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Answering the following questions can help determine if you need
orthotics?
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Do you have foot problems like bunions, corns, flat feet,
hammer toes, painful feet, achilles tendonitis, shin splints, knee pain,
hip pain,or back pain?
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Have you had any prior injuries
(sprains, fractures) or surgeries
to your feet?
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Do you stand or walk on a hard surface
more than 4-6 hours per day?
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Do your shoes wear unevenly?
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Do you walk in a "toe-out" manner?
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Do you have bowed legs or knock
knees?
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Do you have one leg shorter than the
other?
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Do you run and/or play sports regularly?
Wear Patterns
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Take a look at the heels of a pair of shoes. Is the wear pattern even?
Is one heel more worn than the other?
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Take a look at the forefoot portion of the sole of the shoe. Is the
wear pattern even? Is the upper portion of the forefoot worn more on
either the big toe side or the little toe side?
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Is the toe box excessively worn out or worn unevenly?
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Is the heel area excessively worn out or worn unevenly?
Observe your shoes for uneven wear patterns, which may indicate improper
gait or other biomechanical problems. Is the wear pattern even between
shoes? Major causes of asymmetrical wear are limb-length discrepancies
and excessive pronation. The wrong shoe type can cause abnormal wear
patterns. Look at different types of shoes you wear. If the abnormal
wear pattern is consistent, then it is usually a biomechanical flaw.
If only one style of shoes has abnormal wear, then look at the shoe with
the abnormal wear for differences from all the other shoes. For
running shoes, does the wear match the mileage? If the mileage appears
to be low and the wear great, look for problems in the shoe.
If the upper looks like it is hanging over the outside of the shoe, it
may indicate that the last (shape) of the shoe is too curved for the
shape of the foot. If the upper looks like it is hanging over the
inside of the shoe, it may be that the foot pronates too much or the
foot may be too curved for the shoe. Abnormal wear through at the toe
box means the shoe is sized too small. If the heel counter is tipped
to the inside it usually means pronation. If there is excessive wear
on the inside of the heel counter, it is frequently due to excessive
heel motion within the counter indicating that the counter is too big
for the heel.
See
Footwear: Shoe wear patterns offer clues to injury and prevention.
Custom Fitted Orthotics v. Shoe Inserts
The term "orthotic" can refer to almost any device which is worn
inside a shoe.
Shoe Inserts can be inserted into a patient's shoe easily and can
provide support to the foot. These range from rubber or silicone heel
cups to full-length shock absorbing inserts. Some have good arch
support, while others are completely flat. Some even contain magnets
or fluid-filled sacs. These inserts are usually inexpensive, but
but do not last longer than 1 year. The can be
difficult to fit the non-standard size or asymmetrical foot and
do not do a very good job of correcting specific problems.
Custom orthotics are casted for each foot. A wide range of materials
are available and can be chosen based on need. Specific corrections can
be made for the individual's problem. These orthotics can last several
years.
Evaluating Your Present Orthotics
If you currently wear orthotics, be sure that your devices fit the criteria
below:
- Your orthotics should be comfortable and add little extra weight
to your shoes.
- Your orthotics should relieve the symptoms which they were meant
to relieve.
- You should want to wear your orthotics (Orthotics tend not to work very
well when sitting in your gym bag).
- Your orthotics should fit easily into your shoes. This assumes that
you are wearing the proper shoes for your feet.
If your orthotics do not fit the above criteria, follow-up with the practitioner
who made them or consult a practitioner who has expertise in biomechanics
and orthotics.
Common errors
- First, you must wear a good shoe with orthotics! As I have told
many patients, you cannot put a Porsche engine in a Hyundai and expect it
to run like a Porsche!
- Pull out the insert that comes with the shoe and then put in the
orthotic.
- You must wear the orthotic in all your shoes.
Sports and Orthotics
Orthotics can make a significant difference for any athlete who needs them. They will control
pronation, support the arches of the foot and prevent excessive ankle and heel movement.
They will also help improve gait, knee alignment and function and overall balance.
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Runners and joggers wear orthotics to absorb shock at heel contact, provide control and set
up the forefoot for pushoff.
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Sprinters wear orthotics to control the movement of the forefoot.
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Cyclists have a limited need for orthotics and wear them primarily to control the internal and
external rotation of the lower leg.
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Skiers wear orthotics to stabilize their foot in neutral and inhibit motion within the ski
boot.
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Tennis players wear orthotics to provide lateral support, to decrease shear factors, to absorb
shock (especially in the forefoot) and to allow subtalar motion.
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Basketball players wear orthotics to control the forefoot during jumping, to control the rearfoot
during running and to control excessive inversion (protect against ankle sprains).
See my article Proper Shoe Fit for more
information.
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ORTHOTICS