Conditions of the Foot
by Dr. Mark H. Tompkins


Biomechanical Functional Orthotics (BFO)

Background of BFO

Biomechanical Functional Orthotics (BFO) are doctor prescribed shoe inserts (preferably by a Podiatric Physician with specialized education and training in biomechanics and sports medicine) that affect faulty foot mechanics or conditions associated with the, leg, hip, or lower back. The term ‘orthotic’ as defined by Webster’s Dictionary is “The science that deals with the use of specialized mechanical devices to support or supplement weakened or abnormal joints or limbs”. Biomechanical Functional Foot Orthotics, or BFO’s, are not just ‘arch supports’. In the Podiatric community, typical arch supports are over the counter (OTC) supportive foot devices that arbitrarily attempt to treat foot pain…most commonly heel, arch, or forefoot pain. These devices are extremely helpful to many individuals who suffer from mild inflammatory pain due to minor biomechanical problems. The vast majority of OTC arch supports are fabricated from soft, or very flexible, materials that provide low levels of shock absorption and control of abnormal foot motion; and are relatively inexpensive. With the previous explosion and popularity of running (and walking) programs in the country, many new companies have entered into the ‘orthotic’ business. Many of these devices are more rigid (and less forgiving) and are being ‘prescribed’ by sales people with limited or no knowledge of the human foot, or the biomechanics of locomotion; and can cost upwards of $200-300!! Unfortunately, for many patients, these devices do not work, and many times leads to more problems than previously experienced. In my professional opinion, if a standard OTC arch support purchased at a local sporting goods store, pharmacy, or general medical supply store, is not successful in alleviating particular foot problems, then professional evaluation and treatment by a Podiatric Physician (with special education/training in sports medicine/biomechanics) is warranted.

Ideology of BFO

The human foot is comprised of numerous bones, ligaments, tendons, and muscles which must all function in unison. If misalignment of these structures exists, then the result may be foot deformities and/or knee, back and neck pain. BFO’s are independently designed for each patient to address these anomalies or aid in the proper uniform function of the various structures that affect human locomotion. There are a myriad of podiatric-related medical conditions that BFO are used to treat….for additional information and types of conditions, please visit my section devoted to biomechanics.

Fabrication of BFO

The proper evaluation and fabrication of BFO is a multi-step process that requires an intricate level of expertise. There are two phases involved with this process: 1) Clinical Phase; 2) Laboratory Phase. 1) Clinical Phase The Clinical Phase begins with an appropriate, thorough, medical history, and podiatric-medical history and physical. This is step is vital in determining, not only the history behind the particular problem, but any associated factors that may influence proper diagnosis and treatment. A radiological exam (standard foot x-rays in the angle and base of gait) is also vital in evaluating various biomechanical angles and to rule-out (or in) any underlying osseous (bone) pathology. The second step in the clinical phase involves a thorough lower extremity and foot biomechanical examination. A detailed biomechanical examination of the foot and lower extremities involves the evaluation of over 15 various structures, relationships, and joints. Particular attention is given to position and length, as well as range and quality of motion(s). The third step of the clinical phase is the gait analysis. A typical clinical gait analysis evaluates approximately 12 various parameters by visualizing a patient during normal ambulation. The advent of various types of soft/hard ware, now allow a more detailed computer gait analysis to be performed. The last step of the clinical phase, involves the fabrication of neutral suspension plaster casts of both feet. Proper casting technique involves maintaining (holding) the foot in the appropriate position (subtalar neutral/midtarsal locked) position, while the plaster initially dries and hardens. There are alternative methods of casting, or taking moulds of the foot, but this is the preferred method for BFO. Another technique I utilize under specific conditions, is a three-dimensional computer scanning offered by a company called Footmax®. More information may be found at their website.

Laboratory Phase

The Laboratory Phase begins with the proper fabrication and subsequent evaluation of the neutral suspension casts. Once appropriate neutral casts are taken, a prescription is written for the individual BFO to be fabricated at one of the many orthotic labs throughout the country. Proper prescription writing will take into consideration the following factors: Medical history/Podiatric history and physical History of the presenting complaint(s) Radiological examination Biomechanical examination Gait Analysis examination Neutral Suspension Cast evaluation Rigidity of the orthotic vs. foot type Type of activities and shoe gear Parameters of/for treatment Patient/Doctor expectations. Depending on individual labs (which vary greatly based primarily upon, and related to, quality considerations), an approximate 25-step process is then taken to actually physically fabricate the BFO. The BFO laboratory I most commonly utilize (which is one of the most popular and respected laboratories in the country) is PAL Foot Systems. For more information PAL orthotics……please see, www.palhealthsystems.com/footsystems.htm .

Dispensing/Use/Follow-up of BFO

Once the BFO has been fabricated and returned to our office, the patient is requested to make an appointment for dispensing of the devices. They are encouraged to bring the type of shoe/socks that are to be worn most frequently with the BFO with them. There are some initial, progressive wear patterns that are utilized with BFO depending upon the particular parameters of each individual patient and their needs. The majority of patients progress very rapidly to wearing BFO with limited or no problems. Some, more advanced athletes, require more rigid progressive training with their BFO. Patients are typically seen two weeks after initial dispensing to determine if any problems are developing and/or adjustments need to be made (to either the shoe and/or the BFO). After this period, the patient is requested to follow-up every six months to evaluate the BFO and shoe wear patterns. Replacement of the BFO is based upon individual patient considerations, mainly due to type(s) of shoe gear, foot type, and activity levels.


The science, and art, associated with the process of fabricating prescription BFO requires a thorough understanding of the field of biomechanics. Podiatric Physicians, with specialized training in sports medicine and biomechanics, are most qualified to deliver this type/level of treatment. The steps necessary to properly treat a patient with quality BFO should entail the above noted steps, and can be a relatively costly process. However, the benefits that can be gained from appropriate BFO treatment can be life-altering for many patients.



Athletes Foot

Bio-Mechanical Pain


Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails


Morton's Neuroma



Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments


Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus





I M P O R T A N T  C O P Y R I G H T   I N F O R M A T I ON

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Dr. Mark Tompkins | 4402 Vance Jackson, Suite #146 | Phone: 210-341-2202

Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.