The Ultimate Guide To Orthotics

Definition, Types and More

What are orthotics, and what do they do?

Orthotics are devices designed to support and correct the alignment of the feet and lower limbs. They are commonly used to alleviate foot pain, correct biomechanical imbalances, and improve overall foot function. Orthotics can be custom-made or prefabricated and are typically inserted into shoes to provide additional support, cushioning, and stability.

 

The main purposes of orthotics is:

  1. Support: Orthotics provide support to the arches of the feet, helping to distribute weight more evenly and reduce excessive pressure on certain areas.
  2. Alignment: By correcting biomechanical imbalances such as overpronation (inward rolling of the foot) or supination (outward rolling of the foot), orthotics help align the feet, ankles, and lower limbs more effectively during walking and other activities.
  3. Pain relief: Orthotics can help alleviate foot pain caused by conditions such as plantar fasciitis, flat feet, bunions, and heel spurs by providing cushioning and reducing stress on affected areas.
  4. Prevention: They can also be used preventatively to reduce the risk of injury or to support proper alignment in individuals who are prone to foot problems due to factors such as overuse, high-impact activities, or structural abnormalities.

Podiatrists, physical therapists, or other healthcare professionals often recommend orthotics for individuals with foot or lower limb issues. Orthotics are customised to fit each individual’s specific needs and may be part of a comprehensive treatment plan for managing various foot-related conditions.

What conditions can orthotics help treat?

Orthotics, also known as orthoses, are custom-made devices designed to support, align, and correct issues with the feet and lower limbs. They can be used to treat a wide range of conditions, some of them include:

  1. Flat Feet or Fallen Arches: This condition occurs when the arches of the feet collapse towards the ground, leading to pain and discomfort in the knees, ankles, and hips. Orthotics support flat feet by raising the arch back into a more natural position.
  2. Plantar Fasciitis: A condition involving the inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Orthotics can help relieve stress in this area by redistributing pressure evenly across your foot.
  3. Overpronation or Supination: It refers to abnormal foot rolling while walking or running. This results in an uneven distribution of body weight on the foot, causing strain on muscles and tendons, leading to pain and injuries. Properly fitted orthotics prevent these motions, providing stability and balance.
  4. Bunions: A bunion is a painful bump at the base joint of the big toe, which causes it to misalign toward other toes, creating pressure points and deformity over time. Orthotic devices realign the affected joints, reducing pressure, resulting in less pain and preventing further progression.
  5. Hammer Toes, Mallet Toes, and claw Toes: These conditions all involve abnormalities in toe positioning, usually due to bending at one or more joints; they may cause discomfort while walking, running, wearing shoes, etc. Hence, an orthotic device helps straighten them out, avoiding frictional forces against shoes and minimising the discomfort/pain involved.
  6. Rheumatoid arthritis/Osteoarthritis: This chronic inflammatory disease affects joints, including those in our feet. Custom-made cushioned orthotics reduce impact load during activities, thereby minimising associated symptoms like joint swelling/pain, etc.
  7. Diabetes: Diabetic patients often suffer from peripheral neuropathy (loss of sensation in feet), leading to the development of unnoticed sores/wounds, which can be serious if left untreated; a specially designed orthotic device reduces pressure points and improves circulation, preventing such complications.
  8. Achilles Tendonitis: This issue occurs when there is an overuse/injury of the Achilles tendon, the band connecting calf muscles at the back of the lower leg to your heel bone. Orthotics help correct your foot posture, reducing strain on the tendon.
  9. Heel Spurs: These are calcium deposits that cause bony protrusions on the underside of the heel bone. They often occur due to plantar fasciitis or long-term muscle/tendon strain, which makes walking painful. Custom-made orthotics provide additional cushioning, relieving pressure off the heel spur area and making movements more comfortable.
  10. Leg Length Discrepancy: If one leg is shorter than the other, it may lead to imbalance while walking, causing various musculoskeletal issues. A corrective orthotic raises the shorter side to equalise length, thereby restoring proper balance and alignment.

Orthotics should always be prescribed by a trained healthcare professional following a thorough assessment because choosing the incorrect type/fit may worsen existing conditions or create new problems.

What are the signs you need orthotics?

