Custom Orthotics vs. Generic Insoles
By Kevin Wong
One of the biggest challenges I have found over the last 25 years with being an extremity-based doctor is the general lack of public knowledge regarding the feet and how they affect the rest of the body. Starting from a very young age, we are not properly taught about our anatomy and how different body parts work with and affect each other. This comes into play when incorporating the use of orthotics into patient care.
When patients need medical care, the majority of them will begin with allopathic medicine. This is because they believe that pain is the indicator of when to seek treatment. It’s common to only treat the pain of conditions like plantar fasciitis, metatarsalgia, and Achilles tendonitis, rather than identifying and correcting the foot/arch dysfunction and biomechanical problems that are their underlying cause. Interestingly enough, many patients with faulty foot biomechanics live their lives without having any foot pain at all. However, in my experience I have seen that upwards of 87% of all human beings in a standing posture exhibit signs of flat or pronating feet that that can lead to pain and disfunction in the knees, hips, pelvis, neck, and spine. Even common conditions like shin splints and sprained ankles can stem from unhealthy foot function.
Misconceptions about arch anatomy
If you ask 10 people on the street the following question “How many arches do we have under each foot?”. They will likely all answer “one”. The average person never learns that we have three functional arches forming the plantar vault of the foot.
Most of the health care providers patients utilize propagate the notion that the inner arch is the only foot arch that exists. This misinformation people operate under influences the purchasing decisions they will make regarding foot-related products, especially orthotics. Attention must be given to educating the patients properly, so they understand the difference between mass-produced generic insoles that tout arch support and custom orthotics designed to address the unique biomechanics of each patient and restore natural, healthy function of all three arches, thus stabilizing the entire body.
Dictionary.com defines the word “orthotic”, or orthosis, as a device or support, especially for the foot, used to relieve or correct an orthopedic problem. The definition in and of itself is quite vague. The orthotic market is confusing because it is flooded with too many cheap pre-made products.
On one end of the spectrum, there are many brands of off-the-shelf, prefabricated, non-custom orthotics available through retail/drug stores, online retailers, and some care providers. The manufacturers use attractive marketing and catchy statements to influence customers to buy impulsively in the hopes of experiencing pain relief and improved athletic performance.
On the other end of the spectrum, there are flexible, three-arch, custom-made orthotics that have been around for over 69 years. These custom orthotics are only available from specifically trained and qualified health care providers who assess the feet through a weight-bearing scanning or foam casting process. It’s the doctor’s role to offer these products in their practices and educate patients about their benefits. Let’s make some common orthotic phrases and concepts clearer so you can achieve better care results by helping your patients make more informed choices.
When orthotics are advertised we often see comments like these:
“Podiatrist designed and/or recommended”
“Same day solution so patients don’t have to wait
“Premium materials” and/or “quality construction”
Implying that pre-fabricated orthotics are clinically proven is very vague. They generally only have one arch, so they end up helping some patients more than others. Some feel no better or even worse. If the person has a flat inner arch, they may find some initial pain relief from these, but the other two arches (transverse/lateral arch) will get no benefit from these off-the-shelf orthotics. The foot will actually continue to get flatter over time due to the lack of support. During this time, their faulty foot biomechanics could be undermining the stability and healthy function of their entire bodies.
The three-arch, custom, flexible orthotics have over 37 scientific research studies that validate their effectiveness and success with countless patients. Many of the research articles, case studies, and white papers are available for you to access and read. These studies along with over 69 years of successful implementation by countless health care providers across the world are clinical proof that these orthotics are extremely effective.
A podiatrist’s perspective on the foot is more static vs. dynamic. They are treating only the patient’s foot with little regard to the skeletal structures and associated joints above. They also tend to echo the inner or single arch concept so their patients are not exposed to the existence and importance of supporting the three arches. Podiatric orthotic choices can range from very expensive, rigid, one-arch orthotics to telling the patient to go to the store and choose an off-the-shelf brand. This can be very confusing for patients.
Recall that the body is a dynamic system. The feet/ankles intimately affect the knees, hips, pelvis, and spine. When the feet are excessively pronating, this affects the rest of the body and they significantly contribute to some very common clinical conditions patients seek care for, like lower back pain.
Same-Day Solution so Patients Don’t Have to Wait:
In our society, we are accustomed to getting what we want fast. When patients are experiencing pain, they want to feel relief right away. The off-the-shelf orthotic companies try to capitalize on this. Instead of waiting for a custom-molded orthotic that will support that patient’s body completely, they try and get the customer to bite on an inferior product just because it is readily available.
Taking the time to scan or cast the patient and have a pair of orthotics custom-molded for them ensures they will have an unparalleled product that is uniquely designed for their feet and body as a whole.
When I scan and assess a patient’s feet, I can submit a custom orthotics order the same day. If the patient wants them sooner, they can pay a little extra for expedited shipping. Getting the custom orthotics in quickly is never a problem if that is what the patient wants.
Premium Materials and/or Quality Construction:
The term “You get what you pay for” is appropriate here. Pre-fabricated orthotics sold off the shelves and produced in mass quantities for $35-80 are made of materials that allow them to be sold cheaply. How could these companies truly be using quality materials when they make a product that costs so little? Looking at websites of these prefabricated orthotic companies to see what materials are inside the insoles, one can see there is not much to them. It is to be expected for a product under $100.
The three-arch, custom, flexible orthotics are made of top quality, high-performance viscoelastic materials that absorb shock, enhance stability, and provide a propulsive boost during all weight-bearing activities. Their designs and materials have evolved for over 69 years based on patient and doctor feedback. For the best care outcomes, patients should wear their orthotics all the time, so durability is very important.
The off-the-shelf orthotic companies hope the cheap price tag of their products will be very appealing to consumers. This strategy serves them because they are dealing with customers who are uninformed regarding the arches and foot anatomy. Their ads often highlight the low price and the immediate availability.
Doctors concerned about the source of the problem realize the importance of the three arches and the choice of the orthotic for the patients. We are not out to compete with online retailers, a sporting goods store, or a drugstore on price because their pre-fabricated orthotics are of lesser quality and effectiveness.
Each foot has its own unique biomechanical properties and dysfunctions. By analyzing both feet distinctly (using a digital scanner or foam cast), it’s analogous to an eyeglass prescription, where the lens correction is usually different for each eye. For effective and accurate arch support and body stabilization, each foot needs its own custom corrections for all three arches.
Health care providers who are trained in prescribing custom orthotics offer their patients a proven, value-added “experience” rather than an impersonal off-the-shelf solution. No inventory needs to be kept on-site and the one-year money-back guarantee gives patients confidence that spending more money on a quality product is the right move and reinforces the value of their custom orthotics.
For too long, patients have been operating on the incorrect belief that we only have one arch under each foot. The prefabricated orthotic companies have been successful in wooing these customers by capitalizing and further spreading this fallacy with their one-arch insoles. Give your patients the awareness and education about custom orthotics and once they understand foot anatomy and how it affects their bodies, they will be quite amenable to the custom, three-arch, flexible orthotics.
Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.
As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.