Why are these over the counter orthotics not relieving my pain?

person with bent knee holding the back of her ankle

It's tempting that when you are feeling foot pain and are desperate for relief, the commercials may be ringing in your head to buy an over the counter insert to get rid of your foot pain.  If you have obtained over the counter inserts for your shoes, at least you have taken the first step in trying to do something to feel relief.  You have realized that foot pain is not normal, and that you need to do something about it, even if it means buying something at the drug store to put in your shoes in order to keep active.

If you are unable to walk or if your pain is persistent, it is imperative that you should see a doctor in order to make sure it is not something that needs an Xray and immobilization and immediate treatment.  However many aches and pains can come from an injury, an overuse injury, or a sprain or strain.  Sometimes pain can come from a long standing biomechancal issue that is now manifesting itself in your foot causing pain.  So you go to the drug store and try to find somethng off of the shelf, why is the over the counter insert still not getting rid of your pain? This is because although there are some incidences where an over the counter insert may work, there are many reasons why a custom orthotic is far superior.  

An over the counter orthotic may not be the right material

person standing with yellow and blue gym shoes

It is overwhelming looking at the shelf with rows and rows of choices, with labels promising one thing or the other.  When you take the over the counter insert out of the package and try it on, you dont know what you are supposed to be feeling.  The over the counter orthotic may be too hard, or it may be too soft. What does this mean? You assume that if your foot is in pain when walking or standing, then a very cushioned insert should make it feel better. This may be true, however if it is too soft, it may not be giving you enough support, causing instability (imagine walking on a mattress or a pillow) and your foot pain to worsen.  On the other hand, if you have an injury to a certain part of your foot, you may need some cushioning to the area to deweight an injury and the hard shell of the over the counter orthotic may be irritating.  A custom made orthotic will allow the doctor to choose the appropriate material needed for your specific diagnosis. She can determine if you need a hard shell, a soft shell, or a cushioned topcover, or padding to deweight a certain area of your foot and indicate this on the prescription for the lab.   A custom orthotic will be exactly that - custom to your foot and your diagnosis. These specifics that you will find in a custom orthotic can't be found in an over the counter insert. 

The shell is not quite the right shape

orthotic being help up to a person's foot

The shell is the part of the orthotic that cups the heel,  travels across the arch, and ends just before the ball of the foot. Some over the counter orthtoics have shells that are very flexible and not made of plastic, but most of them are made of a semi flexible plastic.  This shell is important to keep your foot in a biomechanically neutral position.  But because the shell on an over the counter insert is not custom made and comes from a generic mold, your foot may have a variability that renders it uncomfortable in an over the counter version. Simply put, it just doesn't fit the mold of an over the counter insert.  Remember, the shape of the shell and arch is the general shape that an arch could be for some people, however not for everyone. If you are one of the people for whom the arch fits correctly and feels good, then you may feel comfort and get some pain relief with the over the counter shell shape.  But with a custom molded orthotic, the doctor will take a plaster or fiberglass mold of your feet after placing it in a biomechanically neutral position.  This casting mold is total contact on the arch, so it will capture the exact shape and height of your arch and the exact width of your rearfoot.  In addition, the topcover may render the orthotic too long or too short, and this may not allow it to sit in your shoe correctly.  

It does not have customized padding in certain areas

If you have foot pain due to a certain diagnosis, then there may be specific padding that may be helpful to either deweight the area, for example in an area of increased pressure,  or to give you extra padding for example in a stress fracture or in fat pad atrophy.  Typically, an over the counter orthotic does not have this customized padding.  The prescription that your doctor will write for in a custom orthotic will be very specific as to the type of padding, and location of the padding that will enhance your treatment and decrease your pain. The correct padding can also prevent an injury from returning by decreasing pressure to a certain area that needs relief.  

It may not be the right type for the shoe you want to place it in

different types of orthotics in a pile

Sometimes an over the counter insert is too thick for a certain pair of shoes, too bulky, or too long.  With a custom orthotic, these specific needs can be incorporated into the shell and the topcover in order to specify according to the patient's needs.  For example, our office is able to manufacture a custom orthotic with a thinner shell in order to fit into sport cleats or a ski boot or cycling shoes.  You will probably not be able to find that in an over the counter orthotic.  By being able to customize the orthotic to fit the shoe that you need it in, then this increases compliance by the patient and in turn, will reduce pain.  The orthotic won't work if you don't have a chance to wear it!  In addition, you are able to work with your doctor to come up with shoe options to enhance compliance. 

It only works if you wear it

pair of shoes with custom orthotics next to itIn order to get rid of pain and to prevent it from returning, a custom orthotic may be what you need. Most importantly, it is important to come in for an evaluation complete with on site radiographs (Xrays) and a thorough exam in order to determine a diagnosis and a treatment plan.  Since the custom orthotic is prescribed by your doctor, you can be rest assured that it is the right orthotic for your diagnosis.  The fact that it is custom molded to your foot ensures that it will also be tailor made to address your foot pain.  With the proper prescription including shell thickness and type of material, length of topcover, and type of topcover with and without accomodating padding and/or cushion, you know that the end product will fit your foot like a glove, like a custom made glove.