In this article, Liam Rothwell – our resident Orthotics expert – tells us all about these medical devices. Also referred to as orthoses, shoe inserts, or insoles – they are worn in the shoes to help relieve foot, leg or back problems.
Orthotics are usually made from materials such as EVA (ethylene-vinyl acetate) rubber, carbon fibre or plastic (polypropylene). These materials make it possible to customise the flexibility and cushioning of the device in order to properly manage the load on the feet. This in turn, allows Podiatrists to treat a range of different conditions along with improving comfort for patients.
Read the interview with Liam to find out more about these specialist devices and how an assessment is made about when to prescribe them.
Firstly, Liam, can you explain to us what Orthotics are?
“An Orthotic is a shoe insert or insole that is designed to change the load and functioning in a person’s feet. It does this by altering the workings of the structures that have a relationship with the foot but also by changing the relationships that the foot has with the ground. There are two types of orthotics:
- Off the shelf orthotics which are prefabricated and are quite general in their support and cushioning
- Custom orthotics which require an assessment and a prescription as they are designed specifically for a patient’s foot and particular condition.
Orthotics are used sometimes because other treatment options haven’t been successful in changing pressure on structures within the foot and lower limb; or when other forms of therapy are not possible.”
And how do Orthotics work?
“An Orthotic device is sometimes recommended if the muscles, tendons, ligaments, joints, or bones of the feet and lower limbs are not managing load efficiently and are causing pain, discomfort or fatigue. They work in two main ways:
- Orthotics alter the function of specific areas of the foot and ankle. They may reduce the amount of pronation (when the foot rolls inwards too much) or supination (when the foot turns outward too much). These changes are designed to improve foot function and reduce pain and injury.
- Orthotics alter pressure coming from the ground to the foot (ground reaction force) when standing, walking or running. By altering these forces, we can protect areas of the feet and body, promote better foot function and reduce the excessive forces that can lead to pain and injury.
Are Orthotics for people with high arches or low arches?
“Firstly, let’s talk about those two different feet shapes or types in turn and the difference in how Orthotics helps with each foot type.
Flat feet is a term used to refer to someone who has very little or no arch. Flat feet may cause foot, ankle, and back pain because having a foot that rolls inward too much can place increased pressure on structures within the feet and further up the body. How an Orthotic would work in this situation is to help provide support to the feet and relieve pressure on the collapsing arches by promoting a more efficient foot position.
High arches are where the arch is in a very high and flexed state. This usually causes the person to bear weight primarily in their heels and balls of the feet. Very high arches attenuate shock poorly and so can place increased stresses on muscles in the feet and lower body. Orthotics can help prevent the feet from rolling excessively outward and distribute the weight and stress across the entire foot.”
How are Orthotics used to treat knee pain?
“Orthotics are used to treat many conditions within the feet including bunions, plantar fasciitis, bursitis and Achilles tendinopathy. But they can also assist with reducing pain and discomfort in the lower limbs, knees, hips and back.
The feet and knees are linked. I’ll explain how. Orthotics encourage optimal functioning and positioning of your foot and therefore help distribute the forces more evenly throughout the foot and ankle, which in turn distributes force more evenly to your knees.
Orthotics also provide cushioning in key areas of the feet such as heel or ball of the foot, which reduces the level of impact on your legs when you move, walk or run.”
Can Orthotics actually cause knee pain?
“If you’re not wearing the correctly fitted devices then yes, you may end up in more pain than when you started. This may also be the case with wearing certain shoes as well.
Shoe inserts are different to Orthotics. We don’t advise people to just buy insoles from the supermarket, pharmacy, athletic or shoe store as they might not be the right one for your feet and actually cause irritation and pain. They may make your shoes feel a little more comfortable in the short term, but they are not designed to correct problems with the feet in the same way that Podiatry made or custom moulded Orthotics would.
Additionally over the counter insoles may offer support to a region of the foot that doesn’t need it – because they are prefabricated they simply don’t suit every foot. They probably also won’t last very long (maybe 6 – 12 months ) and people often find that they don’t fit into all of their shoes; so end up having to buy multiple pairs.
Podiatrists use specific prefabricated orthotics if we feel a patient may benefit from a certain level of support or change in their feet. These are different from insoles from the chemist or supermarket and they are designed by Podiatrists with specific technology and specifications for the foot. They are also easy to modify should a patient’s feet require it.
Custom Orthotics properly contour to the shape of your unique feet and provide support to the specific areas that need it – the arch, heel, toes or entire foot. They manage the biomechanical issues that affect how you stand, walk or run.
We recommend you get used to the Orthotics gradually by wearing them for a few hours each day and will see patients for a follow up appointment to check whether any adjustments need to be made.”
Will people need a different pair of Orthotics for each pair of shoes?
“Custom or semi-custom made or moulded Orthotics are more likely to fit in several shoes because they have been made specifically for you, with a consideration for your specific footwear needs.
After completing a full biomechanical, walking and plantar pressure assessment, one of our Podiatrists will take an impression of the feet. This cast or scan of the feet is then taken to create an Orthotic which is manufactured to specifically fit and support that person’s foot and condition.
This means that we can support specific areas of the foot which need it and they contour to the person’s feet perfectly. Once they are made, they can be modified in our clinic if they are not quite right the first time; and because they are made from durable material, they are also likely to last a long time.”
What should you do next?
The recommendation of Custom Orthotics may be part of a comprehensive treatment plan and a thorough assessment of the biomechanics of the feet.
At Your Foot Clinic, our Podiatrists provide a thorough analysis of your feet, footwear, lifestyle and needs to tailor a treatment plan to suit you.
You can call our clinic to arrange a COVID-Safe appointment. Our entire team has completed COVID-19 Infection Control Training and are here to help.