Custom Made Foot Orthoses are specially designed medical devices that are used by many different people for many different medical reasons. In general, orthoses are designed to support, align, protect, prevent deformity and/or to enhance mobility of a part of the body. Foot orthoses can influence not only the feet, but the knees, hips, back and neck. It is therefore very important to ensure that the person who assesses and treats someone with foot orthoses understand the past medical history, the biomechanics and the pathology of the person being treated.
There are two broad categories of foot orthoses, often with overlap in between.
Corrective Foot Orthoses are designed and fabricated to improve function by correcting biomechanical concerns. People who have Plantar Fasciits, tibialis posterior tendinitis, patellofemoral syndrome (PFS), or bursitis in the hip may be candidates for corrective foot orthoses. In some people, the foot may hit the ground and then over pronate (the arch flattens as in flat foot). When the foot over pronates, there is a corresponding internal rotation of the leg (the leg actually turns in) and the muscles and tendons will no longer work as they are supposed to. Some of the muscles and tendons will have to work harder than they are designed for and they become over used and cause over use injuries such as those mentioned above. Over use injuries can also happen when the foot rolls out too much with over supination (under pronation) which can result in peroneus longus or peroneus brevis tendinitis (which cause pain on the outside of the ankle and into the foot). There are many other problems that can be addressed with corrective foot orthoses that are not mentioned here.
Corrective foot orthoses are usually made to plaster casts of the feet while the feet are held in a corrected or neutral position. The foot orthoses then maintain the corrected position of the foot when walking and running to prevent the position that causes the injury. The foot orthoses are a little firmer than an accommodative foot orthosis, but they should always be comfortable. You may need to get small adjustments after you have had a chance to wear them during your regular activity. For more information on what to expect when getting foot orthoses click on Foot Orthoses - What To Expect.
Accommodative Foot Orthoses are designed to support and protect the feet by cushioning the feet and helping to remove pressure from certain points. They are often used for people who have arthritis or diabetes mellitus. In arthrits and diabetes, there may be boney deformities which tend to be more rigid and cannot be fully corrected. We must then support the feet and cushion any of the boney areas. People who have diabetes may get diabetic neuropathy where there is a loss of protective sensation in the feet which may result in callous build up and/or ulceration. Since the person loses the ablity to feel the pressure on the foot, they will keep doing thier activitiy and not realize that the skin has had so much pressure that is becomes damaged to the point that is opens up and forms an ulcer. For more information see Orthotic Management of the Diabetic Foot below.
Accommodative foot orthoses are made of softer materials to pad the feet and prevent pressure points from becoming painful or in the case of people with Diabetes, to prevent pressure ulcers. The orthoses are usually made from plaster casts of the feet which will reflect the areas of high pressure which require relief. You may need to get small adjustments to the foot orthoses from time to time as the feet may change more often in someone who has arthritis or diabetes mellitus. For more information on what to expect when getting foot orthoses, click on Foot Orthoses - What To Expect.
As this information is general and as everyone is unique, it is important to have a proper assessment by a physician to determine a correct diagnosis. The Certified Orthotist will then assess the biomechanics and medical history to determine the appropriate treatment plan for each individual.
