Custom Orthotics

What are Orthotics?

Orthotics, also known as arch supports or shoe inserts come in a variety of types, shapes and materials. There are over the counter (OTC) orthotics and custom-made orthotics. These devices can then be further subdivided into accommodative orthotics and functional orthotics.

OTC orthotics are readily available in many drug and shoe stores and should be inexpensive. They are a compromise in arch height and support in order to cater to a wider range of people. Some patients may get relief using such OTC devices, however, they are often inadequate in that they do not provide sufficient support, shock absorption, or a proper fit. People purchasing “custom-made orthotics” from shoe stores are often simply receiving OTC orthotics which have been heat molded to better match the shape of their foot. They are also unfortunately charged fees, which should be reserved for authentic custom-made orthotics. Custom-made orthotics are made based on a neutral position casting technique which is performed after a thorough biomechanical evaluation which includes a range of motion study of the entire lower extremity and a gait analysis. More on the actual protocol necessary to fabricate orthotics will be discussed later in this section.

Functional Orthotics

All-purpose Orthotics

All-purpose Orthotics

Functional orthotics are just that, they alter how the foot functions. They specifically control the amount of motion the foot utilizes when walking or running. People often have problems with their feet when their feet excessively pronate (feet roll in) or supinate (feet roll out). Functional orthotics are designed to prevent the foot from rolling in or out excessively and make the foot function more efficiently. In doing so, the feet and legs are less likely to fatigue and hurt if their problem is caused by poor biomechanics. Functional orthotics are usually made from a variety of thermoplastics which are more rigid than accommodative orthotics. They are designed to support the foot while up to 3 times body weight is placed on the device with each step.

Ultrathin Orthotics

Ultrathin Orthotics

If the wrong material is used, the device can flatten out and will provide inadequate support. If the material is too rigid, poor shock absorption and orthotic intolerance can result. To help highlight the aforementioned, consider a size 8-10 men’s OTC orthotic in the following examples: A 155-pound man, with a size 9 foot, purchases these devices for heel pain he gets while running 20 miles/week on concrete vs. a 230-pound man, with a size 9 foot who buys the same set of devices for heel pain he experiences every morning when he gets out of bed. Each of these individuals gets the same device but not the same result. The 230-pound gentleman’s orthotic will bottom out or flatten therefore providing insufficient support and little benefit if any. The 155-pound runner may get sufficient support but will he get sufficient shock absorption necessary to protect him from the concrete?  As such, it is easy to understand how OTC orthotics can often fail and why custom-made orthotics become necessary.

Accommodative Orthotics

Komfort Micropuff Orthotic

Komfort Micropuff Orthotics

Accommodative orthotics are typically made from softer materials like leather, cork, felt, foam, crepe etc. They are more flexible and easier to get used to. These devices are often used in seniors, inflexible high arched feet, and diabetics. Again, diabetics should be cautioned not to treat their own foot problems but rather get a professional opinion as to whether orthotics are appropriate and if so what type. Orthotics are not for everyone or meant to treat all problems. Often times a temporary support such as a Low-dye tape strapping applied to the foot can determine if the support an orthotic provides will help them with their problem. Typically the tape is applied and left in place for 3-5 days. The patient is asked to perform their normal activities of daily living and keep a diary of how their foot responded. If the intensity and or frequency of their original pain is reduced while wearing the tape, then usually an orthotic will help their problem.

Custom Orthotics

In order to make a set of custom-made functional orthotics, several assessment methods are utilized. A biomechanical evaluation is performed which includes a range of motion study of the entire lower extremity and a gait analysis. This helps the doctor understand how your foot functions. The whole process is done in a single 45-minute appointment. A range of motion study evaluates how much motion is available in the critical joints in each of the lower extremities from the hips to the toes. The gait analysis assesses how the lower extremities function while walking.

Neutral position casting is done to capture the shape of the foot before the foot is flattened while standing. Note, if you are being casted for functional orthotics and are asked to step into a foam box or plaster your foot shape will be captured when your arch is already collapsed. It is a technique which is frequently utilized because anyone can do it, i.e. a shoe salesman, nurse’s aid, secretary, etc. It requires no skill, knowledge or qualifications. Unfortunately the devices, which are made from such a technique usually, provide inadequate support. The best custom-made functional orthotics comes by way of neutral position casting. Once the casts are dry they are shipped along with your prescription to an orthotist, someone who specializes in fabricating orthotics.

It usually takes between 2-3 weeks for the devices to be fabricated and shipped back. The patient then returns to the office to be fitted. The molds of the feet are returned to the patient so orthotics can be replaced if lost or broken. Adult patients are typically followed for three months after the receipt of the orthotics, making sure the devices are functioning properly and the patient is well adjusted to the devices prior to discharge. Occasionally modifications are necessary to “fine tune” the orthotics, most of which are done in the office. Rarely do the devices need to be returned to the orthotist for revision. Children who require long-term orthotic use usually get between 18-24 months of use out of a set of orthotics before they are outgrown. The amount of time depends upon when they were casted relative to their growth phases.

Which conditions are treated using orthotics?

Orthotics are used for a host of problems, including bunions, hammertoes, neuromas, plantar fasciitis, limb length discrepancy, irritation to growth plates in children’s feet, tendonitis, shin splints and tight heel cords, to name a few. They are also used post operatively to help decrease the likelihood of recurrence of foot problems which were originally caused by poor biomechanics.

Visit Dr. Wilson’s specialty website for more in-depth information about orthotics.