Orthotics
What is Orthotics?
What do orthoses do?
Custom orthoses versus Over-The-Counter orthoses
How are custom orthoses made?
How are Footmaxx orthoses different?
How long do they last? When should they be replaced?<br />
Do orthoses work?
Will the orthoses correct my foot problem if worn over a period of time?
If I use orthoses, will I become dependent on them?
I have been told that my feet pronate (or supinate), would orthoses help me?
My Doctor says that I have very flat feet. Can orthoses help me?
I have been told that one of my legs is slightly longer than the other. Can orthoses help me?
My feet ache under the ball area at the base of the toes. Will orthoses help?
Will the orthoses fit in all my shoes?
How much to orthoses cost?
Will my insurance cover my orthoses?
Am I able to set up a payment plan?
How long will it take to get my orthoses?
Do I need a doctor's prescription to order custom orthoses?
Can orthoses be ordered the same day that I see the doctor?
Are the orthoses returnable?
How do I start wearing my orthoses?
Do I need to make a follow-up appointment?
After wearing my orthoses, my legs and back were sore. Is this normal?
How long should I wear the orthoses?
How long will it take before I notice an improvement in my feet?
What should I look for when buying a new pair of shoes?
I recently replaced my athletic shoes & now my orthoses do not fit. What should I do?
Are special orthoses required for sports?
How do I care for my orthoses?
Orthotics is the medical field concerned with the design and use of external devices (orthoses) to support or correct deformities or improve function of movable parts of the body. Orthoses are specially designed devices that are worn inside the shoe in order to control abnormal foot motion and/or relieve painful areas of the foot. They are not solely "arch supports," although some people use those words to describe them. The goal of wearing them is to make standing, walking, and running more comfortable and efficient.
The purpose is to create a solid, anatomically correct foundation for the body. They accomplish this by performing three major functions:
- redistribute the forces across the foot so one specific area of the foot is not getting overloaded
- limit abnormal motion, such as overpronation or oversupination
- improve proprioception, which is the foot’s awareness of its position relative to the ground
Rigid orthoses - Made of a firm material such as plastic or carbon fiber, these are used primarily for walking or dress shoes to control motion of the hindfoot. They normally extend from the heel to the ball or toes of the foot, and are worn in closed shoes with a heel height of under two inches. They can be made fairly thin and very little alteration in shoe size is necessary to accommodate them.
Soft orthoses - Made of softer material, these are used to to help absorb shock, increase balance, and take pressure off of sore spots on the foot. It does not provide much support to correct abnormal foot motion. They normally extend from the heel past the ball of the foot to include the toes. They are generally more comfortable than rigid orthoses, however they can deform over time and are usually bulkier in size. They may require extra room, such as a bigger shoe size than normally worn, or even prescription footwear.
Semi-rigid orthoses - With the utilization of more modern materials, these are constructed of layers of soft material, reinforced with more rigid materials to combine the benefits of both rigid and soft designs. They provide for dynamic balance of the foot while walking or participating in sports.
Custom orthoses versus Over-The-Counter orthoses
Over-the-counter orthoses are molded on standardized arch models according to shoe size, instead of molding exactly to your foot. The decision between custom and over-the-counter orthoses is a personal decision, based on your financial situation and the actual cause of the problem you are attempting to treat. If your foot symptoms are not severe or long-term, pre-molded over-the-counter orthoses may provide the same benefits and cost less. In fact, one study found that 72% of people reported less foot pain from over-the-counter orthoses compared to 68% of those who had them custom made. On the other hand, if over-the-counter orthoses have not helped you in the past, that doesn’t mean that no orthoses will be beneficial.
The most common method is based on making a cast mold (Plaster of Paris) of the foot, while holding the foot in the desired position while the plaster hardens. This mold is then sent to a manufacturing facility with specific instructions for the desired correction of your particular foot. The orthoses are then finished with a grinder and a liner may be added to the top surface for further cushioning. Although the materials used will impact the final cost, orthoses tend to be fairly expensive because of the high labor component. The design is also highly dependent on the skills of the various individuals involved, and takes a length of time to complete because of all the steps involved.
A variation of the Plaster of Paris technique is to use compressible foam where the patient presses the foot into the foam and the depression made is used to form the orthoses. There are also various heat moldable orthoses which begin as a pre-molded device based on shoe size which can be shaped by heating the orthosis for 20-30 seconds and then allowing it to cool. These are essentially "semi-customized" because they are modifications of premolded orthoses.
All of the above share the limitation that they are not made in reference to how an individual actually stands and walks, but is an estimate because the molding process does not allow for full weightbearing.
How are Footmaxx orthoses different?
