Orthotics: Prefab or Custom-Made?

If you take a simple stroll down the foot product isle at your local drug store you will find an array of foot products and inserts. You will find inserts for cushion, for comfort, for support and for control. Many questions may cross your mind. What are the differences? Is the $15 insert better than the $7 insert? Are these orthotics? Will they help my foot pain? You may take the time to study the package details closely, but in most instances it doesn't really matter which pair you grab. Most of the inserts at the local drug store are essentially the same.

An insert slips into the shoe and will give you some comfort, cushion and a little support. In some cases, inserts purchased at the drugstore will help alleviate some arch or heel pain and give relief to sore, tired feet. But, an insert is not an orthotic. Orthotics are devices which fit into the shoe and aid in foot function. The most important difference is an orthotic controls abnormal motion and corrects foot function, while an insert will only provide cushion and comfort.

A prefabricated orthotic is a device that is pre-made and designed to fit the most common foot types. Typically, a prefabricated orthotic needs to be purchased at a sports store and they are more expensive than inserts, costing $25-$30. The prefab orthotic is more rigid than an insert and is designed not only to support the arch, but also to help control motion, which will decrease stress on the tendons and ligaments in the arch. Many individuals will do very well with a prefabricated orthotic. Prefab orthotics generally last for one or two years before replacement is necessary.

A functional custom made orthotic is a device that is even more rigid than a prefab orthotic. The custom made orthotic must be rigid to help control the motion in the foot and add support. If the orthotic is soft, the weight of the body would collapse the device and it would no longer function. A custom made orthotic is not only custom molded to your foot and arch, corrective wedges and covers are built into the device to help with motion control and to improve the mechanics of the foot. Individuals with flatfeet, tendonitis, plantar fasciitis, certain foot deformities, knee, hip and back problems may benefit from custom made functional orthotics. The orthotic should make standing, walking, jogging or running more comfortable. Custom made functional orthotics will generally last 7-12 years before needing to be replaced, and can cost between $300-$600.

Functional orthotics are a successful treatment for many problems affecting the lower extremity. In a recent article in the Journal of the American Podiatric Medical Association, 75% of patients surveyed had good to excellent results using functional orthotics to treat heel pain, arch pain, arthritis, bunions, pain from flatfeet or high arches, knee, hip and back pain. A recent article in USA Weekend magazine stated the opposite. The article referenced a study in Foot & Ankle International in which researchers followed 874 healthy, young Israeli army recruits without foot problems. The recruits were given soft custom, semi-rigid custom, soft prefab or semi-rigid prefab orthotics to wear in their boots during basic training. The researchers found no difference in the development of foot problems between the custom made orthotic group versus the prefab orthotic group. The conclusion from this study is that custom made orthotics will not help prevent foot problems from developing. What is important to understand is this study did not evaluate individuals with foot pain or foot problems. The population evaluated was a group of young, healthy, active individuals without any existing foot problems. Therefore, we cannot conclude from this study that prefab orthotics treat foot conditions better than custom-made orthotics.

Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to custom-made orthotics. Certain types of tendonitis respond well to orthotics and other types require orthotics. Posterior tibial tendonitis is the tearing and inflammation of the tendon that helps to hold up the arch. When this tendon is overstressed by arch collapse it cannot heal. Custom made orthotics are essential in the treatment of this condition.

Individuals with high arches may also require orthotics, but they do not respond as well. Custom made orthotics can help slow the progression of bunions and hammertoes, but they will not prevent this process. Orthotics may help with some pain at a bunion, but they will not "cure" the bunion. When the motion in the foot is contributing to the problem, orthotics are generally recommended. If the foot is stable and does not require support, the bunion, hammertoe, neuroma, tendonitis or even plantar fasciitis may not require custom made orthotics for treatment. These individuals may do well with a pre-fabricated orthotic. If you do not have foot pain or an existing foot condition, a custom made orthotic is not necessary for prevention of foot problems.

A custom made accommodative orthotic is soft and designed to reduce pressure and prevent excess friction. Diabetics can develop numbness and loss of circulation in the feet. This numbness and circulation loss puts them at risk for developing open sores on the feet called ulcerations. To help prevent excess rub and friction in certain areas on the feet, accommodative orthotics are recommended. Diabetics who do not have numbness or circulation loss (as diagnosed by their doctor) do not need to have accommodative orthotics, unless the foot has a deformity, like a bunion or hammertoe, then accommodative orthotics are necessary.

Both types of custom-made orthotics are formed by taking a mold of the foot. A functional orthotic mold is fabricated by wrapping the foot in plaster. The foot is held in a corrected position while the plaster is setting. To obtain an accommodative orthotic mold, the patient steps into a foam box. An impression of the foot in a standing position is then created. The molds are sent to a lab and scanned into a computer. A reverse image is produced and the computer generates an image of the foot in neutral position. The computer adjusts the image based on the corrections recommended. A model of the foot is then cut out, in some cases out of wood. The orthotic material is pressed over the foot model and the orthotic is created. The most common material for a semi-rigid custom made orthotic is polypropylene, but other materials, such as graphite are used. A foam-like material is typically used for custom-made accommodative orthotics.

The bottom line is that if you have foot pain, a foot deformity or condition, let your podiatrist evaluate you and decide if orthotics should be part of the treatment. If your insurance will not cover the orthotics and you cannot afford custom made orthotics, consider trying prefabricated orthotics. If you are looking to help prevent foot problems or looking for some extra support, a prefab orthotics is a good option for you, especially if you are active in sports. If you are just looking for a little extra cushion and comfort, an insert at your local drug store will be your best bet.

Christine Dobrowolski is a podiatrist and the author of Those Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot Problems. To learn more about Dr. Dobrowolski and her book visit http://www.skipublishing.com. For more information on prefabricated orthotics visit http://www.northcoastfootcare.com.

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