Custom Orthotics vs Off the Shelf Arch Supports

In this video, Grapevine podiatrist Dr. Marybeth Crane of Foot and Ankle Associates of North Texas explains why custom orthotics are frequently better than prefabricated orthotics.



Custom foot orthotics are made to fix the biomechanics of your foot; however, they’re not for everyone. If you don’t have an underlying problem, but just need a bit of arch support, an off-the-shelf insert may work well for you. However, if you have a repetitive stress injury or foot deformity, then the only thing that you should be using is a custom foot orthotic.

When choosing a practitioner, you need to make sure he or she is experienced in making the orthotics that you need. A three-dimensional scan or cast of your foot should also be made in order to make your orthotic—which is considered the gold standard.

The second thing to consider is which shoes your orthotics need to fit into. Your podiatrist should consider this when fitting you for your custom orthotic.

The last thing to consider is how long your orthotic is going to last. Based on your size and use of the orthotics, your doctor should be able to give you an expected timeframe.

If you’re experiencing foot pain, the first thing to do is visit a Grapevine foot doctor. We will examine the causes of your pain and develop a treatment plan just for you, in order to get you back on the path to a pain-free lifestyle. http://www.faant.com 

New Study: Foot Orthotics Can Prevent Running Injuries

The top three questions runners ask about custom foot orthotics are:
1. Should they use orthotics in their shoes while running if they don’t have an injury?
2. If they have fatigue in their legs while running or a jacked up gait, they often wonder of orthotics will help?
3. Should they wear orthotics forever after an overuse injury?

The answers are yes, yes and yes!! A new study showed that orthotics have a significant benefit in reducing running injuries as prophylaxis. It makes common sense, that if you have an underlying biomechanical deficit, orthotics give you better alignment so therefore should reduce overall abnormal stressors and subsequently injuries. Now there is a new study that shows just that! Piggy-back that on years of biomechanics research and the answers get much more clear.

This study demonstrated that the subjects who wore orthotics had "a significantly reduced rate of exercise-related lower limb injury across the training period". The authors emphasized that participants were not treated for an injury with orthotics, but were prescribed orthotics to prospectively reduce the risk of injury. In addition, they believe that these "preventative results can be cautiously extrapolated to a recreational running setting and should be considered by sports and exercise medicine professionals."

We generally prescribe foot orthotics to treat specific injuries. This study indicates that orthotics can be a valuable prophylactic tool for injury prevention, supporting orthotic use in at-risk populations (e.g. runners) for medial stress syndrome, iliotibial band syndrome and Achilles tendinopathy. Considering the results of this study and the results of a previous study on the use of orthotics in runners by Mundermann, it is recommended to use at least a pre-fabricated Powerstep orthotic which incorporate a medial heel skive and rearfoot post, as a cost-effective means of providing prophylaxis with corrections proven effective in runners. Runners with a previous history of these injuries and/or those that develop symptoms would be good candidates for custom orthoses based on the results of these two studies.

Franklyn-Miller A, Wilson C, Bilzon J, et al. Foot orthoses in the prevention of injury in initial military training: a randomized controlled trial. Am J Sports Med 39(1):30-37, 2011

Mundermann A, Nigg BM, Humble RN, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech 18(3):254-262, 2003

Are Custom Orthotics Worth the Investment?

If you are a frequent visitor to Foot and Ankle Associates of North Texas in Grapevine, TX, you probably already know about orthotics. Maybe you have even purchased orthotics. A foot orthotic is an insole placed into the shoe that helps control foot position.

There are two main types of orthotics: Functional and accommodative. These can be prefabricated; like Lyncos that are popular at Healthy Steps or custom; which the doctor fabricates unique for your feet.

A functional orthotic controls foot movement and helps a person walk in a way that best supports joints and muscles. An accommodative orthotic helps distribute foot pressure evenly over the bottom of the foot. Most patients use a functional orthotic and usually these are custom for long term usage. A functional orthotic can be useful for many problems and are used to balance the biomechanics of your feet. Think of them as an in-shoe tire realignment for your feet. Accommodative orthotics are very useful to distribute stress in the elderly, diabetic and arthritic populations.