Footmaxx software and hardware directly measures how the foot is loaded while walking, utilizing a mat with built in pressure sensors that scan the foot 150 times per second during the walking cycle. A dynamic gait and pressure analysis report, including 2D and 3D images, is then generated and, along with the clinician's descriptive information, is transmitted digitally into a prescription for custom orthotics. This way, the orthosis is manufactured directly from the pressure measurements recorded while you are walking.
How long do they last? When should they be replaced?
Rigid orthotics normally last for years; additions such as top covers and extensions may require periodic replacement.
Soft orthoses made from foam or similar materials do lose their shape over time. The effect of body weight, running, standing and the number of hours the orthoses are worn all factor in to how often they need to be replaced.
If your feet no longer seem to be benefiting from your orthoses, it is reasonable to have them evaluated for appropriateness, refurbishing or replacement. Similarly, if your shoe size has increased significantly, it would be appropriate to have your orthoses reevaluated. Children usually need to have orthoses replaced every one to two shoe sizes, depending on comfort.
It depends on the problem. A New York Times article from 2006 concluded that they are probably over prescribed and gave examples of several patients who had tried orthoses without avail, only to find that their problem could be resolved by stretching, surgery or a similar non-orthoses related solution. There are some scientific studies, however, which have attempted to measure the effectiveness of orthoses. To summarize these studies:
- They probably help prevent stress fractures, although it is difficult to justify custom versus off-the-shelf orthoses for athletes who are asymptomatic.
- They probably have a limited role in treating plantar fasciitis, although it is debated whether they are much better than a simple, less expensive, heel lift.
- They do limit hindfoot motion when this is desired, preventing the heel from being placed too far to the inside or outside.
- The routine use in athletes with flat feet probably has no benefit and certainly do not result in any residual correction of the foot alignment after being worn regularly.
- They can help in changing the pressure on certain parts of the foot and relieving symptoms related to points of pressure or heavy callus.
- There may still be other problems that orthoses benefit, but they either have not been adequately studied, or the studies were not performed with sufficient numbers to show a benefit. Claims that they can relieve hip and back pain as well as other general health conditions appear to have very little supportive documentation.
Will the orthoses correct my foot problem if worn over a period of time?
Orthoses will control the position and motion of your foot. This may prevent the development of pain and disability, and the development of additional deformity. However, orthoses will not change the underlying structure of the foot. If they are not worn, the abnormal function will immediately return. This is similar to glasses, which, if removed, no longer allow you to see properly.
If I use orthoses, will I become dependent on them?
No. Orthoses simply allow the muscles, tendons and bones of the feet and lower legs to function at their highest potential.
I have been told that my feet pronate (or supinate), would orthoses help me?
Yes. Most people said to be "pronaters" have pain on the inside of the foot, ankle and knee. "Supinators" have the opposite problem and tend to have a stiffer foot with pain on the bottom at the base of the toes as well as the little toe side of the foot. Both of these abnormalities can have a major impact on many lower limb painful conditions and may benefit from orthoses.
My Doctor says that I have very flat feet. Can orthoses help me?
Orthoses can help to support the foot in its neutral position, which potentially can reduce the pain caused by "flat feet". However, they will not change the shape of your foot.
I have been told that one of my legs is slightly longer than the other. Can orthoses help me?
There is no proof that a slight leg length discrepancy directly causes musculoskeletal pain. With that said, it is certainly possible that orthoses may help, as the feet can change to accommodate for a leg length discrepancy, which in turn may cause pain. Orthoses can be built with a heel lift to help correct this condition.
My feet ache under the ball area at the base of the toes. Will orthoses help?
Yes, depending on the cause of the pain. There can be a loss of the normal cushioning in this area over time, as well as shifting of weight to this area as a result of other foot problems. The FootMaxx system can measure the specific area of loading digitally and prescribe the orthoses appropriately for maximum relief of pain.
If the pain is due to a more serious problem such as a nerve tumor or arthritis, an orthosis will be of less benefit.
Will the orthoses fit in all my shoes?
It depends on the type of shoe. Sandals or shoes without a heel back typically do not accommodate the orthoses. Shoes with a moderate to high heel are also problematic. The higher the heel, the more the weight is transferred onto the toes and the less supportive any orthosis design is likely to be. There are special dress shoe orthoses that fit more easily into fashionable shoes, however these often require a compromise between support and the ability to fit inside this type of shoe.
On the Internet, you can find orthoses ranging from $10 to $800. Non-custom devices range from inserts purchased at the drug store for $10, up to highly marketed semi-rigid orthoses sold for $150 to $200. Semi-custom orthoses range up to $200 to $300. Custom orthotics can cost anywhere from $300 to $800. A survey of prices in the local area suggest that the average price is in the $350 to $400 range. The Footmaxx price at Ventura Orthopedics is $275.
