Orthotics
What are orthoses?
Orthoses (or orthotics) are special inserts designed to go into
your shoes. These can either help to redistribute and cushion
pressure (accommodative orthotics) or control / improve the way
your foot and leg function (functional orthotics).
Why do I need them?
Your specialist has determined that your foot and leg function
may be improved by using an orthotic and that this may reduce your
pain. By reducing excessive motion and encouraging your foot to
move in the right direction at the right time, orthotics allow the
bones and muscles of your feet, legs, pelvis and back to function
correctly, thus reducing excessive stress and strain.
Why haven't I needed them before?
Our feet were designed for walking on uneven ground of varying
densities (grass, mud etc.). It is rare for anyone to have perfect
foot function and walking on hard flat surfaces aggravates any
abnormal function. Increased levels of activity or reduced function
with age can all contribute to the onset of symptoms. The average
person takes 5,000 to 18,000 steps per day (2,500-9,000 per foot).
It only takes a small level of stress, repeated thousands of times
a day, to either cause or aggravate injury.
Can I be certain they will get rid of my problem?
No. Much like most treatments, no guarantee can be given.
However, your specialist has performed a detailed assessment to try
and determine the potential benefit of orthotics. These should form
part of a wider treatment plan, with many patients needing a
combination of interventions that regularly include footwear
changes, stretching and strengthening exercises. Orthotics form
part of this process but cannot cure everything. If you still have
symptoms, further investigations, injections or even surgery may be
required to resolve your problem.
Will orthotics cure my problem?
Whilst they may help your symptoms resolve, they do not correct
the underlying function, they control function. Rather like a pair
of glasses where you still cannot see when you take them off, when
you stop wearing orthotics, your foot will go back to its original
position.
Does that mean that I need them for the rest of my life?
Not necessarily. Many people develop injuries and the underlying
foot and leg function prevent the injury from healing. Orthotics
can help to reduce stress to the injured area and allow it to heal.
As long as appropriate strength and flexibility are restored, you
may be able to walk or exercise without your orthotics. However, if
the problem returns, this is probably an indication that you need
to use orthotics for this level of activity.
Do I need custom orthotics?
Preformed or off the shelf orthotics are available from shops
and many clinics. There are manyb types of preformed orthotics and
these can be adapted to an individual. These can be extremly good
for many people. However, these provide a standard degree of
control and are generally made for the average foot shape and are
therefore not suitable for everyone. It is not uncommon for each
foot to function differently, thus the level of support (control)
provided needs to differ for each foot. Many people have a foot
shape that does not conform to the average, making preformed
orthoses uncomfortable. Frequently, the degree of control (support)
required is greater than can be provided by a preformed orthotic.
Generally, the fit, feel and function of a custom orthotic is
improved compared to a preformed version.
Will I need to have one for every pair of shoes?
No. Most orthotics are made to the foot not the shoe and are
therefore transferable. However, they still require a shoe of
sufficient length and fit, preferably with a fastening to hold the
orthotic in position and to allow it to function correctly. In some
instances, (more frequently with accommodative orthotics), the
orthotic is made to fit a specific shoe. However, this tend to be
for patients with more sever foot deformities.
Will I be able to wear the orthotics in fashionable shoes?
It depends on the shoes. Many slip on shoes have to be tight in
order to stay on the foot. Therefore, when an orthotic is placed in
the shoe, the shoe either becomes too tight or the heel slips out
of the back of the shoe. Whilst slimmer versions can be made, this
reduces the support of the orthotic and therefore the potential
benefit. Usually, in order to try and resolve the problem, your
specialist will advise you which type of shoe you should be using.
This is often a wider style and fit with a lace or adjustable strap
to hold your foot in position. Whilst this may not be your
preference, this is probably what is required to help you get over
your problem and potentially return to wearing the shoes you
prefer.
I have heard that orthotics are often hard.
This is true. Essentially, for a given degree of support, the
softer orthotics are thicker, whilst harder orthotics are thinner.
Therefore, harder materials are often chosen as they provide better
shoe fit and last longer. Many harder orthotics come with a
lifetime guarantee.
Will I need a softer one for sport?
Possibly. However, many athletes are able to run up to marathon
distance with harder orthotics. It varies considerably from
individual to individual with some people unable to tolerate harder
materials for sport. Often, a hard pair are provided initially to
check that the degree of control is appropriate and whether you can
tolerate it for sport. This can reduce the cost and allow any
modifications before prescribing a second pair. If necessary, a
second softer pair will be prescribed. However, these will wear out
quicker and need replacing from time to time. You should discuss
this with your specialist if you have any concerns.
I only have a problem during sport; do I need them for
everyday?
Probably. If the orthotic is changing the way in which you foot
functions, it can often take up to 4 weeks for your body to adapt.
If you simply wore the orthotic for sport, your body would have to
adapt each time you played. This can cause discomfort, which is
incorrectly blamed on the orthotic.
I have been told my problem is due to my pelvic function. How
does this affect the foot?
As our knowledge of body function has improved, it has become
apparent that poor position (posture) and muscular control of the
pelvis and spine can affect the way in which the legs and feet
function and vice versa. In many cases, it is a combination of
postural and foot related problems. Our assessment includes an
evaluation as to which aspect is the source of the primary problem.
If necessary, we can utilise sophisticated computerised gait
analysis to help determine the source of the problem. In some
instances, orthotics can be used to help improve your overall
function and posture whilst you are performing your stability
exercises. When appropriate strength and stability have been
achieved, you may be able to dispense with the orthotics. However,
if symptoms return and you have continued your exercises, this
probably means that you need to continue using the orthotics.
Will the degree of support I need change with time meaning I
need new orthotics?
Possibly. Unfortunately, there is very little scientific
evidence available to indicate how many people and how often this
is necessary. In some instances, the degree of control needs to be
increased over a period of time or adapted if your posture alters.
This will be advised if necessary. However, a yearly review may be
of benefit as it is more likely that function has been affected by
altered strength and flexibility and this can be addressed prior to
any problems.
!This information sheet is designed to answer the common
questions and concerns raised by patients. At premier Podiatry
limited, we try and ensure that all our patients are advised in
detail about the type and nature of orthotics they require. If you
have any further questions, please contact us for advice.