Orthotics, or arch supports, are devices that slide into your normal shoes. Orthotics fall into two main categories: Accommodative and Functional. Accommodative orthotics simply make you more comfortable simply by alleviating areas of pressure. Functional orthotics allow for better alignment of the 28 bones of your foot, the tendons, and the muscles. Orthotics may also be over-the-counter, or they may be custom-molded.
Who needs orthotics? Most people could benefit from one type of orthotic or another. People with a great deal of inflexibility or a great deal of calluses and boney prominences may benefit from accommodative orthotics. These orthotics are often made of very cushioning materials and off-load, or alleviate areas of pressure. These might slow down the build up of callus tissue and take away pain by giving cushion to boney prominences that some people might have on their feet. This type of orthotic is ideal for Diabetics or anyone else who may have neuropathy or who needs to protect their feet secondary to poor circulation.
Accommodative orthotics tend to be made from very soft and cushioning materials, such as plastizote, ppt, and soft leather. They may have cut outs to allow for boney prominences to sink into them and alleviate pressure.
Functional orthotics are ideal for people who have flexible, or reducible deformities of their feet. This type of orthotic can alleviate muscle strain and pain, and act very much as glasses do for your eyes. They allow the muscles, tendons, and bones to align for more correct function, and alleviate fatigue. Functional orthotics help to eliminate knee, hip, and lower back pain, as well, by creating a situation in which the feet and heels are more even with each other, and eliminating functional limb length discrepancies.
Functional orthotics may even prevent deformities of the foot, such as bunions, hammertoes, and flexible flatfoot from progressing to a stage where surgery is required. All of these deformities are ultimately caused by imbalances of opposing muscle groups (the muscles and tendons on the top vs. the bottom of your foot, for example). When one group gains advantage over another, joints begin to come out of alignment, arches begin to fall, ligaments begin to loosen, and deformities begin to occur. Once these deformities have progressed to a certain stage, however, surgery may be the only option.
Orthotics are made in several different ways. The patient may be asked to step into a ‘foam box,’ which will take an impression of their foot. There is also a computerized version, where the patient stands on a plate and a computer program identifies areas of pressure. Both of these are taken in with the patient in a standing position with all of their muscles firing, and may be quite fallible.
In my practice, I take a plaster mold of my patients’ feet while they are in the treatment chair and in a non-weight bearing position. This allows me to put their feet in a ‘neutral position,’ and allows for a much more accurate product.
There are many stores now making orthotics. They generally charge you the same, or more, than a Podiatrist, and the product does not last as long and is made by inexperienced people. Over-the-counter arch supports may alleviate some pain and improve some function, but there are many versions, some better than others.
Custom orthotics benefit many people. They should be made by your local Podiatrist or a similarly trained Chiropractor. They can make your more comfortable, alleviate arch, heel, knee, back and hip pain, and they will last you for many years.