Custom orthotics hurt your feet - troubleshooting

You tried off-the-shelf inserts, injections, and a host of other treatments to manage your lingering foot pain. None of these resolved the issue and you sought further advice. After a thorough (or not-so-thorough) examination, your orthopedist, podiatrist, physical therapist, or chiropractor recommended custom orthotics.

You said, "Sure, anything to get back to normal," to the tune of approximately $285.00 (or much, much higher so I hear).

You eagerly received the custom devices prescribed by a specialized medical professional and precisely molded to capture every contour of your very own feet. A few hours or days later you cursed while shaking your fist to the sky, asking why the blasted things hurt so much.

This NEVER happens in our practice, where every client prescribed custom inserts happily skips away on the wings of magical inserts carved of unicorn horns for maximum durability and control, lined with a plush top-cover of genuine baby alpaca feathers beneath New Zealand rainbows.

"Yeah that's marginally cute. But my foot hurts."

Before you trash your custom inserts or use them as a door jam or ice scraper, here are a few common reasons why they may be hurting your feet:

1. Inadequate break-in period. 

Many people who are accustom to squishy insoles in cushiony shoes do not take it seriously when we advise them to wear the inserts for just two additional hours per day. Others don't believe us when we instruct them to get use to the inserts in simple everyday activities before trying to exercise or work for prolonged periods in them. While some people need more or less time, this is a realistic and appropriate tapering period.

The fix is to wear the inserts an additional two hours per day, building to a full day of light activity prior to exercising or working hard in them.

2. Inadequate footwear. 

If your shoes are too tight and you jam a custom insert under a sensitive foot, it will usually make the pain worse. If your shoes are old and worn down, the custom device will be sitting on an uneven surface and the contours captured in your foot mold will not apply well. Even new shoes that are chincy (you bought on sale at Kohls) or intentionally flimsy (think minimalist shoes) will work against what the orthotic is supposed to achieve, again causing it to sit on an uneven surface.

The fix is to get into a quality shoe with a firm sole that is also adequate in length and width. Don't try to ride a Cadillac engine on a junk frame.

3. Poor "loading" of the insert.

The most perfect insert in the world may not function as intended if, for example, you have tight hips that force your legs and feet into a toe-out "duck foot" position. If you have weakness or tightness in the ankles, calves, or toes this will likely play into some type of compressive, shear, or tensile strain on tissues in the foot and a compensation in your gait pattern. If you sound like a herd of elephants coming through the house, it is not the "fault" of your shoes, inserts, or even your feet. You may have some old habits to break or strength and flexibility to improve.

The fix is to do all that you can to get your body to move better. Address impairments in balance, flexibility, and strength, and work to approach a more normal gait pattern.

4. Pain and inflammation too severe. 

Almost anything that's a change from the norm will cause a highly sensitive foot to feel even worse. The fix is to lessen severe and intense symptoms medically or with physical measures like exercises, ice, ultrasound, and massage. In some instances 2 to 4 weeks in a night splint or walking boot is warranted to give the foot a fresh start.

5. Orthotics need to be adjusted.

What should be is not always what is. If your feet still hurt after allowing an adequate transition period, placing the insert in an appropriate fitting quality shoe, working on your movement patterns, and taking time to rest and "calm down" highly irritated tissues, it's certainly possible the the inserts are plain wrong for you.

In that case, your foot specialist should be eager to help you and capable of making adjustments and modifications. Sometimes that means adding or taking away supportive material on the device. Other times that may mean adding a heel lift to one side, an extra layer of padding here or there, or redoing the insert all together.

The fix is to ask your foot and ankle specialist, on the front end, if the cost of the inserts includes time to follow-up and make adjustments as needed.

**The physical therapists and pedorthists at Cardin & Miller PT do allow for this as part of the process.While we make no guarantees, we are quite experienced in dealing with people who have failed other treatments and are going on their second or third set of inserts.

Trouble shoot with these fixes before you use your inserts as a candy dish or book mark. Because anything can be a book mark ; ).