Orthotics and Your Feet
Orthotics are devices which fit into the shoe to aid the foot. "Functional orthotics" are rigid and designed to control motion and correct the function of the foot. Individuals with flatfeet, tendonitis, plantar fasciitis, certain foot deformities, knee, hip and back problems may benefit from functional orthotics. "Accommodative orthotics" are soft and designed to reduce pressure and prevent excess friction. Diabetics and those with a loss of sensation or circulation in their feet will benefit from accommodative orthotics. Both types of orthotics are custom made by taking a mold of the foot.
Abnormal motion is typically in the form of pronation. Pronation is the rolling in of the foot and collapse of the arch. The motion starts at the rearfoot, or heel area. When the heel turns in, it allows the arch to collapse. This puts undue stress on the ligaments and tendons in the arch area and contributes to the development of tendonitis, plantar fasciitis, bunions and hammertoes. The functional orthotic helps to control the abnormal motion in the rearfoot. This is accomplished by taking a mold of the foot in its neutral position. The neutral position is the position the foot should be in when walking. When standing, the over-pronated foot is in the uncorrected position. The mold of the foot should be taken with the patient sitting so the foot can be placed in the neutral position.
The molds are sent to a lab and scanned into a computer. A reverse image is produced and the computer generates an image of the foot in neutral position. The computer adjusts the image based on the corrections recommended by your podiatrist. A model of the foot is then cut out, in some cases out of wood. The orthotic material is pressed over the foot model and the orthotic is created. The most common material is polypropylene, but other materials, such as graphite are used. In some cases, hand-made molds are created out of plaster. This was the classic way orthotics were made until newer technology made the process much less labor intensive.
Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to orthotics. The plantar fascia is a ligament type structure on the bottom of the foot which helps to hold up the arch. When the foot collapses, the weight of the body stresses the ligament and results in tearing and inflammation. This results in plantar fasciitis. These individuals typically respond well to orthotics in combination with other treatments. Certain types of tendonitis respond well to orthotics and other types require orthotics. Posterior tibial tendonitis is the tearing and inflammation of the tendon that helps to hold up the arch. When this tendon is overstressed by arch collapse it cannot heal. Orthotics are essential in the treatment of this condition.
Diabetics can develop numbness and loss of circulation in the feet. This numbness and circulation loss puts them at risk for developing open sores on the feet called ulcerations. To help prevent excess rub and friction in certain areas on the feet, accommodative orthotics are recommended. Diabetics who do not have numbness or circulation loss (as diagnosed by their doctor) do not need to have accommodative orthotics. If the foot has a deformity, like a bunion or hammertoe, then accommodative orthotics are necessary.
Accommodative orthotics are made from many different types of material. Some are made of a foam type material, others made from cork and others have covers ranging from soft spongy material to leather. The type of material depends on the type of foot. Many accommodative orthotics, made for diabetics, have two or more layers that form around the foot once they are worn. Three pairs are dispensed every year and they are replaced every 4 months. Other materials are longer lasting. A mold of the foot is taken by stepping into a foam box. In this case, it is important to take the mold standing, so that the orthotic can be made to form around the foot.
Many insurance companies cover orthotics for certain diagnoses. The most commonly covered diagnoses are plantar fasciitis (heel and arch pain), flatfeet and diabetes. Many insurance companies cover the orthotics at 80%. This means the patient is responsible for 20% of the cost unless they have a secondary insurance. If the deductible has not been met, then the amount is applied to the deductible and the patient must pay the full amount. Orthotics are not cheap. They range from $250 to $600.
Medicare covers orthotics for diabetics with neuropathy (numbness of the feet). Medicare does not cover orthotics for any other type of foot problem. Secondary insurance will not cover orthotics if Medicare does not cover them.
Podiatrists most commonly prescribe orthotics, but pedorthotists, orthotists, physical therapists and sometimes orthopedists will also provide orthotics.