A custom orthotic is a specially made shoe insert designed to increase the mechanical efficiency of the foot. My goal when making them for my patients is to have the patient standing in their shoes at the best mechanical position for the maximum function of their mechanism of gait. An orthotic will compensate for any structural or postural instability in the foot, thereby relieving abnormal stresses on the foot, ankles, knees and low back.
How does an orthotic differ from an arch support you can buy at the drugstore?
The over the counter arch support does just that, it helps the arch support your full weight. The custom orthotic, on the other hand, maintains the foot in the normal position through the entire footstrike, from heel contact through mid-stance to toe-off. There is more science in a custom orthotic taking your joint mechanics into account where one size fits all drug store type just doesn’t have the flexibility to adjust for your particular foot or gait mechanics.
Why is this overall control of footstrike necessary?
Because errors in footstrike cause most overuse injuries, contributing to injuries in the foot, ankle, knee, hip and lower back. Depending on the individual foot, the origin of injury may arise in the rearfoot, midfoot, or a combination.
Does every athlete/everyone need an orthodic?
One of my mentors once said “50% of your patients desperately need orthotics, the other 50% will merely benefit tremendously from having them.” I think this may be a slight overstatement but most people do benefit from orthotics. Often times they have positive results other than the ones they presented in my office to address.
The reason this is so often the case is that when one joint in the kinetic chain is not functioning at its best, the joints above and below start to have issues due to their compensating for the joint between them that isn’t performing at its best. As a result often times a patient will come in for a problem in a foot or knee and find their low back or ankle benefits from the adding of an orthotic to their health care regimen.
I've heard people say that they spent hundreds of dollars for orthotics and are still have issues in their foot or legs, why is that?
There are numerous factors one needs to be aware of when making custom orthotics. If your doctor is unaware of these factors or just “Missed” the orthotic may require some correction or re-manufacture. That being said, there is no guarantee with any medical procedure or device that you'll achieve perfection. I can say however that statistically speaking orthotics have a very high success ratio in helping people with lower extremity problems.
The points to consider when making custom orthotics are:
Your orthotic has to support your foot in its neutral position. This position can be hard to find particularly if your practitioner isn’t aware of or looking for it. The result of missing this point is an under or over correction of your joint mechanics which can lead to further issues in any of the lower kinetic chain.
You should also be assessed by your practitioner for anomalies that may appear in the leg itself. If you have a short leg for instance the orthotic needs to have a heel lift added in order to stabilize the pelvis.
It may also be that you have asymmetrical muscular development, which can also aggravate the situation and may need to be addressed with proper training.
What do I do if I get a pair of orthotics and they don’t seem to be working for me ?
Don’t be afraid to contact your provider should you have issues with your orthotic. It may be that there is some further adjustment needed to the device itself based on your user experience.
There is also a break in period and sometimes the patients are not informed of this by their practitioner and therefore their expectations are not being met when it may be they need to alter the pattern of wearing their orthotic for a week or so based again, on their user experience.
I’ve been wearing orthotics more often than not for about fifteen years. What I noticed was amazing as the main positive effect for me was a massive reduction in chronic low back pain. I had no expectation of my back pain improving due to the orthotics and this is the main reason I have become such a proponent of custom orthotics.
Orthotics aren’t a panacea and can’t fix all things for all people. But there are amazing amounts of people who get them and are VERY impressed by the results.