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Arthritis Special Report

Easing Foot, Ankle, and Knee Pain With Orthotics

Johns Hopkins Health Alerts Arthritis Orthotics for Arthritis Pain

The feet each have 33 joints and are highly susceptible to osteoarthritis, rheumatoid arthritis, and other painful conditions. Foot discomfort and deformity caused by these conditions can even lead to pain in the shins, knees, and lower back.

One way to minimize problems caused by arthritis in the feet or ankles is to correct misalignments and poor biomechanics in the feet with shoe inserts; the result is reduced stress on joints in the feet, ankles, and knees and less lower body discomfort and deformity caused by arthritis (particularly in the early stages of these conditions). While some people may benefit from over-the-counter shoe inserts, others require custom-made orthoses (often called orthotics).

Orthotics work in several ways. First, by distributing weight more evenly over the bottom of the foot, they reduce pressure on sore or sensitive areas. Second, certain orthotics contain shock-absorbing material to lessen the stress placed on the lower body when walking or running. Third, orthotics may compensate for structural or biomechanical abnormalities in the feet or ankles. Lastly, orthotics can reduce wear and tear on joints by limiting their motion.

Types of Orthotics

There are two basic types of orthotics: accommodative and functional. Accommodative orthotics are the softer variety and are typically made from materials like plastic foam, rubber, cork, or leather. Accommodative orthotics are designed to cushion tender feet and are often used by patients with diabetic ulcers, calluses, or soreness on the soles of the feet.

Functional orthotics are made of more rigid material—such as thermoplastic polymers, acrylic plastic, or graphite—and are more likely to be used by people with pain in the toes, arches, heels, or ankles, or discomfort in the knee and hip caused by poor biomechanics in the foot and ankle. These more rigid orthotics can also help people with shin splints and those with bursitis or tendinitis in the lower body.

Orthotics can be made with both an accommodative and a functional design, and they are often individualized to address a patient’s specific problem. Most people with arthritis require orthotics that have both accommodative and functional properties.

Custom-Making Your Orthotic

To obtain orthotics, you first must be examined by a podiatrist. The podiatrist will likely examine your feet, ankles, knees, and hips while you are sitting and standing. He or she may also take measurements and observe how your lower body works while you walk.

If the podiatrist feels you could benefit from orthotics, a three-dimensional model of the bottom of your feet will be made. This can be done either by having you place your bare feet in a plaster cast or by using computerized scanning techniques to create an image of your feet. Typically, the podiatrist sends the model of your feet to a laboratory, along with a prescription that describes the modifications that need to be made to address your specific problems.

Custom-made orthotics can cost around $450 per pair. Some health insurance plans cover the cost of prescription orthotics, but many do not. If you are unable to pay for a pair of custom-made orthotics, a podiatrist may be able to modify over-the-counter inserts to fit your needs.

Wearing Your Orthotics

Although orthotics are custom designed for your feet, they may feel uncomfortable at first. Experts suggest that you begin by wearing them for a half hour to two hours a day and then lengthen the time you wear them by 45 minutes each day. The orthotics should be adjusted if they cause pain or leave indentations on your feet. Orthotics tend to fit better in shoes with removable insoles, since the orthotics take up extra room in your shoes. When you shop for shoes, be sure to have your orthotics with you so you can purchase footwear that can accommodate them. A quality pair of functional orthotics can last about five years.

  • For more arthritis articles, please visit the Arthritis Topic Page

    Posted in Arthritis on March 6, 2006

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