To Orthotic Or Not To Orthotic, That Is The Question
Amongst different health professions there are more theories and opinions regarding orthotic use than there are fish in the ocean. Well not quite, but it seems everyone, trained or not, has their opinion on the "evil" pieces of plastic called foot orthotics. As a Podiatrist, it can be quite a frustrating, and at times disheartening, experience to advise or recommend the use of an orthoses to assist a pain or injury, only to have the patient explain that Dr......, Physio......., Coach........, friend.........., or Aunty Flo, said that orthotics shouldn't be used. Some common, and often misinformed reasons, include "they will make my muscles weak", "I will rely on them forever", "its not natural to have a rigid piece of plastic under my arch", or "my feet shouldn't be controlled". Truth be told, the use of orthotics goes much further than sticking a rigid piece of material under the arch and stopping the foot from moving. Despite what many believe, most Podiatrists will only use an orthotic as an adjunct to many other treatment modalities, including stretching, strengthening, gait retraining, footwear selection, and massage modalities. Prior to the implementation of orthotic prescription, many factors are taken into account. The position of the foot, the presentation of the leg, the movements of the joints during both standing and gait, the actual period when a joint does or doesn't move, the axis or centre point of a joint, the position of a joint compared to other joints, the ability of a muscle to control a movement, the available range of motion of a joint during gait and statically, the description of the symptoms, and the presentation of any pain. And that is just the start. From these observations, the next step is choosing the type of orthotic best suited, be it a simple off the shelf orthotic, right through to a custom made prescription orthosis. Once we have decided what type of orthotic might best suit your needs, then we need to think about what material is best. In the past, and to be fair a big reason why we face the anti-orthotic battle that we do, most orthotics were based off a crude prescription system, and were made out of a very rigid, often thick plastic or resin type material. These orthotics were designed to stop any movement at all, holding the foot in a single position. This method has long been modified and improved upon. We now design and manufacture our orthotics from a range of materials, the two most common materials being EVA and polypropylene, with varying thicknesses and rigidity to suit many sports and uses. More importantly, an orthotic is designed to ENCOURAGE AND ASSIST THE FOOT AND LEG TO FUNCTION MORE EFFICIENTLY. This does not mean stopping an arch from collapsing, or forcing a foot to move a certain way. Through a careful prescription, and even more careful manufacture, the proper orthotic will assist a muscle that isn't able to function correctly, will help reduce a joint moving in the "wrong" direction, will help reduce pressure on a joint or a region of the foot, will provide cushioning to an area of the foot that is experiencing high levels of pressure, and will help reduce the stress and force on structures that are functioning inefficiently. One of the most important factors that we utilise in our prescriptions, is the right amount of flexibility in the orthotic. Through a synergisitc approach, we are able to implement the right amount of support, mixed with the right amount of flexibility, "the sweet spot". Also, don't be fooled into the old advice that "the orthotic should be soft". Soft orthotics, whilst they serve a purpose especially in diabetic patients looking for pressure reduction, often require greater thickness to achieve any level of support, ultimately giving them a very unforgiving feel, and difficulty with shoe fitment.
Not all orthotics are created equal, different sports and activities will require different needs. and it is important that these needs are tailored for with any prescription. No other profession is trained as intently in the implementation, prescription, and individualism of orthotic use than a Podiatrist. The most important thing to consider next time you are suffering foot or leg pain is, don't write off the effectiveness of the right orthotic, instead chat to your Podiatrist, we are here to help.
Healthy feet are happy feet!!
Illawarra Sports Podiatry