Have you been told that you need orthotics?
Do you know of others who have orthotics and think it may benefit you?
Do you have pain in your feet, ankles, knees, hips or back?
Most people have heard of orthotics/insoles/inserts, but don’t know what they are or how they can be used to help their feet.
We have put together a blog that covers all you need to know about orthotics! In this blog, we will discuss what orthotics are, what they’re used for and who can benefit from them. We’ll also tell you how we assess and fit our clients with orthotics.
What Are Orthotics & How Do They Work?
Orthotics are devices that can be put into your shoes to help support your feet.
There are many different types of orthotics, ranging from simple options available at chemists to custom orthotics that are created specifically for your feet.
They are designed to help to support the structures in your feet, particularly those that are weak, injured or are not functioning properly.
Orthotics help to place your feet in a proper alignment to allow them to move in the most effective way.
It is important to note that orthotics do not change the structures in your feet. Rather, they provide support where your feet need it most.
What Are Orthotics Used For?
Orthotics can be used to treat a range of issues, from the lower back down to the feet. Some common conditions orthotics can help with include plantar fasciitis, bunions, arthritis, limb length discrepancies, knee pain, callus and corns, ankle instability and many others.
Your feet not only help you get from A to B, but they have the very important task of supporting the rest of your body when you are standing, walking and running.
Everything in the body is connected – ‘The foot bones connected to the leg bone’ and you know how that one goes – so, with that in mind, your foot function can affect the rest of your body, including your knees, hips and back.
With orthotics working to put your feet in the correct alignment, it can relieve strain further up the chain, helping with knee, hip and back pain.
Who Uses Orthotics?
Orthotics can be used by anyone!
Children, the elderly, top level athletes and weekend warriors can all benefit from orthotics if their feet require a little extra support.
While anyone can use them, how do you know whether you need them?
Do I Need Orthotics?
Many people who have experienced foot pain have been told that they need orthotics, whether that be from family, friends, or a health professional.
However, what works for one person may not work for another! Therefore, it is important to make sure that orthotics are the best treatment option for you. And that’s where we, as Podiatrists, can help!
How Does a Podiatrist Figure Out Whether You Need Orthotics?
Firstly, let’s go through how we assess the feet to determine if orthotics are the right option for you. The foot assessment can be broken down into three main parts.
Step One: Sit Down Assessment
An assessment usually begins by assessing the range of motion of the joints within the foot when you’re sitting down. This allows us to see where you may have a restriction or an increase in motion that may be contributing to your foot pain.
We also perform simple muscle testing of the muscle groups that allow the foot to move to identify any weaknesses.
Step Two: Standing Assessment
We then assess the feet when you are standing.
This allows us to see how your feet sit when you are in a ‘static’ position and how they work to support your body weight.
There are certain areas on the feet that we concentrate on when examining the feet in this position, including the heel bone (calcaneus), the ankle, the midfoot, the arch of the foot and the forefoot (toes).
This can tell us what structures are sitting in a different position that may be causing your foot pain and where support may be needed.
Step Three: Walking Assessment
Finally, we examine your feet when you are walking. It is important to know that there are many variations of movement and everyone walks a little differently.
Podiatrists refer to someone’s walking pattern as their gait.
We look at how your whole body moves as you walk, including the position of your shoulders, hips and knees. This helps us to see if there is anything we need to address further up the body that can be contributing to your pain and vice versa. Of course, we will also look very closely at how the feet are moving.
When the foot is making contact with the ground with each step, there are 4 main movements that we look at:
- ‘Heel Contact’ – where the heel is the only part of the foot in contact with the ground.
- ‘Foot Flat’ – whereby the whole foot is in contact with the ground.
- ‘Stance’ – where there is only one foot on the ground and the other is off the ground.
- ‘Toe Off’ or ‘Propulsion’- is the final movement, where the heel comes off the ground and the toes flex to allow you to take the next step.
We assess the position of the heel, the midfoot and the forefoot throughout the entire gait cycle.
This helps us to determine any areas of the foot that require more support.
Now that we know what is assessed to determine whether orthotics are required, let’s look at the common conditions that they can help.
Conditions Orthotics Can Help With
You may be aware that there are lots of conditions caused by certain foot postures and gait patterns.
Depending on your condition and the way that your feet move, orthotics can help your feet in a variety of different ways. Orthotics can aid in correcting alignment, assist weak muscles to function properly and provide your feet with the support they need to work the best they can.
Common conditions that can be helped with orthotics include:
Plantar Fasciitis
What is the Plantar Fascia and what does it do?
The plantar fascia is a ligament that runs from your heel to your toes and is responsible for supporting the arch of the feet.
What Causes Plantar Fasciitis?
Plantar Fasciitis occurs when the plantar fascia has to work harder than usual, either due to excessive load from activity, inefficient gait patterns or poor foot posture.
What happens when you have Plantar Fasciitis?
Your Plantar Fascia eventually fatigues and can become quite painful, with people experiencing pain at varying degrees, with the heel pain sometimes being experienced first thing in the morning, at other times it may be more constant.
