FOOT ORTHOTICS (ORTHOSES)
The general category of foot orthoses includes anything added to your foot that alters the positioning or functioning of the foot. We are referring to pre-fabricated or custom-made foot supports which are designed to go into the shoes and under the foot.
Pre-Fabricated Foot Supports
When a foot support is indicated, a pre-made device can be helpful because it is available for immediate use (no fabrication necessary). They can also sometimes be modified on the spot if more specific control is needed. For some conditions, these can be the total answer to the foot support needed. In other cases, it may be only a temporary or partial fix, when a more specific, custom-made orthotic is necessary. Since these are mass produced, the cost is very affordable, compared with custom-made devices. However, they are usually not covered under insurance plans.
For the convenience of our patients, we carry quality, well-designed, pre-made supports. Prior to dispensing, we make sure that the fit is proper and that there is adequate support.
"Custom-Fit" vs. Custom-Made
Custom-fitting of foot supports is the matching of a pre-fabricated foot support to a foot, either to the foot itself or to a representation of the foot, e.g., an outline, or a measurement, or 3-D impression. This can be of good value, if the price is right and there are multiple types of foot supports to choose from, because you can be getting a good device that comes close to fitting your foot, at a mass-produced price level. Unfortunately, some vendors imply that "custom-fit" is custom-made, when they are only matching a foot imprint to match the size of a premade device. The buyer must beware in these cases, that you are not over-paying for a premade off-the-shelf device.
Custom-Made Foot Supports
Custom foot orthotic
Custom-made supports (orthotics) are used when the most precise control of abnormal foot motion is desired to resolve the problem. Sometimes it is immediately evident that this is the needed solution, and sometimes this is the next step in treatment, after the use and inadequacy of other less supportive devices.
Orthotics can be made from different materials and of varying thicknesses, cushion and rigidity. Because we are trying to control the position and motion of the foot, a semi-rigid device is usually necessary. If they fit and are designed properly, these are comfortable with walking and running. Molded polypropylene (plastic) is the most common material used. Fiberglass/graphite is often used for lower profile (better fitting in shoes) orthotics.
"Accommodative orthotics" are designed to protect a prominence or cushion an area and so have different design/prescription considerations, are usually softer and thicker, and may not last as long.
Fiberglass/graphite orthoticsNumerous measurements are needed for the proper prescription to be written, and impressions of the feet in the desired position are taken. In most cases, this impression needs to be made non-weightbearing, to avoid re-creating the compensations of the foot that we are trying to prevent. The casts are sent to the orthotic laboratory which can then create the supports based on these specific cast foot models and the specifications requested on the prescription. Once the orthotics are fabricated and ready for dispensing, we make sure that they fit, both the person and the shoes, and that they control the foot and leg motion correctly. Follow-up is included in the cost of the orthotics.
Shoes, Sandals, and Foot Supports
Most foot supports require shoes with a back to the heel, so that they will stay in the shoe while walking. Shoes can be very helpful in enhancing the effectiveness of the orthotics, if they are also supportive. Obviously some shoes work better than others, and we make specific recommendations regarding what shoes to choose and use.
The other thing that should be mentioned is that there are some shoes that you cannot put normal orthotics into. For example, the inside sole of women's dress (high-heeled) pump is shaped differently than a low heeled shoe: they are more curved from heel to ball of foot, and are not just a tilted up flat shoe. This necessitates the need for a differently shaped orthotic and complicates the ability to fit something in the shoe (with the foot). Sometimes these challenges can be solved with more creative methods of casting or orthotic fabrication. Or sometimes trying pre-fabricated devices to see what will fit is more practical, as this is not a very functional shoe or foot position to begin with.
Sandals and orthotics are usually not compatible (no enclosed back of the shoe at the heel). There are a few models/brands of sandals which have a fair amount of support by themselves, even when orthotics cannot be worn.