Pedorthics is the management and treatment of conditions of the foot and ankle that requires fitting, making and modifying footwear, sole inserts, and arch supports. The treatment implements special footwear to help those who have painful or disabling conditions caused by disease, congenital defect, or injury.
Derek Nowak, Certified Pedorthist, opened InStep Pedorthics LLC in August 2015 to help Greater Flint residents who need custom foot orthotics and shoe modifications. Nowak’s experience began at his first job as a teen, making plaster casts at an orthotics company. He became a certified pedorthist after taking specialized and required classes, and completing a five-year apprenticeship with an orthoptist, as well as earning certification.
At a typical appointment, Nowak begins his exam with an “in gait analysis,” when he simply watches a client walk. Depending on where they say their pain is, he can decide what is going on with the foot or ankle, and determine what type of orthotic they need. Working on occasion with the client’s podiatrist or orthopedic surgeon, sometimes they have a detailed prescription that makes Nowak’s role even more informed. But, you don’t need a prescription or doctor recommendation to make an appointment – InStep is available to anyone.
Nowak says his most common diagnoses are plantar fasciitis – heel pain; metatarsalgia – pain in the ball of the foot or forefoot; and posterior tibial tendonitis – a tendon in the medial part of the foot that impairs its ability to support the arch, which allows the foot to roll.
“Shoes are very important. They are what hit the ground first.”
“Shoes are very important,” Nowak states. “They are what hit the ground first.” He has learned and refined the technique of fitting shoes over the years. Proper-fitting shoes and the right insert can prevent future injuries and help people regain as much mobility as possible.
According to Nowak, a roomier shoe usually works better, depending on the shape of the person’s foot. If clients don’t bring in their own shoes, sometimes the prescriptions inform Nowak of what type of shoe they will require. The type of foam materials he uses are heat-moldable and can be a soft cushion, like for arthritic clients, or firmer densities, which are best for people who are on their feet all day.
Most often, Nowak makes inserts for runners’ shoes, in addition to designs for people who stand most of the day. He also has many clients from the Baby Boomer generation. “These days, people are trying to stay healthy and stay in shape,” says Nowak. “When they do that – especially if it’s a new part of their routine – often, foot pain comes with it.”
New Balance and Brooks are shoe brands Nowak typically recommends. Specialty stores like Bauman’s and Complete Runner tend to carry the most options for finding a better shoe. “The reason I like those types of shoes is because they offer different widths – narrow, wide – not everyone is a medium width,” he says, adding that he has a wide range of orthotics for his clients. “If someone can’t find anything that works for them, I usually can.”
In the case of foot deformities, Nowak can create custom-molded shoes by casting the foot in plaster, and making the shoe to the exact shape of their foot. Plaster casting tends to be the more “old-fashioned” way. Mostly, Nowak uses AmFit® – an orthotic fabrication system that uses a computer aided design model of a mold. The computer can display a topographical map of the foot, showing where the most pressure is.
Nowak’s client follow-up process is based on how successful he believes the shoe will be, gauging who might need to come back, based on the severity of their pain. After a couple of weeks, he sometimes has to make adjustments, which are just “part of the game.” He does minor tweaks by either adding or taking away materials to provide maximum comfort.
“Whatever I provide, I make sure it works,” Nowak says. “I’m willing to work with someone until it is right.”
Located at 5183 Fenton Road, InStep is open from 8:30am to 5pm, Monday through Friday.
Photography by Eric Dutro