What are Orthotics?
A foot orthotic is a device that can be discretely inserted into the shoe to support, align, prevent and/or accommodate foot abnormalities and improve how the foot functions.
How they help
Custom made foot orthoses (often called orthotics) can help to alleviate painful or debilitating conditions of the lower back, hip, knee, lower limb and foot or complications related to heath conditions such as diabetes and arthritis. They can also help improve balance and accommodate foot deformities that are inherited or that result from injury. Pedorthists typically use a combined approach of orthoses and footwear to create a biomechanically supportive system that addresses the specific condition.
There are two main types of orthotics: Custom-made and Over-the-counter (OTC)
A custom-made foot orthotic is made specifically for the patient following an assessment of their feet and legs by a footcare expert such as a Canadian Certified Pedorthist.
In order to create true custom-made orthotic, your provider needs a 3-D cast that captures the exact contours of your feet in their ideal functional position. Approved casting techniques include foam box casting, plaster slipper casting, wax molding, contact digitizing and laser/optical scanning.
Making a footprint on an ink pad, taking a digital foot pressure scan or walking over a pressure plate doesn’t qualify since none provide the information needed to create custom-made orthotics.
- Custom-made foot orthotics are biomechanically accurate to each patient
- There is an ongoing ability to modify the device to create perfect fit and function
- A vast variety of materials can be used to provide specific support and cushioning for increased function and comfort
- They have a longer lifespan that off-sets the greater initial cost
- Custom-made orthotics initially cost more than an over-the-counter device, although most insurance programs provide orthotic coverage
Many individuals with limited foot care education and training dispense “custom foot orthoses” at health fairs, lifestyle, home and sportsman shows or mall kiosks. Typically, the individuals selling these products are unqualified, unaccountable and in many cases misleading in their practices.
Basic over-the-counter devices are pre-fabricated and mass-produced; they are sold through pharmacies, grocery stores and other retail stores.
- Over-the-counter devices are easily available and more affordable
- There are certain applications for which over-the-counter devices may provide benefit for minor biomechanical abnormalities. For example, they can be used as a temporary device for a child who is rapidly growing or as a "first step" to provide insight into how a patient will respond to and tolerate an orthotic.
- They will not fit all foot types and conditions
- They will only support minor biomechanical abnormalities. More significant issues will likely require a custom-made device.
- They have a shorter life span than a custom-made foot orthotic.
Orthotics should not be purchased in the following circumstances
- Orthotics sold from exhibits at home, trade or sportsman shows, health booths, on the internet, in malls or if no follow-up or return is possible
- People offering mass screenings in your place of employment, or for your whole family, without properly evaluating each person
- People who do not provide proper assessment and follow-up - people that do not provide a full assessment, do not take a three-dimensional cast of your foot, or do not meet for a follow-up session to assess the effectiveness of the orthotic
- Custom orthotics for children under the age of five years – orthotics for this age group are uncommon as many skeletal and soft tissue injuries do not present themselves in very young children; your doctor should determine the need for orthotics based on a global diagnosis of the child
- Dispensers who do not have the capacity to modify the foot orthoses themselves. This may suggest they lack training specific to foot orthoses. Foot specialists often have equipment on site to adjust orthotics once produced in labs which ensures that your orthotic is as custom-made to your feet as possible.
- Practitioners that take no interest in your footwear—custom foot orthotics work best when footwear fits properly and is appropriate to your needs and lifestyle
Methods Used to Fit an Orthotic
Certified Pedorthists employ a variety of three dimensional “casting” techniques and technologies to make an accurate impression of the foot and develop perfect-fitting custom-made orthotics.
Accepted three dimensional casting techniques include:
Direct Mold - The shell material for the orthotic is heated to a desired temperature and then molded directly to the patient’s foot by the Pedorthist.
Foam Box - With the patient sitting or standing, the Pedorthist gently places the patient’s foot on top of a foam box and controls foot alignment while applying pressure to the foot causing it to sink into the foam to capture an accurate 3D impression of the foot. This 3D mold is then used to fabricate the orthotic.
Plaster Slipper Casting - While sitting or laying down, plaster is applied to the bottom and sides of the foot and then, once dried, the set plaster is gently pulled away to reveal an accurate 3D mold for the orthotic.
Wax Mold - This technique is very similar to Plaster Slipper Casting except moldable wax is used to create the orthotic mold instead of plaster.
Laser - A laser light is moved around the foot to recreate an identical image. The image produced is analyzed and modified by computer software to produce a 3D image that will serve as the electronic mold for the orthotic.
Contact Digitizing - To capture the foot’s contours, the client places their foot on a special machine called a “digitizer”. The digitizer elevates numerous pistons which contact the bottom and sides of the foot creating a 3D image on the computer which serves as the electronic mold for the orthotic.
From a mold a Certified Pedorthist will create the custom-made orthotic to fit the patient’s exact foot shape and contours, using orthotic shell materials carefully chosen to meet the patient’s specific needs. Once fabricated, Pedorthists use a special grinder machine to smooth and shape the orthotic to precise accuracy and fit within a patients footware.
Most insurance providers offer coverage for custom-made foot orthotics as they are medically necessary. Be aware, however, that insurance companies are getting much more restrictive about who is allowed to prescribe and who is allowed to dispense orthotics. It is wise call your insurance company and ask "who is allowed to sell me this product?" as some providers are being excluded from being able to dispense orthotics and the patients’ will end up not having coverage.
As a general rule, insurance companies are looking for a prescription and proof that the orthotic has been custom-made.