Looking for more information? Check out these articles.
Neck Pain & Headaches: Fixing Neck Pain & Headaches
Shoulder Pain: Fixing Shoulder Pain
Elbow Pain: Fixing Elbow Pain
Hip & Knee Pain: Fixing Hip & Knee Pain
Understanding Foot Orthoses
Foot function affects just about every joint above it including the spine (See below). Many practitioners are quick to prescribe a pair of foot orthoses without fully understanding why the patient is in pain. Hopefully the information below will help you decide whether you need orthoses and, if you do, how to purchase a pair that adequately supports your feet.
Choosing Your Orthoses
Orthotics is the branch of medicine that deals with creating orthoses. Orthosis (plural: orthoses) is the actual shoe insert.
Do You Really Need a Pair of Foot Orthoses?
Purchasing a pair of foot orthoses can be an overwhelming task. I prefer to first try to fix the root causes of foot, knee, hip, or back pain without using orthoses. This way pain is corrected permanently. Typically this means correcting how we walk, among other things. I’ve found this approach to be very effective in resolving pain from plantar fasciitis, heel spurs, and other foot maladies. It also does wonders for most knee, hip, and back pain.
The benefit of this approach is that the patient will learn more about their body and why they have pain. If, after correcting these issues, pain continues then we will have much more information about how the orthoses should be cast and a better chance of success in eliminating pain.
There are those people, however, who would rather just be fitted with their orthoses and that’s fine, too. Either way may eliminate pain but knowledge of how your body is or isn’t working will improve your chances of completely eliminating your pain, with or without the orthoses.
Is There a Difference in How Foot Orthoses are Made?
Unfortunately finding a properly fitted pair of orthoses is more difficult than you would think. It breaks my heart to see clients bring in their shoe inserts for which they’ve paid hundreds or sometimes over a thousand dollars, only to find they are not helping the feet.
Most orthoses are made (cast) with the foot in a non-weightbearing position. Others step on a platform to have their feet assessed digitally. However these techniques are usually based on a principle that the foot should be casted in what is called “subtalar neutral”. The central theme of this concept is that there is an ideal “neutral” position the foot should be in to function correctly. The problem is that if the foot is cast in this position, then the orthoses are beginning to control the foot at subtalar neutral. Any motion beyond this ideal then potentially causes damage to the foot.
The casting system I use begins with a higher arch (prior to subtalar neutral), allowing the foot to move into subtalar neutral and then back out again. These orthoses are also adjusted to your specific weight.
Something else you should know is that many companies use a pre-fabricated mold that most closely fits the needs of a patient’s foot based on a pressure plate analysis or light model. Technically these are customized orthoses, not to be confused with custom-made orthoses.
Customized orthoses are pre-fabricated arch supports that are the closest match to the foot analysis. They may or may not be an adequate fit. They are cheaper to make but not necessarily cheaper to purchase.
Custom-made shoe inserts fit one foot and one foot only—yours. Often there are differences between the left and right feet that customized orthoses cannot adequately correct. I use a system to custom-make orthoses and address each individual’s needs.
Often the people fitting the orthoses do not understand the differences between these terms, so you have to do your homework to find out which category your orthoses truly fit into.
Tips for Assessing Your Foot Orthoses
Your orthoses should provide complete support during the entire stance phase of gait. Here are three simple, intuitive tests to find out if yours are doing the job.
Many orthoses are too soft and breakdown rapidly. A simple test can demonstrate this. Knowing that your body exerts approximately 3x its body weight with each step, take out your orthoses and see if you can depress your arch with your finger (Figure 1 & 2, below). If your orthoses bend under this minimal force just think what they’re doing (or not doing) when you’re walking or working! Remember the idea of subtalar neutral? If your orthoses are easily collapsable then your feet are probably spending too much time beyond it! The thickness of your orthoses should be adjusted to your individual weight so they will always support your foot with the correct amount of flex.
Figure 1. Collapsing orthosis
Figure 2. Semi-Rigid Orthosis
Here’s another test. Stand in your orthoses and see if there is any gap between the shoe insert and your feet (Figures 3 & 4, below). There should be no gap. If there is, then the orthoses are not supporting your feet when standing.
Figure 3. Gap between foot and orthosis
Figure 4. Orthosis supporting foot while standing
Heel Lift Test
Sit down with your orthoses under your feet. Raise your heel, bringing the orthosis with you (Figures 5 & 6, below). Is there a gap between your orthosis and your foot? If so then your shoe inserts may not be supporting your feet during later part of the walking cycle.
Figure 5. Gapping between foot and orthosis at heel lift
Figure 6. Orthosis supports foot during heel lift
These are three simple tests that you can perform to assess your foot orthoses. If you’re not happy with your orthoses or you are still having pain then please contact me to fix your issues. I also offer group discounts for four or more people casting their orthoses at the same time.
You can reach me at (303) 477-4212 or email me if you’d like an appointment or to ask a question.