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Insight on Insoles

By Tatiana Wellens Bruschayt DPM PhD

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Published: 21Sep2009
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Have you noticed that removable flap of material that lies inside those shoes you have just bought? Sometimes you may have noticed that this piece of material has come loose and has bunched itself deep into the shoe. Why is such a section of material necessary? Exactly what is it? That shoe-bottom shaped material is called an insole.

Insoles or otherwise known as foot care orthoses are tools that podiatrists can use to help to cushion the foot and help to correct the biomechanics of your gait. They may also be used to alleviate pain, maintain and support the arch of your foot, accommodate foot deformity, and to relieve pressure.

The world of insoles is populated by devices in all different sizes, various shapes and a vast multitude of colors! They also have different classifications depending on their function. Foot care orthoses (especially custom made devices) work by slightly changing the angle that your foot strikes the ground. As a result, the biomechanics of your foot are slightly altered to better address the foot pathology that you may be experiencing.

In typical store bought shoes, the insoles you find really only have the purpose of cushioning your feet. However, specialized insoles can be made to deal with your problems and improve your ability to walk and maintain proper foot posture.

What goes into determining whether an insole is right for you? - Biomechanical evaluation - X-rays - Casting

A biomechanical evaluation consists of a series of objective measurements of the movement of the joints in your hips, knees, ankles and feet. Since your feet and their impact directly affects all the joints in your leg, it only makes sense to measure all of the body parts involved to accurately gauge what kind of insole will work best for you. This evaluation also involves a gait analysis so that your podiatrist can see how you walk without them and see if corrections need to be made. X-rays will give your doctor an internal look into the bone structure to verify some of the elements suggested by the biomechanical evaluation. Finally, a cast either in plaster or fiberglass is done to get an impression of your foot in its neutral position. Finally, all the measurements and casts are used to assemble your custom orthosis!

Insoles are a great non-invasive way to get you walking and functioning correctly! Talk to your podiatrist if this is a treatment right for you!

The majority of foot problems are associated with malalignments or imbalances in your feet. Problems that you may experience may include pain, fatigue, and/or deformity. Orthoses are a non-invasive way to correct those imbalances and help you stride in comfort.

Insoles are made of strong materials that can be subjected to the repetitive stresses of your body weight and the impact of the ground upon them without wearing down quickly. They are best used in close-toed shoes that will prevent them from sliding or slipping out! The beauty of these orthoses is that they can be transferred from one close-toed shoe to another. So for individuals that play a variety of sports, these devices can easily be placed into all your athletic foot gear!

Orthoses are durable and are not likely to be replaced if you are receiving them as an adult. As an adult, your bones and the resulting foot structure are probably at the point where significant change will not occur. Children who are prescribed orthoses for their foot pathologies will need new prescriptions due to their rapid foot growth. Orthoses may eventually see some wear and tear to them, and they can be refurbished if necessary.

If both you and your doctor feel that orthoses are the right therapy for your ailments, here are some factors that you might want to consider in order to get the most out of your treatment.

- Bring your shoes to your podiatrist’s office when you are called in to pick up your orthoses. This is a good way to make sure that the doctor sees these insoles properly fit in your shoes. If minor adjustments need to be made, your podiatrist will be qualified to make them.

- Whenever you go shoe shopping, make sure to bring your orthoses with you (along with the socks that you plan on wearing with the shoes).

- Make sure that you return for the follow-up appointment with your podiatrist for an evaluation of your orthoses. Your doctor will be able to ensure that that both your orthoses and your feet are in sync with each other.

As far as insoles go, there are so many options that podiatrists can choose from to suit your needs. Insoles are grouped into classifications depending on their material and subsequent function. The basics of orthoses and their categories are as follows:

Rigid Orthoses

These insoles are called rigid because they are made of a stiff material like carbon fiber or plastic. Such devices are primarily used in controlling foot function. Rigid orthoses can run from heel to the ball of the foot or from the heel to the toes. These insoles are supposed to be used in close-toed shoes which are mainly used in walking.

Rigid orthoses are durable devices are inflexible and resistant to deformity. They are hard to break and do not change their shape. Their major role is to control the motion in the two foot joints following the ankle. They are usually constructed for patients experiencing ailments in the legs, thighs or lower back. In addition, if a patient has a slight limb length discrepancy (one limb is longer than the other) these orthoses can be considered to help with gait and posture.

Semi-rigid Orthoses

This class of orthoses functions to maintain foot balance during sports activities. This type of insole helps muscles and tendons of the foot to perform efficiently and guides the foot through functions. The soft material layers are strengthened by the rigid materials giving the insole the nature of flexibility and stiffness.

Soft Orthoses

The materials that make up this type of insole are soft, moldable and compressible. As a result of these orthoses being easily deformed by pressures, they are not as durable as rigid orthoses and need to be replaced more often. Soft insoles have multiple purposes: ease pressure off of certain foot areas, enhance balance and absorb impact.

This class of orthoses are particularly suited for individuals with deformed feet where there is not protective tissue to help with shock absorption, arthritic patients, and people who have diabetes. Soft insoles are constructed with layers of soft materials making them substantially bulky. As a result, deep shoes or prescription footwear are necessary to accommodate these orthoses.

Tatiana A. Wellens-Bruschayt, DPM, PhD FACFAS. Dr.Wellens-Bruschayt is president of Central Florida Foot and Ankle Center. She is board certified by the American College of Podiatric Surgery. She has performed over 4000 operations on foot and ankle. Check out our website www.flfootandankle.com to receive your free book "No More Pain" Your Guide to Foot and Ankle and to view educational videos or book appointments.

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