We get this question a LOT in our profession. Much like every other question in our industry, the answer is not so straightforward. I’ve been working as a physical therapist for 25 years and have been casting orthotics for 20 years and I still don’t have the exact answer to this question! However, I have learned a great deal regarding this topic over time, and I’m here to share it with all of you.
First let me start out by saying that I truly don’t believe everyone needs orthotics. Sometimes it is a matter of wearing the correct shoe or supplementing with the correct exercise. That being said, by the time someone comes to see a physical therapist with a significant gait abnormality, it can be very challenging to fix it through manual therapy and exercise. We start walking around age 1, the arches in our feet finish developing around age 10, and it usually isn’t until age 30, 40, or 50 that we start thinking we are walking funny. That’s potentially 20, 30, 40 YEARS of an established motor program that needs to be reset. Now, I said “challenging” to fix it…. not impossible.
The way we decide if someone truly needs orthotics is if all our other avenues fail. As movement experts, we use external support as a last resort. We first assess your posture from head to toe. We look for things like scoliosis, leg length discrepancies, hip dysfunction, ankle restrictions, big toe mobility, balance issues and strength. We use manual therapy techniques like joint mobilizations, dry needling, taping, and myofascial release to improve quality of gait movement. We emphasize strength throughout core, hips, knees, ankles and feet to ensure proper motor control.
Depending on what the issue is, we typically can identify if someone is a good candidate for orthotics after 8-10 sessions of physical therapy. That usually equates to around 6-8 weeks of care. If we don’t see a significant change in gait AND you, as the patient, don’t report an improvement with our strategies, we dive into the orthotic discussion.
From my personal experience, casting orthotics is the best way to go for the most custom design. There should be a non-weight-bearing foot assessment, a weight-bearing static assessment and a barefoot gait assessment. We know that not everyone should walk exactly the same way, but there are certain aspects of gait that should be apparent in every gait cycle. For example, the ability of the rearfoot (heel) to move through neutral should be present, but some patients will move through 10 degrees of motion whereas others may move through 3. That may sound like gibberish to you, but I share it with you so you can understand that not all gaits are created equal, but they serve their purpose to allow us to walk! Ultimately, I believe the orthotic should support the way your body wants to walk and not necessarily CHANGE it - an assessment we would make in our physical therapy visits. Custom orthotics can be quite the investment and there are semi-custom options that are available and help determine if a full custom option is worth it. These are typically heat-moldable but less durable. The BEST news: Altitude can help you with any of your orthotic needs!
So, to answer the question of “how do I know if I need orthotics?”.... the answer is to come see us! We can ensure a thorough evaluation and attempt all other options of exercise and manual therapy prior to making the orthotic decision. Like I said in the beginning of this post: not everyone needs orthotics. Let us help you figure it out!
Bob Cranny, PT, Owner