Pre-Fabricated (Over-the-Counter) Orthotics Insert
Background
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 purchasing a bed you may want to check out various orthotics, but you usually do not need a custom product.
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 t try them on for fit.
Things to look for in an orthotic:
Comfortable upper surface
The topic 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 over and then stepped on to help start the process of accommodating to your foot.
Semi-rigid base
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 and instead 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 orthotic of different widths so it is important to purchase an orthotic that is the correct size and with.
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 build 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.
Custom vs Pre-Fabricated Orthotics
Edited August 2nd, 2009