ORTHOTICS? CUSTOM DEVICES? INSERTS? …So what are they?

Here’s the inside scoop…

What is an orthosis?

At AC Podiatry we refer to an orthosis as a custom-made shoe insert that is made from a plaster cast to an individual prescription for a patient following an intense examination revolving around how you move and function.    It is not an off the shelf, prefabricated orthotic and is far superior to the inserts that you might purchase from a pharmacy or online (please don’t!!).

The simplest comparison we can make is to eye glasses.  Getting a custom-made orthosis is like visiting an optician, getting your eyes tested and then receiving a pair of glasses prescribed by the doctor.  An off the shelf or prefabricated orthotic (cringe) is like going to the local service station (or pharmacy) and taking the already prescribed glasses from the counter near the checkout.

There are many ways to make an orthosis with scanning and 3D printing gaining popularity due to its speed and ability to be replicated.  We believe in the tried and true method of hand made (or artisan) orthoses, vacuum pressed off a plaster cast. We believe this provides a far better and more nuanced orthotic that serves our patients far better.

Orthoses can be made out of many materials and it really depends on the individual case.  For someone who needs a slim or narrow orthotic we might use a material such as carbon fibre, in an elderly patient with arthritis we might use a soft EVA and in an active child we might use polypropylene.  Ultimately, we match the material to the needs of the patient and we are one of the few practices in Adelaide that provides that choice.

A common misconception is that orthoses lift fallen arches or stop the foot from rolling in.  That they are only used in people who have flat feet. This is an understandable assumption given that flat feet have always been demonised and seen as problematic.

At AC Podiatry we use orthoses as a way of redistributing forces or stresses away from painful areas by assisting the foot to work better.  This might mean rolling the foot in if someone has a very high arch and rolls their ankles all the time, helping the big toe work better so someone can push off their big toe properly, redirecting pressure away from an area where you get a painful corn or callus or adding a lift to address someone having one leg longer than the other.

In addition, we can use orthoses to improve the way the foot works so that a person can run, walk and even cycle more efficiently. Ultimately, orthoses change the environment that the feet need to work in so that they don’t have to work so hard and by doing so, help relieve pain and aggravation and improve mechanics and efficiency.

When would you use orthoses?

Orthoses are very useful in managing a range of issues including, but not limited to:

Any condition that has a mechanical cause (so a problem that comes as a direct result of walking or activity) a very strong case for orthoses can be made.

In conclusion, well-prescribed, custom-made orthoses are extremely good at helping pain and disability cause by poor foot posture and function. However, it is also important to understand that orthoses are simply a plank in any treatment plan. We would generally look to combine orthotic therapy with other treatment options including strength and conditioning programs, footwear change, mobilisation and dry needling.  We do this because it is our philosophy that orthoses should not be a crutch and that our patients should be able to go about their daily tasks, at least on occasion, without them.