Your mum wears orthotics. Half the people in their sports team slip them into their shoes. Your boss swears by his orthotics in his business
shoes. Even your young niece has small, colourful orthotics in her shoes. So, does that mean that everyone needs orthotics? And if so, why?
Let’s have a look at the truth behind orthotics, who they can help, and who needs them - as well as who doesn’t.
People wear orthotics because, at some point, they’ve had a foot injury, pain or other problem (which can be as simple as not being able to run as fast as their peers) and they’ve decided to get to know why their problem is occurring, instead of just trying to (temporarily) patch up the symptoms. Let us illustrate with a few scenarios:
Meet Jason with heel pain
Jason is a 23-year-old gym enthusiast and soccer player. Jason never used to wear orthotics, but ever since he decided to commit to the gym and join social sports teams, he’s been training harder and longer than he ever has before. One day, Jason noticed pain at the back of one of his heels that radiated up his legs. It only got worse with every practice and game, particularly when he ran. He started to slow down. He couldn’t give the game his all. He felt down about it. He tried resting and using ice and taking anti-inflammatories, but they only gave him temporary relief. When he got active again - the pain would return.
So Jason decided to see his podiatrist, who uncovered via a gait analysis and foot and leg exam, that Jason’s training regimen paired with his foot posture, foot biomechanics and tightness in his Achilles tendon, and some calf weakness were the reason he developed Achilles tendinopathy. Jason was prescribed orthotics as part of his treatment plan to offload the Achilles tendon, and alter his foot posture and biomechanics so that he’d stop naturally overloading and straining the tendon when he was running and being active. Jason also did several other things like a stretching and strengthening program, and a manual therapy (in his case, shockwave) to actually repair the tendon damage. Now that he’s completely pain-free, Jason continues to wear his orthotics so that his risk of overloading the Achilles again remains reduced, by having his foot posture and function better controlled and stabilised.
Meet Betty with a bunion
Betty is a 49-year-old woman that has mild-moderate bunions on both feet. Her mum had severe bunions that made it difficult for her to wear shoes comfortably and caused her much pain, so when Betty noticed her bunions worsening over the years, she needed to know if she was destined to the same fate - or if something could help her, whether that be surgery or something else.
Betty saw her podiatrist who found that when Betty walked, her very flat (pronated) foot type meant that she would always roll onto the inside border of her foot, with every step, including the big toe joint where the bunion was - just like her mum. Betty learned that this was one of the key factors causing her bunions to get more severe and pronounced over time, as each time she walked the pressure on the bunion would force her big toe further inwards towards the other toes. Aside from the appearance of the bunion and the occasional redness and aching when she had a long day on her feet, Betty wasn’t experiencing too much bunion pain - but knew this could quickly change like her mother’s did. Betty wanted to stop her bunion from getting worse, but wasn’t prepared to have surgery this early, knowing the consequences and complications it can have. So Betty’s podiatrist prescribed her a pair of foot orthotics that would support her foot, arch and the inner border of her feet so that when Betty walked, she no longer rolled along the inside or placed excess pressure on the bunion. Her podiatrist ensured the orthotics could fit all her shoes - both sneakers, sandals and casual shoes comfortably. Betty now wears her orthotics every day as a preventative measure to help prevent the bunion from worsening from this overloading factor.
Meet Jim with diabetes
Jim is a 66-year-old man that has been living with type II diabetes for over 20 years. He describes his management of his diabetes as being up and down over the years. He’s experiencing a few side effects from his diabetes, including changes to his vision, and getting some burning, tingling and numbness through areas of his feet. Six years ago, Jim developed a small diabetic foot ulcer, and despite working with his diabetic nurse for many months, failed to see much progress with the wound. Other areas of his feet were beginning to become red and tender too, and the nurse informed him that the skin in these other areas may also break down soon too.
Jim saw his podiatrist, who did an assessment involving pressure plate testing, to find that the amount of pressure that Jim was exerting on specific areas of his feet were at a very high and risky level. His podiatrist immediately set to work creating a pair of custom foot orthotics with specially designed and precisely positioned ‘cut-outs’ that would offload the vulnerable areas of Jim’s feet, including his ulcer, while keeping the rest of his feet comfortable and supported. In the months following, Jim also began other therapies to improve the circulation in his lower limbs to support his healing, and the foot ulcer was able to finally close. Jim now continues to wear his orthotics, which his podiatrist has slightly modified, as a way of preventing Jim from applying too much pressure to these areas again, so that his ulcer risk reduces significantly. Jim has not had a foot ulcer since and sees his podiatrist annually for a review of his feet and orthotics, and any modifications to his orthotics to match Jim’s current circumstances in terms of his diabetes (as it’s a progressive disease process).
