PTs and OTs: How to Choose Orthotics

Physical and occupational therapists play a critical role in identifying the need for orthotics, and must know how to choose orthotics properly for improving a patient’s function.

The orthotics market is wide-ranging; PTs and OTs must know how to choose orthotics properly to enable patients to continue their activities without pain or discomfort and with minimal safety risks. First, the type of orthotic should be considered. There are two main categories of orthotic devices:

Accommodative orthotics are constructed from softer materials and are designed to relieve mild foot pain or pressure and provide additional support to correct minor foot problems.

Functional orthotic devices are designed to support abnormal foot biomechanics and made from firmer, more rigid materials (i.e. plastic polymer).

Does my patient even need an orthotic?

Orthotics are used to treat a variety of conditions from over-the-counter shoe inserts for bunions or foot pain to AFOs for correcting foot drop. Many athletes – runners in particular – choose an orthotic even in instances where it is medically unnecessary. The decision to use orthotics should be based on objective data obtained in a clinical assessment:

• range of motion
• alignment (biomechanical assessment)
• voluntary control of movement
• muscle tone
• pain complaints
• functional level of the patient (ADL assessment)

Additionally, a thorough gait analysis should always be performed. Kinematic measurements of gait include, but are not limited to, joint angles, angular velocities, angular accelerations, and temporal-spatial characteristics such as:

• Walking speed
• Cadence
• Stance time
• Swing time
• Stride length
• Step length
• Stance width

How to Choose Orthotics

When recommending a particular orthotic, the end goal should be to provide the client with a functional device that will enable him/her to continue their activities of daily living without pain and with minimal risk of falling. Be sure to perform a “fit and function” evaluation. In many cases, problems or complaints with orthotics can be avoided from the outset with a proper fit and function evaluation. Dr. Paul Scherer, DPM, describes in Podiatry Today the keys to fit and function: “There are only a few fit and function evaluations for a new orthotic: longitudinal arch contour and contact; hallux dorsiflexion with and without the device; heel cup fit; and reduction of midtarsal joint motion in gait. These are easy to relearn, of great value in developing patient confidence in your devices, and easy to teach to staff.”

Assessing the Orthotic

After providing an orthotic to a patient, be sure to do a follow up assessment i.e. check for pressure marks, alignment, gait, risk of falls, etc. Additionally, you should evaluate the actual orthotic device. According to Arnold Ross, DPM, there are 3 ways to properly evaluate a patient’s orthotic:

1. The orthotics must be strong enough to withstand the patient’s body weight and foot deformity or correction.
2. The contour of the orthotic is critical to proper performance of the orthotic.
3. The orthotics must have the correct amount of correction or tilt based upon your foot measurements.

Choose an Orthotic Based on Patient Needs

Custom foot orthoses or orthopedic footwear can be really helpful, but they should only be recommended for patients who actually need them. Don’t choose an orthotic based on a sales rep’s advice, rather choose one based on clinical necessity, functionality, and comfort. Remember, every person and every condition is unique. What works for one patient might not work for another. So, be sure to properly assess each patient and recommend the right orthotic to help him/her continue to perform activities pain-free and safely.