In the foot care aisle at your local drug store or grocery store, you may have seen readymade orthotics for sale. Does it really matter whether you buy store bought orthotics or custom orthotics from your podiatrist? Well, some people may be able to get away with wearing store bought orthotics for a period of time. We often even start our treatment plans with these type of prefabricated devices so we can get you on the road to better foot health immediately; but most patients do need custom for long term control of their foot type.

When you think about the long term health of your feet, custom orthotics are the way to go! Store bought orthotics are made to fit many foot problems for a large variety of people; one size fits all usually means one size doesn’t truly fit anyone! To be truly effective, an orthotic must be fitted for YOUR particular needs. Wearing an ill fitted orthotic is not only a waste of time, but it can also make your foot problems worse. Over time these problems can lead to leg, knee, hip, and even back problems. Store bought orthotics tend to not offer long lasting comfort. If you find yourself buying store bought orthotics every few months because of foot pain, it may be time to schedule an appointment to see one of the doctors at FAANT. Your podiatrist will produce orthotics that fit only YOUR feet. The materials used will be those that are best suited for your walking and running needs.

Everyone deserves special treatment! With a real custom orthotic that is exactly what you have. Yes, custom orthotics can be costly, but so can surgery from walking incorrectly over the years. I’m always amazed that many insurance companies will often not cover orthotics, but will pay for surgery! Doesn’t make any sense!! Think of the orthotics as an investment and an investment in your health is one of the best choices you can make for yourself.

Patellofemoral Pain Syndrome in Runners: Pain in the Knee!

Knee Pain Slowing Your Run to a Crawl? You may have patellofemoral syndrome.

What is patellofemoral pain?

Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.

The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the "patella") moves on the groove of your thigh bone (called the "femur"). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been implicated as a cause.

What can I do to help my knee mend and relieve the pain ?

Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.

Physical therapy is the mainstay of treatment. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.

Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease excessive foot motion that causes stress on the knee. Even just a simple arch support insert can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.

Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.

Will I ever be able to run again?

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won't get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability. Remember, you'll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”. Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

Do Functional Foot Orthotics Work? Yes!

Dear RunDoc: I read in the NY Times that orthotics often don’t work and I should try running barefoot to strengthen my feet. I tried and my feet got a lot worse. I know you wear orthotics and make a lot of them for your patients. Why do you think custom foot orthotics work in your hands?

RunDoc answers: Hmmm….Good question! I read the article in the New York Times and laughed then cried. They are so biased against orthotics that this is bout the tenth time in the last few years they are trying to make them voodoo. Fortunately, they are wrong and there is science behind it.

Many tens of millions of patients have been helped by custom-made foot orthotics over the past 50 years.

There are many studies published in peer reviewed medical journals showing the effectiveness of orthotics in reducing injury and relieving pain.

One of the most important factors creating the need for orthotics is that we usually walk on essentially hard, flat surfaces that do not exist in nature.

Walking or running barefoot does not change the above.

The science of biomechanics relating to orthotics is complicated and requires years of study. This is why you should have your orthotics made by a well-trained podiatrist in biomechanics and even better, one who has an understanding of your specific sport.

The process of getting an orthotic to be most effective is iterative, often requiring serial adjustments. This is because everybody is different and may not tolerate “perfect” biomechanics.

The conditions for which orthotics are prescribed often take years to develop. They are not going to disappear overnight with the use of orthotics.

Orthotics should not be chosen by how comfortable they feel. Often, they are uncomfortable at the beginning because they are “correcting” your biomechanics with an external device and you have to get used to them.

The reason foot impressions (casts) are taken off-weight-bearing is so the foot can be positioned in an optimal shape that will allow it to naturally bear weight on its own. A three dimensional scanner can also be used to get a “true” picture of the foot without a cast.

Orthotics are not arch supports. They guide the foot through a proper gait cycle, allowing the foot to achieve various optimal positions at the correct time and creating a means for shock absorption, weight bearing, and propulsion.

A flat foot by itself is not good or bad. A high arch by itself is not good or bad. How the patient functions with those features is the issue.

If you have been told you need orthotics and you’re in doubt, get a second opinion. If you have orthotics and they are not working, get them adjusted.

Correctly made functional foot orthotics work! I have built my reputation with them.

Run Happy! And in orthotics if you need them!