Which orthotics are suitable for me?
Orthotics are an area of much debate among the podiatry community particularly regarding which orthotare the most appropriate.
As lower limb injuries such as Plantar Fasciitis have become more common, a larger variety of orthotics have become available to the public with many health professionals and even supermarkets able to sell pre-made orthotics. With so many different orthoses available, with variations in cost and opinions from health professionals, it can be difficult for the public to determine which orthotics are the most appropriate for their complaint.
When choosing orthotics, there are a number of questions that I often ask myself. These questions help determine how long the orthotics will continue to benefit the patient and how much functional improvement the patient requires in their lower limb. Some questions include;
- The age of the patient: Are they a child or adult?
- The foot shape: Do they have flat feet or high arch feet?
- Foot function: Do their feet roll in a lot or a little?
- Structural deformities: Do they have a bunion?
- Their occupation: Are they on their feet all day?
- What physical activities do they participate in?: Is it high intensity activities?
- What footwear do they predominantly wear?: Do they wear footballs or dress shoes?
- Are there any previous injuries or medical conditions impacting the lower limb?: ie. Osteoarthritis/Fibromyalgia/ankle sprains.
Types of orthotics available in podiatry?
There are two main types: Full custom orthotics and “off the shelf” pre-made orthotics. The different types are prescribed depending on the patient’s circumstances.
Full custom orthotics:
Full custom orthotics can be considered the gold standard in orthotic therapy. These orthotics require foot impressions in order to create orthoses that are specific to the individual. As full custom devices are highly customised, they are great for patients with:
- Structural deformities such as bunions
- Individuals that require greater functional correction. ie. Patient’s that roll in a lot, high mobile feet.
- Patient’s with flat and high arch feet.
As podiatrists can request specific additions to be made for the devices to make them more comfortable and persevere function. They are well suited for patients with previous injuries or medical conditions such as osteoarthritis, fibromyalgia and ankle sprains. In addition, full custom orthotics are great for those who use them predominantly for physical activities such as running and football. Also, by requesting more durable materials, these devices can last longer which is good for patients who are on their feet for most of the day such as nurses and tradesman.
Full custom orthotics are also able to fit in more types of footwear as podiatrists can explain the dimensions of the shoes the patient is intending to wear.
Generally, full custom orthotics are more suited for adults than children, as they tend to be more expensive than off the shelf products. Sometimes podiatrist will prescribe full custom devices for children with certain medical conditions such as Juvenile Idiopathic Arthritis as they can accommodate specific needs.
Due to the durable material and specificity of the orthotic shell, full custom orthoses can last over 5 years while still maintaining function depending on use. They can also be refurbished regularly and adjusted to ensure the device continues to match foot type.
Off-the-shelf pre-made orthotics:
There are many different brands and types of pre-made orthotics used by different podiatry clinics. Heat molded devices are a common type of off-the-shelf pre-made orthotics prescribed by many podiatrists. These heat molded devices are made of thermoplastic material which is malleable with heat and allows the orthotic to gradually match the patient’s foot type with the application of heat. They can provide some customisation in the arch and heel areas of the foot but are not as specific as the full-custom orthotics. Podiatrists can add certain additions and modifications to the DOLA heat molded orthotics to improve the patient’s function but this is more limited compared to the full custom orthotics. They are great for patients with:
- No excessive structural deformities ie Bunions
- Individuals that require small improvement in function. ie roll in a little
- Patient’s with flat feet
If treatment options such as strapping has helped improve the injury, there is a strong chance that heat mold DOLA orthoses will further improve injury. Strapping and padding provide some small improvement in function therefore heat molded devices would provide a more permanent version of these treatment options.
Heat molded orthoses come in standard sizes so they are less likely to fit into all shoes such as some narrow dress shoes. Though they should be able to fit most running shoes and sandals.
Who would heat molded orthotics be appropriate for?
Generally, heat molded devices are more suited for children, as these are less expensive than full-custom. Children are more likely to grow out of them before wearing them out which will save parents money as well. Also, most children do not have many foot deformities, so the main aim is to provide support until their muscles are able to further develop and improve their function. They may need full-customs in adulthood or if they begin to develop structural deformities or require more functional correction. The heat molded orthoses can be more suitable for patients that are not on their feet as much i.e. Desk Workers.
The materials for the heat molded devices are less durable than the full-custom, so they do not last as long. Heat molded orthotics generally last between 1-5 years depending on the use. They cannot modified unlike the full custom items, though podiatrists can still make changes such as adding padding.
In summary, the most important thing for a patient to understand is that orthotics should match your foot type in-order to help you. It is important to select devices that will provide the most benefit for the longest period of time.
Even after selecting the full custom or heat molded DOLA orthoses, some patients require more modifications until they suit their feet. Most podiatrists have experience in prescribing and administering orthotics to a diverse range of people with different needs. Podiatrists also have experience in troubleshooting issues to ensure that patients can get the best possible outcome. So if you need advice regarding choosing orthotics or concerns regarding feet and legs, call in to your local podiatrist.