Educate patients and make a thorough examination to see if custom molded orthotics can fix issues brought on by OTC orthotics
A patient appears in your office, indicating that they have pain in their foot or back. While doing a thorough assessment is necessary for finding the cause, it’s also helpful to ask whether they use over-the-counter (OTC) orthotics as opposed to custom molded orthotics.
This is because these corrective devices may actually be contributing to — if not causing — their discomfort if they are not a custom fit.
OTC orthotics and increased foot or back pain
“Orthotics that are too rigid can create foot problems, whole lower kinetic chain problems, or lower back problems,” explains Lev Kalika, DC, owner of New York Dynamic Neuromuscular Rehabilitation & Physical Therapy.
Sometimes these problems exist because they block normal foot pronation, says Kalika, creating excessive internal tibial rotation which can then lead into excessive internal rotation of the whole limb.
“If that happens, an anterior pelvic tilt and increase in lumbar lordosis may occur,” he says.
OTC orthotics can also lead to issues by blocking pronation in specific areas of the foot. For example, they may block rear foot pronation. This can cause low back pain because of the way it affects resupination, says Kalika, ultimately decreasing hip extension which is compensated through excessive anterior tilt and excessive lumbar lordosis.
If the orthotic blocks subtalar joint pronation, “this can result in different compensatory strategies through the whole foot,” says Kalika. It may even cause stress of soft tissues of the arch, distal plantar fascia, distal insertion of the tibialis posterior tendon, flexor digitorum longus, or flexor pollicis longus tendons.
Finally, the use of some OTC orthotics can decrease shock absorption. When this occurs, it can cause stress to extend up to the sacroiliac joint and lumbosacral spine if the patient is hyper mobile in those areas which, Kalika adds, is frequently the case.
Conditions potentially aggravated by OTC orthotics
Jordan Duncan, DC, owner of Silverdale Sport & Spine in Silverdale, Wash., further states that, sometimes, the pain in the foot or back is caused due to OTC orthotics being used in an effort to treat a specific condition for which they shouldn’t be used.
“In cases where pressure distribution and/or accommodation are critical in order to treat painful foot structures, an over the counter orthotic may actually aggravate, rather than relieve, these problems,” Duncan says.
Conditions that fall into this category include:
- heel spurs – when pain exists due to calcium deposits that protrude from the heel bone
- sesamoiditis – pain beneath the 1st metatarsal head, at the sesamoid bones
- metatarsalgia – pain and inflammation in the ball of the foot
When a patient presents with one of these issues, or if they’ve tried other treatment methods and haven’t experienced relief from the pain or discomfort, “custom orthotics may be a better choice,” says Duncan.
Helping patients with custom molded orthotics
One of the first steps in helping patients choose orthotics that are best suited to resolve their foot or back pain, or without making it worse, is to educate them about the difference between OTC and custom molded orthotics. More specifically, talk about how each type can potentially help or further hurt their particular dysfunction or condition.
Next, provide helpful tips for getting the most out of their foot orthotics. Explain that they may want to initially wear them for an hour or a two at a time, for instance, giving their foot (and the rest of their body) the ability to adjust to the new alignment they create slowly over time. And if they notice a squeaking when wearing them, a little bit of powder sprinkled between the orthotic and the shoe can often help stop this sound.
Also mention whether the specific orthotic they choose is more effective when used in one type of shoe over another. Some custom molded orthotics are designed solely for an athletic shoe or comfortable slip-on, for example, whereas others are made to be inserted in a more formal type of footwear.
There are also a few orthotics manufacturers that sell customized shoes with the orthotics built right in, such as by providing specialized flip flops. This provides patients the ability to correct their particular dysfunction or condition without limiting their footwear choices.
Helping patients understand how to best use their custom molded orthotics, and working with them to make the best choices given their condition, can increase the likelihood that they will utilize these devices regularly. It encourages them to stick to their treatment regimen long enough to get the desired results, as well as to reduce (or eliminate) pain.
