What You Should Know About Orthotics

You’ve probably seen clothing that’s purportedly ‘one size fits all.’ As though a scarf designed for a giraffe would fit on a pug dog. Or a jacket suited for a wallaby could work well for a rhino. Not that we’re quite as different as these animals, but all too often, t-shirts or hats or (heaven forbid) shoes that are produced with the ‘one size fits all’ mentality fit a very few somewhat well, but are voluminous for some, and way too tiny for others. Or the size is right, but the cut of the thing is all wrong. Perhaps products like this should be known as ‘one size fits most badly.’ The truth is that, while our bodies are all pretty much human-shaped, we have substantial differences between individuals. These differences are significant enough that mass-produced clothing or footwear can be uncomfortable, or worse, damaging. This is especially true of foot orthoses.

Orthotics really need to be calibrated to your specific foot in order to work well. It’s like getting a prescription for glasses. You wouldn’t give everyone who’s nearsighted the same eyeglasses, would you? Of course not! And just as optometrists need to evaluate people’s eyesight to determine the specific eyeglass shapes that are right for them, so too do trained podiatrists need to evaluate patients’ feet to design orthotics that fit their needs.

Feet are kind of funny things, though. They need to be flexible in order to adapt to changes in terrain (a state known as pronation), and they also need to be rigid in order to give us leverage as we take a step (a state known as supination). The problem is that many people have trouble with over-pronation of their feet. This is probably due to our being, as a whole, a bit (ahem) larger and less active, which leads to more downward stress on the feet, and also to the harder flooring we tend to be exposed to. When the ligaments of our feet have stretched out from this stress, they can no longer provide the rigid structure needed in supination.

As people with over-pronated feet walk around, their feet attempt to compensate for the lack of rigidity. Unfortunately, this compensation puts strain on parts of the foot that aren’t really equipped to take it, and can lead to complications such as bunions, plantar fasciitis, neuromas, stiff big toe joints, and even issues further up in the body like the knees, hips and lower back. These problems can be treated in many different ways, but to really heal, it’s important to correct the improper function of the foot that’s causing the problems.

This is where orthotics come in. Unfortunately, as mentioned above, many orthotics manufacturers adopt a ‘one size fits all’ approach to inserts that are supposedly custom-made. They may have doctors simply take scans of a patient walking across a pressure plate (which offers only a one-dimensional view of the foot), or doctors may take casts of a patient’s foot in an improper position. Proper casting of the foot in the corrected position ensures that orthotics are made that will support the arch of the foot properly. The height of the arch as well as the three-dimensional shape of the foot must be taken into account, as well as how much the patient weighs, how flexible the foot is, and what kinds of activities the patient engages in. Taking all of these factors into account when shaping orthotics helps these inserts to be as supportive as possible for your individual needs.

Okay. So sometimes ‘one size fits all’ works pretty well, like with baseball caps or mumus. But do you really want to take that approach with your feet? Getting expertly prescribed and crafted orthotics can mean the difference between support and healing, or more pain and problems. So, get those mass-produced caps and robes if you must, but let your podiatrist prescribe the orthotic that is 100% custom-fit for you.