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.
Click Here For WalkFit Orthotics
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
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