In this day of increasing awareness and education regarding our own health, people are seeking alternatives to conventional medical intervention for a multitude of ailments. Foot pain is no exception. There are numerous problems that affect our feet and many more solutions. The most important factor for treatment is to use the most appropriate treatment plan for each individual case. The use of foot orthoses (also known as inserts or orthotics) may be a part of the treatment plan for some sore feet. However, before jumping into foot orthoses, it is essential to ensure that the mechanics or physical structure is part of the problem.
When foot pain strikes, the first step in the treatment plan is to consult a medical doctor to have the problem properly diagnosed. The physician will conduct any necessary tests in order to establish the diagnosis, and then a treatment plan can be established. Treatment plans may include: rest, medication, physical therapy, surgery, appropriate footwear and/or foot orthoses. The physician may refer the client for assessment for orthoses.
Once the referral or prescription is obtained from the physician, an appointment with the Certified Orthotist(C.O.) is required for an assessment. During the assessment, the C.O. will first take a detailed history of the client's case including diagnosis, previous treatments, injuries, related surgeries, family history, daily activities and foot wear. Then the C.O. will look carefully at the client's gait (walking pattern) and standing positions. This is followed by an examination of the foot structure. Any abnormalities, boney structure, swelling, deformities and discolourations will be noted. After the assessment, the appropriateness of orthotic use will be discussed. Other factors that may be significant for the individual client will also be discussed including characteristics of proper footwear.
If it is decided to proceed with foot orthoses, there are two routes: over the counter insole or custom made foot orthoses. Over the counter insoles can be purchased in pharmacies and some shoe stores and may be appropriate in some cases. Custom made orthoses are made to the individual foot, usually from plaster impressions. The foot is casted with Plaster of Paris to produce molds and the molds are taken to the laboratory to use in the manufacturing of the foot orthoses. The foot orthoses are fabricated from a variety of materials, again depending on the individual client. In general, a softer material is used for cushioning and protection such as for a person with rheumatoid arthritis or diabetes mellitus. A firmer material is used for a foot orthosis that will control motion and foot position for pathologies such as plantar fasciitis or tibialis posterior tendonitis.
Once the foot orthoses are made, they need to be fit into the appropriate footwear. The C.O. will make sure that the orthoses fit well into the shoe and is comfortable for the client. The client should walk to allow the C.O. to reanalyze the gait. The foot orthoses may need minor adjustments to improve function and/or comfort. The fitting appointment should be followed-up after two to three weeks with a check-up to assess comfort and determine efficacy of the devices. If there are any ongoing issues or problems the clients should be encouraged to return for adjustments.
The provision of foot orthoses is not controlled or monitored by The Ministry of Health. Since there is a large number of people with foot pain and few regulations, there are many people who provide foot orthoses. However, not all providers are created equal, and therefore it is the patients' responsibility to educate themselves and to take an active role in their own treatment plan.
Ask plenty of questions such as:
Where are the orthoses made and by whom?
Orthoses that are made in a lab across the country often take time to receive. Ask for a provider that uses their own lab or a lab close by. There are many high quality facilities that have patient assessments and manufacturing labs in the same location. Make sure that a qualified technician is manufacturing the devices (eg. R.T.O.)
Where are adjustments made and who makes them?
Often after the orthosis is fit into your shoe, minor adjustments may be required to accommodate for your shoe. Your provider should be able to do that in a matter of minutes while you wait.
Are they custom made or prefabricated?
In some cases a ready made orthosis is appropriate and can be fit quickly and less expensively than a custom made orthosis ($50 vs. $500.00). Make sure that if you are paying for a custom made device, you are receiving a custom made device.
How long do orthoses last?
Orthoses do not last forever. With normal wear the average orthosis on the average person will last three to five years. However, with diseases such as Diabetes Mellitus and Rheumatoid Arthritis, changes in the feet and gait may occur which would necessitate more frequent renewal of the orthoses. Also people who are more active, heavier or not careful with the orthoses may need new ones sooner than the average person.
