Orthotics (also known as orthoses) are custom made foot supports.  An impression is taken of your foot from a cast or by standing in a foam box (static impression with the foot held in its “neutral” position.  The theory is that there is a neutral position where your foot functions optimally.  Most feet, when visualized in standing, deviate from this position to some degree.  An orthosis is designed to position your foot so that it is held closer to its “neutral” position.  Podiatrists, orthotists, chiropractors, physical therapists, athletic trainers and kinisiologists can prescribe orthotics.

Usually, after the impression is taken it is sent to a lab where the orthotic is fabricated.  Labs vary in the way they produce the orthotic.  Many labs will digitally scan the impression and match the impression with their closest mold.  There are a few labs that make a truly custom orthotic.  A company from Germany has recently begun taking a dynamic foot impression with the use of a computer monitored force plate that you run across, based on contact pressures and timing an orthotic is created. 

Orthotics are fabricated from a variety of materials.  Some orthotics are rigid - to provide maximal control of the foot position, others are made from material designed to maximize cushioning.  The type of orthotic prescribed should be based on several factors (foot type, weight, running style, etc).  Generally, a higher ached foot is stiffer and responds better to a cushioning type of orthotic.  A flatter foot may respond better to a more rigid orthotic.

Unfortunately, there is not enough research to confidently predict which orthotic is “best” or who will benefit from using an orthotic.  This is where the art of medicine dominates science.  There is some research that suggests that a “full contact insole” may be as effective as an orthotic.  Since insoles are much cheaper, it may be worth starting with an insole that is recommended by an experienced running specialist. 

Insoles are typically purchased “over the counter”.  Companies such as Sorbothane, Sof Sole and Spenco, research what the most common foot shapes are and create an insole to provide a full contact support made from materials designed to offer support and shock attenuation.  Some insoles are even somewhat custom molded by having you stand on the insole after it is heated.  Most specialty running stores will have a selection of insoles and can steer you to the best choice. 

Testimonials cover both sides of the spectrum.  I know people who state they couldn’t run without orthotics and I have met others who threw them away and swear they are better for it.  This could also reflect the artistry (or lack thereof) of the person prescribing and creating the orthotic.  Orthotics are most commonly prescribed for heel pain or plantar fasciitis, although some people find them helpful for IT band pain, knee pain, shin splints and a variety of foot injuries. 

Orthotics or insoles can be a useful way to provide support for your foot and allow injured tissues to recover.  Flexibility of the calf muscles and a properly fit shoe are also essential for optimum foot function.  An often-neglected component of foot care and injury prevention is strengthening and balance training.  The DVD, The Injured Runner – A Balanced Solution, provides an excellent program to help runners develop balance and core strength. You can find more information about this DVD at www.injuredrunner.com.

Bryan Whitesides MPT, OCS

The Injured Runner - Helping runners get back to what they love to do...run!

www.injuredrunner.com