ALL ORTHOTICS ARE NOT CREATED EQUAL
There are many different types of in-shoe devices that are referred to or marketed to the public as “orthotics”. You will see “orthotics” in TV infomercials, booths at consumer shows as well as a growing number of retails stores and specialty shoe stores. Arch supports and insoles sold in drug stores, shoe stores and sporting goods stores are now being called orthotics. Most consumers don’t know the difference between a true custom made prescription foot orthotic and an “orthotic” you can purchase from a retail store or a booth at a consumer trade show.
The following information will help educate you, so you are able to make an informed decision regarding your foot health when being prescribed or when purchasing a custom made prescription foot orthotic.
CUSTOM MADE PRESCRIPTION FOOT ORTHOTICS
Custom foot orthotics are medical devices that are custom made and are worn inside your shoes. They are designed to control the functions of the foot and the alignment of the foot with the lower leg and/or accommodate painful areas of the foot such as a painful pressure point or a corn. Most patients have very good results with custom foot orthotic therapy when worn in combination with well built stable shoes as opposed to old worn out shoes. Treatment with custom foot orthotics can result in a dramatic decrease or total reduction of pain in the feet for conditions such as heel pain, bone spurs and plantar fasciitis as well as pain in the lower legs, knees, hips and lower back.
Types of orthotics
Rigid orthotics are made to realign your feet. They are used primarily for walking or dress shoes and are often made of harder materials, such as plastic or carbon fibre. Rigid orthotics control the motion of two joints in your feet that are below the ankle. They are generally designed to prevent excessive rolling in of the foot, also known as over-pronation
Soft orthotics are more protective or accommodative. They are generally used to absorb shock, improve balance, and remove pressure from uncomfortable or sore areas of the foot. They are used primarily for arthritic, deformed, or diabetic feet and are made of softer cushioned materials that are designed to provide cushioning and shock absorption. One disadvantage of soft orthotics is that they may need to be replaced more frequently as they tend to break down easier than rigid or semi-rigid orthotics.
Semi-rigid orthotics are a combination of protection and functional control. Semi-rigid orthotics are great for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials.
Prescription Foot Orthotic Evaluation
Your assessment for a custom made prescription foot orthotic includes a number of steps and will incorporate the following:
- Medical history including general health, medications and allergies
- History of the main foot or lower leg complaint
- A lower extremity biomechanical examination while you are standing or lying on the examination table. This assesses for restricted joint range of motion, boney malalignment and tight muscles.
- Gait analysis assessment. You will be asked to walk and will be assessed for a number of issues such as a leg length difference or degree of pronation (arch flattening)
- Three dimensional plaster casting or laser scanning of the foot
- Writing of a detailed orthotic laboratory prescription. This is a form that is filled out by the chiropodist or podiatrist It contains all the details needed to manufacture your orthotics. This comes from all the information gained from your medical history, main complaint, biomechanical examination and gait analysis. Along with this information the following are some of the additional considerations that go into the design of your orthotic: your weight, your age, type of activity it will be used for, the type of shoe the orthotic will be used in, and the thickness and width of the orthotic. The detailed orthotic prescription, along with the casts of your feet, are shipped to the orthotic laboratory that manufactures your orthotics.
Your orthotics will generally be back from the orthotic laboratory and will be ready to be dispensed in about 2–3 weeks after your casts are taken.
CUSTOMIZED OR COMPUTER GENERATED ORTHOTICS
Customized devices are relatively new in the market and can be difficult to distinguish from genuine custom made prescription orthotics. Unfortunately, they are often marketed as "custom" and sold at similar prices. They are often referred to as computer orthotics. They are commonly a product of computerized force platform systems that capture and display pressure information on a computer screen and are typically made by modifying and/or adding components to a pre-manufactured insole. The patient is asked to walk over a square mat that is placed on the floor. This produces a two dimensional image on the computer screen and a colourful print out on a sheet of paper and there is usually no cast or 3 dimensional (3D) scan taken of the foot.
If there is no cast or 3D scan of your feet and you are simply walking over a mat on the floor, you are not getting a genuine casted custom made prescription foot orthotic. In qualified hands, force plates or platforms can be useful diagnostic tools for measuring pressure on the bottom of the foot but they are incapable of capturing true, three-dimensional impressions of your feet. Beware of the slick sales spin-- if there is no cast, it can't be custom made.
OFF THE SHELF ARCH SUPPORTS
Off the shelf arch supports are generally found in retail, drug, shoe, and sports stores. They are often helpful for minor cases of foot fatigue and pain and are sized according to your shoe size; they sell for up to $75 . Popular brands include Superfeet, Dr Scholls and Spenco. Our office carries an excellent off the shelf device called Powerstep.
FREQUENTLY ASKED QUESTIONS
If I wear orthotics will they change my feet?
I like to compare orthotics with eye glasses. Glasses help your vision when you wear them but they do not change your eyes. Orthotics are similar. They help realign your feet and legs when you wear them but they do not change the shape or your feet or give you an arch. Orthotics will help to heal an injury and continued use will prevent the injury from returning.
Will I have to wear special black laced shoes with my orthotics ?
No. We can fit orthotics into any shoe you have.
Will my orthotics fit in all of my shoes?
We can make orthotics for any shoe however they are usually designed for a particular type of shoe. An orthotic designed for a jogging shoe will not fit into a high heel or pump. Patients often require more than one type of orthotic to accommodate the differing styles of shoes. This is particularly the case with women’s shoes. You can transfer an orthotic into another compatible shoe. For example an orthotic made for a jogger will fit another jogger and your hiking boots.
How long will my orthotics last?
Your custom orthotics will generally last approximately 3 years. This does however depend on a number of factors such as: the material used, how often you wear the orthotics, the conditions under which you wear them, and how much your feet sweat. The more you wear them under more extreme conditions the faster they will wear. We recommend annual checkups for your orthotics.
I had a pair of orthotics made once before. They were uncomfortable and hurt my feet. My feet are still sore. Will another pair be worth trying?
Although they are custom made, there can be variation in the manufacturing process from laboratory to laboratory as well as variations in the quality of the cast or impression taken. A small percentage of patients need a number of adjustments made. We suggest patience and continue to see the person who dispensed your orthotics to have them adjusted.
I have private health insurance. Will my insurance pay for my orthotics?
We do not direct bill or deal directly with your insurance company. Most private insurance plans cover most or all of the cost of custom made prescription foot orthotics. We suggest you call your employer or insurer directly to see if you have coverage for orthotics and what the limits are for coverage as the amount of coverage varies from plan to plan. Most insurers require you pay in full for the orthotics before you are eligible for reimbursement.
My insurance company requires a prescription and a biomechanical evaluation. Can you provide this?
In Canada most insurance companies require a prescription from your Family Doctor (MD), your Chiropodist or a Podiatrist as well as a biomechanical examination from your Chiropodist or Podiatrist for orthotic reimbursement. This can vary from insurance company to insurance company. We recommend that you contact your insurance company to determine what documentation is needed as well as what health professional can prescribe and/or dispense the orthotic. If you purchase your orthotics from either an unlicensed person or non-approved dispenser your insurance company may deny your claim.