Orthotics
WHAT IS AN ORTHOTIC?

An orthotic is a special type of insole to be worn inside a shoe. It is designed to relieve foot pain by limiting movement in unstable foot joints, or by providing support to excessively stressed areas of the foot.

Orthotics can range from simple off-the-shelf arch supports to custom-made high-tech devices. The materials used to make them vary from hard plastic to softer foams of varying densities. Depending on the combinations used, the orthotics may be rigid, semi-rigid or soft. In general, semi-rigid orthotics provide the best combination of support and comfort. If your symptoms are mild and of short duration, and if the degree of your foot abnormality is minimal, an inexpensive off-the-shelf insole may suffice.

WHAT ARE THE INDICATIONS FOR ORTHOTICS?
Conditions helped by orthotics include bunions, calluses, plantar fasciitis (heel pain), metatarsalgia (achy feet), and symptoms related to high-arched or flat feet. Orthotics may also help relieve pain in the knee, hip and back.

WHO SHOULD YOU SEE TO BE ASSESSED FOR AN ORTHOTIC?
Many practitioners are now providing custom-made orthotics. These include pedorthists, chiropodists, podiatrists, physiotherapists, chiropractors, kinesiologists and physicians. Their training can vary from a weekend-long course to an in-depth program over 3 to 4 years. Some provide this service as a side interest while others specialize and focus primarily on orthotics and footwear modification. (See the next article on Pedorthists.)

If you do need an orthotic, make sure the person doing your assessment and fitting has had lots of training and experience. The success and comfort of your orthotic depends on his or her technical skills, no matter what system is used. It also helps if they have the capability to do some on-site adjustments and alterations, since it will take a lot more time to get a good fit if the orthotics have to be sent back to the lab. Finally you should ask what will happen if you can’t get a comfortable fit.

HOW ARE ORTHOTICS FITTED?
Measurements for orthotics are usually obtained by one the following methods: taking a plaster cast of the non-weight-bearing foot; making an imprint of the weight-bearing foot in a foam block; having the patient walk on a pressure-sensitive pad; or obtaining computer-generated images of the foot with the patient standing or walking. The resulting information is then used to fabricate the orthotic. This may be done on-site or through an outside lab.

If you are being assessed for orthotics, you should be asked to bring in your shoes, since they play an important role in the success of the orthotics. (In order for orthotics to be effective, they should be worn in lace-up shoes that provide enough room and support for the orthotic). Your assessment should also include an observation of your walking patterns and a hands-on examination of your foot.

WHAT IS THE COST OF ORTHOTICS?
Be prepared to pay anywhere from $350 to $500 for a pair of orthotics. Although this may seem like a lot, they should last a long time and the benefits are usually worth the price. If you have an extended insurance plan, at least some of the cost may be covered if you have a prescription from a doctor. It is best to check with your doctor at the outset to make sure that he will support your claim.


WHAT IS A SKI BOOT FOOTBED?
Ski shops provide a type of support called a foot-bed. Foot-beds can make the boot more comfortable and improve edge control by adding inward or outward tilt to the foot. Since foot-beds gain a lot of support from the rigidity of the ski boot, they don’t need to be as substantial (or as expensive) as daily wear orthotics.

(For more information see the article titled “Pedorthic Services.”)