Orthotics

What Are Orthotics?

Orthotics are a special shoe insert, brace, or other device to help with foot, leg, or back problems. They may be prescribed by a doctor, chiropractor, or physical therapist.

Orthotics can help:

• Improve foot or ankle function
• Provide support to your foot, ankle, or back
• Prevent injury to your foot, ankle, or back
• Correct a foot problem or deformity
• Reduce risk for falls
• Reduce pain
• Improve posture

Examples of common orthotics include heel lifts, SMO braces, and AFO braces.

Types of Orthotics

Heel or shoe lift: Device that helps patients who have one leg that is shorter than the other (leg length discrepancy).

If the leg length discrepancy is small (3 centimeters or less), the patient may only need a heel lift. A heel lift is a wedge placed inside the shoe of the shorter leg. If the discrepancy is large (greater than 3 centimeters), a shoe lift is needed. The shoe lift is placed on the outside of the shoe.

Custom shoe insert: Specially made device placed inside a shoe.

Custom inserts are made from a mold taken of the patient’s feet. The inserts are made to meet a patient’s specific needs. They may be prescribed to correct abnormal foot and ankle motion, provide additional cushioning and support, or treat pain in the foot, ankle, knee, or back. Inserts may be made from a firm or semi-soft material depending on their purpose.

Supramalleolar orthosis (SMO): A type of leg brace that supports the foot to just above the ankle bones.

This orthotic is often prescribed to children who have very flexible, flat feet. This can make the foot pronate or roll inward. SMOs help position the foot for standing and walking. They are typically made of flexible plastic with a foam or silicone liner for comfort.

Ankle foot orthosis (AFO): A type of leg brace that supports the leg and foot from just below the knee to the end of the foot, creating an L-shaped frame.

AFOs are used to help control the position and motion of the ankle and foot and assist weak muscles. They can also be used for patients with contractures, a condition in which joints become stiff or tight.

For people with cancer, AFOs can help with foot drop due to chemotherapy-induced peripheral neuropathy. Foot drop is the inability to lift the foot due to muscle weakness or paralysis. The AFO helps patients lift their foot while walking to decrease the risk of tripping and falling.

There are many different types of AFOs. Your doctor or physical therapist will recommend the type that is right for you.

Thoracolumbosacral Orthosis (TLSO): A type of back brace that supports the spine and prevents it from moving.

A TLSO fits from the middle of the chest down to the tailbone. It is usually made of hard plastic with a foam liner for comfort. A TLSO can be used to keep the spine stable after surgery, to correct spinal problems, to help the spine heal, or to protect the spine from injury.

Shoe insert

A shoe insert is any non-prescription or “over-the-counter” insert worn inside a shoe. Shoe inserts can be found at pharmacies and specialty shoe stores. They are mass produced, meaning they are not customized for a person’s foot. Shoe inserts are typically made of gel, foam, or plastic. They can make shoes more comfortable and provide additional support. Over-the-counter shoe inserts are not designed to correct major foot problems.

A few common types of shoe inserts include:

• Arch supports: support the foot’s natural arch
• Insoles: provide extra cushion or support
• Heel cups: provide extra cushion in the heel region
• Foot cushions: create a barrier between the foot and the shoe to prevent irritation and excessive rubbing

Choosing the Right Shoes for Orthotics

The shoes you wear with your orthotic are just as important as the orthotic itself. Choosing the proper shoes allow your orthotic to work the way that it should.

• Always bring your orthotic with you when you shop for shoes.
• Lace-up shoes, such as walking or running shoes, usually work best. These types of shoes come in a variety of sizes and widths to help accommodate orthotics. Avoid slip-on and backless shoes.
• When wearing inserts inside your shoes:
  • Avoid shoes that are too loose or too tight. When placed inside the shoe, the orthotic should fit inside the shoe easily. Make sure the orthotic is not bent or wedged against the side of the shoe. The shoe should hold your foot snugly without squeezing too much in any one area.
  • Shoes with a removable insert work well because removing the insert allows for extra room for the orthotic.

Getting Used to Your Orthotics

Your body needs time to get used to your new orthotics. Your healthcare provider will give you a schedule for wearing them that allows your body to slowly adjust (wear schedule). A short period of soreness in your feet, legs, or back is normal. Discomfort can be reduced or prevented by gradually getting used to the orthotics.

General Wear Schedule for New Orthotics

A gradual “break-in” or “wear-in” period can help you adjust to your orthotics. Always follow the specific instructions given by your healthcare provider.

• Begin wearing your orthotics for 30-60 minutes on the first day you get them.
• After wearing your orthotics for the first time, take off your shoes and socks, and inspect your skin. Look for areas of excessive rubbing or pressure. Pay special attention to bony areas, such as your ankle bones and the outside of your feet. Redness that goes away in 20-30 minutes is normal. However, if the redness does not go away in that time or a blister appears, contact your healthcare provider.
• If no new pain or skin issues occur, double the amount of time you wear the orthotics the next day. For example, if you wore them for 1 hour the first day, wear them for 2 hours the second day.
• The following day, once again, double the time spent in the orthotics if no new pain or skin issues develop. If you notice soreness, you can remain on the same level of wear time for a few days until the soreness subsides.
• Continue this for 2 weeks. After 2 weeks, wearing time should be up to 8 hours each day.

Caring for Your Orthotics

• Avoid placing orthotics in hot areas, such as car dashboards, heaters, or dryers.
• Keep orthotics away from pets that could chew on the plastic.
• Wear socks with your orthotics to help wick away moisture and protect your skin.
• Clean orthotics with a mild soap or detergent and a soft cloth. Do not immerse in water. Allow to air dry completely before use.
• Always wear your orthotics with shoes. Wearing orthotics without shoes can cause you to slip and fall. It can also damage the orthotic.

Does Insurance Cover Orthotics?

Insurance will often pay for orthotics if there is a medical need. In most cases, your doctor or physical therapist will need to prescribe the device and provide documentation. This is known as a Letter of Medical Necessity or a Doctor’s Statement. Each insurance plan is different, so check with your insurance company to learn more.