Currently there are more and more patients coming into the clinic inquiring about orthotics and how their use would affect their body. Orthotics can be divided into two categories and each has their own discussion.
Prefabricated orthotics (over the counter, non-custom)
Orthotics that can be bought at your local drugstore work under the concept that people’s feet fit into basic categories. Often these inserts can be advertised to “reduce back pain” or to “reduce fatigue” or simply to “massage your feet every step.” However, people’s feet are like their footprints, or better yet, like a finger print. No two feet are the same. While shoes and socks are mass produced, we break in shoes and the shoes will adapt – sometimes. Haven’t you even had a pair of shoes that killed?
Basically, the many bones, joints, tendons, ligaments and muscles in your feet and ankles CAN be helped with mass produced orthotics – IF you don’t have any abnormalities or dysfunctions. Many feet are close enough alike that the can feel great with a gel insert or a little arch support. But much like their low cost, they wear out quickly and don’t typically do as much as the box states they will.
Orthotics that are custom molded for your feet will help all feet – injured or not. A custom orthotic is made from a plaster cast of your foot in a non-weight bearing neutral position called subtaylor joint neutral. Based on your mold, it can be determined what the difference between your foot and the ground. Then the orthotic’s use will allow your foot to be in the proper neutral position at ground strike. For people with impairments, this is very beneficial to ensure proper foot mechanics because the injury otherwise would prevent this from happening.
However, I always recommend patients wait until after physical therapy has at least established the initial mechanical improvements with the foot and ankle which can take several weeks. Otherwise the mold and cast will be for the pre-improved foot, thus making the orthotic no longer “custom” for your current foot. It’s always the best idea to try to fix the problem first, as bracing is always an option. And when it comes to a custom orthotics, it really is always an acceptable option.