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26 July 2009

Shank dependent versus shank independent foot orthotics

The approach I take to orthotic prescribing is to put aside all preconceptions of what type of foot orthoses needs to be used. Do the systematic assessment and come up with the prescription variables that are needed and then, and only then, make a decision as to the best type of foot orthotic needed to deliver those prescription variables.

After the prescription variables are decided upon, the first decision is not about custom made vs premade; or brand A vs brand B; etc. That first decision should really be about can a shank dependent or shank independent device be used, as this decision will influence subsequent decisions.

Shank dependent and independent foot orthotics work in different ways. The shank of a shoe is that area just in front of the heel of a shoe. Some shoes are very flimsy in this area.

A shank dependent orthotic is an orthotic that rests on this shank area and depends on it being rigid so that the orthotic can redirect ground reaction forces. Most EVA orthotics are shank dependent. Almost all prefabricated foot orthotics are shank dependent.

A shank independent orthotic is an orthotic that does not rest on the shank area of the shoe. This type of orthotic spans over the shank area. Most custom made plastic foot orthotics are shank independent. A couple of prefabricated orthotics on the market are shank independent.

This is a crucial early decision in the best way to deliver the prescription variables that are needed. I guarantee that most clinicians who use shank dependent orthotics do not check the shank of the shoe before using one! Maybe its time they did.

Craig Payne


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