What Are Orthoses?
Orthoses, or orthotic
devices, are shoe inserts that are intended to adjust an abnormal,
or irregular, walking pattern. Orthoses are not truly or solely
"arch supports," though some people use those words
to describe them, and they perhaps can best be understood with
those words in mind. They improve shoes functions that make standing,
walking, and running more comfortable and efficient, by altering
the angles at which the foot strikes a walking or running surface.
Doctors of podiatric
medicine prescribe the use of orthoses as conservative approaches
to many foot problems; their use is a highly successful, practical
various forms and are constructed of various materials. All are
concerned with improving foot function and minimizing stress
forces that could ultimately cause foot deformity and pain.
fall into three broad categories: those that primarily attempt
to change foot function, those that are primarily protective
in nature, and those that combine functional control and protection.
The so-called rigid
orthotic device, designed to control function, may be made of
a firm material such as plastic, and is used primarily for walking
or dress shoes. It is generally fabricated from a mold of the
individual foot. The finished device normally extends along the
sole of the heel to the ball or toes of the foot. It is worn
mostly in closed shoes with a heel height under two inches. Because
of the nature of the materials involved, very little alteration
in shoe size is necessary.
are chiefly designed to control motion in two major joint complexes
of the foot, which lie directly below the ankle joint. These
devices are long lasting, do not change shape, and are usually
unbreakable. Strains, aches, and pains in the legs, thighs, and
lower back may be due to abnormal function of the foot, or a
slight difference in the length of the legs. In such cases, orthoses
may improve or eliminate these symptoms, which may seem only
remotely connected to foot function.
The second, or soft,
orthotic device helps to absorb shock, increase balance, and
take pressure off uncomfortable or sore spots. It is usually
constructed of soft, compressible materials, and may be molded
by the action of the foot in walking or fashioned over a plaster
impression of the foot. Also worn against the sole of the foot,
it usually extends from the heel past the ball of the foot to
include the toes.
of any soft orthotic device is that it may be easily adjusted
to changing weight-bearing forces. The disadvantage is that it
must be periodically replaced. It is particularly effective for
arthritic and grossly deformed feet where there is a loss of
protective fatty tissue on the side of the foot. It is also widely
used in the care of the diabetic foot. Because it is compressible,
the soft orthosis is usually bulkier and may well require extra
room in shoes.
The third type of
orthotic device (semirigid) provides for dynamic balance of the
foot while walking or participating in sports. This orthosis
is not a crutch, but an aid to the athlete. Each sport has its
own demand and each sport orthosis needs to be constructed appropriately
with the sport and the athlete taken into consideration. This
functional dynamic orthosis helps guide the foot through proper
functions, allowing the muscles and tendons to perform more efficiently.
The classic, semirigid orthosis is constructed by using laminations
of leather and cork, reinforced by a material called silastic.
Orthoses for Children
are effective in the treatment of children with foot deformities.
Most podiatrists recommend that children with such deformities
be placed in orthoses soon after they start walking, to stabilize
the foot. The devices can be placed directly into a standard
shoe, or an athletic shoe.
orthoses need to be replaced when the child's foot has grown
two sizes. Different types of orthoses may be needed as the child's
foot develops, and changes shape.
The length of
time a child needs orthoses varies considerably, depending on
the seriousness of the deformity and how soon treatment is initiated.
Various other orthoses
may be used for multidirectional sports or edge-control sports
by casting the foot within the ski boot or ice skate boot or
roller skate boot. Combinations of semiflexible material and
soft material to accommodate painful areas are utilized for specific
shown that back problems frequently can be traced to a foot imbalance.
It is just as likely that foot problems are brought about by
a back imbalance. It's important for your podiatrist to evaluate
the lower extremity as a whole to provide for appropriate orthotic
control for foot problems.