	Open, deep wounds on the feet that are very slow to heal. Foot ulcers are the leading cause of hospital stays among diabetics.	Peripheral vascular disease and diabetic polyneuropathy combined with poor bio-mechanics.	Orthotics to correct faulty biomechanics and reduce plantar pressure. Ongoing biomechanical foot screening a must.
Rocker Bottom Feet	Collapse of the midfoot, prominent bones cause tissue breakdown (ulceration).	Changes to bone density due to biomechanical imbalance inherent in diabetes.	Orthotics to properly distribute body weight onto health foot face areas to unweight midtarsal area
OTHER CONDITIONS ORTHOTICS MAY CORRECT…
• Ankle joint synovitis • Foot muscle cramps • Foot deformities • General Leg Fatigue	• Leg muscle cramps • Low back pain • Metatarsalgia • Nerve entrapment	• Osteoarthritis • Out-toe-gait • Sacro-iliac pain • Sesamoiditis	• Spastic flat FMX Stress fractures • Subtalar joint pain • Tarsal tunnel syndrome • Sciatica (esp. Piriformis Syndrome