Seeing a frustrated and defeated look on a patient’s face is not how I want to start my clinic day. Before the consultation visit even begins, I feel as if I’m going to lose this conversation.
I look over to the counter, where there are at least five pairs of different orthotics, ranging from over-the-counter inserts to multiple pairs of custom-molded orthotics. There is a shopping bag on the chair next to the patient’s seat, which is filled with several pairs of athletic shoes, and on the ground in front of the chair, there is a shoebox with a new pair of shoes that were purchased the day before but have not been worn yet.
I, not so subtly, glance at the clock, wondering how I am going to manage to keep the rest of my day on schedule after this visit. As I take a deep breath, I quickly come up with a strategy and begin the visit by learning a little about the patient…what brought her in today, how long the pain in her foot has been going on, what things she has tried (outside of spending more than $1000 on shoes and orthotics by now), and what she does for work and exercise.
After examining her feet, I head to the intimidating piles of shoes and inserts. Unfortunately, I find out that her orthotics were either uncomfortable for her or they did not fit her properly. That frustrated and defeated look sweeps across her face again, and it is starting to become all too familiar to me at this point. Today, the marketplace is filled with countless brands and different types of orthotics and that can be very overwhelming to any person, especially if one does not know what he/she is looking for.
Even though each orthotic has its own place in the market, it is important to know that they are not all the same. There are multiple things one should consider when selecting an orthotic, including the softness (or rigidity) of the material it is composed of, the length of the insert (e.g. ¾-length vs full-length), and the condition, or issue, being treated.
In most cases, I prefer a more rigid orthotic that is supportive in the arch. That does not mean it has to be hard and uncomfortable, but when standing on the insert, it should be firm along the arch and not collapse or flatten out. By having support across the entire bottom of the foot, it not only supports the arch and takes tension off the plantar fascia (the large ligament that runs underneath the foot), it also distributes the pressure underneath the foot over a greater surface area, thus taking some of the weight off the heel and the ball of the foot (if a full-length insert is used).
When it comes to the length of the insert, there are a couple of things to keep in mind, including one’s foot type and the foot condition being addressed. I recommend having a full-length orthotic to someone with a rigid, higher-arched foot, because their high pressure points are along the heel and ball of the foot, so it is important to support and/or cushion those areas. On the other hand, someone with an inherently lower arch, or an arch that flattens when standing/walking, may be able to use a ¾-length orthotic, because midfoot support or control is what needs to be addressed.
Another important thing to know is that modifications and customizations can be made to over-the-counter (OTC) orthotics that may not be addressed with the standard off-the-shelf orthotic. These can be done by a healthcare professional who is well educated with foot biomechanics and most often for a lower price than custom-molded inserts, and it may just be what the person needs to help with his/her ailments. And remember, when shopping for an orthotic, a “custom orthotic” usually means that a mold, imprint, or scan of the foot is taken and that is then used to create an insert, which is normally done in a lab or a doctor’s office.
After educating my patient on her condition, discussing her options, and playing arts-and-crafts in the storage closet, I am able to customize a couple pairs of her previously purchased inserts. That day, she leaves the clinic with only fifteen less dollars in her pocket (cost of her co-pay), but with newly modified orthotics and more optimism than she had arrived with. I walk out of the room, took a quick check at my watch…right on time…and then proceed to the room across the hall, where Mr. M is waiting for me to do his routine foot check.
Disclosure: This article is for educational/informative information only and should not be construed as medical advice. To find out which orthotic is best for you, contact the doctor or your own healthcare professional. At Your Feet offers OTC orthotics, customization of already purchased OTC orthotics, Light Orthotics, and custom-molded inserts.