What Kind of Orthotics do I Need?

Not everyone who comes into my office needs to be fitted for orthotics. But, many of the patients I see who are dealing with bunions, hammertoes, neuromas, or plantar fasciitis will keep coming back to my office unless they get the help of an orthotic. That’s because, for so many patients, these conditions are symptoms of an underlying biomechanical imbalance. So, without correcting the imbalance, problems will keep coming back. Unless you wear orthotics that can help compensate for those imbalances.

This rigid, full-length orthotic provides arch support for a flat-footed patient

To determine whether or not orthotics can help protect your feet, I perform a thorough in-office exam. If I notice that your bones, joints, muscles, ligaments or tendons aren’t performing optimally, I’ll likely recommend that you get fitted for an orthotic device. And that’s when we’ll have to determine what type of orthotic is best for you. 

How to Choose the Best Orthotic for Your Feet 

The first thing you have to know is that foot orthotics are constructed from a range of materials; they come in different sizes, lengths and levels of flexibility.

In order to decide which specific mix of customizations is best for you, I’ll consider a variety of factors, including your height, weight, lifestyle, and any medical conditions, such as diabetes, that may impact your foot health. While every individual’s needs vary—heck, that’s why we call these devices ‘custom’—here’s a basic guide to understanding the level of rigidity you’ll require from your orthotics:

We construct soft orthotics, which may also be called "accommodative orthotics," from soft compression materials. The point of these devices is to cushion your feet and alleviate pressure in spots that are frequently sore. People who suffer from the heel pain of plantar fasciitis, or at high risk for diabetic foot ulcers, often benefit from soft orthotics. One thing to consider with this kind of orthotic: in-spite of the name, soft orthotics pack a major punch, space-wise. They are quite bulky, which may require you to wear them with prescription foot wear instead of your typical shoes.

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

Then there are rigid, or "functional,” orthotics. These devices are made from materials like carbon fiber or plastic. Less bulky than soft orthotics, you can fit these devices into most walking shoes, or even in dress shoes if the heels are low and the toes are closed. I typically recommend rigid devices if your feet are strained or achy, 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, but I often advise my patients to select the ¾ length instead. Why? With a shorter orthotic, your device is far more likely to fit into multiple pairs of shoes. Which means that your day won’t start with a choice: wear the pair of shoes you really want, or keep your feet in your orthotics. And, since your orthotics can only prevent pain and worsening foot deformities when you wear them, that’s a choice I never want my patients to make.

Making Orthotics More Affordable

While custom orthotic devices can go a long way towards alleviating your foot pain, they aren’t a cheap solution. Sometimes, insurance will cover your custom orthotics. But other time, 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, then use the funds to cover medical expenses like orthotics. The bad news is, funds typically can’t be carried over from one year to the next. But the good news is, if you have an HSA account you can use those funds at any point in the year to cover the cost of your orthotics. Now, while that's a smart way to make orthotics more affordable, 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 Even a "custom fit" product won't provide the same support as a true, prescription orthotic crafted in this office

Studies have proved that, when it comes to shoe inserts, you really get what you pay for. For runners, custom orthotics are tied to a 28 percent lower risk of injuries and a 41 percent lower risk of stress fractures. Shock absorbing inserts, however, especially the kind that tend to be available over-the-counter or from a 3D printer, really do nothing in terms of injury-prevention. In fact, some evidence suggests you're at an increased risk of injury when wearing these thinner, flat insoles.

While you see the risks of choosing the wrong kinds of insoles, proper orthotics can do more than just prevent injury. Because a custom orthotic is a prescription shoe insert, crafted from a mold of your own foot, they are constructed alongside a thorough gait analysis--both visual and digital. In this way, as your orthotics are built, we can also assess the improper motion of the foot while you walk. By reducing the excessive pronation, the custom orthotic also effectively manages the abnormal motions and pressures that lead to the formation of problems like ingrown toenailsbunions and many other issues that can develop without gait correction.

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



Dr. Andrew Schneider
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A podiatrist and foot surgeon in Houston, TX.