How Can Orthotics Help with Plantar Fasciitis?
Orthotics can help to support the plantar fascia and the structures around them to ensure that they are able to do their job properly without taking on extra load!
Bunions
What is a Bunion?
Bunions are a bony deformity of the big toe.
What Causes Bunions?
Bunions have a number of causes including poor footwear, poor foot function and gait, and even genetics.
What happens when you have a Bunion?
The big toe is bigger than the rest of our toes and has a very important role in the ‘toe off’ phase of the gait cycle.
Having a bunion often means that there is a restriction in movement of the big toe and the feet cannot move from stance to toe off properly.
How Can Orthotics Help with Bunions?
Orthotics help by supporting the big toe as well as the joints in the midfoot to allow as much motion to occur through the big toe as possible.
Ankle Instability
What does the ankle do?
The ankle is a very important joint for foot function as it connects the feet to the leg.
The bone on the inside of your ankle is called the medial malleolus, or the end of the tibia bone. The bone on the outside is called the lateral malleolus, or the end of the fibular bone.
What Causes Ankle Instability?
There are a number of muscles that cross these bones and the ankle joint to allow movement in the foot, as well as ligaments to hold the ankle joint together.
Injury to these muscles, bones or ligaments can cause problems for the feet and force other structures in the feet to compensate for this.
How Can Orthotics Help with Ankle Instability?
Orthotics can help to hold the ankle in the correct position whilst also supporting the muscles that cross the across to get to the feet.
Various Tendinopathies
What are Tendons & why are they important?
Muscles attach onto bones via a tendon, and there are lots of them in the feet.
There are a number of muscles that cross the ankle joint to attach onto the foot.
There are 18 muscles within the feet, plus 11 muscles that start from your lower leg and attach via tendons into your feet. That’s a lot of muscles and tendons! You might have heard of some of them, including the Achilles Tendon.
What Causes a Tendinopathy?
Tendinopathies can occur when there is a weakness in a muscle or when too much pressure is being placed on a tendon.
How Can Orthotics Help with Tendinopathies?
Orthotics can help to support where the muscle bellies and tendons that attach to the bones and allow them to heal.
Bursitis
What are Bursae?
Bursae are small fluid-filled pads that sit in between joints and act as a cushion.
What is Bursitis & What Causes it?
Bursitis is an inflammation of these Bursae pads and can occur in almost all joints in the body.
Where might Bursitis occur?
Areas of the feet that are commonly affected by bursitis include the heel and the balls of the feet.
How Can Orthotics Help with Bursitis?
Orthotics can help to take the pressure of the bursae which are inflamed to help decrease pain and restore function.
Synovitis
What is Synovitis?
The joint capsules within our body are lined with what’s called a synovium membrane, which lubricates the joints to help with movement. Synovitis occurs when the synovial membrane is inflamed.
Where might I get Synovitis & What Happens When I Have it?
Synovitis and can occur in the ankle and foot. Synovitis can inhibit movement of joints which can cause changes to gait.
How Can Orthotics Help with Synovitis?
Similar to bursitis, orthotics can help to take the pressure of the joints where there is synovitis to reduce pain. By taking the pressure off joints, orthotics can help to restore motion in the feet and ankles.
Knee, Hip & Back Pain
How Can My Feet Cause Knee Pain?
Knee pain can often be caused by foot posture and gait abnormalities.
How Can Orthotics Help with my Knee Pain?
Orthotics can help to place the foot in the correct alignment, which then places the knees in better alignment.
Limb Length Discrepancies
What is a Limb Length Discrepancy?
This is where one limb is longer than the other same limb type, for example, everyone will have one leg longer than the other, just like we have one foot that is bigger than the other.
When Does a Limb Length Discrepancy Cause Problems?
If your limb length discrepancy is larger than normal, the body tries to compensate as best it can.
What Does a Podiatrist Look For?
In people who have one foot that pronates more than the other, we assess for a limb length discrepancy.
How Can Orthotics Help with Limb Length Discrepancy?
Orthotics can help by placing the feet in the correct alignment to help the structures further up the leg.
We can also add in a small heel lift to the orthotic to address a limb length discrepancy.
Now that you know some of the conditions that orthotics can help with and how we determine whether you need orthotics, let’s have a look at the process of fitting them!
I Need Custom Orthotics – What is the Process?
Here at Watsonia Podiatry, we very rarely jump straight into an orthotic prescription during your first appointment unless it is necessary.
We will often tape the feet first into a position that will mimic that of an orthotic by supporting the structures where there is pain.
This allows us to determine whether placing your feet in that position is going to be beneficial before starting the orthotic process.
In addition to this, we sometimes prescribe a simple program designed to help strengthen the structures as well as decrease your pain.
If we decide that orthotics are the best option moving forward, we book you in for 2 separate appointments.
Appointment Number One:
The first appointment is our biomechanical/scanning appointment.
In this appointment, we will have another thorough look at your feet to further assess your foot posture & gait.
Sometimes we take a picture of your feet and video you walking to help us with your prescription.
