Foot Orthotics - Primary Care Partners

by Brad Fentor DPT

Foot orthoses or inserts have been prescribed for many decades for those suffering from foot and ankle pain. These 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, 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.

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-fabricated1. 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. This is based on the theory that the medial longitudinal ligament must be allowed enough dynamic movt for activity but should prevent movement into end ranges. The hard shell is usually some type of plastic or poly material but can be made of other things such as cork.

Conditions to be treated

There are several conditions that can be positively affected with shoe inserts including: Patellofemoral knee pain, plantar fasciitis2, tibialis posterior dysfunction3, metatarsalgia, 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 yes, you still need to perform your exercises. 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 is not typically needed and a different type of pad is used instead to help relieve pain.4 The main takeaway is: talk with your therapist first before spending the money to make sure this is something that will help.

Clinic Process

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

References:

1) Collins et al: Foot & Ankle Int 28:396, 2007

2) Baldassin et al, Arch Phys Med Rehab 90:701, 2009

3) Neville, et al, JOSPT 2016; 46:26

4) Koenraadt et a: J Am Podiatr Med Assoc 102:18, 2012