Nothing will sneak up on you quite like foot pain.

A persistent heel pain will make getting out of bed a dreaded task; chronic arch pain affects the way you walk and stand, and even how you sleep.

Most people don’t know that foot orthotics–custom-made devices that fit inside your shoes–could be the answer to solving these problems.

This article explains in detail what foot orthotics are, the condition which they can best help, the differences between custom made and shopshelved products, and how to go about using them rightly and safely.

Whether you’re browsing for the first time or trying to understand a clinician’s advice, this will clarify the basics.

What Are Foot Orthotics and How They Work

The purpose of foot orthotics is to support/cushion and even re-align the structures within the foot.

They may be basic foam inserts which are bought off the shelf in a pharmacy shop, to precisely manufactured custom made devices which are made with a mold of your foot.

This terminology can at times be confused with shoe insoles, which in essence are just added padding, orthotics however are intended to aid or rectify the biomechanical problem.

Types of foot orthotics–from basic padded inserts to Custom fabricated devices. These are the most readily available form of OTC orthotics.

The offer standard sizes and are designed for general “kind” of each of the three types of foot shape – flat arch, high arch, general heel support.

In contrast, custom orthoses are prescribed by a podiatrist, or an orthopedic surgeon and are designed specifically for you, after a thorough examination of your foot structure and function.

In both categories a device can be rigid (made of a solid plastic or carbon fiber for control of motion), semi-rigid (blend of soft and hard materials), or soft (foam for postpressure and comfort).

Ankle-foot orthoses, or AFOs, are components which are usually more superiorly placed than the ankle; these are used with neurological conditions or severe instability.

How Orthotics Alter Foot Mechanics The central to the function of any orthotic is pressure redistribution.

Any deviation from the foot’s natural position, such as a fallen arch, an over pronation, or any anatomical deformity, results in the load not being evenly distributed throughout the foot.

This results in focused loading on certain tissues.

An orthotic transfers the load by dispersing it more evenly and alleviating pressure on weakpoints.

Various load potentially affect not only between-the-bones of the foot. The modified force pattern over a period may also influence on posture, knee alignment and the mechanics of the low back because the foot is the platform of whole body.

Again, the shoe is a factor; an orthotic can only be effective if there is a shoe with sufficient volume and structure to support it.

— ## Conditions Where Foot Orthotics Help

Foot orthotics are not an all round fix, but for some conditions they are a very useful adjunct to treatment.

The key is to match the devices to the problem, which a skilled clinician can look at through a proper assessment.

Daily Foot Discomfort- Plantar Fasciitis, Flat Feet and High Arches The most commonplace complaint requires an orthotic to counter plantar fasciitis.

Is the condition that affects the soft tissue on the bottom of the foot that causes that piercing, stabbing heel pain that is most noticeable upon the first few steps taken in the morning.

Orthotics with a firm heel cup and arch support will also help decrease strain on the fascia.

Flat foot (overpronation) and high arch (supination) both have abnormal loading patterns which cause heel pain, shin splints and knee pain.

A device that supports the medial arch or cushions the lateral border of the footmay significantly diminish these consequences.

Medical and Sports-related Conditions For patients with rheumatoid arthritis or osteoarthritis in the joints of the foot orthotics can offload painful areas to improve patience walking ability.

Another area where custom devices play an important role is the management of diabetic foot which can result in ulcers. Prevention of ulcers is crucial as they may have serious consequences.

Sports overuse injuries such as Achilles tendinopathy or stress fractures due to abnormal biomechanics may also be successfully managed with an orthotic intervention as part of a wider rehabilitation program.

For bunions and Morton’s neuromas, off-forefoot pressure-reducing techniques are effective. However, structural deformities cannot be corrected using orthotics.

— Depending on your needs, what’s better: Custom or prefabricated foot orthotics? The pros, the cons, and the evidence. The most important question people ask – and rightly so – is if it’s really worth to pay that much more for custom orthotics.

