Orthotics in Physiotherapy

May 01, 2022

Orthotics are shoe inserts used for correcting the biomechanics of your feet where it is that your foot mechanics are causative or a part of the reason for your presenting complaint. This commonly includes heel (spurs, plantar fascia, Achilles tendon), knee, hip or lower back complaints.

I have an arch, I don’t need orthotics do I?

Orthotics can be for people with all foot types. We think of them as a device to control your foot’s motion to within normal limits. They are not designed to stop normal motion but reduce or control excessive motion causing potential harm.

The biomechanics of the foot are very important for the optimal functioning of the rest of the body when you stand and walk. If your feet aren’t well positioned or moving optimally the effects can be felt not only in the feet but up your body. The foot should be in what is known as a neutral position where the foot bones sit nicely on one another. This position lies between a pronated (flat foot) and supinated (very high arch) position. Pronated feet are very common in today’s world where we are always walking on hard, flat surfaces that offer no support to the arches of our feet. Increased body weight also puts more pressure through the feet from above and often leads to a flattening effect. Do you have an arch lying down that then disappears when you stand on your feet or a very large arch that perhaps moves too much in walking?

The arch in the foot is an important structure that allows mobility and shock absorption on impact with the ground but also locks into a solid position that creates a spring effect in walking and running. When the arch flattens it leads to other parts of the body to compensate and become overloaded, leading to injuries. A common issue we see with pronated (flattened arch) feet is calf pain as your calf must work harder in the pushing off phase of walking because the arch doesn’t have the normal spring effect. Another common problem is knee pain. This results from the bones in the feet rolling inwards and out of alignment resulting in the knee joint to also point towards your midline. This position can lead to uneven pressure on the knee joint and patellar (kneecap) tracking problems.

Can’t I get them from the Chemist or shoe shop?

The orthotics we prescribe may appear similar to some orthotics within these retail stores but, generally these retail orthotics lack the degree of rear-foot control of our medical grade devices. Many of the ‘orthotics’ available off the shelf within these stores are not for foot control but shock absorption and therefore have little effect on fixing the problem. Simply pick them up and try to bend the inside of the orthotic where the heel cup moves into the arch of the foot. This is the crucial area for many true orthotics and should therefore be difficult to move, resisting excessive motion of your foot.

In short, off the shelf orthotics are generally very soft, don’t last long and are a one shape fits all rather than custom made to your foot and your biomechanics. This therefore requires anatomical knowledge and a good understanding of biomechanics to ensure prescription and fitting doesn’t result in a secondary problem. Often we see people with problems stemming from poorly fitted orthotics within retail stores, many who have invested a fair bit of money chasing different shoes and inserts to find the answer. We are all different and require individual prescription. Some will need extra adjustment (wedging, doming, firmer/softer, full length, 2/3 length) and hence our physio’s are best to give you advice re your footwear, orthotics and individually prescribe and shape your orthotic. The orthotics we use are heat moulded to your feet to position them (and the lower limb) into a neutral alignment.

What about the Podiatrist?

Orthotics from a podiatrist on the other hand are quite rigid and are custom made from scratch to the shape of your foot and are made very precisely. These are often quite expensive and can be uncomfortable for athletic pursuits. It is also extremely important that should you see a Podiatrist they have a greater knowledge of the body’s biomechanics and will take into account more than just our foot. If your feet require more than what we provide, we can refer you to an excellent team of Podiatrists who we trust to provide you with an orthotic that takes into account more than just your foot.

What are your Orthotics like?

The orthotics our physiotherapists fit lie somewhere in between retail stores and Podiatry orthotics in more way than one. They are inexpensive, rigid and are moulded to the shape of your foot.

If you have flat feet, or think you might need orthotics, come in and see us to get fitted and put you on the right track. There’s more to addressing your mechanics than orthotics alone. Evidence shows orthotics and a combination of other interventions (stretching, strengthening, education around movement habits) have a greater outcome than orthotics alone. Book your appointment now.

Written by: Scott Ward