Not everyone who comes into my office needs orthotics. But, without them many of my patients will keep coming back. Why? Without orthotics, bunions, hammertoes, neuromas, and plantar fasciitis return. That’s because these conditions are often symptoms of an underlying biomechanical imbalance. So, without correcting the imbalance, you won't find pain relief. Unless you wear orthotics and let them work on the imbalances.

And guess what? Orthotics can help do more than correct your body's biomechanics. For many runners, adding orthotics can improve athletic performance. By getting your body in proper alignment, orthotics can also help you build bone and muscle strength. Plus, they can help improve your posture, and may even reduce your risk for athletic injuries.

Still, not every one needs orthotics. So, in my office, I conduct thorough exams to see if orthotics can help you. What am I looking for? Signs that your bones, joints, muscles, ligaments or tendons aren’t performing the way they should. And, if I spot those signs, I’ll likely recommend that you get fitted for an orthotic device. At that time, we’ll have to decide what type of orthotic is best for your feet. 

How to Choose the Best Orthotic for Your Feet 

Many castings for orthotics will involve a process like this one.

There's so much variety in the world of orthotics. I can make them from a range of materials. They come in different sizes, lengths and levels of flexibility.

So how do I decide which custom blend to deliver? A variety of factors go into the decision. These include your height, weight, and lifestyle. I also consider any medical conditions, such as diabetes, that may impact your foot health. Of course, every one has different needs—heck, that’s why we make these devices ‘custom.’

But here’s a basic guide to picking your proper level of orthotic rigidity.

Soft orthotics: also called "accommodative orthotics," they're built from soft compression materials. They cushion your feet and relieve pressure in sore spots. Soft orthotics are great if you have heel pain or plantar fasciitis. They're also perfect if you're at high risk for diabetic foot ulcers.

One thing to consider: soft orthotics take up lots of space. They're bulky enough that you may have to wear them with prescription shoes. Since they may not fit into typical pairs.

Rigid orthotics: also called "functional,” they're made from carbon fiber or plastic. They are less bulky than soft orthotics. So you can fit them into most walking shoes, or even in closed-toe, low-heel dress shoes. I recommend rigid devices for strained, achy feet, or if you’re also experiencing leg and back pain.

Now that we’ve reviewed the flexibility of your orthotics, let’s talk length. A full length orthotic can be very supportive. Still, I often tell my patients to choose the ¾ length instead. Why? With a shorter orthotic, your device can fit into many different pairs of shoes. Which means that your day won’t start with a choice: wear the shoes you want, or keep your feet in your orthotics. And, since wearing your orthotics prevents pain and foot deformities, that’s a choice I don't want you to make.

Which Conditions Do Orthotics Treat? 

Orthotics can help with more than foot pain. Wearing orthotics can also relieve back, knee and hip joint pain. That's because many of these problems result from your foot positioning. Or from insufficient shoe padding, something orthotics can also correct.

Diabetes can also protect their feet with orthotics. With diabetes, you may develop peripheral neuropathy. (This oc

curs with damage to the blood vessels that supply your extremity nerves.) With neuropathy, your feet may go numb, or feel painful.

When feet go numb, you won't notice if your shoes hurt or put pressure on your feet, so wounds may go unnoticed. Orthotics help keep pressure off your feet to avoid this kind of damage.

If you have high arches or flat feet, you also may need orthotics. With high arches, you lose foot support, and may experience knee pain and heel pain, or even shin splints. With low arches, ankle, foot, and back pain are all common. In both situations, orthotics can support your foot. And keep it in a natural position to stave off pain.

Finally, orthotics can help prevent foot deformities such as bunions. Bunions develop at the base of your big or little toe (bunionette). This change happens if your foot or toe bones move out of place. some of the bones in the front of your foot and toe shift out of place. Orthotics can take pressure off your big toe joint, so it doesn't shift. Even if you already have a bunion, a custom orthotic can protect your foot from continued growth.

The same is true for hammertoes. Orthotics can help keep your foot in a relaxed, natural shape. So even existing hammertoes don't get worse.

This rigid, full-length orthotic provides arch support for a flat-footed patientMaking Orthotics More Affordable

Custom orthotic devices go a long way towards alleviating your foot pain. But they aren’t a cheap solution. Sometimes, insurance will cover your custom orthotics. But other times, you may have to pay out of pocket for these devices. That’s where a Health Savings Account can help make your orthotics more affordable.

If you open a Health Savings Account (HSA), you can set aside pre-tax dollars to cover the expense of orthotics. The bad news is, you can't carry over funds from one year to the next. But the good news is that you can use HSA funds at any point in the year to cover the cost of your orthotics.

Now, that's a smart way to make orthotics more affordable. But here's one cost-cutting method that won't work as well: buying OTC shoe inserts. And this is why. 

Custom Orthotics vs. Lower Tech Inserts 

Studies show that, when it comes to shoe inserts, you get what you pay for. Custom orthotics decrease runners' injury risk by 28 percent. And they offer a 41 percent lower risk of stress fractures. But shock absorbing inserts, especially ones you get over-the-counter or from a printer? They don't offer injury-prevention. In fact, some evidence suggests wearing these thinner, flat insoles increases your risk.

Now you see the risks of choosing the wrong kinds of insoles. But proper orthotics do more than prevent injury. Because custom orthotics are prescription shoe inserts. They're crafted from a mold of your own foot. So your fitting process includes a thorough gait analysis--both visual and digital. In this way, as I build your orthotics, I assess the improper motion of the foot while you walk.

That way, your orthotic will reduce excessive pronation (aka rolling. Confused about pronation vs supination? Remember, pronation is when your foot rolls inward as you stride. And supination is when your foot rolls outward while you walk or run, making your foot raise off the ground during movement.) Both can be problematic for your feet, as they aren't part of a 'normal,' healthy gait. But don't worry. Orthotics can manage these abnormal motions and pressures that cause ingrown toenailsbunions. Plus many other issues that can develop without gait correction.

If your feet hurt and you think orthotics may help, come into my Houston podiatry office for a consult. Working together, we can get you the help and support that your feet need.