It is important to note that your privacy is of the utmost importance, so your pictures or videos are confidential, you will not be identifiable, and we obtain your consent before doing this.
Following this, we begin the scanning process.
At Watsonia Podiatry, we use a laser scanner and software that takes impressions of your feet.
We mark various landmarks on your feet using a pen to make sure the scanner identifies your feet properly. 
Once the feet are scanned, we check the images to make sure that we are happy with the scans. The scans need to be very precise for the orthotic prescription.
We then complete a prescription form online, which allows us to specify every little detail about the orthotics – right down to the degree or millimetre!
The orthotics prescription includes information such as the size, the materials, where the correction is needed, the amount of correction needed and more.
What do we make our Orthotics out of?
The material that we make the majority of our orthotics out of is called EVA.
EVA tends to be softer and more flexible than other materials on the market.
We choose to use this material as it tends to be more comfortable and fits into shoes slightly better than other materials.
We are also able to modify this material by including additional correction as well as grinding away sections are required.
Sometimes, people will need much firmer orthotics and we can use another material called polypropolene.
This material is much firmer and harder to modify if required.
This prescription is then sent off to the orthotic lab along with the scans of your feet to be made into your very own orthotics.
Appointment Number 2:
You will then return to the clinic in 2 weeks’ time for an orthotic issue.
It is very important that you bring the shoes that you wear most often to this appointment, so that we can fit the orthotics into them.
This can include your runners, work shoes, favourite boots etc.
If we need to make any modifications to the orthotics, we will do this at this appointment.
We check that the orthotics contour your feet well and that the support is in the correct place.
We always order our orthotics a size larger than your shoe size, as this means we can grind away the excess material to fit them into your shoes nicely.
As orthotics place your feet in a different position to what they are used to, they do have a wearing in period.
We will discuss this with you at this appointment and also issue a handout that covers all the information as well.
Follow Up Appointment
Your next appointment will be 5 weeks after your orthotics have been issued.
This appointment allows us to touch base with you to make sure that you are loving your orthotics and they are giving you the support that you need!
At this appointment we will check that you have adjusted nicely to the new orthotics.
We can also make any necessary modifications to the orthotics in this appointment.
Ongoing Care & Treatment
We then review you at least every 12 months to ensure that your orthotics continue to give you the support that you need!
Our custom orthotics generally last for 5-6 years.
Orthotics can make the world of difference to your feet and we want to make sure that your foot pain resolves as quickly as possible.
They are definitely an investment for your feet and we understand that!
As you can see from the breakdown of appointments above, we are very thorough in our assessment and fitting of the orthotics.
Our prescriptions allow us to tailor the orthotics specifically to your feet to get the best result possible, as everyone’s feet are different.
What is the Difference Between “Off the Shelf” and “Custom” Orthotics?
You may be thinking, “I can get ‘orthotics’ from my chemist which are much cheaper, why do I need custom orthotics?”
It’s a question that we get asked quite often as podiatrists.
There are many differences between custom orthotics and what you can get from the chemist, which we call prefabricated orthotics.
The main difference is that custom orthotics are designed and created specifically for your feet alone.
Prefabricated orthotics are generic, meaning that whilst they can offer some support, they are not tailored exactly to your feet and may not help your specific problem.
There is a large variety of prefabricated orthotics available at chemists and sports shops and it can often be difficult to pick out the right ones.
Prefabricated orthotics can offer varying degrees of arch support and cushioning.
A difficulty that we face as podiatrists is that it is challenging to be able to modify prefabricated orthotics.
Due to the material used, what you see is what you get and very little can be added to improve them if required.
This limits the amount that they are able to support your feet and if they’re not quite right, you may notice that your foot pain lingers.
In some cases, prefabricated orthotics can greatly assist with your foot pain.
However, this is dependent on your current foot situation.
If you’re not sure whether the prefabricated orthotics you have are doing enough for your feet, book in to see us today.
Does Watsonia Podiatry Have Prefabricated Orthotics?
At our clinic, we also have the option of a prefabricated orthotic, which we have had great success with.
We Use DOLA orthotics that are essentially generic in nature but can also be modified to fit your feet. Whilst a prefabricated is not initially customised to your feet, the DOLA range are able to be modified quite extensively to provide adequate support.
These prefabricated orthotics offer a significantly larger amount of support and cushioning than insoles or orthotics that can be bought at a chemist or sports store. We offer both full length and ¾ length orthotics.
So why is there such a difference in price between prefabricated and custom orthotics? In short, custom orthotics are more expensive than prefabricated orthotics due to the processes and materials required to make them. Each foot is different, so we always aim to make sure that we provide an orthotic that will support your feet as much as possible.
If you are experiencing pain or discomfort in your feet, lower limbs, knees, hips and back, it could be due to one of the common conditions we have mentioned or possibly another foot related problem. Book in to see one of our friendly podiatry team here at Watsonia Podiatry, we can assess your feet and determine whether orthotics are right for you, or if another treatment may be more appropriate.
You can book online or call us on 03 9432 2689.