Orthotics

When the foot’s natural structure is compromised or the foot functions improperly, pain and injury can occur either in the foot itself or elsewhere in the body (usually in the knee, hip, or lower back). This pain and injury can be corrected – or even avoided – through the proper use of orthotics.

The orthotic accommodates for or corrects specific structural or mechanical problems, bringing the lower body into alignment and allowing for efficient joint mechanics and correct force transmission.

Variances in Orthotics

There are many different types of orthotics available.

Length

Full-sole orthotics typically have a hard high-density foam base that is covered by foam-rubber and/or felt for comfort and a small amount of cushioning.

Three-quarter length orthotics run from the heel of the shoe to just short of the ball of the foot and are either made of plastic or of the same materials as full-length insoles.

Rigidity

Soft orthotics are made of pads and flexible felt supports. These are best for mild overuse syndromes and for use in shoes that are too narrow for other orthotics.

Semi-rigid orthotics are generally best for athletes with higher symptom levels than those using soft orthotics. Semi-rigid orthotics are well-tolerated by people doing speed workouts and jumping exercises.

Rigid orthotics (also called functional orthotics) allow the patient to control the symptoms of most overuse conditions.

Customization and Cost

Off-the-shelf orthotics are widely available to the public through pharmacies and sporting goods stores. Dr. Scholl’s and Spenco shoe inserts fall into this category (Spenco does offer inserts that can be customized by a professional, but these products are not available off-the-shelf). These inserts are designed to address common foot problems, but they are not individually customized. Additionally, these orthotics are more commonly made for and marketed to people who stand on their feet all day or who have foot and lower body problems due to being overweight. Most of these products are full-length soft orthotics (many have gel in them). Not all off-the-shelf shoe inserts are the best orthotic option for athletic individuals who need a product that can withstand the forces caused by running, jumping, and doing other physical activity. These are the least expensive type of orthotics.

Semi-custom orthotics are available from specialty foot care stores (like The Good Feet store). A representative from the store examines your standing posture and asks about your pain and injuries. Based on this information, they will select a pair – or more – of specific types of orthotics designed to address the problems you are having. These orthotics are pre-made instead of being made from a mold of your feet. Semi-custom orthotics are significantly more expensive than the off-the-shelf products, but they typically last much longer and many stores even offer a lifetime guarantee. These inserts do not require a doctor’s prescription or even a diagnosis (although a diagnosis may help). They are rarely covered by medical insurance.

Custom orthotics are most often received from a podiatrist. At the doctor’s office, someone from the office will take a mold of your feet while you are standing. This mold will be used to cast your custom orthotics. The orthotic-making process is most often done off-site, but some podiatrists elect to make the orthotics themselves. When the orthotics are made off-site, you have to come back to the doctor’s office several weeks later, and they give you your new orthotics and check to make sure they were made correctly. This is the most time-consuming and expensive process, but it is also the best way to specifically address all of your foot problems at once. If you think your feet might still be growing, you probably want to avoid getting custom orthotics (if able) until after your feet have stopped growing (due to the cost). Custom orthotics require a prescription (which is not a big deal since you’re getting the orthotics from the doctor anyway). It is rare for medical insurance to fully cover custom orthotics for people who need them for athletic purposes, but some plans may cover part of the cost.

Wearing Orthotics

Regardless of the length, material, stiffness, or type of orthotic, it must replace the shoe’s insole – not rest on top of it. Many athletic shoes come with a slightly contoured insole, often with a bit of a heel cup and a small arch support. Pain and injuries can result if the orthotic is placed on top of an uneven surface such as the insole of a shoe. The orthotic will not be effective unless it is placed directly on the bottom of the inside of a shoe.

In the Performing Arts

Wearing orthotics while performing or rehearsing can be difficult. Dance shoes, shoes for a costume, and personal dress shoes (for a concert) often aren’t big enough for the orthotics. Marching band shoes may not have a sole that can be removed by the performer (because it’s glued in and the shoe does not belong to the musician). When dancers or actors have to perform barefoot, orthotics are, of course, not an option.

One way a performer can get the most out of a pair of orthotics even if the orthotic can’t be worn in rehearsal or performances is to wear them at all other times of the day. Oftentimes, this means that performers must wear supportive, closed-toe shoes (like athletic shoes) whenever they are not in rehearsal or performing.

Break-In Schedule

When you are beginning to wear a new pair of orthotics, be certain to follow a break-in schedule. Orthotics change the way your foot hits the ground, which means that they also change the way your muscles work. While this change is for the better, your body still needs time to adjust. If you suddenly start wearing orthotics all day every day, you are going to have a great deal of muscular soreness, tightness, and pain – possibly even some joint discomfort.

Wear the orthotics for 2-4 hours on the first day and increase your daily wear time by no more than 1 hour per day until you are wearing them 8-10 hours per day. During your break-in period, do not wear your orthotics while exercising until after you begin wearing them 8-10 hours per day.