What are orthotics and when to use them
Apparently you have arrived at this site because someone has recommended you consider orthotics for your foot pain, or even perhaps leg or back pain that you may be suffering from. This “someone” may have been your doctor, or a family member or friend who has used orthotics in the past.
Some of you have arrived at this site because you are having some sort of foot, ankle, leg or even back pain and you have seen the word orthotics in researching your problem, but you are confused because you have learned that there are many different types of orthotics and you are not sure what type might be good for you or even if orthotics will actually help.
The purpose of this site is to explain the various types of orthotics that are in the marketplace and the various indications for their use. Possibly the most common use for orthotics is the treatment of heel pain ,but keep in mind it is not the only treatment for this condition so after researching or actually speaking to a doctor you may be confused as to what the proper treatment is for this condition. This site will attempt to lay out a protocol for the treatment of heel pain (as well as other uses for orthotics).
Orthotics may also be referred to as arch supports, insoles or shoe inserts. Usually items like arch supports and insoles are devices that you can purchase in drug stores and supermarkets and although they do serve a purpose they generally do not eliminate pain that has been present for some period of time and does not seem to be getting any better. In these instances an orthotic will be necessary. Orthotics can be divided into different categories. One is a prescription orthotic which is a device that is prescribed by a doctor and made specifically to an individuals foot structure. They are specific to an individual in the same way that prescription eyeglasses are to an individual.
Prescription orthotics are further divided into two subgroups. The first is what is known as an accommodative orthotic.
As the name implies it accommodates a deformity, generally occurring in the foot. A simple example would be someone who has a very painful callus on the bottom of their foot. An accommodative orthotic can be built in such a way to relieve the pressure on the callus when the person walks and thus relieve the pain. In some instances, over time, the callus will actually disappear as a result of wearing this type of orthotic.
An accommodative orthotic has many other uses. In my opinion it is the best type of orthotic to use in the treatment of heel pain, heel spurs and plantar fasciitis. I will explain why I feel this way in a later posting.
Accommodative orthotics are also quite good at absorbing shock. One of the functions of feet besides getting us from point A to point B is to absorb the shock that is created every time we take a step and our foot hits the hard surface of the ground. Some people have a foot structure that does not absorb shock very well and this is one of the problems that may cause pain in the ankles, knees, legs, hip and lower back. An accommodative orthotics does two things. One it is generally made out of material that helps absorb shock like compressed layers of cork or rubber. Secondly, the orthotic is designed to realign the foot with the ground so when the foot does hit the ground during the gait cycle it is put into a position to try and better absorb some of the shock that is being created.
If there is a problem with accommodative orthotics it is the fact that they tend to be bulky and for that reason will not fit in all shoes. They are generally reserved for sneakers and laced shoes. They usually will not fit in loafers, dress flats and certainly not in high heels. So of course the problem becomes one where the medical problem requires an accommodative orthotic but because of certain restrictions, like the need to wear “dress” shoes to work, there is a problem with getting the orthotic to fit into the shoes. This then becomes a tug of war between trying to wear the required shoes for work and the ability to remedy a particular medical problem. Do not despair, there are alternatives.
The second type of prescription orthotic is known as a functional orthotic. This type of orthotic attempts to address a given medical problem by altering the biomechanics of the foot. Basically biomechanics (as it relates to the gait cycle) is the way our bones, muscles and ligaments function, in sequence, to enable us to ambulate. As you can imagine, those with biomechanical abnormalities at some point in time may develop pain. A prescription orthotic works to basically “bring the ground up to the feet” so when a person walks, the feet may remain in their most ideal and functional alignment and thus minimize any pathological motion in an effort to reduce pain.
Functional orthotics are generally made out of much stiffer materials, usually varying thickness of plastic type products. Now you may be thinking how comfortable can a piece of plastic be under your feet. The reality is since they are made to the contour of an individuals foot, they tend to be very comfortable. Functional orthotics are generally reserved for younger individuals, certainly pediatric problems are almost always treated with functional orthotics. There is a saying in medicine that “structure follows function”. What that means is that if an individual walks abnormally over a period of years, the skeletal structure adapts to that way of walking. So as you can imagine, the older an individual is and longer they have been walking a certain way, the harder it is to make a change. This becomes an issue when using functional orthotics. Since a hard rigid orthotic “forces” the foot into a new position it can be a problem for older individuals whose musculo-skeletal system will not adapt to the new position after years “functioning” in a certain position.
There is no specific age range cut off for the use of functional orthotics because quite frankly there are some older individuals who are still almost as mobile and flexible as they were when they were younger and theoretically would do fine in a stiff orthotic.
Both types of prescription orthotics can have many types of additional components added to them. This of course is predicated on the type of medical condition that is being treated. That is one reason why many times a prescription orthotic is needed over something bought in the supermarket. But, it goes way beyond that. In a true orthotic there is no such thing as one size fits all. Let me explain.
