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Orthotics - what's the deal?

"I have flat feet, I need orthotics". This is a common thing I hear in the clinic. Orthotics are probably the most asked about thing from GP's and other medical/allied health professionals. It is also something that I feel is often misunderstood. I want to quickly try to summarise my thoughts around this topic.

Orthotics are put in place to change the way our foot moves when walking. This can alter the loading through the feet and legs (and potentially hips and back) in a way that reduces stress to areas that are either currently problematic, or deemed to be at risk of being problematic.

There are many therapeutic options available in podiatry that are not orthotics. Although orthotics can be very beneficial for the right case, it is fair to enquire with your practitioner as to whether there are any other options that would suit your case. I always try my best to remind people that most injuries are like a big puzzle, with lots of pieces. Some are big pieces, and some not so big. Orthotics are just one piece of the puzzle, and usually other advice will be required in addition to recommended them.

Before prescribing orthotics, I often like to trial a few temporary changes via padding and/or taping to see how someone's body responds. It gives me more insight as to whether orthotics may work well, and how they should be designed.

In podiatry there are 2 main types of orthotics: prefabricated (over the counter style) and customised (fully customised to an impression or 3D image of your foot). A custom orthotic can have many variations and the Podiatrist can decide where to support your foot and how much (amongst many other things such as padding and pressure relief area's etc).

Some of the people who may be suited to pre-fabricated orthotics are:

  • Individuals who are under 16 years of age. A lighter frame typically does not need as much 'support' and often kids will bounce back quickly once you give them some exercises to do and support them for a short period of time. Also we need to be consider how quickly people this age group can grow out of their orthotics.

  • People who have a fairly 'short term' injury. I will often prescribe these as a 'rehabilitation tool'. If I am confident an injury will settle well with therapy, I may opt for these devices for 6-8 months to reduce pain when walking/running whilst we rehabilitate. Ideally after this rehabilitation time, we will have reduced our reliance on orthotics and phase them out.

  • If we want to trial your body's response to support.

I consider these factors for the use of custom orthotics (not limited to the following):

  • If your body is no longer growing and you are likely to require support for longer than 1 year. One thing parents can be disappointed with is when their child grows out of their custom orthotics very quickly.

  • If the way you walk is 'severely' rolling in or out. Prefabricated orthotics will address a low level of 'rolling in' (over-pronation). They typically don't address rolling in or out heavily.

  • If the way your feet move is asymmetrical. Given pre-fabricated orthotics are identical to each other, they may not cater for a person that has 1 foot move in a different way to the other.

  • If the joints in your feet do not move as much as we would like or are asymmetrical. If your joints do not move enough, putting a support under your foot that doesn't match your foot accurately, your foot may not 'contour' the pre-fabricated orthotic. This often can lead to pain and other issues.

  • If you need to fit your orthotics in very low bulk shoes such as ballet flats and pump style shoes

  • If you have had success with prefabricated orthotics and would like a more durable option.

If you're thinking about foot pain and whether orthotics are appropriate for you, feel free to chat to your podiatrist about if they think it would work for you. Don't be afraid to ask questions about what else you could be doing to help prevent or manage your pain/injury. it is also important to understand why orthotics may be beneficial for you.

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