How do clinicians decide on what type of foot orthotic to use?

Foot orthotics are widely used by podiatrists and other health professionals to treat a wide range of problems that go wrong with the feet. They could be used to support the foot, to protect the foot and to cushion all or part of the foot. They can be used to change the function of the foot for biomechanical problems. As well as the wide range of indications for foot orthotics, there is also a wide range of types of foot orthotics that can be used. These vary from the pre-made to the custom made to a very wide range of different materials to a wide range of densities of the types of materials that the foot orthotics are made from. A good clinician has to take all of this into account to work out what is the best type of foot orthotic with the right kind of design features with the right material for the nature and type of foot that the patient has. There are many different clinical tests that the clinician will or could do to help make that determination.

Probably the simplest observation is the height of the arch. Is it low or is it high or is it somewhere in between and more important what does that arch do between when the foot is up in the air and when the foot is fully weightbearing on the ground. All of this will get factored into the decision-making process of making the decision as to what is best for that foot. Another test that is often used is the lunge test that measures the range of motion of the ankle joint while standing and lunging towards a wall. The ankle joint range of motion is really important when it comes to foot orthotics as if the ankle range of motion is reduced, then that will probably mean that the foot orthotic is either not going to work too well or is going to be uncomfortable. The lunge test will usually be done in the shoe with the foot orthotic to see how well it works. If there is an issue with the ankle joint, then stretching for the calf muscles will often be used as well as the use of a heel raise. If the foot is flat, another test that is often done is a test known as the supination resistance test. For this clinical test, the clinicians put their fingers under the arch of the foot and tries to lift it up, noting how much resistance there is to do this. If the supination resistance is high, then a lot of force from a rigid foot orthotic is going to be needed to correct that flat foot. If the supination resistance is low, then a soft flexible foot orthotic is all that is going to be needed. This are only a small number of the total range of tests and observations that a clinician is going to consider when deciding on the best foot orthotic for each individual person.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.