Dr Mark Nelson
Foot & Ankle
Clinic Home Page
Foot Medical Information
What are Orthotics?
Orthotics are shoe inserts that are intended to correct an
abnormal, or irregular, walking pattern. Orthotics are not truly or solely
“arch supports,” although some people use those words to describe them, and
they perhaps can best be understood with those words in mind. They perform
functions that make standing, walking, and running more comfortable and
efficient, by altering slightly the angles at which the foot strikes a
walking or running surface.
Doctors of podiatric medicine prescribe orthotics as a conservative approach
to many foot problems or as a method of control after certain types of foot
surgery; their use is a highly successful, practical treatment form.
Orthotics take various forms and are constructed of various materials. All
are concerned with improving foot function and minimizing stress forces that
could ultimately cause foot deformity and pain.
Foot orthotics fall into three broad categories: those that primarily
attempt to change foot function, those that are primarily protective in
nature, and those that combine functional control and protection.
The so-called rigid orthotic device, designed to control
function, may be made of a firm material such as plastic or carbon fiber,
and is used primarily for walking or dress shoes. It is generally fabricated
from a plaster of paris mold of the individual foot. The finished device
normally extends along the sole of the heel to the ball or toes of the foot.
It is worn mostly in closed shoes with a heel height under two inches.
Because of the nature of the materials involved, very little alteration in
shoe size is necessary.
Rigid orthotics are chiefly designed to control motion in two major foot
joints, which lie directly below the ankle joint. These devices are long
lasting, do not change shape, and are usually difficult to break. Strains,
aches, and pains in the legs, thighs, and lower back may be due to abnormal
function of the foot, or a slight difference in the length of the legs. In
such cases, orthotics may improve or eliminate these symptoms, which may
seem only remotely connected to foot function.
The second, or soft, orthotic device helps to absorb shock,
increase balance, and take pressure off uncomfortable or sore spots. It is
usually constructed of soft, compressible materials, and may be molded by
the action of the foot in walking or fashioned over a plaster impression of
the foot. Also worn against the sole of the foot, it usually extends from
the heel past the ball of the foot to include the toes.
The advantage of any soft orthotic device is that it may be easily adjusted
to changing weight-bearing forces. The disadvantage is that it must be
periodically replaced or refurbished. It is particularly effective for
arthritic and grossly deformed feet where there is a loss of protective
fatty tissue on the side of the foot. It is also widely used in the care of
the diabetic foot. Because it is compressible, the soft orthotic is usually
bulkier and may well require extra room in shoes, or prescription footwear.
The third type of orthotic device (semirigid) provides for
dynamic balance of the foot while walking or participating in sports. This
orthotic is not a crutch, but an aid to the athlete. Each sport has its own
demand and each sport orthotic needs to be constructed appropriately with
the sport and the athlete taken into consideration. This functional dynamic
orthotic helps guide the foot through proper functions, allowing the muscles
and tendons to perform more efficiently. The classic, semirigid orthotic is
constructed of layers of soft material, reinforced with more rigid
Orthotics for Children
Orthotic devices are effective in the treatment of children
with foot deformities. Most podiatric physicians recommend that children
with such deformities be placed in orthotics soon after they start walking,
to stabilize the foot. The devices can be placed directly into a standard
shoe, or an athletic shoe.
Usually, the orthotics need to be replaced when the child’s foot has grown
two sizes. Different types of orthotics may be needed as the child’s foot
develops, and changes shape.
The length of time a child needs orthotics varies considerably, depending on
the seriousness of the deformity and how soon correction is addressed.
Other Types of Orthotics
Various other orthotics may be used for multidirectional
sports or edge-control sports by casting the foot within the ski boot, ice
skate boot, or inline skate boot. Combinations of semiflexible material and
soft material to accommodate painful areas are utilized for specific
Research has shown that back problems frequently can be traced to a foot
imbalance. It’s important for your podiatric physician to evaluate the lower
extremity as a whole to provide for appropriate orthotic control for foot
Printer Friendly Format
Orthotic Tips From The
Wear shoes that work well with your orthotics.
Bring your orthotics with you whenever you purchase a
new pair of shoes.
Wear socks or stockings similar to those that you
plan on wearing when you shop for new shoes.
Return as directed for follow-up evaluation of the
functioning of your orthotics. This is important to making certain that
your feet and orthotics are functioning properly together.
