Medicine Information Article:

Orthotics: Prefab or Custom-Made?

If you take a simple stroll down the foot product isle at yourlocal drug store you will find an array of foot products andinserts. You will find inserts for cushion, for comfort, forsupport and for control. Many questions may cross yourmind. What are the differences? Is the $15 insert better thanthe $7 insert? Are these orthotics? Will they help my footpain? You may take the time to study the package detailsclosely, but in most instances it doesn't really matter whichpair you grab. Most of the inserts at the local drug store areessentially the same.

An insert slips into the shoe and will give you some comfort,cushion and a little support. In some cases, insertspurchased at the drugstore will help alleviate some arch orheel pain and give relief to sore, tired feet. But, an insert isnot an orthotic. Orthotics are devices which fit into the shoeand aid in foot function. The most important difference is anorthotic 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 anddesigned to fit the most common foot types. Typically, aprefabricated orthotic needs to be purchased at a sportsstore and they are more expensive than inserts, costing$25-$30. The prefab orthotic is more rigid than an insert andis designed not only to support the arch, but also to helpcontrol motion, which will decrease stress on the tendonsand ligaments in the arch. Many individuals will do very wellwith a prefabricated orthotic. Prefab orthotics generally lastfor one or two years before replacement is necessary.

A functional custom made orthotic is a device that is evenmore rigid than a prefab orthotic. The custom made 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. Acustom made orthotic is not only custom molded to your footand arch, corrective wedges and covers are built into thedevice to help with motion control and to improve themechanics of the foot. Individuals with flatfeet, tendonitis,plantar fasciitis, certain foot deformities, knee, hip and backproblems may benefit from custom made functionalorthotics. The orthotic should make standing, walking,jogging or running more comfortable. Custom madefunctional orthotics will generally last 7-12 years beforeneeding to be replaced, and can cost between $300-$600.

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 resultsusing functional orthotics to treat heel pain, arch pain,arthritis, bunions, pain from flatfeet or high arches, knee, hipand back pain. A recent article in USA Weekend magazinestated the opposite. The article referenced a study in Foot &Ankle International in which researchers followed 874healthy, young Israeli army recruits without foot problems.The recruits were given soft custom, semi-rigid custom, softprefab or semi-rigid prefab orthotics to wear in their bootsduring basic training. The researchers found no differencein the development of foot problems between the custommade orthotic group versus the prefab orthotic group. Theconclusion from this study is that custom made orthoticswill not help prevent foot problems from developing. What isimportant to understand is this study did not evaluateindividuals with foot pain or foot problems. The populationevaluated was a group of young, healthy, active individualswithout any existing foot problems. Therefore, we cannotconclude from this study that prefab orthotics treat footconditions better than custom-made orthotics.

Individuals with plantar fasciitis (heel and arch pain) whoalso have flatfeet usually respond best to custom-madeorthotics. Certain types of tendonitis respond well toorthotics and other types require orthotics. Posterior tibialtendonitis is the tearing and inflammation of the tendon thathelps to hold up the arch. When this tendon is overstressedby arch collapse it cannot heal. Custom made orthotics areessential in the treatment of this condition.

Individuals with high arches may also require orthotics, butthey do not respond as well. Custom made orthotics canhelp slow the progression of bunions and hammertoes, butthey will not prevent this process. Orthotics may help withsome 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 stableand does not require support, the bunion, hammertoe,neuroma, tendonitis or even plantar fasciitis may not requirecustom made orthotics for treatment. These individuals maydo well with a pre-fabricated orthotic. If you do not have footpain or an existing foot condition, a custom made orthotic isnot necessary for prevention of foot problems.

A custom made accommodative orthotic is soft anddesigned to reduce pressure and prevent excess friction.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, unless the foot has adeformity, like a bunion or hammertoe, then accommodativeorthotics are necessary.

Both types of custom-made orthotics are formed by taking amold of the foot. A functional orthotic mold is fabricated bywrapping the foot in plaster. The foot is held in a correctedposition while the plaster is setting. To obtain anaccommodative orthotic mold, the patient steps into a foambox. An impression of the foot in a standing position is thencreated. The molds are sent to a lab and scanned into acomputer. A reverse image is produced and the computergenerates an image of the foot in neutral position. Thecomputer adjusts the image based on the correctionsrecommended. A model of the foot is then cut out, in somecases out of wood. The orthotic material is pressed over thefoot model and the orthotic is created. The most commonmaterial for a semi-rigid custom made orthotic ispolypropylene, but other materials, such as graphite areused. A foam-like material is typically used forcustom-made accommodative orthotics.

The bottom line is that if you have foot pain, a foot deformityor condition, let your podiatrist evaluate you and decide iforthotics should be part of the treatment. If your insurancewill not cover the orthotics and you cannot afford custommade orthotics, consider trying prefabricated orthotics. If youare looking to help prevent foot problems or looking forsome extra support, a prefab orthotics is a good option foryou, especially if you are active in sports. If you are justlooking for a little extra cushion and comfort, an insert atyour local drug store will be your best bet.

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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