Prescription orthotics v.s. prefab inserts – what works?

Honestly, I think this is a question that is not asked enough by patients.  Why do I need an Rx orthotic doc?  Couldn’t I do just as well with a less expensive stock insert?  And the answer is that in many cases, yes, you can do just as well with a prefabricated insert.  The prefab insert may perform just as well as the more expensive Rx orthotic.

Rx orthotics, or what many doctors call orthoses, are foot supports made from a mold or impression of the patient’s foot.  Impressions can be made in a number of ways, most common of which is plaster or foam.  New methods include computer scanning with direct transfer of the digital image to the orthotics lab.

But what can an Rx orthotic do for the patient?  That really depends upon the condition that is being treated.  An orthotic is really a combination of many different sciences.  First is the science of biomechanics.  Biomechanics is how the foot functions.  If the biomechanics are not optimal (called pathomechanics) then an orthotic may help to restore normal foot and ankle biomechanics.

Second is materials science.  Do you need a rigid (functional) orthotic.  What about semi-rigid?  Or softer, often called an accommodative orthotic?  The material and construct of the orthotic really does matter in the success of the orthotic.

I learned a big lesson when I owned a shoe store.  I would go in on Saturday morning to act as the doctor and helped to solve fitting issues for the shoe store staff.  Once or twice a month I would speak with a customer who had the greatest pair of orthotics, but couldn’t fit them into their shoes.  Their question was; “Do you have any shoe that I can use with my orthotics?”  So remember, from an academic standpoint, orthotics may seem like a great solution for a problem.  But from a practical standpoint, sometimes they just aren’t used.  And that can be true for a number of reasons.  They may be too bulky, they may be uncomfortable or they may just not be compatible with the shoes the patient prefers to wear.  There’s many a pair of Rx orthotics that are sitting on the bottom of the closet collecting dust.

So where to start when considering a pair of orthotics?  Just like everything else in life, sometimes it’s best to start out as simply as possible.  And that starting point might be with a non-Rx insert.  There’s a number of new suppliers of prefab supports that offer a great product.  And often, the insert can act as a base for modification.  That means that your doc can get you into an inexpensive insert and use it as the platform on which modifications can be made.  And if you like the way the prefab insert works and you want to take a step further into a more corrective device, then perhaps the Rx orthotic is indicated.

<<comments and discussion>>

Written by Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com

Pediatric orthotics and arch supports

One of the unusual products we offer at Myfootshop.com is a line of pediatric orthotics.  Pediatric arch supports can be hard to find and often quite expensive.  We offer a Whitman plate, UCBL preform and gait plates.  If you need help with the selection or use of any of these products, please feel free to join us in the product support section of our forum.

What’s the success rate for surgical correction of stage 1-4 talar dome fractures?

The talus is such a little bone.  Subsequently, a small defect in the talar dome can often result in significant disability.  Talar dome OCD’s can be corrected in a number of ways, but what’s the success rate of these procedures?

Join us in this conversation regarding the success rate of surgical correction of talar dome fractures.

Does bunion really surgery work?

Bunion surgery can be a very successful surgery.  Much of the success lies in matching the problem (stage of bunion) with the most appropriate bunion surgery.  There’s a host of different approaches to bunion surgery.  Granted, most surgeons will use just a few common types of bunion surgery procedures, but within those surgeries there will be a number of variations in technique.

Learn more about bunion surgeries and the possible complications of bunion surgery in our discussion forum on foot surgery.

Can growth factor be used to treat plantar fasciitis?

Human growth factor can be derived from human platelets.  And a number of doctors are trying to treat conditions like plantar fasciitis with growth factor.  How is it done?  Well, a small vial of blood is drawn from the patient and is spun in a centrifuge to isolate the platelets.  The platelets are then re-injected into the inflamed portion of the fascia.

More information on this topic can be found in our discussion on the use of human growth factor in treating plantar fasciitis.

Freiberg’s Infraction

Freiberg’s infraction is a unique form of avascular necrosis (AVN) that occurs in the second metatarsal.  The age of onset varies but does tend to affect patient in their second to third decades most frequently.

Join us for more discussion on Freiberg’s infraction.

Foot and ankle surgery images

Interested in foot and ankle surgery?  Then you’re sure to enjoy our image library of foot and ankle surgery.  The images describe most common foot and ankle surgeries and have links to more information on the surgery. 

Foot and ankle anatomy

Struggling to describe where your foot hurts?  Trying to understand foot and ankle anatomy? We use a convenient foot and ankle anatomy page in The Foot Talk Discussion Forum.  The images on the anatomy page are numbered with a legend found adjacent to the image.  By using the numbers, we can talk more effectively in the forum. (all images are protected by copy right)

Forefoot pain – what could it be?

There’s any number of different conditions that can contribute to plantar (bottom) forefoot pain.  These conditions include bursitis, capsulitis, Morton’s neuroma or even anterior tarsal tunnel syndrome.
But what about cases where the pain is specific to the dorsum (top) of the forefoot?  And what if there’s now swelling?  There’s only a few conditions that might fit into this category of symptom.

For more information, please join us in this discussion.

Ankle v.s. subtalar joint pain – how can I tell the difference?

The ankle and the subtalar joints are often referred to as the ankle.  But when we take a closer look at the two joints we find that they really do have distinctly different functions.   For clinicians and surgeons, differentiating subtalar joint pain and ankle pain can sometimes be a challenge.  A thorough history of the onset of the injury and nature of the pain is helpful.  Your doctor will also examine the ankle to look for the location of the pain and how it is affected by range of motion and resistance to range of motion.  Diagnostic testing is also in order.  Tests might include x-rays, MRI or even a diagnostic block of the ankle or stj.  Injecting local anesthetic in the stj is a little trick we often use to differentiate the two joints.

Join us in this discussion for further information on differentiating stj and ankle pathology.

<<comments, questions and more discussion>>