The truthful answer is: it all depends upon your specific circumstances.

How do you know if you really need custom orthotics? Custom devices are generally only necessary if your foot shape or problem is complicated enough that a regular shape can not do the trick.

In cases of severe deformity, diabetic foot problems, post surgical rehabilitation and particular paediatric cases such as very severe flexible flat foot, a custom fit is in some instances superior to that available off-the-shelf.

For simple problems – mild plantar fasciitis in an averagely shaped foot, say – a good OTC orthotic may be just as effective and at a tenth of the price.

What the Science Tells Us About Effectiveness. For the purpose of discussion, clinical research on orthotics is truly mixed.

The effectiveness of both custom and prefabricated orthotics in pain reduction has been shown in several studies for various conditions such as plantar fasciitis and patellofemoral pain syndrome where the results are often similar in the short-term.

The long term advantages are questionable and depend greatly on whether or not the orthotics are used as part of a program of treatment (stretching, strengthening, good footwear etc.), and not just as a quick fix.

Expert opinions indicated that orthoses should be prescribed for specific indications and used selectively.

Expectations matter: orthotics may ‘suspend’ symptoms and assist to optimize function but not any more than this.

— ## How to Obtain and Use Foot Orthotics

Custom foot orthotics takes more than stopping off a shelf.

An appropriate fit is achieved by knowing about your foot type, your shoes and your symptoms.

Getting Assessed: Which Healthcare Professional and What will Happen. Podiatrists are usually the specialists who need to provide an assessment for an orthotic Prescription, but Physiotherapists and Orthopedic Doctors are also able to prescribe orthotics.

A comprehensive assessment often entails gait analysis, joint range of motion evaluation, forefoot and rearfoot assessment with the foot in both weight bearing and non-weight bearing, and at times a pressure-mapping analysis.

Then clearly define, with your clinician, what problem this orthotic is targeting, what shoes are safe to wear with it, and other treatments that will complement it.

That will lead the conversation to set realistic expectations from beginning.

Wearing in, caring for your new orthotics,and looking out for potential problems I would recommend wearing your new orthotics for only 1-2 hours per day initially and building up to full time over a period of 2 weeks. Giving your muscles and joints time to adapt to your new orthotic control gradually

They should be cleaned regularly with a damp cloth be careful not to subject them to excessive heat; this can cause warping of softer materials.

However if you notice the development of new pain or blisters, or if your posture becomes progressively worse after several weeks of consistent use, go back to your clinician for re-evaluation.

Most custom devices last two to five years (based on activity level and materials used) while OTC versions require replacement on average every six to twelve months.

Myths, pitfalls and cleverer options to foot orthotics Some myths about orthotics are well established.

If you are aware of what their true constraints are it will help you to make more intelligent choices regarding foot health in general.

Myths surrounding the use of orthotics The most popular myth about using orthoses is that they will rectify foot problems permanently.

They do not – they will suppress symptoms while you are wearing them but they will not retrain the muscles or change the shape of the bones permanently.

Another misconception is ‘more expensive doesn’t always means more effective’; this can often be contradicted by research.

However, some practitioners have expressed concern that long term orthotic use without strengthening could result in attrition of the intrinsic muscles of the foot.

This doesn’t imply that orthotics are dangerous. It simply says that they should not be used as a blind, multi-year scheme.

Other ways to help the feet. Selecting the correct footwear could be as vital as any insole/insert.

Proper arch support, a wide toe box and the proper heel height alone can greatly decrease the amount of stress.

Targetted strengthening exercises, such as toe curls, one-legged calf raises and short-foot exercises are effective in strengthening the intrinsic muscles supporting the arch internally.

Calf and Plantar Fascia stretching daily is good for heel pain.

For those who are heavier, even the smallest changes would help significantly reduce foot loading.

These may go along with orthotic therapy and, in mild problems, might even substitute for orthotic devices.