When using orthotic therapy to treat a certain problem, there are many issues that must be addressed. Beyond the obvious one of what type of pain is the person having, other issues need to be dealt with. A person’s weight probably plays as significant role as anything else in determining the type of orthotic that is required. It is not so far fetched to think that the orthotic requirements of a 280 pound man would be different than that of a 150 pound man, even if they have the same foot size. Beyond that other factors such as activity levels, athletic vs. sedentary, play a major role in determining the type of orthotic needed. As mentioned earlier, the type of shoe a person is required to wear plays a role as does the occupation of a person. Some people have jobs that require they stand most of the day, others are required to climb ladders all day, still others are required to do heavy lifting all day. These variables all have an impact on the way an orthotic will help a person alleviate their pain.
In order to make prescription orthotics some type of impression needs to be taken of the feet. This typically consists either of a plaster of paris impression of both feet where the foot is held in a “neutral” position (the ideal relationship of the foot to the leg), a foam box where you step into the box with the doctor attempting to hold your foot in a neutral position and the foam captures your foot print similar to walking in sand. Some doctors and labs are using computer imaging to capture the patient’s actual foot structure.
Because the foot must be held in a neutral position plaster of paris casting is generally regarded as a far more accurate method of casting then the other methods. With impression boxes and computerized imaging the foot has to be placed on the ground and at the same time held in a neutral position which becomes difficult to do and leads to inaccurate impressions which of course can adversely affect the orthotic. I have some seen some websites offer custom made orthotics; they offer to mail a foam impression box to the patient and the patient has to step into the box to capture the footprint. I cannot think of a more inaccurate way to take an impression. If there is a high incidence of poor impressions when a doctor holds the foot into the impression box, one can only imagine what happens when the patient takes their own impression.
As previously discussed some types of orthotics will not fit into the types of shoes a person needs/wants to wear. Every thing in life is a series of give and take and this potential problem is no different. If a person is in a lot of pain and the only type of orthotic that will help them is a bulky orthotic then they are just going to have to adjust their shoe style to fit the orthotic. For problems that are not quite so severe prescription orthotics can also be made to fit dress shoes particularly flats and pumps. The problem here is two-fold. One because dress shoes tend to be snug fitting to begin with, an added orthotic may make the shoes too tight, and two, because an orthotic has to be radically modified to fit into a dress shoe this can reduce some of the effectiveness of the orthotic. Much of this has to do with the type of problem you are trying to alleviate. Some conditions will do fine with a modified orthotic, others will not.
Yes, they even make orthotics for high heel shoes. Do I recommend them? Generally not! They can be useful for conditions like capsulitis or metatarsalgia or perhaps even Morton’s neuroma (but these people would do a world of good to their foot condition if they just stopped wearing high heels), but the overall problem with dressthotics as they are generally called is that in order to fit into high heels they have to be so thin and narrow, in most cases they are worthless. You could probably get just as much relief sticking a piece of cardboard in the shoe. If your doctor has recommended this type of orthotic I would suggest you consider a shoe style modification in order to accommodate a better orthotic.
When it comes to the needs of children, orthotics are somewhat different and are used to serve different purposes. Most children start to walk at around 12 months of age. At this point in time almost all of them are flat footed and many walk with their toes pointing outward in an effort to better balance themselves. They are flat footed at this point because their arch has yet to develop plus in some children, the amount of fat in their feet appear to make their condition worse than it actually is. Having said that does this mean that all children should be in orthotics? No, because in the vast majority an arch will develop over time. In those children that do not go on to develop an arch you might argue had you put them in orthotics when they first started walking there is a chance they too would have developed an arch. Two problems with this. One, how do you know which child will not go on to develop an arch and secondly in theory if you put them in an orthotic at 12 months of age you could assume an arch would develop, but, in reality it probably would not help for the simple reason the child would have to be in orthotic 24/7 and we all know that is not practical. Young children generally do not like to be in shoes and this works against the whole concept.
So how do you know if your child is a candidate for orthotics? If you see that your child has difficulty keeping up with the other children or he/she avoids certain activities that might be a sign that there is a foot related problem. I generally find that podiatrists and orthopedists are the best doctors to consult in these situations because most pediatricians have less than a passing interest in foot function and foot disorders.
Children’s orthotics are made out of the stiffest plastic available because the goal here is to maintain the foot in a certain alignment. The young skeletal system is very adaptable to stress put on it (unlike the adult skeletal system) so the foot can be held or aligned in a maximum position.
Some children also suffer from in-toeing or out-toeing. In many instances this is caused by the way the child was positioned in the mother’s uterus. This type of problem can be corrected through the use of orthotics which force the foot to move in the opposite direction in order to create a normal gait. In more severe cases of in-toeing or out-toeing where there is a skeletal component causing the condition, orthotics alone will generally not work.
