Orthotics – clearing up misconceptions

by admin on August 20, 2013

As a podiatrist, one of the more valuable options for treatment of mechanical abnormalities of the foot and ankle are orthotic devices.  Commonly just called orthotics, these are molded insoles that alter the mechanics of gait and the function of the foot.  Yet in talking with patients I hear a lot of misinformation about orthotics.  Often when I recommend orthotics, I’ll have patients ask “Can’t I just buy an arch support at Wal-Mart?”  Well, the two are apples and oranges, although companies that sell arch supports know you don’t know the difference, and attempt to capitalize on it.  So, allow me to clear the air.

OrthosesBiomechanically, we talk about the foot in “neutral” position as being the standard, resting position of the foot in the average person.  Neutral position is where the hip, knees, ankle, and foot are lined up and there is an average arch.  In the neutral position, muscles work most efficiently, tendons glide smoothly, and ligaments are under minimal tension.  The farther away you get from neutral position, the harder all of these structures have to work to move, transfer body weight, and propel your body forward.  The army famously did not accept flat-footed individuals for a long time because they could not keep up in a march.  In a flat-footed individual the ankle collapses inward with weight, torquing the knee while the hip struggles to remain straight.  The muscles have to work harder to achieve normal walking movement, expending more energy than someone who is not flat-footed.  Overuse of the muscles, right off the bat, leads to early fatigue and fatigue leads to injury.  Return of the foot to the neutral position makes the muscles more efficient and work more easily.  Most of our orthopedic problems affecting the feet stem from deviation from the neutral position.

This is where orthotics come in.  Orthotics are designed to return the foot to neutral position to function more efficiently. There may be support of the arch if necessary, but there may also be support in the ball of the foot, support of the ankle, cushioning of the heel, balancing of the forefoot to the rearfoot, or any number and combination of dozens of modifications that can be made to orthotics to treat specific injuries or problems.  If someone needs an orthotic device, measurements are taken and cast impressions are taken, while the person is sitting in a chair, with the foot in neutral position.  The cast is then sent with the measurements and a prescription for the specifications (modifications, materials to be used, etc) to a lab that fabricates the orthotics based on the cast.  The process is similar in many ways to being measured for and having glasses made.  They are specific to your body, specific to a problem you are having.  This is the important distinction between orthotics and arch supports.

In orthopedic lore, arch supports are said to have developed when housewives of the early 20th century discovered that they could help combat foot fatigue when standing long periods if they stood on a broom handle.  This concept was capitalized on by Dr. Scholl (yes, there was a real Dr. Scholl, you can read about him here) who made the first commercially available arch supports.  These were really little more than a piece of cork stuffed up under the arch inside of the shoe, marketed to prevent foot fatigue.  Later on cushioned insoles (think gels) were also developed, to combat the hard and inflexible soles of most shoes in the olden days.  These two types of inserts (arch supports and cushioned insoles) still form 90% of what you can buy over the counter.  Their purpose is to make your shoes more comfortable, though not necessarily more functional.

I hope this helps to clear up the difference between prescribed orthotics and over the counter arch supports.  For one thing you may want to think twice before wasting your money on a pair of arch supports for your excruciating heel pain.  Secondly, if your doctor is prescribing you orthotics, that’s probably because you actually need them.  There is just no substitute.

Comments on this entry are closed.

Previous post:

Next post: