Orthotic inserts (either prefabricated or custom) may be helpful in the treatment of certain established foot and ankle conditions, such as plantar fasciitis, acquired adult flatfoot deformity, metatarsalgia, and peroneal tendonitis. Orthotics work by providing a supportive base for the foot to rest on. This serves to partially realign the foot, and most importantly to help disperse the force going through the sole of the foot over a wider area. An orthotic is like a bed for your foot. Just as a good bed will support your back when you sleep, a good orthotic will support your foot when you stand and walk. Similar to when you purchase a bed, you may want to check out various orthotics before purchase, but usually a custom product is not needed.
Most stores specializing in comfort shoes, as well as many running and hiking stores, will carry a wide array of orthotics. In addition, many online stores have a wide selection of reasonably priced orthotics, although they have the disadvantage of not being able to try them on for fit.
Things to look for in an orthotic:
Comfortable upper surface
The top 2-5mm of an orthotic should provide a soft surface for the foot to rest against. Many orthotics are made of materials that will change shape overtime, based on the loading that the orthotic is exposed to (i.e. if you have a lot of pressure in a certain area of the foot, a depression will develop there over time). Some pre-fabricated orthotics are heat moldable. They can be heated in the oven and then stepped on to help start the process of accommodating to your foot.
The soft surface of the orthotics should sit on a semi-rigid base that gives the orthotic its shape. Usually, this base includes an arch support. The height and stiffness of the arch may determine how comfortable the orthotic is for the patient. Determining an appropriate arch height and stiffness can be counter intuitive. For example, if a patient has a markedly flatfoot, a stiff arch support to prop up the arch may seem desirable. However, this type of arch may create too much localized discomfort in the midfoot, and these patients may be best served with a lower, more flexible arch. In a similar manner, it may seem intuitive that someone with a high arched foot should have an orthotic with a high arch support. However, such a high arch may serve to increase the loading on the outside of the foot, so patients with a high arched foot may be better off with a recessed area under the base of their great toe, as this will serve to position their foot in a more neutral position.
Sizing the orthotic
It is important to size the orthotic appropriately. Different manufacturers make orthotics of different widths, so it is important to purchase an orthotic that is the correct size and width.
Orthotic add-ons for specific conditions
Some orthotics have add-ons which can be of help in certain conditions. These may include:
- Built in Metatarsal pad: This built up mound positioned just before the base of the 2nd and 3rd toe can be helpful in the treatment of metatarsalgia, by off-loading the painful area.
- Recessed area under the base of the great toe: A depression under the base of the big toe can be very helpful in patients with a high arched foot, and may help patients with sesamoiditis.
- Increased heel padding: This can be helpful in patients with symptoms from overload heel pain.
- Increased heel height: Adding a few extra millimeters to the height of the heel may help in some conditions, such as insertional Achilles tendonitis.
Edited September 24, 2015