Meet Kayla with growing pains
Kayla is a 12-year-old school student who had previously been experiencing growing pains, which her podiatrist prescribed her orthotics for to help her recover faster (along other hands-on therapies like foot mobilisation and a stretching and strengthening program). However, this isn’t the first time Kayla has needed orthotics. At the age of 8, one of Kayla’s feet still persisted in turning inwards toward the other (in-toeing) and it became a real problem for her as she got more active, and kept tripping over her feet during sports and at school, often hurting herself in the process. This was Kayla’s first experience with orthotics, where she had a ‘gait plate’ orthotic that, together with physical therapy, helped bring Kayla’s feet into the straight alignment they’re in now. Kayla stopped wearing the orthotics entirely after finishing her in-toeing treatment, and only had a new pair since the development of persistent growing pains that again interfered with her at school, at home, and socially. After getting the relief from her growing pains and being able to complete sports games without pain, Kayla continues to wear her orthotics to support her foot posture and function, helping reduce the risk of the recurrence of her pain.
Meet Tom with a leg length difference
Tom is a 31-year-old IT worker with notable hip and knee pain in one of his legs. After trying every exercise and brace under the sun with no avail, Tom saw his podiatrist who diagnosed him with a leg length difference of 13mm - the longer leg being the one in pain. Tom’s podiatrist explained all of the different ways that his body will be compensating at the hips and knees to account for this difference when he walks, even though Tom couldn’t recognise a notable difference himself - as most people can’t.
Tom’s podiatrist prescribed a pair of foot orthotics that looked quite different from one another, with one of his orthotics having a notable ‘raise’ in the orthotic that would even out his height, bringing his hips to the same level, instead of one being tilted higher and the other lower. Tom continues to wear his orthotics to this day, with them being a simple, easy and versatile way to keep his symptoms gone completely.
Meet Gary, who was on a waiting list for an aged care home because he falls
Finally, Gary is a 78-year old retiree with early Alzheimer's disease who falls on a regular basis. Gary suffered several lacerations on his arms and legs from his most recent fall but prior to this he was in hospital for an extended time with a skull fracture that resulted from a fall. Gary’s wife, now mature aged children, and home care package provider were all concerned that his home was no longer safe for him and put him on a waiting list for the local aged care facility.
Gary’s podiatrist prescribed a pair of custom foot orthotics along with better shoes and a foot and ankle exercise program and he stopped falling because the orthotics improved information proprioceptive feedback to his brain so his balance improved. Gary continued to wear his orthotics and as a result he got to live in his home with his wife for another 5 years until his passing.
Now that you have an idea of the types of scenarios where you may need orthotics, let’s describe the scenarios where you don’t: if you’re not experiencing any foot or lower limb pain, if you’re participating in sports without pain and discomfort, and if you’re happy with your performance when you’re active, then it’s safe to say that it’s very likely that you don’t need orthotics.
Orthotics aren’t just something our podiatrists hand out ‘for the sake of it’ - much like prescription glasses, they’re a very genuine and effective medical device with very specific medical functions. As such, we will only prescribe them if they will genuinely help to improve your pain levels and your quality of life.
Great question - orthotics are absolutely not all the same - despite some tricky marketing agents trying to label any and every one-size-fits-all shoe liner as an “orthotic”. This absolutely isn’t true, and explains why some orthotics “don’t work” for some people - because they’re not real orthotics! We’re very passionate about setting the record straight here - and have even gone through what orthotics are and the difference between orthotics and footbeds here.
While our answer is a very clearly resounding no, we get that you may be experiencing foot complaints that can leave you wondering if orthotics could help or not. The answer here is that it very much depends on what’s going on, what’s causing the issue, and whether orthotics can help with that specific issue (for example, if you’re dealing with recurring warts and want to keep them gone for good, orthotics won’t help you).
Our podiatrists are always available for a consultation to see if orthotics could play a role in your treatment plan. The best part is that if they don’t - that’s okay - your podiatrist is highly experienced and will show you exactly what can help you, and how it will work.
Book your appointment with our podiatry team online here or call us on 1300 993 338.