The word orthotic comes from the Greek word ortho, which means to straighten or align. Put simply an orthotic (correctly called foot orthoses) is a device that is designed to change the shape of the inside of your shoe. Your clinician will use it to limit motion, support structures, offload and redistribute pressure areas and improve biomechanical movement of the lower limb. Your orthotic may do just one, or perhaps all of these jobs depending on a number of things. The dependant variables are primarily how customised to the individual foot the device is and what the device is made from.
We use orthotics in injury prevention and as part of a rehabilitation program if an injury has occurred. It gives the muscles, tendons, ligaments and bones of the foot the support that they need to allow the patient’s immune system to repair any damage and so relieve pain levels.
The first choice that your clinician will make is whether a fully customised device is needed or whether an off-the-shelf orthotic will do the job. Off the shelf orthoses have been around for many years and are for sale at most sports shoe stores and many chemists as well as online manufacturers. These devices vary in the material of manufacture and shape. The manufacturers are generally trying to accommodate the average foot. These devices can be made from plastics, foams and gels and patients have varying levels of success when they use them.
Perhaps the greatest benefit of an off the shelf orthotic device is that they can be accessed by anyone and they are very inexpensive. With an average price in the $30-$40 range they are usually the first stop for most people with sore feet. There can be disadvantages though in this. Most people have little idea of what kind of device they want to buy as they generally don’t have a diagnosis of their pain. Do they want a soft device or a firm device? A device with a higher arch or a flatter cushion? Remember that most of these devices cater for an average foot so if your foot is unusual these devices may not work for you.
Off the shelf devices.
Sometimes a clinician may adjust or help to reshape and off the shelf device for your foot. This is known as a semi customised device. You will know if it a semi customised device as usually the orthotic is given to you in the consultation when you first present with the problem. Sometimes the off the shelf device is heat moulded to your foot, however, they are not customised orthotics in the true sense of the word.
The second choice is a fully customised device. This is most often done by a podiatrist or an orthotist. The consultation most often follows with the clinician taking a history of the presenting complaint. They will enquire as to your activity levels, footwear and the nature of the pain. They will also be checking the movement and strength of joints and muscle groups and will often try to replicate the pain being felt in order to gain a diagnosis. It is usually at this point when the clinician will decide whether further investigations such as X-Rays, MRIs or Ultrasound are needed to clarify the diagnosis.
Customised devices contour to the foot giving better support. This is a semi-rigid polypropoline device
Should diagnostic imaging not be required, the clinician will often look at the patient moving and weight bearing. Some clinicians use video and computers to further measure problem areas with precision and others will do this manually using angle measuring tools. Finally, in order to truly customise a device an impression of the patient’s foot is needed. This can be done using traditional methods such as plaster or foam boxes or more modern methods using pressure pins from a computer pad or perhaps the most modern being that of laser foot scanning. Pressure pads do not give a 3-dimensional picture of the foot and cannot truly be considered fully customised but do give a good understanding of where load is being carried.
Our Biomechanics and gait lab at Central West Foot and Ankle Clinic
Finally, the clinician uses all the information that they have gathered from the patient, the diagnostic equipment, the gait analysis and the testing of the foot by hand to design and manufacture the customised device. The clinician will choose their material which can be plastic, foam or carbon fibres depending on activity and purpose and the device is manufactured. Usually with a customised device the support of the clinicians provided after the fitting until the patient outcomes improve.
The benefits of such a device are that usually that they are far more comfortable, fit shoes better, are lower profile and sleeker and work more effectively than an off the shelf device and therefore the patient is generally out of pain at a much faster rate. The trade-off is that the clinician is creating a one off device. It is made to measure specifically for the patient in mind usually using much greater levels of precision and so they are far more expensive. Most fully customised devices when adding on consultations, assessments and foot impressions add up to $600-$800 depending on the clinic and the clinician that is visited.
The option that works best for you will depend on your budget, the shoes you like to wear, how long you’ve had the problem and your level of pain. But these are questions for you to answer!