Foot orthoses (sometimes referred to as ‘orthotics’) are shoe inserts that can be recommended or prescribed for you in the context of your lower limb pain or injury.
Although once believed to be analogous to a brace which corrected your alignment or appropriately repositioned your foot, a modern and contemporary understanding of the underpinning science allows us to confidently state that they rarely achieve such goals, and if they do it is unpredictable and person specific anyway; (much like human responses to most medical interventions are). Furthermore, foot orthoses do not seem to have to be able to achieve such goals to achieve positive outcomes or success.
Instead of framing foot orthoses as corrective devices or supports, we should instead consider them as a useful tool in modifying loads/forces on tissues. They have the ability to reduce the amount of force on tissue (ligament/tendon/bone), whether this be the time it is under force, the direction of the force or the magnitude (i.e. total amount) of the force. Whether they are successful in doing this. (and the exact tissue/s they may be able to do it for,) will depend upon their design features, such as the material they are made from and their shape.
We will consider medication for this next analogy. If a drug is administered at a dose which is too low, then it is likely there will be no beneficial effects. At too high a dose the risk of ill effects (adverse reactions/toxicity etc.) is greatly increased. Ideally somewhere in the middle is the correct dose which will bring about the desired outcome, assuming of course it is the appropriate drug for the problem in the first place. Using this as a premise for foot orthoses, it is quite possible to wear such devices and feel no benefits at all or indeed feel adverse effects from them (comfort/tolerance issues or pain at a new site). The challenge when prescribing them is to ensure they are the correct intervention for the problem, and then that they are ‘dosed’ as appropriately as possible, which our Sports Podiatrists aim to do following a thorough and individualised examination.
Most recipients believe that foot orthoses are a life sentence (not unlike the spectacles issued by their Optician); essentially an external device which corrects a function of their body. The reality is that for many they are likely to be more like a sling for a dislocated shoulder rather than a pair of glasses – a tool used in the short term to help desensitise an irritated part of your body and as a short term piece of a wider rehabilitation puzzle. There will of course be individuals whom for which longer term use is advised, and this will normally be part of the discussion at their time of issue.
The physics of the situation is unavoidable; if you put something in your shoe, there will be less volume available for your foot. As such shoes may feel a little more snug initially, but should never feel uncomfortably restrictive or tight. Our Sports Podiatrists usually design foot orthoses with one eye on the footwear worn (and the activities being performed upon it) which gives them reasonable confidence they can get them in to most appropriate footwear, even if it means having a slightly different pair for your running shoes to your work brogues.
The key differences here are generally the cost (custom-made are more expensive), the durability (custom-made last longer) and the control our Sports Podiatrists have over the design features such as materials and shape etc. (custom-made allow far greater control of these). Regardless of the choice made here, if the device issued is essentially the “right drug at the right dose” then the outcome is likely to be positive. Cheaper off the shelf devices absolutely have the ability to achieve these good outcomes for many if chosen well.
To summarise, foot orthoses are just one tool utilised within a wider rehabilitation strategy. They’re better thought of as ‘force modifiers’ than they are ‘arch supports’ or ‘skeleton alignment correctors’ Responses to them are variable and specific to each person. The chance of a positive outcome with them greatly increases if a reasoned prescription process is applied following the individualised assessment of the context and needs of the recipient. A discussion regarding why they may be needed, how long they may need to be worn for, and what sort of device may best achieve success would usually take place at the conclusion of an assessment.
If you would like to discuss anything further or would like specific advice on foot orthoses, or a current injury, you can book a consultation with a member of our Podiatry team here.