Orthotics 2.0

Foot orthoses or inserts have been prescribed for many decades for those suffering from foot and ankle pain. I have written about these previously and this post should provide some updates and further clarity from my previous venture into this space. Orthotics can come in different materials, shapes, and varieties, and they are often utilized to help with reduction of pain in the feet or the legs in general. Finding the best fit and knowing what conditions can be treated with the use of orthotics are very important for prospective buyers to know. Another often asked question is related to cost since orthotics can quickly become very expensive. With this in mind, the following sections explore types of orthotics and how they work, conditions to be treated, and the process of acquiring them. This will help when making a decision about what is the best choice for each person.

How Orthotics Work

Most people imagine the orthotic is placing the foot in a specific position or controlling motion. This isn’t actually correct as the orthotics are not fixing anything or even providing enough control to align the lower leg. What they do is alter the sensation and neurosensory feedback the feet are giving the brain which should induce a change. This is not that different from how different types of running shoes can alter one’s gait based on the forces they transmit from the ground to the foot. In general, a rocker bottom shoe often leads to a heel strike pattern, a more minimal shoe can cause more of a mid-foot strike. Orthotics are having a similar impact based on the feedback they give the sensory systems of the body.

Custom vs. Pre-fabricated

This is usually a very important question for people since the difference in cost can be quite large. Do I need custom made orthotics or will pre-fabricated ones work just as well? Custom orthotics are usually made from a custom mold of the person’s feet whereas a pre-fabricated orthotic is made from a generic base shell. Any off-the-shelf orthotic seen in the store falls into this category. The best evidence to date indicates there is no difference between the expensive custom made inserts and those that have been pre-fabricated. This is great news since it can save a great deal of money for those seeking relief. This is not to say everyone should choose the cheapest option available. There are good options to be had for $40 to $60 but the extremely cheap pair for $15 is likely not worth even the small amount of money it costs.

When purchasing orthotics off-the-shelf it’s important to know what to look for. The best orthotics will be made of a dual density construction with a lighter foam on top of a harder base shell. The hard shell is usually some type of plastic or poly material but can be made of other things such as cork. The biggest mistake people often make is purchasing an orthotic with too much arch support. Unless you have high arches (a statistically small subset of people), then a medium level of support is probably best. Some orthotics come with a metatarsal pad as well which is helpful for treating a condition called metatarsalgia. If pain is not along the balls of your feet (the metatarsophalangeal joints) then this is likely not necessary.

Conditions to be treated

There are several conditions that can be positively affected with shoe inserts including: Patellofemoral knee pain, plantar fasciitis, tibialis posterior dysfunction, and achilles tendinopathy. It’s important to note that most evidence indicates efficacy in the short term - usually 3-6 months - for relief of symptoms. This still means that other interventions are needed for long term relief, so performing your exercises is still important. It’s also important to note that even if someone has a pathology listed above, inserts may not always be indicated. For instance, achilles tendinopathy may benefit from orthotics. But this is usually only in cases where excessive rearfoot motion is noted. For metatarsalgia, a full insert could be used but more frequently a different type of pad is used to help relieve pain. The main takeaway is this: talk with your therapist first before spending the money to make sure it is going to help.

Process of Acquiring Orthotics

At PTSC, we can assess and get someone fitted for orthotics fairly quickly. With the use of prefabricated orthotics patients are able to save money and take home their inserts on the same day. The overall process is fairly simple with the size and fit assessed by the therapist along with any additional changes that need to be made such as rearfoot posting. Our orthotics are also heat moldable which help with improved fit and reduce break-in times as well.

For store-bought orthotics, the most commonly recommended brand is Superfeet. These come in assorted colors and types but can be found at several retailers such as REI. For a cork bottom, I have found the brand, Sole, to be a good choice which also has a variety of styles available. Regardless of the orthotic, it’s important to try them on to ensure the fit is correct, especially in the arch. Once purchased, a pair of orthotics should have good longevity and be usable for 1-2 years depending on the amount of wear.