If you look at the orthotics pictured in this article they all seem to have the same general shape, obviously because they are all meant to fit under a person’s foot. Prescription orthotics do not end there. Many foot and leg conditions also require additions be made to the orthotics in order to solve a certain problem. These additions range from the type of covering over the orthotic (soft vs. firm), to different types of pads added to the orthotics (metatarsal pads, metatarsal bars, dancer pads, scaphoid pads, cuboid pads, accommodative pads, etc.), to the angle in which the orthotic is cut to regulate the ultimate position of the heel to the ground and the forefoot relative to the rearfoot.
Does this mean that every foot or leg condition needs to solved with a prescription orthotic? No, of course not. In general terms if you have a foot pain such as a painful heel that you have had for a couple of days perhaps as a result of playing tennis or hiking and have never had the problem before, you certainly can try a store bought arch support. I generally do not find store bought arch supports to be much better than the arch supports that come in a good pair of sneakers, but you know what, if they do the job and alleviate the pain then its worth their relative small cost. Prescription orthotics are generally reserved for pain that is not resolving itself through various methods and has been present for a minimum of 3-4 weeks. I should also mention that prescription orthotics are also used by doctors when they determine a patient has a structural problem that may lead to problems later on in life and so they work as a preventative measure. An example would be the use of prescription orthotics for the prevention of bunions or their use after bunion surgery to help prevent a recurrence.
The problem with many foot conditions is the fact that they are aggravated by the simple act of walking, something we are all required to do on a daily basis. If you injure your hand, you can put your arm in a sling, not use the hand for a period of time, and the hand will heal. We do not have that luxury with a foot problem; every step we take seems to aggravate the pain. Yes, we can put patients in a cast or have them use crutches, but for many that creates a difficult situation. What I personally like about orthotics is that in many cases the orthotic will relieve the stress being placed on the painful part of the foot and so in essence is “resting” that area and allowing it to get better.
Prescription orthotics are hand made by an orthotic lab technician according to a prescription written by a doctor. As stated earlier in this article, the type of orthotic that is made for an individual is determined by more than just the foot problem. Weight, age, occupation, activity, shoes worn all play a part in the equation in determining the proper orthotic. That is why if you happen to be suffering from heel pain the type of orthotic that you require may be different than the one your cousin Bob received from his doctor.
It would seem to the casual observer that prescription orthotics would be the device of choice in those who require some sort of support in their shoes to relieve various types of foot pain as well as ankle , leg and lower back pain. So what is the drawback? For most people it is cost. As time goes on, more and more insurance plans seem to be dropping orthotics from their list of covered services and this means that the burden falls on the patient. The cost of custom made prescription orthotics can run from a couple of hundred dollars up to several hundred dollars. In many instances the patient will pay this cost because it is a necessary component in relieving their pain, others simply will not be able to afford it.
To remedy the void created in the marketplace between prescription orthotics and supermarket purchased arch supports, the orthotic industry has developed what is known as off the shelf orthotics. These are orthotic devices developed by the same orthotic labs that make prescription orthotics but instead of being custom made to the actual contour of a patient’s foot structure, they are sold by shoe size. They are a tremendous alternative in individuals where the cost of prescription orthotics are prohibitive or for those individuals who know through their reading and research that they are probably candidates for an orthotic and would like to try something before they go running to the doctor. These orthotics are generally made out of the same medical grade materials that prescription orthotics are made out of.
Like prescription orthotics, off the shelf orthotics come in various lengths and widths to fit various types of shoes. Like prescription orthotics various modifications can be added to them to relieve certain foot conditions. They can be modified according to the patient’s weight.
Off the shelf orthotics do have one similarity to supermarket arch supports and that is price. They are generally a few dollars more than the devices you can purchase in a supermarket or drug store, but they offer so much more.
MY RECOMMENDED OFF THE SHELF ORTHOTICS
The SuperStep orthotic is a full length maximum support orthotic which may be worn in a sneaker or laced shoe. It is designed primarily for heel pain and arch pain but is useful in many other foot and leg condtions. They come in varying thickness to accommodate all different body weight. To learn more, click here.
This Slim 3/4 is a great orthotic for those who must wear dress shoes on a regular basis. They will fit in mens and womens shoes with the exception of high heels. They will fit in pumps and flats. They too are great for heel and arch pain. Because they can be modified with pads added to them, they are great for a lot of forefoot problems. To learn more, click here.
Childrens orthotics are useful in children generally up to around the age of seven. They are sold in childrens size and adult size up to size 6. They are helpful for a multitude of foot problems and because children grow so quickly and require new orthotics on a regular basis, these orthotics offer a great value over prescription orthotics.
Visit my site for more information on this subject and other foot and leg conditions. www.foot-pain-explained.com