What Is a Foot Orthotic?

                                                              Foot Orthotics 101
An orthotic (or the proper term, orthosis) is a device that artificially supports a part of the body. In our case, the foot. For the sake of the layperson whose eyes happen upon this blog post, we will use the term orthotic or the pleural, orthotics.  Just as there are a host of reasons to put a person into orthotics, there are also a multitude of different devices. These devices each have their best uses, and we will go through the areas where they perform well, and where they do not. There are prefabricated (prefabs), or over-the counter (OTC) orthotics, custom foot orthotics, which are also called functional foot orthotics, and there are accommodative orthotics. Sometimes you will find a hybrid of the functional and accommodative types, known as hybrids.
Prefabs run the gamut of really poor ones that do not do what they are pretending to be, and then there are some really good ones. It is easy to tell which is which. If it says it provides support, but it is easy to crush the arch area with one’s fingers, then the chances of it supporting one’s body weight is not very likely, and that is a bad one. If on the other hand, it keeps its shape with pressure, that is good, and if it is heat moldable, even better. Unfortunately, most people bypass the OTC insoles thinking the sales person is just trying to upsell them, where if they spent the extra $30-50, they would have an exceptional experience. Another perk is no prescription is required, and many times, issues like plantar fasciitis or other foot maladies can be helped quickly with a pair of these.
Custom foot orthotics are the choice for more complex foot issues. These devices are sometimes covered by insurance, because there is a diagnosis code associated with it and a billing code. These devices can correct many rearfoot, midfoot, and forefoot issues. These require seeing a medical professional, and a prescription. Not all custom devices are created equal. My personal belief is the most effective orthotics are produced when the person who did the history, assessment, casting or scanning, is also the person who fabricates the devices. That almost never happens.  I will do a separate post on library orthotics, but I don’t believe they should be allowed to be called, or billed as custom devices, because they are not. Custom devices also give the practitioner options such as different degrees of comfort, durability of materials, and the amount of control to various parts of the foot. It is also important to know the lab’s limitations. If the lab used is fine for a fairly common foot morphology and biomechanical issue, great. If however, they are not so great with a complex foot issue or morphology, then find someone who can. Do not compromise.
Accommodative orthotics, are devices that accommodate areas of the foot that have either a deformity, or bony prominences that need relief, or a wound that needs offloading.  Custom diabetic insoles are a perfect example of this type of orthotic, where they have a Charcot foot with callusing.   
Hybrids do double duty. The custom diabetic insoles are able to give support similar to functional devices, accommodate a bony prominence, and hold the foot in place to prevent sheer forces. I also put foot orthotics with prosthetic toe fillers in this category.  
We are always happy to help guide our practitioners to better devices. Not everyone feels comfortable asking questions about materials, biomechanics, or better assessment techniques. In the end though, it is not about our egos, it is about the patient and how we can best serve them as healthcare practitioners.