Orthotics, also called orthoses, are devices that are worn to relieve pain associated with foot and ankle deformities and to help prevent or delay surgery. Most people think of shoe inserts or arch supports when they hear the word orthotics, but they can also include devices such as foot pads, ankle braces, and similar items.
Your foot and ankle orthopaedic surgeon may recommend starting treatment with less expensive off-the-shelf orthotics and progressing to custom-made orthotics if the symptoms and diagnosis require it.
Foot pads are the simplest devices. They can be placed on the bottom of the foot, or inside the shoe, but take up only a small area in the shoe. They are used to treat conditions that often cause pain at the front of the foot. Many styles, shapes and sizes are available, including circle or "doughnut" pads, bunion pads, and metatarsal pads.
Shoe inserts, also called inlays, insoles, foot beds, and arch supports, are placed into the shoe. These are used to treat a wide variety of problems, including arthritis and flat feet. They create a solid foundation for the body, decrease pain, and improve function and gait. There are many different kinds of inserts, from ones that are soft to ones that are very firm, and in different sizes or shapes. Other inserts need to be shaped to an individual's foot. Custom foot inserts may support, correct or prevent foot abnormalities or deformities. Many practitioners, including prosthetists, orthotists, and certified pedorthists, can make custom orthoses.
A period of adjustment is required for any new shoe inserts. The shoe inserts and the shoes are considered as a unit because the inserts occupy volume inside the shoe. This leaves less room for the foot. An appropriate period of breaking in should be allowed for a new insert. If it causes pain or pressure to the foot, the practitioner can make adjustments to improve the fit. Adjustment and proper fitting of the orthosis typically is included in the service provided.
Ankle braces are devices that the patient must put on before fitting into a shoe. They are used to treat a large variety of diseases like ankle arthritis, ankle instability, foot drop, and tendinitis. Depending on the type, severity, and location of the condition, some braces need to be custom made for the patient.
Shoes are important. They can improve the success of foot and ankle orthoses. The practitioner making the orthosis will ask that the shoes be brought to the office for planning and fitting. Not all shoe types will work properly with orthoses. This should be discussed with the practitioner before purchasing shoes.
It depends on the problem. Orthotics can change the pressure on certain parts of the foot to relieve symptoms. This especially is true in diabetics and other individuals who are at risk for skin breakdown. Certain ankle braces are good at controlling
motion and can help take pressure off of an arthritic joint. The result can be pain relief for patients who are unable or unwilling to undergo surgical correction.
Orthotics range from $10 to $800. Off-the-shelf devices range from basic inlays purchased at the drug store for $10 to $20 to more advanced orthoses sold for $150 to $200. Semi-custom orthoses (off-the-shelf versions that can be modified) range from $60 to $300. Custom orthotics can cost anywhere from $300 to $800.
Most current insurance programs do not pay for orthoses, even if prescribed by your doctor. If they are not covered under your health care plan, they may be a covered medical expense under a Flexible Spending Account. Medicare Part B currently covers one pair of shoes and three pairs of shoe inserts per year for patients who have an approved diagnosis of diabetes and related conditions.
Original article by Joshua Tennant, MD
Last reviewed by Jason Tartaglione, MD, 2018
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.
