The use of true prescription-level orthotics to aid in the treatment of foot ailments has steadily increased over the last thirty years. Commonly prescribed by podiatrists, sports medicine physicians, and other medical professionals, orthotics function to provide support for flat arches, shock absorption for high arches, and allow for an extensive amount of control to the pressures of the heel and the bottom of the foot. Because each orthotic is made specifically from a structurally corrected mold of the foot, the alteration and improvement of foot function is dramatically improved over that of less specific over-the-counter inserts and inserts made of a non-corrected mold of the foot. Each orthotic should ‘fit like a glove’, so to speak, and should be be completely comfortable to wear the entire day. Most people can begin wearing new orthotics without discomfort right from the start. However, there are a small amount of people who require a break-in period to get the feet used to standing on the inserts all day. This article discusses this break-in process, and how one can get the most out of their new orthotics in as little time as possible.
When new orthotics are uncomfortable to wear, it can be incredibly frustrating. Many people expect instant relief of foot discomfort, and this is understandable given the nature of foot pain and the costs sometimes incurred to get orthotics in the first place. Orthotics should not cause discomfort. One has to assume they were properly casted for in the first place, and the proper prescription was used to make additional modifications to the basic design based on the physician’s examination of the foot structure. One also has to assume the lab correctly fabricated the insert to the proper specifications. To instantly assume that either one of these steps were done incorrectly does not help what really must be done: a break-in period performed with patience and persistence. The frequency of improper casting, prescription writing, or manufacture of orthotics is usually quite low. These factors should only realistically be considered after all other measures have failed to provide lasting comfort.
The break-in period is a short span of time in which the foot becomes accustomed to the control that the orthotic is providing. In essence, a proper orthotic will provide gentle but firm support of the foot structures. This includes support of all the muscles and ligaments which have become lax during a lifetime of abnormal support. The orthotic will force these structures to realign properly. For some, this can cause a brief irritation of the lax tissue, or it can force some muscles to function properly for the first time. These actions can cause discomfort, and this will be felt while the orthotic is worn. A simple plan to gently introduce the foot to increased support is vital in making the orthotic comfortable to wear. When one first receives their orthotics, they should be worn immediately. When and if the orthotics become uncomfortable, they should be removed from the shoes. After several hours, they can be placed back in the shoe and used again until discomfort develops. Alternately, one can wait until the next day to try again. This cycle is to be repeated daily, with a longer wear time achieved each day. Eventually, after two or three weeks, the orthotics will no longer be uncomfortable. Another common strategy is to wear the orthotics for one hour the first day, and then increase the wear time by one hour each day that follows. In this author’s professional experience, it is very uncommon for a properly followed break-in period to fail providing a complete adjustment of the foot to the orthotic.
There are other factors that do contribute to the failure of a break-in period leading to comfort with an orthotic. The most common of these involves an incompatibility of the shoe with the orthotic. Although orthotics are designed to fit into a wide variety of shoes, not every shoe in circulation is appropriate for an orthotic. The orthotic should not slide under the foot with shoe use. This indicates a shoe that is sized to big for one’s actual foot size. They also should not have to be crammed into the shoe, with little room left for the foot. This indicates the shoe is too small for the foot or is too small or narrow to work with an orthotic. Stubbornly holding on to improper shoes at the expense of orthotic comfort strictly for style reasons is foolish, and will never lead to a comfortable orthotic. One must be sensible and reasonable regarding their shoe selection. This does not mean a sacrifice of fashion sensibility, it simply means being reasonable and accepting of ones own body and foot structure needs. Another good example of this is the high heel. High heels force the body to place great pressure on the ball of the foot. This takes away the natural walking pattern the body uses to propel itself. An orthotic will never function properly in a high heel shoe as the body does not use the foot properly during this abnormal walking pattern, and pressure is not properly transferred through the orthotic. Although some boutique-style orthotics are constructed to be used in these types of shoes, their usefulness is debatable. Another factor contributing to break-in failure involves instances in which a shoe may properly fit, but certain design choices by the manufacturer creates a limitation for proper orthotic use. For example, some athletic shoes contain extra padding around the top of where the shoe hits the heel.
This padding pushes the heel slightly forward in the shoe, causing the foot to slide too far down the orthotic. The ‘arch’ of the orthotic will now be slightly further back, and this can be the source of discomfort. Another example includes shoes that already add arch padding inside the shoe. Although this padding on its own offers little true support, the bulk of its volume can force the orthotic slightly out of alignment in the shoe, or it may prevent its fitting altogether. This internal padding needs to be removed prior to wearing orthotics. Sometimes this material is easily removed in one loose piece, and other times it is lightly glued into the shoe. If it is stitched in, removal will be difficult and may leave an rough surface for the foot to rest on. A different shoe should be selected in this case. Finally, one must consider the medical condition leading to the use of orthotics in the first place as a possible cause for break-in failure. When someone has a foot condition in which there is a constant state of inflammation and tissue damage, and this has not yet healed, then the introduction of a firm device under the irritated tissue can cause pain and discomfort. Certain conditions, such as those involving heel or arch damage, must be healed or sufficiently improved before an orthotic can be tolerated properly. Once the condition is treated, then the orthotic will function more comfortably and will usually contribute to the prevention of the condition returning if it was related to one’s foot structure in the first place (as many foot problems are).
Once all outside factors are accounted for, and one has gone though a proper break-in period, any continuation of orthotic discomfort should be a cause for concern. It is at this very uncommon time that one must consider factors like improper casting, prescribing, and manufacture as a cause for continued discomfort. The physician prescribing the orthotic should review the orthotic completely at this point, as subtle changes or problems can sometimes be missed that can contribute to an uncomfortable orthotic. At times the orthotic may need to be returned to the lab for modification or replacement. In many instances, a simple modification in the doctor’s office can bring about an alteration that is successful in making the orthotics comfortable. With all this in mind, one final factor needs to be considered. There are those out there, who by personal quirk, psychological irritation, or bad luck simply cannot tolerate anything to be placed under the feet outside of a loose and cushioned shoe. Unfortunately, these people will never be able to tolerate an orthotic. Fortunately, this is an extremely rare occurrence in this author’s experience.
Source by Scott Kilberg DPM