Custom orthotics also known as custom insoles or even custom foot beds are commonly prescribed and used in the treatment of running and other athletic injuries involving the lower extremity. Your lower extremity consists of your hip, thigh, knee, leg, calf, ankle and foot. Custom insoles can be used to correct abnormal alignment of your foot which can have a negative effect on the rest of your lower extremity. For example, if your foot pronates excessively it can cause your ankle to roll inward while walking and even more so when running. Because your knee is attached to your ankle via your leg/calf your knee will also twist inward if you pronate excessively. Of course your hip is connected to your knee via your thigh and it will also twist inward if you over-pronate.
What is the difference between over the counter insoles like Dr. Scholl’s and the Custom Orthotics you make? This is a common question I get. The main difference is that the over the counter orthotics or insoles such as Dr. Scholl’s or Superfeet are molded to a generic foot. Since most people have a difference in foot size from right to left it is common for the insole to not support the correct areas of one foot and can also be uncomfortable or ineffective. A true custom orthotic is molded to your foot so that it hits you in all the right spots resulting in symmetrical support. This is accomplished through a molding process. There are many ways to take molds. Some still user the 1950’s plaster of Paris mold then ship it off to a lab where they transfer the mold to plastic. Some use a foam box that takes your foot impression. The foam box is then shipped off to the lab where they transfer the mold to plastic. Some even use a computer scanner that you stand on or walk on. That image is transmitted electronically to a lab where they convert it to plastic. At San Diego Running Institute Dr. Allen either heat molds the plastic to your foot while you are here or use an injected mold and molds it to your foot while you are here for your appointment. Your orthotic never ships to a lab because we have our own lab on site. This ensures quality control and expedites orders. When we use to use a lab it would often take 2 weeks to receive the orthotic. Our normal turn-around time is 5-7 days because we have an in-house lab.
What are the difference between a molded orthotic and a custom orthotic?
This is question I frequently get asked regarding insoles. A molded insole is simply a mold of your foot. Instead of using an over the counter insole you had insoles molded to your foot. A true custom insole will not only utilize the molds of your feet but the molds will be customized to offset any abnormal mechanics of your foot and ankle such as over-pronation. A simple mold of your foot does nothing except….well represents the shape of your foot. Customizing the mold is what truly makes an insole custom. There are many doctors, therapists and even running stores out there that take advantage of the public perception that a molded insole is a custom insole. To reiterate, a custom mold is just that….a mold of your foot. It does absolutely nothing to offset any abnormal mechanics. Only by customizing the mold, with custom parts can you offset abnormal biomechanics. For example, if your knee was dislocated and a mold was made of it how would that help you? It wouldn’t, because your knee is still dislocated! But it might if the mold was customized to push the knee back into alignment and support it there. At our San Diego Orthotic Lab the molds are taken by the doctor (no kids taking molds here please, the molds are customized by the doctor and then the new custom orthotics are fitted into your shoes and a computerized gait analysis is performed for you…by the doctor (there is an additional fee for computerized gait analysis).
My podiatrist watched me walk across his office and told me I pronate and need $600 orthotics. Should I trust him/her?
- The fact that you are asking tells me you are suspicious anyway. No one can watch you walk across their office barefoot or down a hall and accurately evaluate your gait mechanics! I love the kid at the local running store who claims you “over-pronate’ and need more “stability”. Most of them could not tell you how much pronation is too much anyway. Next time you are in that situation have a little fun. When the kid tells you that they see you over-pronating ask this simple question. “How many degrees of pronation is too much?” or “How many degrees of pronation is normal?” Watch their eyes bug out at this question. In fact most doctors do not even know the answer to the question.
I had a gait analysis at the local “McRunning Store”. The guy there says I need to run more on my forefoot and get some minimal shoes. Should I trust him?
- Research shows that roughly 67% of runners are heel strikers, about 225 mid-foot strikers and only 1-2% land on their forefoot. It is an urban running legend that if you change from a heel striker to a mid-foot or forefoot strike that you will increase your performance and decrease your injury risk. This is simply not true. In fact the majority of runners that change their form usually get injured in the process! There are many, many successful heel strikers winning races out there….how does the guy at McRunning Store account for that? In the field of Biomechanics there are two different ways that gait can be analyzed.
- I can watch someone run and ask “Why do they run that way”. I can take measurements of their anatomy, arch height, foot length, width, leg length, muscle strength and joint range of motion. I can deduce from my measurements WHY someone runs with foot flair or pronates excessively on their right side if compared to the left. I can then create a custom insole that offsets or supports the mechanics that are thought to be contributing to their running injury.
- I can watch someone run and say “you should not run like that. You are doing it all wrong. You should run like this”. I can ignore that there may very well be a reason they run the way they do and try to force them into a particular running form that I DEEM better than the way they run.
Try this analogy. I watch someone riding their bike and I can tell that they are favoring the right side. In example #1 I would inspect their bike, measure tire pressure, measure the crank shafts to ensure they are equal length, check their handlebar height and seat position. If I found anything to be asymmetrical I would work to correct it. Like the crank shafts being unequal in length. Unequal crank shaft length would account for WHY they might be favoring their right side while riding.
In example #2 I would simply ignore all of the variables and tell the person to stop favoring their right side while riding and ride their bike in a way that I DEEMED more favorable. This approach does not account for all of the possibilities and also ignores the fact that there are many, many different riding styles available and that each user must ultimately find which one is best suited for them. To force someone into a certain biomechanical position because it “works for you” is neither a logical nor an effective approach.
If you think you might need custom orthotics and want more information please email firstname.lastname@example.org or to schedule an appointment call 858-268-8525
The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.