Will my insurance cover my orthoses?
Most current insurance programs exclude orthoses as a covered benefit, even if prescribed by your doctor. Surprisingly, a few will still cover this cost, even if the policy states that it excludes them. Due to the inconsistency and unpredictability of the insurance coverage, the office policy is to require payment up front for this product. However, as a courtesy, we will file your insurance claims for you and issue you a refund if your insurance does happen to cover the product.
If not covered by your insurance or Flexible Spending Account, orthoses may be tax deductible, since they are medical devices — but only with a receipt indicating that the orthotics were custom-made.
Am I able to set up a payment plan?
Full payment is expected at the time of order.
How long will it take to get my orthoses?
In most cases, you should receive them in the mail within 2 weeks after your Footmaxx measurement appointment.
Do I need a doctor's prescription to order custom orthoses?
No. A prescription is not required if you wish to simply have your feet assessed using the FootMaxx system and orthoses made based on that assessment. If you wish to have your feet evaluated to see whether orthoses or other forms of treatment are likely to be of benefit, that would require an office visit and associated charge.
Can orthoses be ordered the same day that I see the doctor?
Probably, although you may be asked to return at another time for the FootMaxx measurement if the office schedule is too busy.
For sanitary reasons, the orthoses are not returnable once they have been used. However, if upon receipt you are unhappy with the fit, quality or workmanship, FootMaxx will refund the purchase price.
How do I start wearing my orthoses?
You should not wear your orthoses all day from the first day, but gradually increase the duration for which they are worn by half an hour per day for the first week.
When you can wear your orthoses comfortably for four hours, then it is likely that you can wear them all day. If you are breaking in an orthosis for high impact sports such as running, remember to remove the arch support which is already in the shoe and start out with a walking program. If you have attempted this "break in" for more than a couple of months and are still uncomfortable, you may need some modification or it is possible that the problem for which you purchased the orthoses is not amenable to this form of treatment. You should therefore be re-evaluated and the orthoses modified or a different form of treatment or diagnostic testing performed.
Do I need to make a follow-up appointment?
Not routinely. You have better things to do than hang around a doctor’s office! However, if you have gone through the break-in period and have any concerns, please contact us to arrange for an office visit. We will be happy to arrange for an adjustment or a return if the orthoses are not helping you.
After wearing my orthoses, my legs and back were sore. Is this normal?
It is not uncommon to experience discomfort in the foot, leg, or lower back when you first start to wear orthoses, due to the usage of new muscle groups and the new alignment of the lower extremity. This will generally resolve after two or three weeks.
How long should I wear the orthoses?
Once the initial wearing in has been completed you can wear your orthoses as much as you like. The most important time to wear them is when you are weight-bearing for long periods or exercising.
How long will it take before I notice an improvement in my feet?
Once the "break in" time is completed and appropriate footwear is being worn, most people would begin to notice an improvement in the first of 4-6 weeks. Between 6-12 weeks is generally when you can expect the most improvement. These time frames will obviously vary depending on the individual foot problem. If the pain is not improving after a couple of months, it may be necessary to have the orthotics reevaluated.
What should I look for when buying a new pair of shoes?
If you already own custom orthoses, they should be brought along for trying different shoes. Simply remove the insole that is within the footwear and compare it to your orthoses for sizing and shape. If they seem similar, slide the orthoses in making sure that the heel cup rests flat in the shoe. This will give you a better idea of the final fit of different shoes prior to purchase.
If you wish to get custom orthoses for a specific pair of shoes, bring them along for your assessment so the insole can be traced. The orthoses will then be carved exactly for your footwear.
I recently replaced my athletic shoes & now my orthoses do not fit. What should I do?
This would be most likely caused by the medial arch cup of the footwear being different from shoe to shoe. If this arch within the shoe is removable or may be cut down to a flatter base, doing so should solve the problem. If not or you are unsure, please contact us for an office appointment.
Are special orthoses required for sports?
Standard orthoses are appropriate for most activities, including sports which do not involve excessive impact on the feet. People who participate in high impact sports may benefit from more 'sport specific' orthoses which are fabricated from more resilient materials which may more efficiently help to dissipate some of this force. Some orthoses are made specific to a specific sport, which makes some intuitive sense, although there is little objective data to verify their necessity.
How do I care for my orthoses?
Remove the orthoses from shoes at night to allow perspiration and moisture to evaporate. The orthoses should be cleaned periodically by wiping them down with a damp cloth. If the orthoses have a soft top-cover, sprinkle them with baking soda or talcum powder to help absorb any odor they may collect. DO NOT immerse the orthoses in water (e.g. sink, washing machine). DO NOT subject them to heat sources (e.g. heater, fireplace).