Your podiatric physician/surgeon has been
trained specifically and extensively in the diagnosis and treatment of all
manners of foot conditions. This training encompasses all of the intricately
related systems and structures of the foot and lower leg including
neurological, circulatory, skin, and the musculoskeletal system, which
includes bones, joints, ligaments, tendons, muscles, and nerves.
Reprinted with permission from the American Podiatric Medical Association.
Dr. Nelson's "Top 10 Tips" for
Treating Plantar Fasciitis (aka - "Heel Spurs")
1) Wear a
custom-made prescription orthotic (best treatment) or a quality pre-made type
- *very important*
2) Use a "Strassburg Sock" night splint while sleeping to gently stretch the plantar fascia.
- *very important*
3) Do "runner's
stretches" (or other stretches) to stretch the back of the calves and the
arch of the foot. - *very important*
4) Stretch the arch of the foot in bed before getting out of bed in the morning.
5) Consider taking
anti-inflammatory medications (NSAIDs), if you can tolerate them, but be
cautious of possible dangerous side effects.
6) Apply ice to
the arch and heel after being active on the foot.
7) Don't run, jog
or use stair climbers until the pain resolves.
8) Don't climb
ladders, don't walk barefoot, avoid going up/down stairs, avoid prolonged
walking/standing, and avoid smoking.
9) If overweight,
try to lose weight.
10) If not
improving, see your podiatrist who may be able to offer you other treatments,
such as "cortisone" injections, anti-inflammatory medications, extracorporial shock wave therapy,
physical therapy, surgery and more.
The Strassburg Sock ™
Strassburg Sock treats plantar fasciitis heel pain at night while you sleep in comfort. Plantar
fasciitis is also commonly called "heel spur syndrome" or "heel spurs".
This style of night splint is much more comfortable to wear while sleeping than
traditional hard plastic back (or front) style night splints. Plus, the
Strassburg Sock night splint is much less expensive than most other styles of
Looking for Orthotics?
Visit our Foot Care Store.
We offer a variety of different models from Walkfit, SuperFeet, OrthoFeet,
PowerStep and more.
Which Orthotic / Arch Support Should I Use?
Dr Nelson's comments:
The best fitting and functioning type of arch support is a custom made
prescription orthotic, which can be made by your podiatrist. Generally,
for most people, I recommend trying a pre-made arch support before progressing
to an expensive pair of custom made orthotics. Finding a comfortable and
effective pre-made arch support can be difficult. There are hundreds of
varieties on the market and that can make it confusing for customers. Due
to the variations in people's foot shapes, foot problems and style variations in
different products, there is no "one type fits all" arch support available.
That's why DrNelsonClinic offers different brands and models like
WalkFit and PowerStep to
choose among. Fortunately, for most people, I've found that the
OrthoFeet BioSole gel self-molding orthotics work for almost everybody.
Among the hundreds of pre-made arch supports I've seen and used, the
BioSole models give the best support and pain relief for people with
plantar fasciitis and heel pain. It's by far my favorite model for
people with heel pain, due in part to the higher arch and shock absorbing
gel under the heel. Be aware that the standard OrthoFeet BioSole "sport"
model is rather thick through the arch and it fits into athletic, work boots and
walking shoes, but may not fit into a shallow shoe, like a dress shoe. If
you want to use the OrthoFeet in a shallow shoe, like a dress shoe, then use the
"thin-line" or "high heel dress" models. The "sport" model may also be too
high in the arch area for people with very flat feet. For elderly or
arthritic people and those that want extra cushioning and softness under the
foot, while still getting extra support under the arch, try the OrthoFeet
BioSole "soft" model. If you don't need extra arch support or heel pain
relief and only want shock absorption and cushioning under the foot, try
the OrthoFeet "ThermoFit" model. After you start using any brand of arch supports,
remember to break them in gradually, because is will take some time for the orthotic and your feet to adjust to each other. I personally use the
OrthoFeet BioSole sport model in my athletic shoes and have found them to be as
effective and comfortable as my expensive custom prescription orthotics.
But, it did take longer to "break-in" the OrthoFeet supports than my custom
orthotics. If you don't have plantar fasciitis or heel pain or if you have
a flat foot and can't tolerate an arch support with a higher arch, but still
want great foot support to relieve foot fatigue and strain, you should also
consider SuperFeet Synergizer orthotics, which are
our most popular arch supports. SuperFeet Synergizer orthotics have
been highly recommended by sports and outdoor publications such as Backpacker™