Orthotics are devices placed inside your shoes to correct biomechanical foot issues, such as problems with how you walk, stand or run. Here are some signs indicating that you might need orthotics:

  1. Persistent Foot Pain: If you consistently experience pain in your feet while running or walking, it may be a sign your feet aren’t functioning correctly and you need orthotics.
  2. Frequent Ankle Sprains: Recurring ankle sprains could indicate an imbalance in foot structure requiring correction via orthotics.
  3. Uneven Shoe Wear: If one shoe wears out faster than the other one or if there’s uneven wear on a single shoe (for example, only on the outside heel), it implies abnormal foot mechanics.
  4. Flat Feet or High Arches: Both conditions potentially lead to various problems due to the altered stress they put on feet and can benefit from custom-made orthotics.
  5. Lower Back Pain, Hip Pain or Knee Pain without apparent cause: These conditions could indicate abnormalities in foot function affecting overall body posture and alignment.

What are the different types of orthotics? Are hard or soft orthotics better?

Orthotics can be classified into different types according to their manufacturing process, the materials used, and their function.

  1. Functional Orthotics: These are designed to control abnormal foot motion and may be used to treat injuries such as shin splints or tendonitis. Typically made from plastic polymer or graphite (a hard material), they offer control rather than cushioning.
  2. Accommodative Orthotics: These devices are more focused on comfort than functionality. They are typically softer devices used for conditions like diabetic foot ulcers, painful calluses on the bottom of the feet, and other uncomfortable conditions.
  3. Prefabricated/Over-the-counter Orthotics: These orthotics come ready-made in various sizes and can be bought without a prescription from pharmacies or sports shops.
  4. Custom-Made Orthotics: Based on the individual needs identified by a podiatrist during an assessment, these orthotic devices are customised specifically for your feet. They are made using 3D scans or plaster cast impressions taken by your healthcare professional.
  5. Soft/Padded Orthotics: Usually constructed from soft compression materials that provide additional cushioning for shock absorption purposes.
  6. Rigid/Hard Orthotics: These are generally made of firm materials like carbon fibre or plastic and are primarily intended to control the movement of one or two major joints under the ankle joint.
  7. Semi-rigid/Semi-flexible Orthotic Devices: Particularly common among athletes, these devices help balance while walking/running but provide enough flexibility to absorb some force when landing jumps etc., which reduces stress on particular muscles/joints/tendons.
  8. Unloading / Offloading orthosis: This type is usually prescribed for relief of pressure over certain areas, such as wounds and ulcerations, which need time to heal without any disturbance.

Whether hard or soft orthotics are better depends on individual needs. Hard or rigid orthotics are usually more durable and provide greater support, making them suitable for people with serious biomechanical disorders. Hard orthotics may be uncomfortable for some people. Soft orthotics, while more comfortable, are less durable and might not provide the same level of structural support. It’s best to consult with a podiatrist who can assess your specific condition and recommend the most suitable type of orthotic device.

Can orthotics help treat the pain in the ball of your foot?

Pain in the ball of your foot, medically known as metatarsalgia, is a common and treatable issue. The pain can manifest differently depending on the person, but common symptoms include: 

  • Deep bone ache 
  • Shooting or burning pain in the toes 
  • Feeling like there’s under your foot 
  • Immediate sharp pain when beginning movement

This condition can be caused by various factors including increased physical activity load, ill-fitting footwear or certain medical conditions such as neuromas or bursitis.

Treatment options vary depending on individual circumstances but may involve:

  • Reducing time spent on feet
  • Icing for inflammation reduction if swelling or bruising is present 
  • Taking prescribed medications
  • Wearing appropriate footwear
  • Strengthening exercises for flexibility and strength improvement 

Using orthotics for pressure relief 

Depending on the treatment and cause of your pain, your podiatrist may recommend orthotic inserts (arch supports) or offloading techniques, such as strapping metatarsal domes or padding. These interventions are designed to alleviate pressure and discomfort in the ball of the foot by aligning the foot properly and providing support to the injured area.

Lifted Heels of Feet

Diagnosis and Prescription

How does a podiatrist diagnose foot problems and prescribe orthotics?

A podiatric diagnosis usually begins with a comprehensive patient interview. The podiatrist will ask about the patient’s medical history, lifestyle, work environment and any specific pain or discomfort they’re experiencing. A thorough physical examination of the feet and legs follows.

The physical examination may involve gait analysis (observing how you walk or run), joint mobility tests, muscle strength tests and possibly neurological examinations to check for nerve damage. The podiatrist might also perform skin and nail assessments to identify any abnormalities such as corns, calluses or infections.

