Many people come to my office complaining of foot pain from conditions such as bunions, hammertoes, a pinched nerve (neuroma) or heel pain (plantar fasciitis). I perform a thorough evaluation and examination, and together we review the origin, mechanics, and treatment plan for the specific problem or issue. The patient usually asks if they need an orthotic and, if so, which type would be best.
I recommend a foot orthotic if muscles, tendons, ligaments, joints or bones are not in an optimal functional position and are causing pain, discomfort, and fatigue. Foot orthotics can be made from different materials, and may be rigid, semirigid, semiflexible or accommodative, depending on your diagnosis and specific needs.
Different types of orthotics
Most of my discussions center around three types of foot orthotics: over-the-counter/off-the-shelf orthotics; "kiosk-generated" orthotics; and professional custom orthotics. Over-the-counter (OTC) or off-the-shelf orthotics are widely available and can be chosen based on shoe size and problem (such as Achilles tendinitis or arch pain). Kiosk orthotics are based on a scan of your feet. A particular size or style of orthotics is recommended for you based on your foot scan and the type of foot problem you are experiencing. They may help with heel pain, lower back pain, general foot discomfort, or for a specific sport.
For custom prescription orthotics, a health professional performs a thorough health history, including an assessment of your height, weight, level of activity and any medical conditions. A diagnosis and determination of the best materials and level of rigidity/flexibility of the orthotics is made, followed by an impression mold of your feet. This mold is then used to create an orthotic specifically for you. The difference between OTC/kiosk and custom orthotics may be likened to the difference between over-the-counter and prescription reading glasses.
Which type of orthotic is right for you?
A person of average weight, height and foot type, and with a generic problem such as heel pain, usually does well with an over-the-counter or kiosk orthotic. They are less expensive, and usually decrease pain and discomfort. However, you may have to replace them more often. Someone with a specific need, or a problem such as a severely flat foot, may benefit from custom prescription orthotics. While more expensive and not usually covered by insurance, they generally last longer than the OTC/kiosk type.
Before investing in orthotics, I recommend spending your hard-earned money on quality, properly fitted shoes specific for your work or athletic activities. You may be surprised to learn that many people have not had their feet professionally measured at a shoe store in years. As we age, our foot length and width changes. And sizing may not be consistent between brands; the same size 9 1/2 narrow shoe may differ significantly from one manufacturer to another.
If your pain or discomfort does not improve with new shoes, try over-the-counter or kiosk orthotics for a period of time. If you see improvement, fine. If not, see a health care professional for an evaluation for custom prescription orthotics.
In my experience, certain groups of people benefit from an examination performed by a health care professional, and a prescription for custom orthotics. These include people with diabetes who have loss of feeling in their feet, people with poor circulation, and people with severe foot deformities caused by arthritis. In fact, Medicare has a program that covers 80 percent of the cost of diabetic shoes and orthotics, because studies have shown that they decrease the chance of developing an open sore that can lead to amputation.
In summary, if you feel you know what is causing your foot pain, you don't fall into any of the groups that benefit from professional custom orthotics, and you already wear a properly fitted pair of shoes, go ahead and try the OTC or kiosk orthotics. For most people, these will provide relief. After taking these steps, if you notice no improvement in your condition, then seek out the advice of a health care professional.
(James P. Ioli, D.P.M., is a contributor to Harvard Health Publications.)