What are orthotics and how do they work?

In-shoe orthotic devices (sometimes called orthoses) are specialist insoles that fit inside the shoes to help support your feet and posture when you need it. They are generally dispensed to you after an individual assessment called a biomechanical evaluation carried out by a specialist podiatrist. They can be off-the-shelf or bespoke, although bespoke orthotics are more accurate and last longer providing excellent value for money over many years.

Orthotics can treat a wide variety of musculoskeletal pain from, and even if your feet don’t hurt, they may be contributing to your other aches and pains- the way your foot strikes the ground impacts your knees, your hips and your back. They work in a variety of ways and research is now started to find scientific evidence of their benefits:

  • They support your feet and leg.
  • They can level your pelvis and reduce pelvis torsion.
  • They prevent shearing forces in the feet.
  • They can control excessive pronation of the leg at the knee and hips.
  • They can cushion sensitive feet and the body as a whole.
  • They can help to provide a better posture. * They can cure overuse injury and reduce future injury risk. 
  • Etc.

Orthotics are becoming increasingly more popular around the world because they are offering a longer solution to pain if they are prescribed correctly by a specialist podiatrist. They are now being frequently dispensed by a variety of practitioners because of the benefits to the patient. They can take some getting used to, however, but a good practitioner should provide fitting and use instructions, and guide you as to what shoes they best work with.

Children’s orthotic

How do orthotics work?

The truth is – we don’t know exactly how they work, we know they do from patient responses. Orthotics probably work by controlling abnormal motion across the joints of the foot, legs and pelvis while helping the posture as a whole. They are not just physical support, however. Orthotics offer proprioception from what is called the ‘orthotic reaction force’, which in effect is the bodies interpretation of how the orthotics feel underfoot. If the body is happy with the orthotics and how they feel, i.e. comfort, then the brain will interpret this as good and provide spatial awareness to other parts of the body. When orthotics work and the user/patient is happy with them, they can also increase the happy neurotransmitters (dopamine, endorphin) released in the brain when the body and mind are happy.

They can be made based on an impression of your feet, so they fit perfectly, don’t feel hard or uncomfortable in your shoes (once you get used to them), and are made from a variety of materials including carbon fibre, polypropylene and ethylene vinyl acetate (EVA) – the same material running shoe midsoles are made from.

Because orthotics need to support your whole posture and body weight, they need to withstand impact forces, the heat and moisture inside your shoes and a variety of foot types and conditions. This is why there are such a wide variety of orthotics, manufacturing methods and materials. These days orthotics can be made with a traditional plaster of Paris cast right through to the very latest 3D printing and CADCAM technology. A good pair of bespoke orthotics can last between 5 and 10 years depending on use. The issue is the wearer because they are more likely to change than the orthotic are. Experienced practitioners know that because users can change in their musculoskeletal system not to mention body weight and revising activities, that the orthotics prescription may have to change from time-to-time. Which is why once someone has received orthotics and used them for a few months, they should go back to the dispensing practitioner and have a clinical review of where they are at with their posture – biomechanics and how they move.

Orthotics being made using CADCAM

In summary

Orthotics are incredibly crucial in the treatment of sports injuries. They are highly successful if appropriately dispensed by an expert in this field and will last a long time under normal circumstances. They can help reduce the risk of injury and improve the running style and efficiency. They are not always successful, and this can be down to a variety of factors including poor running shoe, practitioner and prescription. When orthotics work well, which is most of the time they can be life-changing. One of the most specialist companies in the UK for biomechanical assessments and manufacturing orthotics (on the same day as the assessment) is Sub-4. Definitely worth checking out.