Foot Orthotics

As with knee orthotics, foot orthotics are designed to realign the lower extremities, theoretically reducing the stress on the involved joints. Foot deformities develop over time in people with arthritis, leading clinicians to recommend orthotics as a method of preventing, or at least slowing, the deformation (Hanes 1996; Hillstrom et al. 2001a, 2001b). The most common problems that occur with arthritis are excess pronation, rolling in at the ankle, and loss of motion in some of the forefoot joints. As arthritis progresses, deformities can occur throughout the foot. Both the deformations and the abnormal movement can cause pain in the foot, ankle, knee, and even up into the hip.

There are three types of foot orthotics: flexible, semi-rigid, and rigid. If you have looked at shoe inserts in the pharmacy, you have probably looked at flexible or semi-rigid inserts. Over-the-counter, flexible inserts are the least costly, and they come in standard sizes and designs. The correction given is minimal, however, so use them only if you do not have too much misalignment and are primarily looking for additional shock absorption. If you have slight discomfort, you may try other insole modifications that are also less costly than custom orthotics. Inexpensive padding for the metatarsal (ball of the foot) or heel is available over the counter. Any modification should not cause pain, but help alleviate pain because of improved alignment. If the padding or insert increases existing pain or causes new pain, remove it immediately. Talk to your doctor before you try any drastic modifications.

Some manufacturers make semi-rigid orthotics that can be purchased over the counter; however, you need to know what sort of alignment problem you have. For more severe arthritic pain, deformity, and malalignment, see a healthcare provider who has experience designing orthotics for people with arthritis. Custom-made orthotics are more expensive, but they are tailored to your specific needs. They should provide better pain reduction and movement control when compared to a prefabricated insert.

Another source of foot pain that happens more frequently in middle-aged people and those with arthritis is plantar fascitis. The hallmark of plantar fascitis is extreme pain upon standing in the morning, greatest under the heel and arch. Initial treatment may include flexible heel cups that provide cushioning under the heel and help control pronation. With chronic pain, your physician or therapist may recommend a foot orthotic. I have had good results with some patients by using an aggressive approach during the initial symptoms. This multi-faceted approach includes frequent stretching of the calf muscles, self-massage of the sole of the foot, modification of shoes, and modified activity until the pain subsides. The shoe modification emphasizes good arch support and slight heel padding. If your symptoms do not resolve within a week or so, you need to see your physician or therapist.