Custom Orthotics - What to request from your doctor when you have them made.





Custom orthotics can be expensive and for this investment to be worth your time and money there are a few things you should look out for when having them made. This section overviews the basics / dos and don’ts of custom orthotics.


Length: I always make my orthotics full-length to the toes - this allows the maximum customization.


Heel: Orthotics can be made with an “extrinsic”heel post which is an additional piece that wraps around the heel to bring it to level with the ground or an “intrinsic”heel in which the plate of the orthotic is simply shaven down to make a flat spot on the bottom of the heel to bring it level.

I usua

lly use intrinsic heels because the additions I make to the arch stabilize the orthotic enough but if you are looking for the ultimate stability and durability the extrinsic heel post is an option but remember, an extrinsic heel post will add bulk to the orthotic which may make it more snug in a shoe.

The heel can be shallow or deep, I usually use a deep heel for more control, however if you need more padding in the heel, this will make the heel more shallow.



Plate/Shell: Most are made of polypropylene or graphite. Graphite is lighter but will crack easier, polypropylene will usually not crack, but will deform slowly over time. A poly shell will also break in faster. Most of the orthotics I make are polypropylene.


Top cover: What your feet actually touch. There are many, many options but for tennis I like either neoprene or a water-proofed leather. Typically I like to make my top covers slightly thicker just for some extra padding.




Arch Height: A custom orthotic can be made with varying arch heights, usually I go without 3/4 of the patient’s arch height, that way there is some flexibility but also stability.


Additions:

Arch reinforcement- this is padding on the underside of the orthotic plate. There isn’t anything magical about it but it does stop the orthotic from moving as much in the shoe


Arch padding - A layer off adding under the top cover which makes break in easier to tolerate and the device more comfortable overall.


Key points :


Unless your foot is molded/casted/scanned and then a orthotic is made specifically from that impression- IT IS NOT CUSTOM! There are countless places that will “scan” your feet on a pressure sensor then choose a pre-fab insert that “correlates” to your foot shape. This is not custom. These inserts are simply the same insert with varying arch heights. There is nothing wrong with choosing these if they feel good and are reasonably priced but do not let anyone tell you they are custom.


Custom orthotics will not reshape your foot permanently, they simply bring the ground up to your foot and prevent abnormal motion while they are being worn, when you take them off your foot will return to its original shape.


There is not very good literature out there as to the benefits of custom vs over-the-counter orthotics. The way I explain it to patients is that custom orthotics are like a Cadillac and over-the-counter are like a Kia car. Both will get you from place to place, the custom will just do it more comfortably and with more bells and whistles. For athletes, I usually recommend custom due to the forces being imparted on the foot during sports such as tennis. Over-the-counter will perform OK for a while but will need to be changed so frequently you are better off just getting the custom up front and not have to constantly change inserts when they burn out or break after a month or two.

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