By Dr. Steven Gershman, DPM
To begin discussing shoe insoles, I will start with explaining what is a shoe insole and what types there are in general.
A shoe insole is the footbed or material inside the shoe that the bottom or plantar surface of your foot lays on. In most well-made shoes today, the material or insole is removable. There are shoes that have glued in insoles, however in general these are shoes that are not as well made. The removable insoles that come in most shoes vary in type and material ranging from very simple thin cushioning to sophisticated multiple layered arch support inserts. These are the shoe inserts that are inside the shoes you purchase.
Orthofeet, a leading orthotic footwear brand, takes it even further and designs all of its shoes with a unique shoe insert they call the "orthotic insole”. This is a very sophisticated shoe insert that has features of expensive or custom replacement shoe inserts. They are constructed with multiple layers of advanced materials and an anatomical arch that sits in the correct position under the foot. The purpose of these orthotic insoles is to provide optimal arch support to keep the foot in a neutral position, prevent excessive pronation and align the foot and body. An aligned body experiences less foot pain and is not prone to as many injuries. The materials and construction also play a key role. Utilizing thick grade materials to disperse shock forces and provide supportive cushioning will protect the foot and soften every step. These inserts are also called plantar fasciitis insoles as they are designed as arch support insoles which can help relieve painful plantar fasciitis. These are the best shoe inserts I have seen that are standard in a shoe.
Many people require additional support than the insert that is usually found in standard shoes. Today there are countless options of over the counter inserts sold online or in retail stores. Some use scanning technology that claims to measure the foot and recommend a specific type of insert for each person. I have found these in-store machines are very inaccurate and the corresponding insoles are limited in their effectiveness. I have tried varying insoles over my 31 years of practice and have come to the conclusion that Orthofeet insoles have the advanced features that are most effective in treating numerous foot conditions in my patients. I have summarized below the Orthofeet insoles and will use their features to provide a general look at replacement insoles and the types available.
For extra cushioning and comfort, Orthofeet offers Biofit insoles. They provide more than average arch support with excellent extra soft cushioning. This insole works well for people with bony protuberance areas such as the ball-of-the-foot at the metatarsal heads or at the heel where the fat padding has thinned out with age. Also, just tired sore feet that require more cushioning than the regular shoe inserts do well with these. Diabetics can also use these insoles for protection of high-risk areas. Click here to see the Biofit insoles.
Arch Support Insoles
The next step up is insoles with enhanced arch support as well as cushioning. Good arch support needs to be firm enough to hold up against body weight and ground forces in the shoe. My choice in the office for patients is Orthofeet Thermofit insoles. This insole has a dense firm bottom and arch support, while also including a soft cushioned top. It was designed for diabetics as it can be heat molded to contour the foot tightly for customized support and accommodate deformities on the bottom of the foot. It is a very good insole for flat feet that won’t tolerate a large arch support but still require some arch. I also recommend it for non-diabetics who experience heel pain and ball-of-foot or metatarsal pain. These are excellent insoles for boots where some arch and a lot of cushioning helps with work or hiking boots. Orthofeet Thermofit insoles are Medicare approved and are only dispensed through medical providers. To locate a provider that carries Thermofit insoles click here.
Up to now I have been discussing "insoles”. A big leap in technology and usefulness are orthotics. Orthotics provide superior arch support, control of motion and stabilization of the foot, and better contour of the foot than insoles. Orthotics are used for a variety of painful foot conditions, gait and balance issues, leg and knee pain, and even back pain. Orthotics are classified in to two categories, non-custom also known as over-the-counter orthotics and the "gold standard”, custom orthotics.
- Non-custom orthotics
In my office I dispense Orthofeet Biosole Gel orthotics as my choice in non-custom orthotics. I consider it the best orthotic of the non-custom variety as I have found these are the most efficacious for a variety of foot pathologies. The Biosole Gel collection is available in several styles that fit different shoes styles and needs. For example, the Dress orthotic is ¾ in length and is appropriate for flats and heels while the Gel-Sport is a thicker orthotic that fits in athletic footwear for enhanced shock absorption and cushioning. When a patient presents with foot pain that is related to faulty structure or biomechanics, I often start treatment with these. They are also very effective in treating plantar fasciitis and heel pain. In addition, when a patient has ball-of-foot issues and over pronates they provide biomechanical control and distribute the weight bearing forces over the entire bottom of the foot rather than just the heel and ball-of-foot. The Biosole Gel molds to the foot over time, contouring well while supporting the arch. The gel pad under the heel cushions the heel bone and reduces pressure for those suffering from heel pain. A non-custom orthotic is generally an inexpensive and quick way to treat a variety of foot, ankle, leg, knee and back conditions. Click here to see the Biosole Gel orthotic collection.
- Custom orthotics
When non-custom orthotics fail to alleviate the pain or the condition causing the pain is beyond what over-the-counter orthotics can help, then a true custom orthotic is called for. Patients with severe structural deformities, hypermobility, hypomobility, significant biomechanical defects or are too heavy for non-custom orthotics, require custom orthotics. Custom orthotics are also generally the best for flat feet as they can provide arch support while controlling the excess motion often found with flat feet especially when highly pronated. Custom orthotics help reduce the rotational motion that is one component of pronation. Excess rotational motion can cause issues beyond the feet, at the ankles, knees, hips and back.
A custom orthotic is made from a mold or three dimensional non-weight bearing scan of the foot. In addition to non-custom orthotics, Orthofeet offers a direct to the foot moldable orthotic called the Biothotic. This is a medical grade orthotic that is only dispensed at medical provider facilities. So, a custom orthotic truly contours the foot tightly. Usually it is fairly rigid so it can handle all the pathologic forces causing the problem. In some cases, especially in diabetics, a softer more accommodating orthotic is prepared to off load bony prominences. Custom orthotics usually have a heel cup to control heel motion in pronation, with an arch that is high enough to limit excess pronation, but not too high that will force the foot beyond what it can tolerate. Above all it must be comfortable. If an orthotic is not comfortable in a few days, I have found it was not made correctly or something is wrong with it. It may not cure the problem quickly, but it needs to be comfortable to enable the person to wear it full time for it to have positive effects.
Regardless of the insole type, at the least, it should provide comfort for the feet and improve their function in any shoe style. If the correct device is used, it can in many cases improve foot, ankle, leg, knee and back pain. Indications that a person may need insoles or orthotics are: plantar fasciitis, heel spur or heel pain, joint pain, neuromas, capsulitis, tendonitis, arthritis, foot fatigue, nerve pain, loose wobbly feet and ankles, weak dropping arches, painful calluses on the bottom of the feet, and others. Orthotics will not perform magic and make your feet prefect. However, they can make your feet function better, while providing total foot comfort.