Doctor holding orthopedic insole

If the Shoe Fits

Orthotics support your feet
Author: Sarah M. Aldridge, MS

Horses and humans have one thing in common: they’re only as good as their feet. Let’s face it, if your feet hurt, it can feel like everything hurts. Foot and ankle pain can prevent you from getting up and out, enjoying life, exercising and working. And the pain can radiate to other parts of your body, such as your knees and hips.

If you ask four people if their feet hurt, chances are one of them will say yes, according to the Arthritis Foundation. That’s because foot problems run the gamut from painful bunions and hammer toes to rheumatoid arthritis, fallen arches and poor circulation from diabetes.

Those over-the-counter (OTC) slip-in shoe inserts can look awfully enticing. Cooling gels, comfort fit, air pillows and arch support—soothing descriptions bring a smile as you picture your feet riding on a cloud. And you don’t even need to see a doctor. But don’t believe all the advertising hype. There are times when you need an expert’s guidance on the right orthotic for your feet, especially if you have a bleeding disorder.

Orthotic options

Shoe orthotics are devices that support and comfort your feet. They can provide cushioning that helps redistribute your weight, taking the pressure off sensitive parts of your foot. Shoe orthotics can also align and support your foot and ankle, improving overall function and correcting deformities, according to the American Academy of Orthopaedic Surgeons (AAOS). They also can help fix your gait, if you roll your foot inward, called pronating, or outward, called supinating, when you walk.

You’ve probably noticed displays at your local pharmacy or favorite sporting goods store showcasing several different types of shoe inserts available without a prescription. If you have low arches or flat feet, you can pick up a pair of arch supports. Heel pads slip into the back of your shoe to provide cushioning. For plantar fasciitis, relief may come in the form of shock-absorbing soft arch supports and soft heel cups. Adhesive foot cushions can be affixed to different parts of your shoe as a barrier where the shoe rubs against your skin. 

OTC inserts save you money, but in the long run, there may be better alternatives to save your feet. The Arthritis Foundation stands by research showing that custom-made inserts can produce changes in the biomechanics of your feet, slowing or preventing arthritis. These inserts actually alter muscle activity in your foot, fixing your gait and decreasing stress. People who wear them report fewer incidences of foot pain and take fewer pain relievers. Further, a 2008 Cochrane Review, an analysis of clinical trials, revealed that custom-made orthotics lowered the pain in people with all kinds of foot problems, from arthritis to plantar fasciitis.

Ankle bleeds and the foot

In the bleeding disorders community, foot and ankle problems develop as a result of chronic bleeds in the ankle, which can become target joints. A vicious circle can result, says Nicole Hroma, PT, senior physical therapist at the Comprehensive Hemophilia and Thrombophilia Program at the Anne and Robert H. Lurie Children’s Hospital of Chicago. For instance, when your ankle bleeds, you feel pain, then you may lose some range of motion (ROM) after a period of immobilization from the bleed. This can cause you to change your gait to compensate.  This then may cause lateral impingements, a squeezing of the scar tissue or inflamed tissue in the ankle when the bones of the foot move upward. This pinching sensation further causes pain on the outermost part of the ankle. “You need to stop the cycle at the point of loss of motion—that’s where orthotics come in,” Hroma says.

HTC’s customized care

There are reasons to head to your HTC instead of a podiatrist, Hroma says. Some podiatrists use hard orthotics, which are not beneficial to people with bleeding disorders. “The rigid orthotic holds your foot in a fixed position, not allowing for normal pronation/supination while walking,” she says. “When you pivot on it, it puts undue stress on your knee.” In addition, chances are you’ll have much more interaction with your HTC staff during the follow-up when you’re getting used to your orthotic. “We take the time to work you into something,” says Hroma.

Plus, your HTC knows you, your body and your bleeding disorder. “You have a very skilled PT at your HTC. One of our main jobs is gait analysis and postural analysis,” Hroma states. Gait analysis looks at how you walk or run. It evaluates your step and stride length, and whether you’re pigeon-toed or if you duck walk. Postural analysis looks at how the foot aligns with the knee, hip and back, says Hroma.

To create your shoe orthotic, the PT at your HTC will perform the afore-mentioned analyses, and use a goniometer to measure your ankle and forefoot, and determine your ROM in the ankle.  At Hroma’s institution, the PTs then work with orthotists, licensed professionals who fashion orthotics. But sometimes necessity is the mother of invention. “Often, I’ve MacGyvered an orthotic,” Hroma says with a chuckle. 

Shoe orthotics use many materials to achieve what your foot needs. Acrylic is crack resistant, while cork helps absorb shock. Hroma uses a leather and cork heel lift for some of her patients. “It’s lightweight and comfortable.  It does the job it’s supposed to do,” she says. Polyethylene foam decreases pressure on your foot. Silicones add the “ah” factor, being flexible, yet firm, and comfy to wear. Your new shoe insert may contain a combination of some of these materials. 

Common conditions in kids

If you see your child walking funny to avoid ankle pain, an orthotic may be called for. “A straight heel lift will help open up the sinus tarsus, the lateral part of the ankle that gets crunched down and causes pain, impingement and bleeding,” says Hroma. 

In contrast, if your 3-year-old appears to be flat-footed, that’s normal. “We don’t want to use an orthotic too early,” Hroma says. Toddlers need to develop the calcaneus, the heel bone that Hroma calls the “driver” of the foot. allowing it to go through normal torsion (twisting), which helps develop bone.

But if your child reaches the age of 7 or so and has foot and ankle issues, consult your PT. “We will prescribe a custom orthotic that incorporates holding the calcaneus in a neutral position,” Hroma says. This, in turn, helps the arches develop properly, she says. 

A common problem in kids is plantar flexion, walking on their tip toes. This puts undue pressure on the sinus tarsus. For this condition, a softer heel lift would be prescribed, says Hroma. “It allows the foot to roll over, so the child can stretch out his forefoot a little bit.”

Adjustment period

Custom orthotics may not feel instantly comfortable. Because they help you walk correctly, you may have to gradually increase the number of hours you can wear them. “In the beginning, we have them wear their orthotics half the day,” Hroma says. During their off-time, her patients are supposed to follow their home exercise plan to stretch and strengthen their foot and ankle, she says. Eventually, you should be able to wear orthotics for a longer period, and feel more comfortable when walking.

A few years ago, some popular shoe brands came out with a shoe with a rocker bottom. These shoes have been tested on people in the bleeding disorder community. “For an adult with an ankle that is fused, it does help you push off,” Hroma says.

All orthotics come down to what is needed vs. what is practical. If your teen won’t wear a night splint or perform the recommended exercises, work with your PT to find middle ground. “We have to be realistic in terms of what we can accomplish,” Hroma admits. “We have to be creative in making sure their ankle is sound.”