Orthotics

Orthoses

Commonly referred to as "orthotics," are shoe inserts that are intended to adjust an abnormal, or irregular, walking pattern. They perform functions that make standing, walking and running more comfortable and efficient by altering the alignment between the foot and the lower leg.

Podiatrists prescribe the use of orthoses as a conservative approach to problems such as plantar fasciitis (arch pain), tendinitis and "runner's knee." Their use is a highly successful, practical form of treatment.

Orthoses are not truly or solely "arch supports," though some people use those words to describe them. Orthoses are medical devices that require a prescription and are custom-made by trained individuals. Podiatrists specialize in assessing and understanding the bio-mechanical faults of the foot and what is required to balance excessive pronation (collapsing in) and supination (rolling out).

Not all problems can be corrected by orthoses and not all problems require orthoses. In fact, your podiatrist may recommend an over-the-counter arch support, cushioned heel cup or insoles for your shoes. However, if you do buy prescription orthoses, in most cases they should be 85 to 95 per cent successful in relieving, preventing and/or correcting the problem for which they were prescribed.

Orthoses take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.

To learn more about foot motion and orthotics, watch the Sun Run InTraining TV video clip:
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Foot orthoses fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthoses

A rigid orthotic device, designed to control function, may be made of a firm material such as plastic, and is used primarily for walking or dress shoes. It is generally fabricated from a mold of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot.

Rigid orthoses are chiefly designed to control motion in two major joint complexes of the foot, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually unbreakable. Strains, aches and pains in the legs, thighs, and lower back may be due to abnormal function of the foot or a slight difference in the length of the legs. In such cases, orthoses may improve or eliminate these symptoms, which may seem only remotely connected to foot function.

Soft Orthoses

A soft orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned via a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes.
The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be replaced more frequently. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthosis is usually bulkier and may well require extra room in shoes.

Semi-rigid Orthoses

A semi-rigid orthotic device provides for dynamic balance of the foot while walking or participating in sports. This orthosis is not a crutch, but an aid to the athlete. Each sport has its own demand and each sport orthosis needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthosis helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semi-rigid orthosis is constructed by using laminations of firm material for control and soft material for cushioning.

Orthoses for Children

Orthotic devices are effective in the treatment of children with certain foot and leg deformities. Most podiatrists recommend that children with such deformities be placed in orthoses soon after they start walking, to help stabilize the foot. The devices can be placed directly into a standard shoe or an athletic shoe.
Usually, the orthoses need to be replaced when the child's foot has grown two sizes. Different types of orthoses may be needed as the child's foot develops and changes shape.

The length of time a child needs orthoses varies considerably, depending on the seriousness of the deformity and how soon treatment is initiated.

Other Types

Various other orthoses may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot or ice skate boot or roller skate boot. Combinations of semi-flexible material and soft material to accommodate painful areas are utilized for specific problems.

Research has shown that back problems frequently can be traced to a foot imbalance. It is just as likely that foot problems are brought about by a back imbalance. It's important for your podiatrist to evaluate the lower extremity as a whole to provide for appropriate orthotic control for foot problems.

Tips on Orthotics from B.C.'s podiatrists

• Wear shoes that work well with your orthoses.
• Bring your orthoses with you whenever you purchase a new pair of shoes.
• Wear socks or stockings similar to those that you plan on wearing when you shop for new shoes.
• Return as directed for follow-up evaluation of the functioning of your orthoses. This is important for making certain that your feet and orthoses are functioning properly together.

Source: American Podiatric Medical Association