What’s the difference between Orthotics?
When the term ORTHOTICS are mentioned, most people associate that with more expensive and custom made arch supports for the feet. In more chronic/complex cases a custom orthotic is the best option for pain reduction. What many don’t realise is that there are also some very high quality, clinically designed over the counter orthotics readily available for immediate use. Often the cost is a fraction of custom made orthotics, where you avoid waiting times of 4 weeks for manufacture…… and in many cases can provide the same/similar treatment outcome! This simply depends on what purpose the orthotics are going to serve for you.
The use of orthotics has progressed quite significantly since the 1980’s. Gone are the times where they were rigid, custom made orthotics varying from hard plastics to stainless steel! They would be aggressive, high and often quite uncomfortable to wear (and in many cases causing blistering or creating new pain!).
The modern orthotic can present in a number of different varieties, where technology and a better understanding on how orthotics actually work on the body has essentially produced a new wave of orthotic options. There has also been major advances in materials ranging from lightweight 3D printed plastics to various elastic foams called EVA.
Orthotics as a current intervention can operate across various responses in the foot to treat a number of problems. Up until only this decade the application of orthotic correction was based purely upon a theory first discussed in the 1950’s known as ROOT THEORY. It essentially described the optimal alignment of the foot and ankle and how the leg’s alignment would also change dependant upon whether your foot flattened out with weight applied or tip outwards too far.
Podiatrists no longer prescribe to “ROOT” theory
Many practices and practitioners to this day still subscribe to this outdated theory, and you may see them advertise orthotics using the following graphic. This is misleading to the public and not how functional orthotics work to improve symptoms.
What we now know is that the feet are a complex system that provides invaluable feedback to our nervous system around position, balance, stability and force/loading. This comes through highly organized system of sensory receptors throughout our feet that provide the brain feedback on where force is being applied, where joints are positioned and stages of movement through the foot! So to simply look upon orthotics as devices that essentially correct alignment to a straight position is a very inaccurate and antiquated way of looking at things!!
Orthotics don’t necessarily have to correct alignment as per the above image and in fact we know this to not be a reliable measure for orthotic success. Orthotics operate acorss many different influences of the foot as follows:
Yes, they do provide support and influence foot positioning
Reduce strain and load on soft tissues, joints and support structures. Important to realise that even if an orthotic isn’t fully correcting the foot increased support aids to reduce stress into tissues. This becomes key in injury management, pain reduction and ultimately relief - if the stress is reduced then the tissues aren’t under strain! This becomes extremely relevant in common foot conditions such as plantar fasciits, heel pain, achilles pain and shin splints.
Increase sensory contact zones. If you can imagine the soles of the feet are dense with sensory receptors that provide feedback on pressure and movement. By introducing an orthotic it literally alters the foot’s ground contact and can aid in ‘reprogramming’ the feedback through the sole of the foot. This is thought to optimize movement, balance and control.
So, what does that mean when it comes to the different types of orthotics that exist? Glad you asked……..
We essentially have 3 types of orthotics to choose from:
Premade, off the shelf insoles available at pharmacies/sports stores etc
Medical grade prefabricated orthotics - generally supported by Podiatrists and designed by Medical Practitioners
Fully Customized orthotics - specifically made for the individual’s feet.
Now depending upon many factors, the style and type of orthotic will vary. Your budget, clinical needs, accessibility, growth (in kids) and footwear.
In many instances a fully customized orthotic is not necessary and the other options are sufficient. Think of it like fuel for your car.
The 91 grade fuel is the lowest grade, cheapest and nastiest fuel. Will work on most cars however with extended use can actually be detrimental. Think of this as the simple cushion insoles from a pharmacy. These are very low support and will wear down quickly.
The 95 grade fuel is medium grade, better quality and suits almost all vehicles. It’s more specific much like a medical grade prefabricated orthotic. Medical grade over the counter orthotics are an excellent entry level orthotic and often all that is required to provide relief. These have more control and durability to provide relief.
The 98 grade fuel is premium grade, the highest quality and most expensive. Often there is a particular need to use this type of fuel much like generally speaking custom made orthotics approach a particular need for the patient.
The moral of the story is that for many foot or leg related problems, a good quality medical grade over the counter orthotic is more than sufficient in reducing stress on tissue structures in the feet and ultimately providing relief. In cases where this didn’t help enough, a custom device may be better suited.
Not all orthotics are created equal!