In some cases, imaging studies like X-rays, ultrasound scans, or MRIs may be ordered to obtain more detailed information about the structure of your feet and ankles. These images can reveal issues such as fractures, deformities, or arthritis that might be causing your symptoms.

If orthotics are thought necessary for treatment, the podiatrist will take an impression or 3D scan of the foot. This provides an accurate model on which the orthotic device can be crafted.

Do I need a prescription for orthotics?

Many over-the-counter orthotics can be purchased without a prescription at pharmacies and medical supply stores. However, custom-made orthotics that are specifically designed to fit your feet usually require a prescription from a podiatrist or other qualified healthcare professional. These professionals conduct an examination of your feet, ankles, and legs to determine the best type of orthotic for your needs.

It’s important to note that even though some over-the-counter options don’t need prescriptions, it is highly recommended to seek advice from healthcare professionals before selecting any kind of foot support. This ensures that the device suits your individual needs and potentially avoids further complications.

Should you get custom or over-the-counter orthotics?

In Australia, if you want the cost of custom-made orthotics covered by Medicare (under the Chronic Disease Management Plan) or private health insurance, you will generally need a podiatrist’s assessment and prescription. So, while not all types of orthotics technically require a prescription in Australia, it’s always advisable to consult with relevant healthcare providers when considering this type of treatment.

Fitting and Selection

How do you get fitted for orthotics?

Getting fitted for orthotics involves a few key steps that are designed to ensure that the orthotic device perfectly matches your foot shape and adequately addresses your specific podiatric issues. 

Here is a step-by-step guide on how you can get fitted for orthotics:

1. Consultation: 

The first step is to consult with a podiatrist or an orthopedist who specialises in foot care and the use of orthotics. During this consultation, you would discuss any symptoms or problems you’ve been experiencing related to your feet.

2. Evaluation: 

Following this initial discussion, the podiatrist will then conduct a thorough evaluation of your feet. This typically includes visual inspections, walking/running analyses, as well as physical examinations which involve feeling different areas of your feet and legs to detect any abnormalities or areas of pain.

3. Diagnosis & Prescription:

Based on these findings, they’ll then make their diagnosis and prescribe the necessary treatment plan which may include using custom-made orthotics if deemed necessary for managing your condition effectively.

4. Casting/Scanning:

To create custom orthotic devices that match the exact contours of your feet, an impression needs to be taken using either plaster casting techniques or 3D digital scanning methods, depending on what technology is available at their practice.

5. Manufacturing Process: 

Once they have obtained accurate impressions/scans of both feet, they are sent to an Orthotic Laboratory, where they are used as templates for creating personalised in-shoe devices made from various materials, such as plastic polymers or carbon fibre composites, depending upon individual requirements.

6. Fitting Session & Adjustments:

After the orthotics are manufactured (which usually takes 1-2 weeks), return to the clinic, where the podiatrist will fit these newly made devices inside shoes while ensuring proper alignment and comfort levels are achieved. During the wear-in period, minor adjustments can be made based on feedback regarding the feel underfoot during normal walking/running activities.

7. Follow-Up Care: 

Lastly, it’s important to schedule regular follow-up appointments to monitor your progress and make any necessary adjustments or replacements over time, as your podiatrist recommends.

Do you need special shoes for orthotics?

Using orthotics does not necessarily mean you need special shoes. However, certain characteristics should be considered when choosing footwear to ensure it can effectively accommodate your orthotics.

 

  • The most important factor is that the shoe has a removable insole. This allows the orthotic device to fit into the shoe properly. It’s also crucial for the shoe to have enough depth, especially at the toe area, so as not to cramp your feet or cause discomfort.

 

  • A secure fastening system like laces, straps, or buckles is preferred because it helps keep both your foot and the orthotic securely in place while walking or running. Slip-on styles may not provide sufficient support.

 

  • In terms of fitting, there should be enough room for your longest toe when standing up (approximately 1 cm space from the longest toe). The ball of your foot—which is its widest part—should match the wide part of your shoe.


It’s recommended that after purchasing a pair of shoes you find suitable with your orthotics, take them to your podiatrist for assessment before wearing them extensively. Your podiatrist can check if any modifications are needed and whether it fits correctly with your device.

In some cases, specially designed therapeutic/medical-grade footwear might be necessary for individuals with severe foot deformities or conditions that cannot be accommodated by regular footwear. 

How can you determine what orthotics to buy? 

