Custom Orthotics vs. Over-the-Counter Orthotics

It’s warm here in NYC.  Nice.  About bloody time.  That means it’s time to get out, get active, and develop some real foot pain.  And for heel pain, metatarsalgia, and general aches, as well as back pain, hip pain and knee pain, you might need an orthotic.  But, as is often wondered in the halls of my NYC podiatry office - boxers or briefs?  Oh, and also, custom orthotics or over-the-counter orthotics?

An orthotic is an arch support that is placed in the shoe for support, comfort and stability.  Generally the device is made of some sort of plastic, graphite, foam or cork, and may be covered with vinyl, leather or cloth.  And do these devices work?  You bet your plantar fascia they do!  Orthotics help to distribute weight more evenly and can help to bring the ground surface into contact with the foot.  Studies have demonstrated a role in relieving various foot conditions as well as back and leg pain, shin splints and knee pain.  Although more studies demonstrating specific benefits are lacking, it is intuitive, and has been my clinical experience in over 10 years of practice, that a custom-made or over-the-counter foot bed will make a shoe more comfortable and help alleviate foot pain.

There are two ways of constructing an orthotic:

custom made orthotic is designed from a plaster, fiberglass or scanned model of a foot.  The device is specific to the user and provides optimal support.  The other method is to design an orthotic based on the average foot, and dispense it as an over the counter orthotic.  Although it can be argued whether or not the “average” foot exists, these devices can work surprisingly well and provide a good amount of support and comfort.

An over-the-counter orthotic can be used as a starter or a backup orthotic, with the goal of transitioning to a custom orthotic.  It is important to select an orthotic that provides a support, not just cushioning.  I do not recommend the orthotics that are sold in pharmacies on the advice of a scanning kiosk that determines the foot type.  These devices are typically too soft to provide any support, and it is personally frightening, and yes Dr. Phil, maybe I feel just a bit threatened by a drug store kiosk diagnosing my patients’ foot type and recommending orthotics.  (Warning- shameless plug up ahead)  I do, however recommend the brand of orthotics that we carry in my NYC podiatry office.

The best type of orthotic for patients is generally a custom orthotic.   It fits better, and will last forever if constructed properly.  A good over the counter orthotic, however, will provide good support and alleviate most painful foot conditions.  Either way, get some support, get outside, and enjoy the weather before the inevitably feverishly hot summer arrives.

See you in the office.

Ernest Isaacson

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