Pre-Fabricated Orthotics Insert

(Over-the-counter Orthotics)

Edited by MaCalus V. Hogan MD, Alexandra Gabrielli MD, & Stephanie M. Jones BA

Background

Orthotic inserts (either prefabricated or custom) may be helpful in the treatment of certain foot and ankle conditions, such as plantar fasciitis, acquired adult flatfoot deformity, metatarsalgia, and peroneal tendonitis. Orthotics work by replacing the original liner in one’s shoe, and provide a supportive base for the foot to rest on. Some orthotics aim to partially realign the foot, and most importantly to help disperse the force going through the sole of the foot over a wider area. An orthotic is like a bed for your foot. Just as a good bed will support your back when you sleep, a good orthotic will support your foot when you stand and walk, and aid in relieving pain. Similar to when you purchase a bed, it is important to check out various orthotics before purchase, but usually, a custom product is not needed.

Most stores specializing in comfort shoes, (as well as many running and hiking stores), will carry a wide array of orthotics. Additionally, there are online stores that have a wide selection of reasonably priced orthotics, however, there is no way to try these on for fit prior to ordering.

Things to consider when looking for an orthotic:

Comfortable top surface (the area touching for foot)

The top 2-5mm of an orthotic should provide a soft surface for the foot to rest against. Many orthotics are made of materials that may change shape over time. This is based on the amount of load that the orthotic is exposed to (i.e. if you have a lot of pressure in a certain area of the foot, a depression will develop there over time). Some pre-fabricated orthotics are heat moldable. They can be heated in the oven and then stepped on to help start the process of accommodating to your foot.

Semi-rigid base

The soft surface of the orthotics should sit on a semi-rigid base that gives the orthotic its shape. Usually, this base includes an arch support. The height and stiffness of the arch may determine how comfortable the orthotic is for the purchaser. Determining an appropriate arch height and stiffness can be counter-intuitive. For example, if someone has a  flatfoot, a stiff, high-arch support may seem like a good idea. However, a stiff, high-arch support may create too much localized discomfort in the midfoot, and it may be better to find a lower, more flexible arch.

In a similar manner, it may seem intuitive that someone with a high arch foot should have an orthotic with a high arch support. However, a high arch orthotic may increase the forces on the outside of the foot, so people with a high arch might be better off choosing an orthotic with a recessed area under the base of the big toe, as this will serve to position their foot in a more neutral position.

Sizing the orthotic

It is also important to size the orthotic appropriately. Different manufacturers make orthotics of different widths, so it is important to purchase an orthotic that is the correct size and width to ensure that the orthotic will fit comfortably in the shoes that you plan to wear them with. You should remove the insert that comes in your shoe before fitting in the orthotic. Orthotics are designed to be the only insert in the shoe and can cause discomfort if the original insert is not removed.

Orthotic add-ons for specific conditions

Some orthotics have add-ons which may be helpful in certain conditions. These add-ons may include:

• A built-in Metatarsal pad: This built up mound of padding is positioned just before the base of the 2nd and 3rd toe and can be helpful in the treatment of metatarsalgia, by off-loading the painful area.
• A recessed area under the base of the great toe: A depression under the base of the big toe may be helpful in patients with a high arched foot or sesamoiditis.
• Increased heel padding: This may be helpful in patients with symptoms from overload heel pain, like plantar fasciitis.
• Increased heel height: Adding a few extra millimeters of height to the heel of an orthotic insert may help in conditions such as insertional Achilles tendonitis.

A combination of a well-fitted orthotic, often combined with physical therapy strengthening and stretching program, can be very helpful for many conditions. However, if patients continue to have painful symptoms after an over the counter orthotic, they may need to see an orthopaedic foot and ankle specialist for evaluation and management.

Custom vs Pre-Fabricated Orthotics

Edited March 3, 2019

mf/ 9.17.18