Orthotics

What are orthotics?

Orthotics are a special brace, shoe insert, or other device to help with foot, leg, or back problems. Your doctor, chiropractor, or physical therapist can prescribe orthotics and give your instructions for when and how to wear them. You may also hear the term orthosis or orthoses.

How orthotics can help

Orthotics are used to:

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

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

Ankle foot orthosis (AFO) 

An ankle foot orthosis (AFO) is a leg brace that supports the leg and foot. It goes from just below the knee to the end of the foot to make an L-shaped frame.

AFOs help control the position and motion of the ankle and foot and support weak muscles. They can also be used for patients with contracture, 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 the foot while walking to decrease the risk of tripping and falling.

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

Heel or shoe lift

A heel or shoe lift 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 

A custom shoe insert is a device placed inside a shoe that is made from a mold taken of the person’s foot. The inserts are made to meet a patient’s specific needs. Custom inserts may be prescribed to correct foot and ankle motion, give cushion and support, or treat pain in the foot, ankle, knee, or back. Inserts may be made from a firm or semi-soft material.

Supramalleolar orthosis (SMO) 

A supramalleolar orthosis (SMO) is a type of leg brace that supports the foot to just above the ankle bones. This orthotic is often used for children who have very flexible, flat feet which can make the foot pronate or roll inward. SMOs help position the foot for standing and walking. They are usually made of flexible plastic with a foam or silicone liner for comfort.

Thoracolumbosacral orthosis (TLSO)

A thoracolumbosacral orthosis (TLSO) is a back brace that supports the spine and keeps 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 a 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 give 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 rubbing

Choosing the right shoe for orthotics

• The shoes you wear with your orthotics are just as important as the orthotic itself. The proper shoes allow orthotics to work the way that they should. Always bring your orthotics 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.
• When wearing inserts inside your shoes:
  • Choose supportive shoes. Avoid slip-on and backless shoes.
  • Avoid shoes that are too loose or too tight. The orthotic should fit easily inside the shoe. Shoes with a removable insert work well because removing the insert allows for extra room for the orthotic inserts.
  • Make sure the orthotic is not bent or wedged against the side of the shoe.
  • The shoe should hold your foot snug without squeezing too much in any one area.

How to wear your orthosis

Always follow the instructions for your specific type of orthosis.

• Wear foot and leg orthotics with shoes. Wearing orthotics without shoes can cause you to slip and fall. It can also damage the orthotic.
• Wear socks under your orthotics to help wick away moisture and protect your skin from irritation or rubbing.
• Check straps and buckles for proper fit.
• Heat or standing can cause swelling in your leg or foot and cause the orthotics to be tight. If this happens, remove your orthotic until the swelling decreases. If swelling does not go away, contact your care team.

Getting used to your orthotics

You need time to get used to your new orthotics. Your health care provider will give you a wear schedule to allow your body to slowly adjust. Some soreness in your feet, legs, or back is normal at first. Gradually getting used to the orthotics can help prevent or reduce discomfort.

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 health care provider.

• Start by wearing your orthotics for 30-60 minutes on the first day.
• After wearing your orthotics for the first time, take off your shoes and socks, and inspect your skin. Look for areas of 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. If redness does not go away in that time or a blister appears, contact your care team.
• 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 next day, if no new pain or skin issues develop, double the time spent in the orthotics from the previous day. If you have soreness, keep the same wear time for a few days until the soreness goes away.
• Continue this for 2 weeks. After 2 weeks, wear time should be up to 8 hours each day.

How to care for your orthotics

• Check your orthotics every day for parts that are damaged, worn, cracked, loose, or torn. Inspect the metal, plastic, screws, straps, and buckles.
• Clean orthotics with a mild soap or detergent and a soft cloth. Do not immerse in water. Allow to air dry completely before you put it back on.
• Keep orthotics away from heat, such as a hot car, heater, or in the sun. Do not use a hair dryer to dry your orthotics.
• Keep orthotics away from pets that could chew on the plastic.
• Clean Velcro with soap and water. Use a wire brush, toothbrush, or fine-toothed comb to remove lint and hair.
• Use a silicone spray or light oil to care for metal joints.

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.