Simple Tips for Integrating Foundational Stabilization into Chiropractic Care and Getting Optimal Outcomes
BIOMECHANICS
Ronda Sharman
DC
It is hard to believe that I am currently enjoying my twenty-fourth year practicing as a chiropractor. Early in my career, I remember meeting docs who had been in practice 20 years or more and thinking, “Wow, I cannot even imagine what that must be like.” How time flies. I find myself treating a young mom with a toddler and can remember treating that same person when she was a toddler in that same room 20 years ago.
What an honor to witness generations of people evolve and grow while serving them along the way. Nothing gives me more purpose than helping others experience less suffering and enjoy a greater expression of health so they may engage more fully in the beauty of life. My patients have taught me so much over the years. One of the most important things I have learned is to be present with people, meeting them exactly where they are, and seeing each one wholly as a person. Work can begin from that place. Sometimes it is hard for patients to confront the work required to change their life, and they need someone to help them in a way that doesn’t overwhelm them, so they can see a path forward that is manageable.
That applies to us too. I know my colleagues have supported me along the way when I wanted to integrate something new into my practice. Sometimes the unknown seemed scary or complicated, whether it was converting to electronic health records, integrating nutritional protocols, building out space, or integrating rehab protocols into my practice. I always knew I could count on colleagues who had mastered that process. They always seemed to break it down for me with some simple tips to help me see that it could work.
Stability starts at the feet
My hope is that this little article will remind you of the importance of looking at the feet and how easy it can be to address what you find. So many pieces drive healing and optimal functioning of us as humans. In our office, patients benefit from not only chiropractic but also other modalities and approaches. One of my favorite places to start is with the feet. I have used custom foot orthotics in my care since I first started in practice. Yes, I remember helping my patients step into those foam foot casting kits during their appointments. (They still work if you don’t have a digital foot scanner!) I hope sharing my experience wifi demonstrate just how easy it can be to integrate postural alignment through foot stabilization into care.
Tuning in to a few simple things in the history and postural analysis can prompt me to make a foot scan a high priority. Besides people who come in with an actual foot problem, I look for things in their history, such as if the patient’s back, hip, or knee hurts worse with prolonged standing, when wearing flat shoes, or while doing chores in the house without shoes. At that point, I wifi often even say, “In the next visit or two, I would like to digitally scan your feet to see how they may be playing a role in your problem.” When doing my initial exam, I always have the patients stand without shoes and look out for pronation, bunions, bowed Achilles tendons, uneven heel wear, or other clues that unhealthy foot function may be the underlying cause of their problem.
Educating patients about foot function
When I think a patient needs custom orthotics, I always start with a foot scan on my digital foot scanner. I don’t even discuss orthotics — just the need to take a closer look at the feet. In my experience, patients are much more interested in learning about themselves than thinking about how to integrate custom orthotics into their footwear. That can be overwhelming since they don’t even know how easy custom orthotics can be to use at that point. Alternatively, they may have had a past poor experience with rigid orthotics, which are very different from flexible custom orthotics that support all three arches of the plantar vault.
It’s important to help patients understand that the foot has three anatomical arches, and properly aligning each one plays a role in balance and stability. Chiropractors today are very lucky that digital foot scanning is a terrific and easy way to educate the patient. Immediately after the scan, while patients are still standing at the scanner, I show them the three arches of the foot on a sample orthotic. Then I review the patient’s report of findings, pointing out which arches are collapsed or intact and letting them know if one foot is more collapsed than the other. I point out the outline of the inner part of the foot and discuss whether pronation is present. I give patients their score and let them know if they have mild, moderate, or severe arch collapse. At that point, I can explain how custom orthotics may change things for them depending on their individual case.
A Chiropractor’s role in custom orthotics success
The next two steps are critical. First, we discuss which shoes they wear and decide which type of custom orthotic best suits their needs. For example, if my patient is a police officer who wears work boots all day and has low back pain with prolonged standing, I am always going to start with an orthotic for his work boot, not his Sunday church shoes. If I have an athlete who pronates and we are trying to prevent injury, I want to know if their cleats have removable insoles or not. I may even delay the order until he or she brings me the cleats. If my patient is a teacher who wears dress shoes, I want to know if she wears ballet flats, loafers, or 1-inch heels. Knowing all the types of orthotics and the types of shoes patients wear most is important to ensure a successful outcome and happy patient.
Second, when the orthotic arrives, we always call the patient and ask them to bring at least one pair of shoes they will be wearing. I find it most critical that the doctor actually takes the time to fit the patient for the custom orthotic. During that time, you can teach the patient about taking out the manufacturer’s insoles and whether it is necessary, depending on the style of orthotic. I also insist on trimming them myself; I never let patients trim their orthotics. While I am doing that, I can explain everything about the break-in period. Ordering custom orthotics is the easy part; fitting them, making sure the patient understands the type of shoes they will work with, and explaining how to break them in creates meaningful and lasting change for your patients. They will thank you for it and send their friends and family to your practice.
I hope that I have shared a few simple tips to think about when addressing the feet, including integrating custom orthotics that support all three arches. Please feel free to reach out with any questions. I have used custom orthotics for 24 years and am happy to help!
Ronda Sharman, DC, is a graduate of Virginia Tech University in Blacksburg, Virginia, and Palmer College of Chiropractic West in San Jose, California. She has been in private practice for over 23 years and owns Life Care Chiropractic & Wellness Center in Waldorf, Maryland. Dr. Sharman is a past president of the Maryland Chiropractic Association and has served on the board of directors for more than 18 years. She is the recipient of two of their Presidential Awards and was named their 2009 Chiropractor of the Year. She can be reached at [email protected].
