Foot Orthotics: The basics

With a lot of athletes getting advice to use foot orthotics to prevent injuries, or to correct bio-mechanics of the foot, or as a part of their rehabilitation, I came across many athletes who were unsatisfied with the orthotic they were using. Their problems did not get solved and it ended up being a money-making business for the person who sold it to the athletes.

With this article, my intention is to educate the reader on a few things which are mandatory to be done if and when a foot orthotic has been advised to an athlete.

When are these orthotics recommended?

Orthotics are recommended for athletes showing pronated feet/supinated feet/ flat feet on foot assessment.

They are also recommended if the biomechanical assessment suggests that the affected foot posture might be contributing to your injury, like in the case of ankle sprains, plantar fasciitis, posterior tibialis tendinitis, shin splints, patellofemoral syndromes, back pain, bunions and many more.

Usually they are recommended once the initial inflammation of the injury subsides (after phase I of the rehab programme). In-case a pre-season assessment is carried out, they are recommended to athletes as a preventive measure and also as a measure to improve performance in their sport.

What do these orthotics do?

They help in correcting your foot posture, thereby helping in normalizing the sync of various joints that is required during the dynamic sports activity.

How do you know your foot posture is affected?

• You can do a self test by inspecting you arches in standing. Also you can do wet test, where you can just wet your feet and leave an imprint on a piece of paper and compare with this picture.

• Also you can get your foot assessed by a physiotherapist/ sports physician/ podiatrist before buying a foot orthotic.
• Foot posture index- this is a rating scale whichevaluates your foot posture which may be done by your team physio to find out wehter you have pronated feet or not, along with detailed foot assessment.

Why does the foot posture get affected?

The current research says that our feet were designed to walk on surfaces like mud, sand, grass and all other natural environments. With more and more modernization (cemented roads everywhere, even on few playcourts) and increasing number of tournaments, the feet tends to get tired faster.

When will the advantages occur?

The advantages will occur when the dynamic support of the foot, that is the muscles of the foot, are exercised.

This what most of the atheletes are not told to/ do not do.

Our foot bony structure is supported by passive and dynamic support system

• Passive support system- ligaments, fascia, joint capsules over a period of years either get stretches out, or may not heal properly following an injury leading to changes in the foot posture.
• Dynamic support system is provided by foot muscles which when over-used or over-stretched also contribute to alterations in the foot posture.

When foot exercises are followed for certain period of days without orthotics- they help in activating the dynamic support. They increase the strength and endurance of the foot muscles along with increased joint proprioception. When orthotics are worn along with regular exercises, they do the 100 % job.

The simple “pre foot orthotic” rehab

• Basic foot and ankle exercises should be performed 15 reps 2 sets each for 1 week

1. toe gripping
2. towel scrunches
3. walking on outer part of foot
4. tennis ball calf raise

• Progress to ankle strengthening using theraband 15 reps 2 sets each for 6 weeks

(starting from yellow- to – green- to- blue)- continue basic exercises.

• As you start using the orthotic, it is essential that this pre foot orthotic rehab to be continued atleast twice a week.

• When this simple ankle rehabilitation is followed with correction of foot posture via orthotics, change in foot wear it helps in smooth, easy recovery back to your sport.

**not all cases will be resolved with this rehab, a few cases may need further detailed evaluation and approach by a physio/ podiatrist/ sports physician.

What could be other causative factors ?

• Sometimes the sports shoes may be worn out and may need to be replaced
• Weak core muscles should be strengthed along with the foot rehab
• Gait correction, correction of running technique.

How much do these orthotics cost & how long do they last?

• Custom made orthotic by an orthotist- Rs 700- 800. The ones bought from local orthotist last for around 6-8 months depending on the type of usage and sports you are into.
• Branded companies:- 2500- 3500 Rs. In case of branded companies, addition of certain pieces to correct pronation, for foot problems, etc may add another 400-500 to the cost. The ones bought from a branded company lasts for around 1 year , again depending on the type of usage and sports you are into.
• The quality may vary in case of branded & local orthotics. The quality may also vary depending on the material used to make the orthotics.
• Avoid using orthotics made of gel as they are not useful for sports persons.