As a physical therapist specializing in foot pain, I have come across a number of patients with different types of foot orthoses. A foot orthotic is an insert designed to help support, align or improve function of the foot. Many people seek out orthotics to help alleviate foot pain, but are troubled with deciding whether they need a custom orthotic.
Custom orthotics are inserts generated from a 3D print of the patient’s foot. These are not normally made by physical therapists. Most commonly these will be made by either orthotists, prosthetists or podiatrists. A custom orthotic can cost upwards of $500 with little coverage from insurance. Many times I have seen these custom orthotics fail for a number of reasons. The device can be made too rigid, not allowing for proper tri-planar movement of the foot. Runners with this type of device can be at risk for tibial stress fractures. My biggest issue is that many times the orthotic may be measured in non-weightbearing. Many people do not have pain in non-weightbearing, so why would we make an orthotic this way?
This systematic review by Collins et al offers us some perspective into the effectiveness of foot orthoses in lower limb overuse conditions. Lower limb overuse conditions typically arise from either abnormal foot mobility or through excessive tissue stress. This can result in foot pain, such as the commonly known diagnosis of plantar fasciitis. The article suggests that a foot orthotic can be helpful in the plan to remedy this pain, however a custom orthotic is NOT necessary.
When prescribed correctly, prefabricated devices can be just as effective as custom devices in treating lower limb pain. The biggest advantages to prefabricated devices is that they are cost effective, as well as readily available. Some of the troubles with custom orthotics are that they are resource intensive and expensive, and can have a large gap of time from the fitting, to the actually supply of the orthotics (~2 weeks). As previously mentioned, these orthotics may also be fitted by an orthotist. An orthotist does not have the same training as a Doctor of Physical Therapy, whom we may consider to be a “movement specialist” or “gait specialist.”
Hopefully the next time you feel pain in your foot, you’ll consider a few things. First, you will want to think about who you want diagnosing your pain. Consider a Doctor of Physical Therapy, a movement specialist who can properly analyze gait and movement dysfunction. Secondly, you will want to consider cost. Prefabricated devices are readily available and can be modified to effectively and efficiently treat your pain. Please feel free to reach out to me when considering how to solve your foot troubles or for a consultation.