Running, other sports and even walking can make a lot of demands on our feet and ankles. These demands cause stress on the feet that can lead to pain and injuries. Orthotics can help in positioning the foot correctly and prevent pain and suffering in the feet.

What are orthotics?
An orthotic is a medical device used to support and align the foot. Foot orthoses comprise a custom-made insert or foot bed fitted into a shoe. Commonly referred to as orthotics, these orthoses provide support for the foot by redistributing ground reactive forces as well as realigning foot joints while standing, walking or running. An orthotic serves to prevent, support or correct foot deformities and foot functioning.

The word orthotic comes from the Greek "ortho", which means to be straight, right, upright or to correct. Orthotics cushion the impact of the hard surfaces we walk on and provide shock absorption. They also can relieve pressure by providing support behind a problem area such as a callous, a neuroma or a metatarsal head. Orthotics can provide support in cases of flatfoot or over pronation. They can be used correct mal-alignment problems, such as one leg being longer than the other.

How orthotics work
Orthotics are designed to correct faulty foot function by reducing the amount of ankle rolling and arch flattening while walking and running. Over time this will reduce the amount of rotation of the ankles, legs and knees. By correcting the over-pronation, orthotics re-align the feet and ankle bones to their neutral or best position and restore normal foot functioning. Therefore, orthotics not only help alleviate problems in the feet but can also help with aches and pains in other parts of the body such as the knees and lower back.

Orthotics can help correct deformities in children's feet, especially if they start to wear them early before the bones in the foot are fully formed. The younger the child starts to wear the orthotics, the more effective they will be. Orthotics are worn in sneakers or closed-toe shoes such as school shoes for children or loafers for adults. They don't fit in sandals or most high-heeled shoes.

There are now some brands of sandals and shoes that can have the orthotic built right in. If you are wearing orthotics, you should see your podiatrist at least once per year for a checkup to see if they are still in good condition and are correcting the problem, or if they need to be repaired or replaced in the case of children. Diabetics may have to have their orthotics or inserts changed more often, based on the condition of their feet.

Conditions treated with orthotics
Poor foot functioning can be blamed for many common foot conditions. However, research has shown that bad alignment of the feet can affect other parts of the body, including the knees and lower back. Orthotics can be used to effectively treat a variety of conditions such as plantar fasciitis (heel pain), heel spurs, metatarsalgia (pain on the ball of foot), shin splints, bunion pain, Morton's neuroma, Achilles tendonitis, knee and back pain.

Over-pronation (foot rolling over on the inside) is a common condition treated by orthotics. Some podiatrists believe that over 70 percent of the population suffers from mild to severe over-pronation. Over-pronators do have an arch present, however the arches are lowered and the feet and ankles roll inward during walking and running. This causes the legs to rotate inward, leading to an irregular motion in the knee joint which forces the pelvis to tilt forward putting tension on the lower back.

Types of orthotics available
Regardless of the type of orthotics available, they are all designed to achieve the same goal, better foot functioning and pain relief. Generally, there are two types of orthotics -- custom-made orthotics and off-the-shelf insoles. Orthotics can be soft, flexible, semi-rigid or rigid.

The soft, floppy over the counter ones are only for cushioning, padding and shock absorption; semi-rigid gives more support but are not as hard as the rigid ones, and rigid orthotics are firm and are designed to correct foot functioning. Orthotics can be made of various materials, such as viscoelastic, silicon, closed-cell rubber or closed-cell polyethylene. The difference in material determines the firmness, durability and cushioning properties of the orthotic.

Podiatrists routinely prescribe and dispense custom-made rigid orthotics. The podiatrist takes an impression of your foot either with a cast or 3D scanner and sends it to a lab and the orthotic designed for persons with problems with foot functioning and or foot deformities that need correction. They are used in circumstances where over-the-counter types will not work or do not provide enough correction.

Can orthotics work for me?
Most people who suffer from fallen arches (over-pronation) will need a firmer orthotic, since an off-the-shelf, floppy insert will not provide enough correction or support. In the case of children, most often they will need custom-made orthotics to correct the deformity and relieve the symptoms. As a rule, the younger the child is, the more effective the orthotics are and the more correction they will get. They often need them in their school shoes as well as the shoes they play sports in.

Special inserts and orthotics are available for diabetics, especially if they have or had callouses on the foot, a foot ulcer or amputation. They do an excellent job to decrease pressure and friction on the foot while providing support and offloading the foot as well. The podiatrist can determine the type of orthotic or insole that will work best for your foot type or foot condition.

The difference between orthotics and insoles
Regular over-the-counter insoles are floppy and designed to provide only cushioning and shock absorption. They may feel comfortable at first, however they cannot truly address the biomechanical problem of over-pronation, as an orthotic does. They can help with symptoms because they are softer than custom-made orthotics and are easier to get used to. However, if they do not relieve the symptoms, custom-made orthotics may still be needed.

Orthotics are custom-made for your feet and are designed to correct the deformity and improve foot functioning when they are being worn. They have a lifetime warranty for adults and you may only need to repair the covering from time to time. Because children's feet continue to grow, they may need to be replaced at sometime.

Your feet are the foundation of our bodies and orthotics can help restore the balance needed for your feet to function at their best. If you have foot pain, foot deformity, fallen arches or back pain, see a podiatrist for an evaluation - you may need orthotics.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

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