© SKI Publishing
Orthotics Work For You?
By Christine Dobrowolski,
Orthotics are devices which fit into the shoe to aid the foot. "Functional
orthotics" are rigid and designed to control motion and correct the function
of the foot. Individuals with flatfeet, tendonitis, plantar fasciitis, certain
foot deformities, knee, hip and back problems may benefit from functional orthotics. "Accommodative
orthotics" are soft and designed to reduce pressure and prevent excess friction.
Diabetics and those with a loss of sensation or circulation in their feet will
benefit from accommodative orthotics. Both types of orthotics are custom made
by taking a mold of the foot.
The goal of the functional orthotic is to improve the mechanics of the foot,
control the abnormal motion in the foot, decrease the pain in the foot, ankle,
knee, hip or back and to add support. The orthotic should make standing, walking,
jogging or running more comfortable. The orthotic must be rigid to help control
the motion in the foot and add support. If the orthotic is soft, the weight of
the body would collapse the device and it would no longer function.
motion is typically in the form of pronation. Pronation is the rolling in of
the foot and collapse of the arch. The motion starts at the rearfoot, or
heel area. When the heel turns in, it allows the arch to collapse. This puts
undue stress on the ligaments and tendons in the arch area and contributes
to the development of tendonitis, plantar fasciitis, bunions and hammertoes.
functional orthotic helps to control the abnormal motion in the rearfoot. This
is accomplished by taking a mold of the foot in its neutral position. The neutral
position is the position the foot should be in when walking. When standing,
the over-pronated foot is in the uncorrected position. The mold of
the foot should
be taken with the patient sitting so the foot can be placed in the neutral
The molds are sent to a lab and scanned into a computer. A reverse image is
produced and the computer generates an image of the foot in neutral position.
adjusts the image based on the corrections recommended by your podiatrist.
A model of the foot is then cut out, in some cases out of wood. The orthotic
is pressed over the foot model and the orthotic is created. The most common
material is polypropylene, but other materials, such as graphite are used.
In some cases,
hand-made molds are created out of plaster. This was the classic way orthotics
were made until newer technology made the process much less labor intensive.
orthotics are a successful treatment for many problems affecting the lower extremity.
In a recent article in the Journal
of the American Podiatric
Medical Association, 75% of patients surveyed had good to excellent results
from functional orthotics. This includes 17% who felt the orthotics "cured" their
pain. Less than 10% had no relief. The most commonly treated condition in the
study was a painful heel. Over 20% of patients surveyed were treated for a
painful heel and 20% were treated for a painful arch. Fourteen
percent of the individuals
were using orthotics for flatfeet. Other conditions treated with orthotics
were knee, hip and back pain, foot arthritis, bunions and high
was not specifically evaluated.
Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet
usually respond best to orthotics. The plantar fascia is a ligament type structure
on the bottom of the foot which helps to hold up the arch. When the foot collapses,
the weight of the body stresses the ligament and results in tearing and inflammation.
This results in plantar fasciitis. These individuals typically respond well
to orthotics in combination with other treatments. Certain types of tendonitis
well to orthotics and other types require orthotics. Posterior tibial tendonitis
is the tearing and inflammation of the tendon that helps to hold up the arch.
When this tendon is overstressed by arch collapse it cannot heal. Orthotics
are essential in the treatment of this condition.
Individuals with high arches may require orthotics as well, but they do not
respond as well. Orthotics can help slow the progression of bunions and hammertoes,
they will not prevent this process. Orthotics may help with some pain at a
bunion, but they will not "cure" the bunion. When the motion in the
foot is contributing to the problem, orthotics are generally recommended. If
is stable and does not require support, the bunion, hammertoe, neuroma, tendonitis
or even plantar fasciitis may not require custom made orthotics for treatment.
These individuals may do well with a pre-fabricated orthotic.
Diabetics can develop numbness and loss of circulation in the feet. This numbness
and circulation loss puts them at risk for developing open sores on the feet
called ulcerations. To help prevent excess rub and friction in certain areas
on the feet, accommodative orthotics are recommended. Diabetics who do not
have numbness or circulation loss (as diagnosed by their doctor) do not need
accommodative orthotics. If the foot has a deformity, like a bunion or hammertoe,
then accommodative orthotics are necessary.
Accommodative orthotics are made from many different types of material. Some
are made of a foam type material, others made from cork and others have covers
ranging from soft spongy material to leather. The type of material depends
on the type of foot. Many accommodative orthotics, made for diabetics, have
or more layers that form around the foot once they are worn. Three pairs are
dispensed every year and they are replaced every 4 months. Other materials
are longer lasting. A mold of the foot is taken by stepping into a foam box.
case, it is important to take the mold standing, so that the orthotic can be
made for form around the foot.
Many insurance companies cover orthotics for certain diagnoses. The most commonly
covered diagnoses are plantar fasciits (heel and arch pain), flatfeet and diabetes.
Many insurance companies cover the orthotics at 80%. This means the patient
is responsible for 20% of the cost unless they have a secondary insurance.
deductible has not been met, then the amount is applied to the deductible and
the patient must pay the full amount. Orthotics are not cheap. They range from
$250 to $500.
Medicare covers orthotics for diabetics with neuropathy (numbness on their
feet). Medicare does not cover orthotics for any other type of foot problem.
insurance will not cover orthotics if Medicare does not cover them.
Podiatrists are the most common prescribers of orthotics, but pedorthotists,
orthotists, physical therapists and sometimes orthopedists will also provide
Dobrowolski is a podiatrist, runner, and author of "Those Aching Feet:
Your Guide To Diagnosis and Treatment of Common Foot Problems," available
via her publisher, SKI Publishing, and at Barnes & Noble and Amazon.com.
by Dr. Christine Dobrowolski, DPM
Products at Northcoast
Heel Pain Kit