Often injured athletes swear by them and some have stated they actually improve performance. Orthotics are one of the most often asked about items in the clinic where I work. Orthotics in and of themselves will not make you become the next Mark Allen once placed in your shoes. But, they can help alleviate pain and discomfort in the foot and leg if properly prescribed and fabricated.
What are Orthotics?
Orthotics are a device that is placed in a shoe to eliminate pathological stresses to the foot or other portions of the leg (Hunter, etal).
They can help reduce pain associated with plantar fascitis, patellar pain syndromes, illiotibial band syndrome, shin splints, achilles tendonitis, and even stress fractures. Some sources go so far as to say they help even with back pain.
My point is, orthotics can be an effective part of a treatment program for a recurrent or chronic problem. But, they should be used as part as an overall treatment program and never as the sole treatment option.
Is an Orthotic for You?
Well a doctor, physical therapist, or athletic trainer is a good place to start.
These people can evaluate your problem and make suggestions for the best possible outcome. I myself don’t recommend an orthotic device to every person who comes to the clinic with foot or leg pain associated with running.
In fact, quite the opposite. If I think an athlete can do without orthotic intervention I tell them so. It saves them from undue cost and from having to stick them in all their shoes. If I think an orthotic will help the athlete as part of their treatment process, though, I would definitely give it a try. If you have tried other treatment options without success and are considering orthotics ask your doctor or therapist. You may be one step closer to being pain free.
How do Orthotics Work?
By far, the most often cited use for orthotics is to control a biomechanical problem. The most common biomechanical problem they are used to correct is hyperpronation. This is basically an excessive inward rolling of the ankle during ambulation (for further clarification see my article on plantar fascitis). Orthotics can also help provide shock absorption during walking/running and help to relieve pressure sensitive areas of the foot.
Orthotics can be full length, meaning they run the entire length of the foot, or three quarter length, where the orthotic stops just behind the balls of the foot. They can be rigid, semirigid, or soft.
Rigid orthotics are most commonly used when absolute control of a biomechanical deformity is needed.
They are made out of inflexible acrylics or carbon fiber composites. Due to their inability to absorb shock we rarely use these devices with running injuries. Although, they do work well in athletes who are involved in non-endurance sports, such as football, or with a heavier athlete whose problem is not well controlled with a semirigid device.
One of the major drawbacks of rigid orthotics is the person’s foot has to be casted and the cast sent away to have the device manufactured.
The other drawback to this procedure is price. It is not uncommon for a set too cost over $200.
Soft orthotics are used in a variety of conditions from rheumatoid arthritis to diabetic foot conditions and occasionally in athletics.
They are generally made of Plastizote, polyurethane, or similar soft materials. Soft orthotics are great shock absorbers and help to decrease shear forces along the skin. However, they do little to help correct biomechamical problems. Usually, if an athlete has no biomechanical deficiencies and just needs shock absorption, we will use on over the counter insert, such as Spenco, in his or her shoe.
Rarely do we fabricate a soft orthotic for a runner because of its inefficiency to control foot motion. But, when we do, it is easily done in the clinic and relatively cost efficient.
Semirigid orthotics are by far the most prescribed device we fabricate in the clinic. As the name implies they are neither rigid nor soft.
They are usually made from a soft and a rigid material that are glued or melted together, molded to the shape of the foot and trimmed to fit in the shoe. The materials we use are Plastizote, the softer of the two, and Aliplast.
Older semirigid orthotics were made from cork, but it is hard to shape and doesn’t last as long as the newer materials. These devices have the stiffness to be able to control biomechanical problems and the flexibility and cushioning to be worn during prolonged running.
Like the soft orthotics they are easily fabricated in the clinic and relatively cost efficient. One of the great things about being able to fashion these devices in your own clinic is if the athlete has a problem. If more cushioning is needed, if the orthotic is “sticking” the person, or if the device needs to be beveled, the person can come in and in no time at all additions can be made.
In fact, this is the problem with many of the mail order orthotics. They have to be packed and shipped every time you need the device adjusted which leads to more money being spent out of your pocket. So, I highly recommend getting the orthotics made locally.
Commonly Asked Questions
How Long Do Orthodics Last?
The semirigid devices we fabricate generally last around a year. Although, if one is putting in many miles (such as Ironman or marathon training) we may need to resurface the device at about 6 months. This ensures adequate cushioning during longer training and racing.
How Long to Wear-in Orthotics?
Generally I suggest a “wearing” in period of about a week to let the foot adapt to the device.
Do I Need New Shoes to Wear With My Orthotics?
I tell people that the orthotic is only as good as its base of support. If you put a new orthotic in an old worn shoe it will not be as effective.
One needs to make sure they are in the right shoe for their foot and that they buy new shoes every 500-600 miles. For a person putting in 30 miles a week that’s about 5 months.
Some sources suggest that buying two pair of shoes and alternating them maybe of benefit. I myself have never done this, mainly because of cost issues, but I do know many athletes who do.
Are Orthotics Different for Running Shoes vs Regular Shoes?
The orthotics I fabricate can be alternated between any of your training or racing shoes. I mention this only because the orthotic needs to be cut a little lower to fit into racing or fast paced training shoes. So, if you are getting orthotics made I highly recommend taking all your running shoes with you and making sure of a proper fit in all your shoes.
How Do You Clean Orthotics?
The orthotics can be easily cleaned with dish soap and water and left to air dry overnight. Generally, the orthotics I make for running shoes are for just that. If a person has a more severe problem they may need a second pair made for their work shoes. These are cut a bit higher and have more bulk than a sport orthotic.
How Long Do You Wear Orthotics?
A person will have to wear their orthotics as long as their pain persists or as long as they have a biomechanical problem. I myself suffered for years from chronic plantar fascitis and finally got it under control with the use of orthotics and night splints. I now am running pain free, but if I try to run without my orthotics my feet let me know it the next day. So, if someone wants to wean him or herself from orthotics that’s great, but heed the warning signs.