Orthotics

What are orthotics?

Orthotics are special braces, shoe inserts, or other devices to help with foot or ankle problems. Your doctor or physical therapist can prescribe orthotics and give you instructions for when and how your child should wear them. Orthotics may also be called an orthosis or orthoses. 

A certified orthotist will measure and fit your child for an orthotic and make sure it fits properly. They will work with your child’s therapists to select the best orthotic for your child’s needs.   

How orthotics can help

Orthotics are used to: 

• Support the foot or ankle 
• Prevent pain and injury to the foot or ankle 
• Improve foot or ankle function 
• Correct a foot problem or deformity 
• Help prevent falls 
• Reduce pain 
• Improve posture 

Examples of common orthotics include AFO braces, heel lifts, shoe inserts, and supramalleolar orthoses. 

Ankle foot orthosis (AFO) 

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

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

Foot drop 

Foot drop is the inability to lift the foot, causing the toes to drag while walking. Causes of foot drop include:  

• Nerve problems caused by nerve injury after injury or surgery 
• Chemotherapy-induced peripheral neuropathy  
• Muscle weakness or paralysis caused by medical conditions like muscular dystrophy or cerebral palsy 
• Spinal cord injury 
• Stroke or brain injury 

An AFO helps your child lift their foot while walking, which reduces their risk of tripping and falling. 

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

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 difference is small (3 centimeters or less), your child may only need a heel lift. A heel lift is a wedge placed inside the shoe of the shorter leg. If the difference 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 the shoe to correct a specific problem.  It is made from a mold taken of your child’s foot.  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. 

Shoe insert (non-prescription) 

A shoe insert is a non-prescription (over-the-counter) insert worn inside a shoe. Shoe inserts can be found at pharmacies and specialty shoe stores. They are not customized for each person’s foot. Non-prescription shoe inserts are typically made of gel, foam, or plastic. Inserts 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 

Supramalleolar orthosis (SMO) 

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

Choosing the right shoe for orthotics

• The shoes your child wears with your orthotics are just as important as the orthosis itself. The proper shoes allow orthotics to work as they should. Always bring your child’s orthotics with you when you shop for shoes. 
• You may need to purchase new or slightly larger shoes to fit the brace. Your child may need right and left shoes that are different sizes or widths.  
• 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. 
• Talk to your orthotist or therapist for specific shoe recommendations for your child’s needs.  
• When wearing inserts inside shoes: 
  • Choose supportive shoes. Avoid slip-on and backless shoes. 
  • Avoid shoes that are too loose or too tight. The orthosis should fit easily inside the shoe. Shoes with a removable insert work well because removing it provides extra room for orthotic inserts. 
  • Make sure the orthosis 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. 

How to wear orthotics

Always follow the instructions for your child’s specific type of orthotics. Some tips include: 

• Wear the orthotics with shoes. Wearing orthotics without shoes can cause your child to slip and fall. It can also damage the orthosis. 
• Wear socks under your orthotics to help prevent moisture and protect skin from irritation or rubbing. 
• Check straps and buckles for proper fit. 
• Remove orthotics if your child has swelling. Heat or standing can cause swelling in the leg or foot. This can make the orthotics feel tight. If this happens, remove your child’s orthosis until the swelling decreases. If swelling does not go away, contact your care team. 

Getting used to your orthotics

Your child will need time to get used to their new orthotics. Your care team will give you a wear schedule to help your child’s body adjust and prevent or reduce discomfort. 

General wear schedule for new orthotics

A gradual “break-in” or “wear-in” period can help your child adjust to their orthotics. Always follow the specific instructions given by your child’s health care provider. 

• Start slowly: Have your child wear the orthotics for 30–60 minutes on the first day. 
• Check the skin: After the first wear, remove shoes and socks and look for redness, rubbing, or pressure, especially on bony areas like the ankles and outer edges of the feet. 
  • Redness that fades within 20–30 minutes is normal. 
  • If redness does not fade, or if a blister develops, contact your child’s care team. 
• Increase wear time gradually: If there is no new pain or skin irritation, double the wear time each day (for example, 1 hour on the first day, 2 hours on the second day). 
• Keep the same wear time if soreness occurs: Do not increase wear time for a few days until the soreness goes away. Then, your child can continue increasing wear time. 
• Reach the goal for wear time: Continue this gradual schedule for 2 weeks. By the end of 2 weeks, your child should be wearing the orthotics for up to 8 hours per day. 

How to care for your child's orthotics

• Check your child’s 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 soak them in water.  
• Allow orthotics to air dry completely before you put them back on. 
• Keep orthotics away from heat, such as a hot car, a heater, or direct sunlight. Do not use a hair dryer to dry 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. Coverage may depend on your insurance and the type of coverage. 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. Talk to your health care provider or social worker to find out what insurance might cover.  

Questions to ask your care team about orthotics 

• Why does my child need orthotics? 
• Which type of orthotics are right for my child?   
• How many hours a day should the orthosis be worn?  
• How can I help my child get used to their orthotics?  
• What signs of pain or skin problems should I watch for?  
• What kind of shoes work best with this orthosis?   
• How do I clean and take care of the orthosis so that it lasts longer?  
• Will insurance help pay for the orthosis, and what paperwork is needed? 
• How do I find a local orthotist? 
• When should I call the care team? 

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