What can you tell me about custom orthotics?

February 12, 2013 9:26 AM

I have seen a podiatrist and have been diagnosed with hallux limitus. I wore an aircast for about 6 weeks starting in December, and felt improvement upon my return visit, but my doctor warned that it was likely my original pain would return and it has. I understand it will get worse with age. The doctor recommended custom orthotics, and told me to schedule a follow-up to get the mold made if I decided to pursue that course. Before I do, I want to understand a little more about what this means and how it will help.

I'm an early 30s female with no other foot/medical problems.

My original symptom:
I had persistent, annoying pain at the top of my left foot near my big toe. It didn't feel so much like the joint as what I guess is the extensor tendon. It didn't hurt less or more when I was running or walking, but it was a constant 2 or 3 on a pain scale of 10. I was (and am) able to flex my foot as much as I ever have been able to without the pain getting worse, and pressing or massaging the area didn't lessen the pain. My doctor took an X-ray, went through my history, explained the diagnosis as basically early-stage arthiritis and prescribed the aircast/boot, which was more uncomfortable than my original symptoms.

Where I'm at now:
A month after taking off Das Boot, my pain is back at the original level, as expected. I'm uncomfortable and it sounds like custom orthotics are the next thing I am supposed to try. Now that I understand the diagnosis, I recognize other symptoms like a painless popping/grinding feeling sometimes when I move my toe. Although it is worse in the left foot, I experience that symptom on the right as well.

My shoes:
I have a few pairs of simple boots with 1-2" heels (cowboy boots, black knee-highs) and a lot of slip-ons with kitten heels or just simple 1" block heels. In summer I cycle through a few pair of short wedge sandals and flip flops. I regularly wear arch supports in all the shoes that allow them because I find them comfortable. I don't wear crazy high heels outside of the occasional fancy event, and I am really picky about uncomfortable shoes. So even if I'm rocking my strappy gold heels, I am never in pain at the end of the night and am not the girl switching to flip flops mid-event.

My activity level:
I live in a city where I walk a decent amount. I am not an athlete. I started Couch to 5K last June and continued through November, when the pain in my foot really started. I've been afraid to start back up because I worry it will contribute to the foot problems I already have. I was running in these shoes, which I bought last summer.

My questions:
- Is there anything particularly awkward or annoying about custom orthotics, or is it just another shoe insert like the arch supports I already wear?

- Is it a terrible idea to ever wear shoes without orthotics moving forward? Is it harder to shop for/size shoes that will allow for them? Is this when I retire my go-to gold, strappy heels? Do I need to rethink my running shoes?

- My doctor emphasized that the reason the aircast helped was because it stabilized my foot and gave it time to rest. She also suggested I wear shoes that have strong, stable tops and don't bend so much (though I am having a hard time interpreting that into actual shoes.) So... how does more support beneath my foot in the form of a custom orthotic, which won't prevent my range of motion, actually help with the problem I seem to have?

posted by calcetinporfavor to health & fitness (9 answers total)

You will have trouble with summer shoes and with ladyshoes for sure. Orthotics are rigid molded plastic. They will not fit in many women's shoes. Shoes with laces and stiff soles tend to work better, though boots are ok for me, too. I wear summer oxfords in the warm months, and I don't really wear flats anymore unless it's for short periods OR the heel cup is pretty high. Yes, you can stop wearing them for a while, but I wouldn't--I would just do short periods. The pain comes back.

Here's a somewhat technical explanation of why they will help.
posted by liketitanic at 9:46 AM on February 12

If you look at Google Images for custom orthotics, a lot of this will clarify. You are not going to be able to wear them with flipflops or sandals at all, and you're going to be very limited on heels and styles of flats. If they will fit in your existing boots depends on how much room there is in there. I think you should clarify with your podiatrist whether you will need to wear these all the time or if there is an acceptable ratio of wearing / not wearing to get benefit.

Finding fashionable shoes to wear with orthotics is a thing, but it's not un-doable.
posted by DarlingBri at 10:02 AM on February 12

Custom orthotics are basically very stiff, full-length shoe inserts. You put them into a shoe in place of the insole, generally. You can have them made in different stiffness grades (different types of material, basically) but I always have mine made from the stiffest material possible so that they last longer — at $300 a pop, I don't want to have to replace the stupid things every year.

You are supposed to (per my doc, anyway) wear them in every pair of shoes, all the time. I don't, but then again my issues that caused me to get orthotics are pretty mild at this point and are now triggered almost solely by running, so YMMV. When I got them, I did ask specifically how the hell you're supposed to put orthotics in (say) sandals, and was told to use adhesive / rubber cement. Right. (I never did, but at the time I was living in a cold climate where sandals were a weekend-at-the-beach thing anyway.)

I wear my orthotics in my everyday / casual shoes, the ones in which I spend the most hours overall, and then in my running shoes. You may need to reconsider your running shoe choice; generally you don't want to combine a custom orthotic with a "support shoe", you need the shoe itself to be neutral. (However, I have found that my expensive 'support shoe' running shoes without the orthotic are indistinguishable to me from the neutral shoe with them in, to the point where I'm not sure I'm going to get more orthotics for my running shoes. The cost is a wash, however.)

One suggestion: bring your shoes with you when you go to the orthotist to get the molds made and then again when you go for the final fitting. That's the best opportunity to ask questions.

