The Uses and Abuses of Orthotics
Different sports make different demands on the foot and ankle. These demands lead to stresses that predispose some athletes to certain injuries. For these athletes, an orthotic device may be appropriate.
As a medical device used to support and align the foot, an orthotic also serves to prevent or correct foot deformities. Orthotics cushion impact against hard surfaces and may be shock absorbing inserts. They also can relieve pressure by providing support behind a problem area such as a callous, a neuroma or a metatarsal head injury. Orthotics can provide support in cases of flatfoot or overpronation. They also can correct malalignment problems such as leg length inequality.
The three basic types of orthotic include:
soft – used for cushioning and padding (often temporary)
semiflexible (permanent) – preferred by athletes because they’re more giving than rigid orthotics and less likely to cause blisters
rigid – often not tolerated by athletes
Orthotics may be custom made or sold over-the-counter. Devices made in your doctor's office may include felt pads, metatarsal pads and heel wedges. These may be made of viscoelastic, silicon, closed-cell rubber such as Spenco or closed-cell polyethylene. The differences relate to durability and cushioning properties. Custom orthotics are used in circumstances where over-the-counter types will not work.
Orthotics are often overprescribed and may not be useful for all diagnoses. They can be abused. Athletes should watch out for orthoses labeled "sports orthotics" or "dress orthotics" because they categorize the patient and take away choice. Athletes should also avoid "prophylactic orthotics" designed to prevent future problems.
Most orthopaedic and sports medicine doctors believe athletes should avoid wearing rigid or hard orthotics whenever possible. Hard orthotics, by being rigid and unforgiving, may contribute to foot problems such as seasamoiditis, neuroma or stress fractures. They may also increase energy consumption in running athletes. Appropriate shoe selection and proper shoe fit may eliminate the need for orthotic devices in many athletes.
The following are examples of the use of orthotics in various sports:
Runners and joggers wear orthotics to absorb shock at heel contact, provide control and set up the forefoot for pushoff.
Sprinters wear orthotics to control the movement of the forefoot.
Cyclists have a limited need for orthotics and wear them primarily to control the internal and external rotation of the lower leg.
Skiers wear orthotics to stabilize the foot in neutral and inhibit motion within the ski boot.
Tennis players wear orthotics to provide lateral support, decrease shear factors, absorb shock (especially in the forefoot) and allow subtalar motion.
Basketball players wear orthotics to control the forefoot during jumping, control the rearfoot during running and control excessive inversion.