Medicine Information Article:

Orthotics and Your Feet

Orthotics are devices which fit into the shoe to aid the foot."Functional orthotics" are rigid and designed to controlmotion and correct the function of the foot. Individuals withflatfeet, tendonitis, plantar fasciitis, certain foot deformities,knee, hip and back problems may benefit from functionalorthotics. "Accommodative orthotics" are soft and designedto reduce pressure and prevent excess friction. Diabeticsand those with a loss of sensation or circulation in their feetwill benefit from accommodative orthotics. Both types oforthotics are custom made by taking a mold of the foot.

Functional Orthotics

The goal of the functional orthotic is to improve themechanics of the foot, control the abnormal motion in thefoot, decrease the pain in the foot, ankle, knee, hip or backand to add support. The orthotic should make standing,walking, jogging or running more comfortable. The orthoticmust be rigid to help control the motion in the foot and addsupport. If the orthotic is soft, the weight of the body wouldcollapse the device and it would no longer function.

Abnormal motion is typically in the form of pronation.Pronation is the rolling in of the foot and collapse of thearch. The motion starts at the rearfoot, or heel area. Whenthe heel turns in, it allows the arch to collapse. This putsundue stress on the ligaments and tendons in the arch areaand contributes to the development of tendonitis, plantarfasciitis, bunions and hammertoes. The functional orthotichelps to control the abnormal motion in the rearfoot. This isaccomplished by taking a mold of the foot in its neutralposition. The neutral position is the position the foot shouldbe in when walking. When standing, the over-pronated footis in the uncorrected position. The mold of the foot shouldbe taken with the patient sitting so the foot can be placed inthe neutral position.

The molds are sent to a lab and scanned into a computer. Areverse image is produced and the computer generates animage of the foot in neutral position. The computer adjuststhe image based on the corrections recommended by yourpodiatrist. A model of the foot is then cut out, in some casesout of wood. The orthotic material is pressed over the footmodel and the orthotic is created. The most commonmaterial is polypropylene, but other materials, such asgraphite are used. In some cases, hand-made molds arecreated out of plaster. This was the classic way orthoticswere made until newer technology made the process muchless labor intensive.

Functional orthotics are a successful treatment for manyproblems affecting the lower extremity. In a recent article inthe Journal of the American Podiatric Medical Association,75% of patients surveyed had good to excellent results fromfunctional orthotics. This includes 17% who felt the orthotics"cured" their pain. Less than 10% had no relief. The mostcommonly treated condition in the study was a painful heel.Over 20% of patients surveyed were treated for a painfulheel and 20% were treated for a painful arch. Fourteenpercent of the individuals were using orthotics for flatfeet.Other conditions treated with orthotics were knee, hip andback pain, foot arthritis, bunions and high arches.Tendonitis was not specifically evaluated.

Individuals with plantar fasciitis (heel and arch pain) whoalso have flatfeet usually respond best to orthotics. Theplantar fascia is a ligament type structure on the bottom ofthe foot which helps to hold up the arch. When the footcollapses, the weight of the body stresses the ligament andresults in tearing and inflammation. This results in plantarfasciitis. These individuals typically respond well to orthoticsin combination with other treatments. Certain types oftendonitis respond well to orthotics and other types requireorthotics. Posterior tibial tendonitis is the tearing andinflammation of the tendon that helps to hold up the arch.When this tendon is overstressed by arch collapse it cannotheal. Orthotics are essential in the treatment of thiscondition.

Individuals with high arches may require orthotics as well,but they do not respond as well. Orthotics can help slow theprogression of bunions and hammertoes, but they will notprevent this process. Orthotics may help with some pain ata bunion, but they will not "cure" the bunion. When themotion in the foot is contributing to the problem, orthoticsare generally recommended. If the foot is stable and doesnot require support, the bunion, hammertoe, neuroma,tendonitis or even plantar fasciitis may not require custommade orthotics for treatment. These individuals may do wellwith a pre-fabricated orthotic.

Accommodative Orthotics

Diabetics can develop numbness and loss of circulation inthe feet. This numbness and circulation loss puts them atrisk for developing open sores on the feet calledulcerations. To help prevent excess rub and friction incertain areas on the feet, accommodative orthotics arerecommended. Diabetics who do not have numbness orcirculation loss (as diagnosed by their doctor) do not needto have accommodative orthotics. If the foot has a deformity,like a bunion or hammertoe, then accommodative orthoticsare necessary.

Accommodative orthotics are made from many differenttypes of material. Some are made of a foam type material,others made from cork and others have covers ranging fromsoft spongy material to leather. The type of materialdepends on the type of foot. Many accommodative orthotics,made for diabetics, have two or more layers that formaround the foot once they are worn. Three pairs aredispensed every year and they are replaced every 4 months.Other materials are longer lasting. A mold of the foot istaken by stepping into a foam box. In this case, it isimportant to take the mold standing, so that the orthotic canbe made to form around the foot.

The Cost

Many insurance companies cover orthotics for certaindiagnoses. The most commonly covered diagnoses areplantar fasciitis (heel and arch pain), flatfeet and diabetes.Many insurance companies cover the orthotics at 80%. Thismeans the patient is responsible for 20% of the cost unlessthey have a secondary insurance. If the deductible has notbeen met, then the amount is applied to the deductible andthe patient must pay the full amount. Orthotics are notcheap. They range from $250 to $600.

Medicare covers orthotics for diabetics with neuropathy(numbness of the feet). Medicare does not cover orthoticsfor any other type of foot problem. Secondary insurance willnot cover orthotics if Medicare does not cover them.

Podiatrists most commonly prescribe orthotics, butpedorthotists, orthotists, physical therapists and sometimesorthopedists will also provide orthotics.

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

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