As a sports podiatrist, I frequently encounter patients struggling to know when orthotic shoes or orthotic devices are required for their injury and whether to choose custom orthotics or prefabricated orthoses. Whether you’re an athlete or a weekend warrior, the decision isn’t always straightforward, as it depends on several factors, including the individual’s specific condition, activity level, and biomechanical needs. This blog will delve into the pros and cons of both custom orthotics and prefabricated orthoses, supported by recent evidence, to help guide those experiencing lower limb injuries towards the best choice for their situation.
Understanding Orthoses
Orthoses can play a crucial role in managing various lower limb injuries by providing the necessary support and correction to alleviate pain and improve performance. Orthotic shoes and orthotic devices are broadly classified into two categories: custom and prefabricated (also known as off-the-shelf or over-the-counter orthoses).
Custom Orthotics
Custom orthotics are specifically tailored to an individual’s foot structure and needs. They are created based on a detailed assessment that includes a thorough physical examination, gait analysis, and sometimes advanced imaging techniques.
Pros:
- Personalisation: Custom orthotics address specific biomechanical issues, providing tailored support. This is particularly beneficial for complex foot structures or severe conditions.
- Effectiveness: Studies have shown that custom orthotics can significantly reduce pain and improve function in individuals with specific conditions. For instance, a study published in the Journal of Foot & Ankle Research found that custom orthotics were more effective than prefabricated ones in reducing pain and improving function in patients with plantar heel pain (Landorf et al., 2020).
- Durability: Custom orthotics are generally made from high-quality materials, making them more durable and longer-lasting than prefabricated options.
Cons:
- Cost: Custom orthotics are more expensive than prefabricated orthoses, which can be a barrier for some individuals.
- Time-Consuming: The process of creating custom orthotics involves multiple visits to a healthcare provider and a waiting period for the orthoses to be manufactured. However, this process can often be expedited if required.
Prefabricated Orthoses
Prefabricated orthoses, also known as over-the-counter (OTC) orthoses, are mass-produced and available in standard sizes. They can be a suitable option for many individuals, particularly those with mild to moderate foot issues.
Pros:
- Cost-Effective: Prefabricated orthoses are significantly cheaper than custom orthoti shoes, making them accessible to a broader population.
- Convenience: These orthoses are readily available and do not require a lengthy manufacturing process. They can be purchased and used immediately.
- Adequate for Mild Conditions: For many individuals with minor biomechanical issues or those seeking preventive support, prefabricated orthoses can be effective. A study published in Sports Health indicated that prefabricated orthoses were beneficial in reducing pain and improving function in individuals with medial tibial stress syndrome (MTSS) (Yates & White, 2021).
Cons:
- Limited Customisation: Since they are not tailored to individual foot structures, prefabricated orthoses may not provide the necessary support for severe or complex conditions.
- Durability: Prefabricated orthoses are often made from less durable materials, which may wear out more quickly than custom orthotics.
- Fit Issues: The standardised sizing may not fit everyone perfectly, potentially leading to discomfort or inadequate support.
Exercise-Induced and Chronic Injuries
Several common exercise-induced and chronic injuries can benefit from orthotic intervention, including medial tibial stress syndrome, tendon injuries, stress-related injuries, and plantar heel pain. Here’s a closer look at how orthotic shoes and devices can help with these conditions:
- Medial Tibial Stress Syndrome (MTSS): Prefabricated orthoses have shown promise in reducing pain and improving function in individuals with MTSS, making them a viable first-line option for mild cases (Yates & White, 2021).
- Tendon Injuries: Custom orthotics can provide targeted support and offloading for tendon injuries, such as Achilles tendinopathy or posterior tibial tendon dysfunction. The personalised fit and correction can help alleviate stress on the affected tendons, promoting healing and reducing pain (Kulig et al., 2015).
- Stress-Related Injuries: Custom orthotics are often recommended for stress fractures and other stress-related injuries due to their ability to provide precise biomechanical correction and shock absorption, which can reduce the risk of further injury (Garrow et al., 2020).
- Plantar Heel Pain: Plantar fasciitis is a common condition that can benefit from orthotic intervention. A systematic review published in the Journal of Sports Medicine highlighted that custom orthotics were more effective than prefabricated ones in managing chronic plantar fasciitis (Hume et al., 2019).
When to Visit a Sports Podiatrist
If you’re experiencing lower limb pain or injuries, it’s crucial to seek professional consultation. A sports podiatrist can provide an accurate diagnosis and develop an appropriate treatment plan tailored to your specific needs. Here are some signs that it might be time to visit a sports podiatrist:
- Persistent Pain: If you have ongoing pain in your feet, ankles, or lower legs that doesn’t improve with rest or over-the-counter treatments, it’s time to seek professional help.
- Activity Limitation: If your pain is limiting your ability to participate in sports or daily activities, a sports podiatrist can help identify the cause and recommend effective treatment options.
- Previous Injuries: If you have a history of lower limb injuries, a sports podiatrist can help you prevent recurrence and manage any ongoing issues with the appropriate orthotic support.
- Foot Deformities: Conditions such as flat feet, high arches, or bunions can benefit from the specialised care and orthotic solutions provided by a sports podiatrist.
As a sports podiatrist, I encourage anyone experiencing lower limb pain or injuries to seek professional consultation. An accurate diagnosis and appropriate treatment plan are crucial for effective management and recovery. During a consultation, a podiatrist can assess your specific needs and recommend the most suitable orthotic device, whether it be custom orthotics or prefabricated orthoses.
Both custom orthotics and prefabricated orthoses have their place in the management of lower limb injuries. The decision should be based on individual needs, the severity of the condition, activity levels, sporting requirements, and budget considerations. Recent evidence supports the efficacy of both types but highlights the superior benefits of custom orthotics for more severe or complex conditions. If you’re unsure which option is best for you, consult with a sports podiatrist to ensure you receive the most appropriate and effective care for your lower limb health.
Helping the Central Coast Feel Well, Move Well and Perform Well!