Choosing the right orthotics depends on your specific needs, foot structure and lifestyle. First consider your symptoms or conditions – orthotics can help with problems such as plantar fasciitis, flat feet, high arches, bunions or diabetes-related foot issues.

Next, consider the types of shoes you regularly wear. Different orthotics are designed to fit different shoe styles – from athletic trainers to formal dress shoes.

Finally, consider your daily activities. If you’re active and play sports often, you might need a more robust orthotic than if you’re mostly sedentary.

A podiatrist can provide a comprehensive assessment of your feet using methods like gait analysis or 3D foot scanning technology and recommend appropriate custom-made or over-the-counter orthotics based on these factors.

Performance, Effectiveness, Treatment and Relief

Are orthotics really effective?

Orthotics are effective for a range of foot-related conditions. These custom-made shoe inserts are designed to address various foot and lower limb issues. Orthotics work by realigning the structures of the foot and leg to prevent certain movement patterns that can cause pain or injury.

Orthotics are beneficial in managing symptoms associated with many conditions, including plantar fasciitis, Achilles tendonitis, shin splints, bunions, and even knee or back pain. They also assist in distributing weight evenly across the foot to alleviate pressure on specific areas. They are helpful for both adults and children experiencing foot pain.

However, it’s important to understand orthotics aren’t a one-size-fits-all solution; what works best for one individual may not work for another. The effectiveness largely depends on an accurate diagnosis of the problem. Therefore, consultation with a qualified podiatrist is essential when considering orthotics, as they can assess your individual needs and design an appropriate treatment plan.

Furthermore, patient compliance plays a significant role, too – wearing them as advised is crucial for optimal results. 

How much should orthotics cost? Are they covered by Medicare?

The cost of orthotics can vary greatly depending on the complexity of the condition being treated, the type and material of the orthotic device, and whether it is custom-made or prefabricated. On average, you might expect to pay anywhere from $100 to $800 per pair for custom foot orthoses in Australia. Off-the-shelf devices are usually cheaper but may not provide the same level of correction or comfort.

As for Medicare coverage, standard Australian Medicare does not typically cover orthotics unless they are required as part of a chronic disease management plan. However, some individuals with specific health conditions may be eligible for partial reimbursement through the Chronic Disease Management (CDM) programme if their GP includes it in their care plan.

Private health insurance funds often provide varying levels of coverage for podiatry services, including orthotics, under their extras cover based largely on your level of coverage and annual limits. It’s recommended that you check with your private insurer regarding what is included in your policy before purchasing an orthotic device. 

How many hours a day should you wear orthotics?

The number of hours you should wear orthotics can vary depending on the specific condition they’re treating and your body’s adjustment period. Initially, it’s recommended to gradually build up the time you spend wearing your orthotics each day. You might start with just one hour a day, then increase by an hour every subsequent day until you are able to comfortably wear them for full days.

Once adjusted, they should be worn anytime you’re bearing weight on your feet—this includes walking or standing. So, ideally, if comfortable, around 7-10 hours per day during regular daily activities would provide optimal benefits.

However, it’s essential that you listen to your body and take breaks when needed throughout this process. Any discomfort should be discussed with your podiatrist, as adjustments may need to be made.

Can orthotics help with sports performance and injury prevention?

Orthotics can significantly improve sports performance and injury prevention. They are specifically designed to align the foot and ankle into an anatomically efficient position that enhances balance, control, and power during physical activity.

While engaging in sports activities, our feet endure intense pressure and strain. Poor biomechanics or structural abnormalities may lead to overuse injuries such as shin splints, Achilles tendonitis, or plantar fasciitis. Customised orthotics can help distribute weight evenly across your feet, relieving these pressure points and reducing pain and discomfort.

Moreover, they provide stability for the foot by preventing excessive movement of arches, thereby improving the functional efficiency of lower limbs during running or jumping activities. This not only optimises performance but also reduces fatigue levels. In addition to this preventive role against sports injury, orthotics also assist in the rehabilitation process post-injury by correcting alignment issues whilst providing support and comfort.

How long does it take for orthotics to fix your feet?

The time it takes for orthotics to “fix” your feet greatly depends on the specific issue at hand and individual factors such as age, overall health, and commitment to using the devices properly. Generally speaking, some people might start feeling relief in a few weeks, while others may need several months or even longer.

