Introduction
Foot orthoses, often referred to as orthotics, are custom-made shoe inserts that support the feet and enhance foot posture. A podiatrist may recommend orthoses for those who have persistent foot or leg issues that affect the health and functionality of their feet. A person who is prone to calluses, for example, can use specially manufactured shoe inserts to equalize their body weight across their feet. Additionally, athletes may wear orthotics to tackle any foot issues that can impair their performance. These prescription shoe inserts are either "off the shelf" or custom-made using a plaster cast or a digital image of the patient's foot created with computer assistance.
What Are the Uses of Foot Orthoses?
The various uses of foot orthoses are:
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Reduce shear forces and offload high-pressure zones.
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Protect soft tissue regions that are at risk (such as in diabetes).
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Adjust stiff abnormalities and fix flexible deformities (such as in pes planovalgus).
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Reduce uncomfortable movements (like hallux rigidus).
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Ankle fusion, for instance, can restore lost motion and enhance gait and mobility.
What Are the Conditions That Can Be Treated With Foot Orthoses?
The following foot and lower limb issues can be successfully managed over time with orthoses:
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Calluses and corn.
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A foot ulcer.
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Tendonitis.
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Ankle sprains that repeat often.
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Foot and leg bone stress fractures that repeat frequently.
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Heel pain.
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Patellofemoral syndrome, or pain in the front of the knee.
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A few hip and low back discomforts, especially those made worse by prolonged standing or walking.
What Are the Different Types of Foot Orthoses?
The purpose of orthoses is to treat a person's specific foot issues. The numerous orthoses can take the following forms:
Functional foot orthoses (tailored kinetic) are available to provide all the capabilities listed below, including posture adjustment.
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Prefabricated Orthoses: These are devices that a podiatrist can customize to address a particular issue.
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Cushioning Orthoses: They are used to provide the foot with additional shock absorption.
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Pressure Relief Orthoses: Using pressure relief orthoses, the wearer's body weight is distributed more evenly across the foot's sole, removing pressure points that may be the cause of problems like corns or calluses.
How Is the Foot Assessed for Orthoses?
If foot orthoses are thought to be necessary, a thorough understanding of how the feet work will be needed. This can be accomplished by looking at the foot and paying special attention to the following:
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The joints' range of motion.
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The strength of the muscles in the feet.
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The placement of the foot's bones when standing.
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The way people walk will be carefully examined (either on a treadmill, on a level surface, or by repeatedly performing the painful activity).
Orthoses are typically prescribed in conjunction with other treatments, such as a regimen of stretches and strength training, to help with posture and alignment. These exercises are often created by the podiatrist with the patient’s input and initiated at the time that orthotics are prescribed. Other physical treatments could be:
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Mobilization.
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Manipulation.
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Taping and strapping.
To speed up the healing process for persons with diabetic foot ulcers, wound cleansing, dressings, and pressure-relieving orthoses are all recommended. After the orthoses are fitted, one might need to see a podiatrist to make sure they are functioning properly. The shoe inserts may occasionally need to be slightly adjusted. To assist patients in managing their foot issues over time, a podiatrist will come up with an ongoing treatment plan.
What Are the Benefits of Foot Orthoses When Used for Different Clinical Conditions?
1.Plantar Heel Pain: Several research studies and reviews advocate the use of foot orthoses for plantar heel pain:
- According to a 2022 best practice guide by Morrissey et al., tape, stretching, and specific guidance should come first when treating people with plantar heel pain. People who do not make enough progress, however, "may have shockwave therapy before receiving personalized orthotics."
- According to the clinical practice recommendations for the Journal of Orthopedic Sports and Physical Therapy, "Foot orthoses, either prefabricated or custom-made or fitted, to support the medial longitudinal arch and cushion the heel in people with heel pain or plantar fasciitis help alleviate pain and improve function for short- to long-term (two weeks to one year), especially in people who respond well to anti-pronation taping techniques.”
- According to Whittaker et al.'s evaluation of 19 clinical trials, there is moderate-quality evidence that using foot orthoses is a useful strategy for short- and medium-term pain relief in plantar heel pain.
2. Patellofemoral Pain Syndrome (PFPS):
Foot orthoses can considerably enhance knee, sport, and recreational function in those with patellofemoral pain syndrome (PFPS), according to Chen et al. 's review and meta-analysis from 2022. According to the 2019 recommendations published in the Journal of Orthopaedic and Sports Physical Therapy, "Patients with more than usual pronation should be given prefabricated foot orthoses to relieve pain, but only for a brief period of time (up to six weeks)." Foot orthoses should be used in conjunction with other treatments.
Squatting with one or both legs extended can be used to determine whether or not patellofemoral discomfort is being provoked:
- If the patellofemoral region experiences pain as a result of this test, the doctor may urge the patient to repeat the procedure while wearing a foot orthosis.
- If doing so lessens the pain, it suggests that a foot orthosis can be helpful for the patient.
Another examination designed to find PFPS patients who will most likely benefit from foot orthoses is:
- A non-weight-bearing position is used to measure the patient's foot width, which is then compared to standing mid-foot width.
- Foot orthoses may be beneficial if the midfoot width significantly widens. The test is not trustworthy, according to research by Matthews et al.
3. Tibialis Posterior Tendon Dysfunction:
- A potent foot inverter is the tibialis posterior. Using orthoses in the early phases of tibialis posterior tendon weakness may lessen discomfort, according to a 2021 systematic review. Additionally, it has been discovered that for patients with tibialis posterior tendon dysfunction, customized orthoses may be preferable to prefabricated foot orthoses.
- When there is a malfunction, an orthosis can be employed to provide external inversion and supination support.
- This should lessen the strain on the tibialis posterior muscle.
4. Achilles Tendonitis:
- Patients with Achilles tendinopathy have reported less discomfort after using custom-fit semi-rigid insoles for four weeks, along with exercises.
- When compared to lower-heeled and more traditional footwear, higher-heeled shoes and maybe orthotics can reduce stress on the Achilles tendon in runners.
- This may theoretically be used on kids who have Sever's disease (a type of heel pain) to help lessen the tensile pressure on that developing calcaneus (heel bone).
What Are the Factors to Be Considered While Prescribing Foot Orthoses?
There are several factors to take into account when deciding on the type and design of orthoses, regardless of the type:
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Body mass.
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Thoughts of the patient.
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Current footwear.
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Activities.
Additionally, sound clinical judgment, thorough history-taking, cooperative decision-making, and communication are important for the success of foot orthoses. Depending on the circumstance, orthoses should be used in combination with other therapy to avoid reliance and overuse.
Conclusion
By lowering the magnitude and pace of loading, foot orthoses have been recognized as one potential method for minimizing the frequency of lower extremity injuries. Foot orthoses have been demonstrably proven to increase comfort and ease symptoms in several foot-related illnesses, including plantar fasciitis, rheumatoid arthritis, and foot pain (such as metatarsalgia).
