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Orthotics can be a step in the right direction for sore feet

There are a lot of reasons for sore feet. When the problem is biomechanical, the answer for many people is orthotics: custom-made shoe inserts that help the feet work as they should.

There are a lot of reasons for sore feet. It’s often something simple, such as poorly made or badly fit shoes. But sometimes it’s more than that. Issues with the structure or function of the foot, such as flat feet, are called biomechanical problems. These issues can affect how you walk, which in turn can affect your feet with problems such as heel pain, but can also affect the ankle joints, leg muscles and even the hips and lower back.

Sometimes proper footwear can help, but for many people the answer is orthotics: custom-made shoe inserts that help the feet work as they should.

What they do

“Orthotics are a biomechanical intervention,” says registered chiropodist Justin Turner of the Women’s College Hospital Foot Care Centre, which provides custom orthotics to address a variety of foot problems. “They work to change the way the foot is functioning from a functional point of view, if possible; or to accommodate a foot deformity.”

In addition to treating biomechanical foot problems such as flat feet or very high arches, orthotics are used to relieve pain from conditions such as plantar’s fasciitis (also known as heel spurs), bunions, hammertoes and metatarsalgia. They are also used to address knee problems and even hip and back problems. They can reduce pressure, stress and strain on the feet and legs. Some people with chronic conditions such as osteoarthritis and rheumatoid arthritis use orthotics to offload high-pressure areas, and many people with diabetes use orthotics to reduce pressure on the feet.

What they don’t do

Orthotics only work when you’re wearing them. They don’t “cure” foot problems. For example, orthotics can improve the pain and mechanical issues associated with flat feet, but the person will still have flat feet. They might help slow the progression of a condition such as bunions, but they won’t make the bunion go away.

“Orthotics are a compensation, like glasses,” Turner says. “When I wear my glasses I can see; I take them off and I can’t see. It doesn’t matter that I’ve worn glasses for 20 years, it hasn’t fixed my eyesight or corrected it. It’s a compensation.”

Shoe choices

An orthotic can be used in any shoe, provided there is space for it.

“The only limiting factor is the space in the footwear. To that end, there are several different designs or types of orthotics. There are orthotics designed to fit into running shoes or walking shoes. There are orthotics that can be designed for dress shoes,” Turner says.  “There are different options in terms of orthotic styling and design to reflect different shoe choices. But the difference is, when you start tailoring an orthotic to fit a different shoe or type of shoe, that orthotic needs to be reduced in size and volume so you’re going to get less effect.”

So, yes, you can get an orthotic to fit platform pumps. But because of the shoe that it’s made for, it will have to be smaller and shallower than an orthotic intended for a walking shoe. A smaller, shallower orthotic can’t provide the same benefits as a larger, deeper orthotic.

But a smaller orthotic that gets worn still works better than a more effective one that never gets worn.

“You have a therapeutic goal in mind to address their mechanical concern, but it also has to be practical so somebody will use it. It doesn’t do any good to have a great orthotic that sits in a closet because that person won’t wear a laced running shoe; they want to wear a high heel,” Turner says, adding that some people have more than one model. “We work with what people are willing to do. We want people to get a result.”

Orthotics can also be designed for specific sports and athletic shoes.

Drugstore products versus orthotics

Most drugstores and many shoe stores carry a variety of insoles and shoe inserts. These range from simple flat foam insoles to moulded footbeds made by well-known shoe companies. Some of these are called orthotics, but obviously they are not custom-made.

“There’s a wide variety of off-the-shelf products, so it’s hard to compare them to custom,” Turner says, adding that the Women’s College Foot Care Centre does carry some off-the-shelf products. But all off-the-shelf products are mass-produced based on the average foot, while a custom orthotic is a precision medical device based on a particular foot and its specific mechanics. Not surprisingly, there is a big price difference, with off-the-shelf products ranging in price from less than $10 to about $65, while custom orthotics cost about $450-$500.

“Off-the-shelf products can provide some pain relief, and work very well for some people. They won’t work with everybody. Likewise, a custom orthotic won’t work for everybody. But the biggest difference is, when we do a custom device we do a plaster cast mould of your foot – so you’re getting a true three-dimensional mould of your feet – which the lab will then use to create your custom device.”

The difference is a bit like having a pair of prescription eyeglasses made for you, rather than getting the magnifying glasses available at the drugstore, he says. But who needs which product?

“Not everybody needs a custom orthotic. A lot of people need something, but not necessarily a custom orthotic.” Turner says. “But people who are having mechanical issues that aren’t resolving with good footwear and maybe some exercises might want to consider an orthotic.”

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Related Materials

Read more on foot care:

Feet first: proper foot care

For more information on foot care:

Women's College Hospital foot care centre

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