For conditions like plantar fasciitis or flat feet, you may notice an improvement in discomfort fairly quickly because the orthotic is designed to re-distribute pressure away from painful areas. However, structural changes like correcting overpronation or realigning bones in the foot will take considerably more time—often six months to a year.

Can orthotics be used alongside other treatments?

Absolutely, orthotics can indeed be used alongside other treatments. In fact, it is quite common for podiatrists to recommend a combination of different treatment approaches to address a particular foot problem or condition. 


These devices can complement other treatments, such as physiotherapy exercises, stretching routines and strength training programs aimed at improving muscle balance and joint mobility. They may also be used in conjunction with medications or surgical procedures if needed.

For instance, if you have plantar fasciitis—a painful condition involving inflammation of the band of tissue running along the bottom of your foot—you might benefit from wearing orthotics and doing specific stretches recommended by your healthcare provider. Furthermore, in cases where individuals suffer from conditions like arthritis or diabetes that affect their feet’s health and function, using orthotics with prescribed medications could help manage symptoms more effectively.

Side Effects and Risks

Are there any side effects or risks associated with using orthotics?

Yes, while orthotics can often provide relief from pain and improve foot function, potential side effects or risks may occur. One of the most common issues is discomfort or a period of adjustment as your feet get used to the new support. This is usually temporary and subsides as your body adjusts. In some cases, individuals may experience blisters if the orthotics aren’t fitted properly. It’s important to have them correctly sized by a qualified professional to avoid this problem.

 

A more serious but rare risk is the worsening of symptoms if the orthotics are not correctly prescribed or worn improperly. For instance, using an incorrect type of insole might increase strain on certain muscles or joints instead of relieving it. Furthermore, over-reliance on orthotics without addressing underlying causes, such as strength imbalances or flexibility issues, can potentially create long-term problems.

 

Finally, improper care for your orthotic devices (like not cleaning them regularly) could potentially lead to skin infections. Therefore, while beneficial for many people with foot-related issues, these potential side effects underscore why it’s crucial that you work closely with a professional when using such devices.

Is it bad to wear orthotics all the time?

Generally speaking, if your podiatrist has recommended you wear orthotics most of the time for optimal benefit, it is advisable to follow their guidance. Orthotic de͏vices are customised to fit your feet and ͏address specific foot problems. Therefore, wearing them as advised could help correct these issues over time.

However, constant use of orthotics might also lead some individuals to become over͏ly dependent. Ideally, our muscles and joints should work naturall͏y without needing additional support. Over-reliance on orthotics may weaken certain muscles͏ in the foot since they no longer need to work as hard due to the extra support provided.͏

The key ͏poin͏t here is balance, while consistent use of prescribed͏ ͏orthotic devices can be beneficial in managing specific conditions or injuries; long-term dependency should be avoided where possible so as not to inhibit ͏muscle function.

Maintenance and Care

How do I care for orthotic inserts? How often should I replace them?

Caring for your orthotic inserts involves several simple steps that can extend their lifespan and maintain effectiveness. Here are some simple steps to take care for them:

 

  1. Cleaning: Regularly clean your orthotics to remove dirt, sweat, and bacteria that may build up over time. Use a mild soap or detergent and a soft cloth or sponge. Gently scrub the surface of the insert before rinsing it with warm water. Avoid using harsh chemicals, as these could damage the material of your orthotics.
  2. Drying: After washing, let your orthotics dry naturally at room temperature away from direct heat sources like heaters or sunlight, which can warp them.
  3. Rotation: If you regularly wear more than one pair of shoes, consider getting a second pair of orthotics to rotate them.
  4. Storage: When not in use, store your inserts in a cool and dry place, away from direct sunlight.
  5. Inspection: Regularly inspect your orthotics for signs of wear and tear, such as cracks or thinning areas, especially if they are custom-made.


Replacement frequency

How often you should replace your orthotics depends on how often you use them, what activities you do while wearing them (e.g., running vs daily walking), the type of footwear they’re used in (work boots vs sneakers), body weight and biomechanics (how someone walks/runs).

Generally speaking:

 

  • Soft Orthotics need to be replaced every 6-12 months.
  • Semi-rigid Orthotics should be replaced every 12-24 months.
  • Rigid Orthotics last between two to five years before needing replacement.

 

Please remember that even if your orthotics are still in good physical condition, but you have changes in your foot health or overall health (e.g., pregnancy, injury), it might be necessary to get new ones to reflect these changes. Always consult with a podiatrist when unsure.

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