Orthotics are either functional or accommodative. Accommodative orthotics are like an egg crate, conforming to bony prominences, calluses or wounds. Functional orthotics are more widely used; they are like eyeglasses. Eyeglasses change the angle of light coming into your eyes to help you see better. Orthotics change the angle the ground reactive forces hit your feet to help you walk better, at the proper angle, to decrease pain. Dr. Hoy graduated from the medical school that did the original research on orthotic therapy, and trained by some the best original professors of the trade. Some conditions which orthotics are used include:
- Plantar fasciitis, heel pain. This is a condition where there is pain in the heel or arch that comes from abnormal increased stretching of the ligament that spans the bottom of the foot. Orthotics minimize the amount of stretching to decrease pain, and is the mainstay of treatment for this condition. In order to do that the orthotic has to be rigid to hold up the body weight. There are over-the-counter orthotics that do that, but they must be rigid on the bottom. Examples of that include Superfeet, Powerstep and Prolab over-the-counter orthotics. If these help, custom functional orthotics may provide better, longer lasting relief that is more precise.
- Flat (pes planus), pronated or over-pronated feet. This is where the arch collapses in the feet. The condition may be flexible or reducible or it can be rigid and non-reducible. The arch collapse causes many problems such as ankle pain on the outside and/or the inside, arch pain, plantar fasciitis, bunions and hammertoes, shin splints, to name a few. It may also cause knee, hip and back pain. The tendon that makes the arch go up has to work very hard, and like a rubber band, it can be stretched out, painful or fail. This is called posterior tibial tendon dysfunction. Arthritis can then develop in the rearfoot joints. Orthotics work to support the arch from collapsing and allow the muscles to work properly without over-exertion. In order to do that the orthotic has to be rigid to hold up the body weight. There are over-the-counter orthotics that do that, but they must be rigid on the bottom. Examples of that include Superfeet, Powerstep and Prolab over-the-counter orthotics. If these help, custom functional orthotics may provide better, longer lasting relief that is more precise.
- Morton’s neuroma. This is an inflamed nerve on the bottom ball of the foot just back from behind the toes, specifically between the 3rd and 4th toes. It sometimes occurs between the 2nd and 3rd toes, when it is called a 2nd interspace neuroma. When the foot is pronated, as in #2 above, increased motion of the foot causes the neuroma to form. They can also form by wearing tight or high heeled shoes, or doing lots of activity using the ball of the foot. Orthotics help to control the motion on the foot. Usually a metatarsal pad is also placed in a custom functional orthotic to help offweight the neuroma. That means the pad lifts the foot off the ground where the neuroma is so that the neuroma is not touching the ground when walking.
- High arches, pes cavus, supinated foot. Patients with this type of foot may get pain in the arch, the ball of the foot, the heel, and even the Achilles tendon. Plantar fasciitis (#1 above) and ankle sprains may be common with this type of foot. Oftentimes over-the-counter orthotics do not have a high enough arch for these patients. Custom functional foot orthotics will better distribute the weight in these patients to prevent abnormal increased stretching that can cause pain. They also stabilize the foot to prevent ankle sprains.
- Bunions. These are protrusions of the bone behind the big toe bone (1st metatarsal) due to an increase in the angle between that bone and the bone behind the 2nd toe bone (2nd metatarsal). There is a bump behind the big toe that comes out. There can be pain in the bump as well as pain in the joint behind the big toe bone. Besides activities that require patients to be on their big toes, such as ballet dancing and high heeled shoes, bunions are usually genetic and caused by a foot type that is pronated (#2 above). Functional orthotics can help decrease pain in the bunion by keeping the pressure off the inside of the foot. They also help to prevent bunions from progressing, or returning after bunion surgery. Orthotics work to support the arch from collapsing. In order to do that the orthotic has to be rigid to hold up the body weight. There are over-the-counter orthotics that do that, but they must be rigid on the bottom. Examples of that include Superfeet, Powerstep and Prolab over-the-counter orthotics. However, custom functional orthotics are generally recommended in bunions to prevent progression, return, and to provide better, longer lasting relief that is more precise.
- Leg length discrepancy. This is a common condition where one leg is longer than the other, either due to genetics or development. Leg length is usually checked in the orthotics fabrication process, and proper heel lifts are added to the orthotic as needed. If the discrepancy is too large for a heel lift to be added, the patient may need to add the heel lift to the shoe. Leg length discrepancies may cause hip, knee and back pain, and may cause greater deformities in one foot as opposed to the other foot. For example, the patient may have any of the conditions listed above (#1-5) in one foot and not the other because of a leg length discrepancy.
Shoes for orthotics. Orthotics are meant to work on a flat surface. Do not use them in high heel, poor quality, loose or non-supportive shoes. The best type of shoe for orthotics are laced up, have a small opening and a deep, stiff heel counter, should not torque, and bend only at the toes. Be sure to remove any inserts or foot beds from your shoes before inserting your new orthotics, and do not place the orthotics on top of them. If the shoes with the orthotics are too tight, you may need to obtain larger shoes.
We are passionate about the science of orthotic therapy and will be happy to fit you with orthotics that will help to resolve many painful foot and ankle conditions without surgery.
“I was a patient of J. John Hoy, DPM, FACFAS, FACFAOM seeking help to get new orthotics to address my knee pain. He was on schedule, knowledgeable, and kind. He was also able to address toe issues that I had been having troubles with- immediate pain relief. Lucky for me I don’t need to see him very often, but so appreciate that he has his practice in Seattle.” -Elizabeth C.