Anyway, as a guy I can't comment on the heels issue, although I suspect that the answer is that if you're having enough problems to warrant an orthotic, you definitely shouldn't be wearing shoes that change your weight distribution as much as heels (of basically any height) do. But I think that's a question to ask your doc or orthotist about. And I also suspect that a custom orthotic that's designed to have your foot planted flat won't work very well if you put it into a heeled shoe, so the boots may be out as well. But again, that's a legitimate question to ask. Maybe it's a situation where they're verboten for a few months / year / whatever, but at some point you can reintroduce them for short periods or something.

Orthotics definitely seem to be something that work more easily in mens' shoes than womens'. Of the few women I know or have met who wear orthotics, they mostly seemed to wear Oxfords or sneakers a lot. But I'm sure that the orthotist can make specific suggestions, or perhaps craft an orthotic specifically for a particular favorite pair of shoes if that's important to you.
posted by Kadin2048 at 10:05 AM on February 12

I have arthritis in my feet, and hallux limitus. I don't wear orthotics, as the podiatrist I was sent to for final diagnosis was more interested in telling me about surgical interventions than anything else and I've found other solutions for the moment that serve me. (One day I'll go to a different podiatrist and ask!)

If you haven't been linked to it already, you might want to look through the Barking Dog shoe blog, which specializes in women's shoes for problematic feet, and usually mentions if you can fit orthotics into the shoes.

I have no idea if this information will help, but this is what I do for my feet without orthotics:

I wear Skecher Shape-Ups (specifically these). Ignore the health claims, they're BS. But they have rigid soles with rocker bottoms, which means that my feet bend very little but I have a fairly normal gait. I also wear men's shoes even though I'm not a man because it's hard to find wide women's shoes, and as a result of the arthritis my feet have gotten slightly wider (probably due to not wearing slim shoes anymore, really), and the toe box is higher, as the joint at the base of my big toe has gotten thicker vertically due to arthritis, bone spurs, and whatnot.

I have several rigid-sole and stiff-sole shoes and sandals for somewhat dressier wear from Dansko, Skechers and a couple other brands that I don't remember offhand. My doctor recommended New Balance shoes to me, but I haven't tried any of them since I was happy with the Skechers.
posted by telophase at 10:07 AM on February 12

Immobilizing the toe joint is going to make the arthritis progress much faster and I urge you to pursue alternative treatments from a good sports PT who specializes in that kind of thing. You can get soft wedges that just go under the big toe for example. Look for some Morton's toe pads and insoles online too.
posted by fshgrl at 10:26 AM on February 12 [1 favorite]

I second the suggestion to see a physical therapist or orthopedist for a second opinion. In my own experience and that of friends and family who have also seen podiatrists, they almost invariably prescribe orthotics. (I had a podiatrist tell me I needed orthotics because I was "aging" -- I was 25 at the time -- and I never got them and it's now years later and I've had zero issues.) I'm not saying orthotics are never warranted, but they seem to be prescribed much more frequently than they are actually needed.
posted by payoto at 10:32 AM on February 12

My foot problems are different but my custom orthotics definitely help. Whenever I cheat and wear shoes without them the pain recurs. I did have to entirely redo my shoe collection for the orthotics though. They only fit in shoes that I can remove the insoles from and not even all of those. (So no heels, ballet flats, flip flops, but I have found a couple of pairs of sandals that work) The Barking Dog shoes link is a good ones since most of those are shoes that work with orthotics.
posted by kbuxton at 11:11 AM on February 12

I recently went through an orthotics process for metatarsalgia. My orthotics weren't particularly stiff, but they would only work in athletic shoes - even my Dankso clogs couldn't fit them. So I had to buy new athletic-type work shoes (the kinds where in the insoles come out) to wear them, or go without.

That said, a few caveats: the orthotics ended up aggravating other parts of my leg, and even after returning for some significant adjustments to the inserts, I still have pain in other places.

And, it turns out that my doctor never wanted the orthotics folks to make me custom inserts; he said a simple, inexpensive toe pad was all I needed, and the orthotics people had just gotten too ambitious.

So, that may mean that a second opinion with an orthopedic might be a good idea for you.
posted by Ms. Toad at 11:37 AM on February 12

Custom orthodics are the best thing I've ever bought.

That said, I eventually ended up getting better custom orthodics from a comfort shoe store for a fraction of the price than my original orthodics from a podiatrist. The shoe store also made modifications to the shoes themselves to make them work better for me. I ended up with a pair of high heels that were far more comfortable than any other shoe I'd ever worn. The store was in Las Vegas so I basically just got the same thing cocktail waitresses get.

http://cesarsshoeworld.com/

Cesar is so amazing that IMO it is worth a trip to Vegas to shop there, especially if you want comfortable yet attractive high heels. I moved to the other side of the country but plan to go back every couple of years to buy shoes, because it's not just the custom inserts but also all the other custom alterations he makes to the soles, pre-stretching parts of the leather so you don't get blisters breaking in your new shoes, etc. He also sold me an amazingly comfortable pair of customized altered athletic shoes that cured my repeatedly sprained ankle. Next time I visit Vegas I am going to bring along a couple of pairs of winter boots (something he understandably doesn't stock) for Cesar to work his magic on.

Note: The whole shebang (shoes, custom inserts, and alterations) on a pair of high heels with the cocktail waitress treatment will run about $400, but IMO it's totally worth it because they last for over a year of daily wear and eliminate or significantly reduce a tremendous amount of foot, ankle, knee, hip, and lower-back pain. In comparison, the podiatrist charged me more than that for inserts alone, so it's a relatively good value.
posted by Jacqueline at 4:18 AM on February 15