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Author: Christine Dobrowolski, DPM Article source: http://www.kabish.com/. Used with author's permission.
If you take a simple stroll down the foot product isle at your
local drug store you will find an array of foot products and
inserts. You will find inserts for cushion, for comfort, for
support and for control. Many questions may cross your
mind. What are the differences? Is the $15 insert better than
the $7 insert? Are these orthotics? Will they help my foot
pain? You may take the time to study the package details
closely, but in most instances it doesn't really matter which
pair you grab. Most of the inserts at the local drug store are
essentially the same.
An insert slips into the shoe and will give you some comfort,
cushion and a little support. In some cases, inserts
purchased at the drugstore will help alleviate some arch or
heel pain and give relief to sore, tired feet. But, an insert is
not an orthotic. Orthotics are devices which fit into the shoe
and aid in foot function. The most important difference is an
orthotic controls abnormal motion and corrects foot function,
while an insert will only provide cushion and comfort.
A prefabricated orthotic is a device that is pre-made and
designed to fit the most common foot types. Typically, a
prefabricated orthotic needs to be purchased at a sports
store and they are more expensive than inserts, costing
$25-$30. The prefab orthotic is more rigid than an insert and
is designed not only to support the arch, but also to help
control motion, which will decrease stress on the tendons
and ligaments in the arch. Many individuals will do very well
with a prefabricated orthotic. Prefab orthotics generally last
for one or two years before replacement is necessary.
A functional custom made orthotic is a device that is even
more rigid than a prefab orthotic. The custom made orthotic
must be rigid to help control the motion in the foot and add
support. If the orthotic is soft, the weight of the body would
collapse the device and it would no longer function. A
custom made orthotic is not only custom molded to your foot
and arch, corrective wedges and covers are built into the
device to help with motion control and to improve the
mechanics of the foot. Individuals with flatfeet, tendonitis,
plantar fasciitis, certain foot deformities, knee, hip and back
problems may benefit from custom made functional
orthotics. The orthotic should make standing, walking,
jogging or running more comfortable. Custom made
functional orthotics will generally last 7-12 years before
needing to be replaced, and can cost between $300-$600.
Functional orthotics are a successful treatment for many
problems affecting the lower extremity. In a recent article in
the Journal of the American Podiatric Medical Association,
75% of patients surveyed had good to excellent results
using functional orthotics to treat heel pain, arch pain,
arthritis, bunions, pain from flatfeet or high arches, knee, hip
and back pain. A recent article in USA Weekend magazine
stated the opposite. The article referenced a study in Foot &
Ankle International in which researchers followed 874
healthy, young Israeli army recruits without foot problems.
The recruits were given soft custom, semi-rigid custom, soft
prefab or semi-rigid prefab orthotics to wear in their boots
during basic training. The researchers found no difference
in the development of foot problems between the custom
made orthotic group versus the prefab orthotic group. The
conclusion from this study is that custom made orthotics
will not help prevent foot problems from developing. What is
important to understand is this study did not evaluate
individuals with foot pain or foot problems. The population
evaluated was a group of young, healthy, active individuals
without any existing foot problems. Therefore, we cannot
conclude from this study that prefab orthotics treat foot
conditions better than custom-made orthotics.
Individuals with plantar fasciitis (heel and arch pain) who
also have flatfeet usually respond best to custom-made
orthotics. Certain types of tendonitis respond well to
orthotics and other types require orthotics. Posterior tibial
tendonitis is the tearing and inflammation of the tendon that
helps to hold up the arch. When this tendon is overstressed
by arch collapse it cannot heal. Custom made orthotics are
essential in the treatment of this condition.
Individuals with high arches may also require orthotics, but
they do not respond as well. Custom made orthotics can
help slow the progression of bunions and hammertoes, but
they will not prevent this process. Orthotics may help with
some pain at a bunion, but they will not "cure" the bunion.
When the motion in the foot is contributing to the problem,
orthotics are generally recommended. If the foot is stable
and does not require support, the bunion, hammertoe,
neuroma, tendonitis or even plantar fasciitis may not require
custom made orthotics for treatment. These individuals may
do well with a pre-fabricated orthotic. If you do not have foot
pain or an existing foot condition, a custom made orthotic is
not necessary for prevention of foot problems.
A custom made accommodative orthotic is soft and
designed to reduce pressure and prevent excess friction.
Diabetics can develop numbness and loss of circulation in
the feet. This numbness and circulation loss puts them at
risk for developing open sores on the feet called
ulcerations. To help prevent excess rub and friction in
certain areas on the feet, accommodative orthotics are
recommended. Diabetics who do not have numbness or
circulation loss (as diagnosed by their doctor) do not need
to have accommodative orthotics, unless the foot has a
deformity, like a bunion or hammertoe, then accommodative
orthotics are necessary.
Both types of custom-made orthotics are formed by taking a
mold of the foot. A functional orthotic mold is fabricated by
wrapping the foot in plaster. The foot is held in a corrected
position while the plaster is setting. To obtain an
accommodative orthotic mold, the patient steps into a foam
box. An impression of the foot in a standing position is then
created. The molds are sent to a lab and scanned into a
computer. A reverse image is produced and the computer
generates an image of the foot in neutral position. The
computer adjusts the image based on the corrections
recommended. A model of the foot is then cut out, in some
cases out of wood. The orthotic material is pressed over the
foot model and the orthotic is created. The most common
material for a semi-rigid custom made orthotic is
polypropylene, but other materials, such as graphite are
used. A foam-like material is typically used for
custom-made accommodative orthotics.
The bottom line is that if you have foot pain, a foot deformity
or condition, let your podiatrist evaluate you and decide if
orthotics should be part of the treatment. If your insurance
will not cover the orthotics and you cannot afford custom
made orthotics, consider trying prefabricated orthotics. If you
are looking to help prevent foot problems or looking for
some extra support, a prefab orthotics is a good option for
you, especially if you are active in sports. If you are just
looking for a little extra cushion and comfort, an insert at
your local drug store will be your best bet. Christine Dobrowolski is a podiatrist and the author of
Those Aching Feet: Your Guide to Diagnosis and Treatment
of Common Foot Problems. To learn more about Dr.
Dobrowolski and her book visit
http://www.skipublishing.com. For more information on
prefabricated orthotics visit
http://www.northcoastfootcare.com.
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