Orthotics and Your Feet
Orthotics are devices which fit into the shoe to aid the foot.
"Functional orthotics" are rigid and designed to control
motion and correct the function of the foot. Individuals with
flatfeet, tendonitis, plantar fasciitis, certain foot deformities,
knee, hip and back problems may benefit from functional
orthotics. "Accommodative orthotics" are soft and designed
to reduce pressure and prevent excess friction. Diabetics
and those with a loss of sensation or circulation in their feet
will benefit from accommodative orthotics. Both types of
orthotics are custom made by taking a mold of the foot. Functional Orthotics The goal of the functional orthotic is to improve the
mechanics of the foot, control the abnormal motion in the
foot, decrease the pain in the foot, ankle, knee, hip or back
and to add support. The orthotic should make standing,
walking, jogging or running more comfortable. The orthotic
must be rigid to help control the motion in the foot and add
support. If the orthotic is soft, the weight of the body would
collapse the device and it would no longer function. Abnormal motion is typically in the form of pronation.
Pronation is the rolling in of the foot and collapse of the
arch. The motion starts at the rearfoot, or heel area. When
the heel turns in, it allows the arch to collapse. This puts
undue stress on the ligaments and tendons in the arch area
and contributes to the development of tendonitis, plantar
fasciitis, bunions and hammertoes. The functional orthotic
helps to control the abnormal motion in the rearfoot. This is
accomplished by taking a mold of the foot in its neutral
position. The neutral position is the position the foot should
be in when walking. When standing, the over-pronated foot
is in the uncorrected position. The mold of the foot should
be taken with the patient sitting so the foot can be placed in
the neutral position. The molds are sent to a lab and scanned into a computer. A
reverse image is produced and the computer generates an
image of the foot in neutral position. The computer adjusts
the image based on the corrections recommended by your
podiatrist. A model of the foot is then cut out, in some cases
out of wood. The orthotic material is pressed over the foot
model and the orthotic is created. The most common
material is polypropylene, but other materials, such as
graphite are used. In some cases, hand-made molds are
created out of plaster. This was the classic way orthotics
were made until newer technology made the process much
less labor intensive. Functional orthotics are a successful treatment for many
problems affecting the lower extremity. In a recent article in
the Journal of the American Podiatric Medical Association,
75% of patients surveyed had good to excellent results from
functional orthotics. This includes 17% who felt the orthotics
"cured" their pain. Less than 10% had no relief. The most
commonly treated condition in the study was a painful heel.
Over 20% of patients surveyed were treated for a painful
heel and 20% were treated for a painful arch. Fourteen
percent of the individuals were using orthotics for flatfeet.
Other conditions treated with orthotics were knee, hip and
back pain, foot arthritis, bunions and high arches.
Tendonitis was not specifically evaluated. Individuals with plantar fasciitis (heel and arch pain) who
also have flatfeet usually respond best to orthotics. The
plantar fascia is a ligament type structure on the bottom of
the foot which helps to hold up the arch. When the foot
collapses, the weight of the body stresses the ligament and
results in tearing and inflammation. This results in plantar
fasciitis. These individuals typically respond well to orthotics
in combination with other treatments. Certain types of
tendonitis respond well to orthotics and other types require
orthotics. Posterior tibial tendonitis is the tearing and
inflammation of the tendon that helps to hold up the arch.
When this tendon is overstressed by arch collapse it cannot
heal. Orthotics are essential in the treatment of this
condition. Individuals with high arches may require orthotics as well,
but they do not respond as well. Orthotics can help slow the
progression of bunions and hammertoes, but they will not
prevent this process. Orthotics may help with some pain at
a bunion, but they will not "cure" the bunion. When the
motion in the foot is contributing to the problem, orthotics
are generally recommended. If the foot is stable and does
not require support, the bunion, hammertoe, neuroma,
tendonitis or even plantar fasciitis may not require custom
made orthotics for treatment. These individuals may do well
with a pre-fabricated orthotic. Accommodative Orthotics Diabetics can develop numbness and loss of circulation in
the feet. This numbness and circulation loss puts them at
risk for developing open sores on the feet called
ulcerations. To help prevent excess rub and friction in
certain areas on the feet, accommodative orthotics are
recommended. Diabetics who do not have numbness or
circulation loss (as diagnosed by their doctor) do not need
to have accommodative orthotics. If the foot has a deformity,
like a bunion or hammertoe, then accommodative orthotics
are necessary. Accommodative orthotics are made from many different
types of material. Some are made of a foam type material,
others made from cork and others have covers ranging from
soft spongy material to leather. The type of material
depends on the type of foot. Many accommodative orthotics,
made for diabetics, have two or more layers that form
around the foot once they are worn. Three pairs are
dispensed every year and they are replaced every 4 months.
Other materials are longer lasting. A mold of the foot is
taken by stepping into a foam box. In this case, it is
important to take the mold standing, so that the orthotic can
be made to form around the foot. The Cost Many insurance companies cover orthotics for certain
diagnoses. The most commonly covered diagnoses are
plantar fasciitis (heel and arch pain), flatfeet and diabetes.
Many insurance companies cover the orthotics at 80%. This
means the patient is responsible for 20% of the cost unless
they have a secondary insurance. If the deductible has not
been met, then the amount is applied to the deductible and
the patient must pay the full amount. Orthotics are not
cheap. They range from $250 to $600. Medicare covers orthotics for diabetics with neuropathy
(numbness of the feet). Medicare does not cover orthotics
for any other type of foot problem. Secondary insurance will
not cover orthotics if Medicare does not cover them. Podiatrists most commonly prescribe orthotics, but
pedorthotists, orthotists, physical therapists and sometimes
orthopedists will also provide orthotics. Christine Dobrowolski is a podiatrist and the author of
Those Aching Feet: Your Guide to Diagnosis and Treatment
of Common Foot Problems. To learn more about Dr.
Dobrowolski and her book visit
http://www.skipublishing.com. For more information on
prefabricated orthotics visit
http://www.northcoastfootcare.com.
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