Foot pain
Description
An in-depth report on the causes, diagnosis, treatment, and prevention of foot pain.
Alternative Names
Bunions; Corns; Hammertoe; Plantar fasciitis
Insoles and Orthotics
Insoles are flat cushioned inserts that are placed inside the shoe. They are designed to reduce shock, provide support for heels and arches, and absorb moisture and odor. In general, they can be very helpful for many people. For example, in a study of foot pain in New York police officers, more than 60% of them reported more comfort and less foot pain after using insoles. People respond very differently to specific insoles. What may work for one person may not for another. The thickness of socks must be considered when purchasing insoles to be sure they do not squeeze the toes up against the shoes.
Purchasing Insoles
. Insoles can be purchased in athletic and drug stores. Shoe stores that specialize in foot problems often sell customized, but more expensive, insoles. In general, over-the-counter insoles offer enough support for most people's foot problems. Most well-known brands of athletic shoes have built-in insoles.
Brands and Materials.
There are many types of insoles available. They are composed of various materials, such as cork, leather, plastic foams, and rubber materials. Very beneficial insoles are now made from viscoelastic polymers (such as Sorbothane, Airplus, Spenco, Dr. Scholl's Massaging Gel, and others), which are gel-like materials that act both as liquids and solids. In a 1999 military study comparing Sorbothane with foam insoles, Sorbothane offered better protection against heel strikes while marching and running.
Heel Cushions for Shortened Achilles Tendons
. People who have developed short, tightened Achilles tendons, usually women who have worn high-heeled shoes for prolonged periods, should consider using heel cushions. Like insoles, heel cushions are inserted inside the shoes. They should be at least 1/8 inch thick, but not more than 1/4 inch thick.
Orthotics
For severe conditions, such as fallen arches or structural problems that cause imbalance, podiatrists or physicians may need to fit and prescribe orthotics, or orthoses, which are insoles molded from a plaster cast of the patient's foot. Orthotics are usually categorized as rigid, soft, or semi-rigid.
Rigid Orthotics.
Rigid orthotics are used to control motion in two major foot joints that lie directly below the ankle. They are often used to prevent excessive pronation (the turning in of the foot) and are useful for people who are very overweight or have uneven leg lengths. Some experts warn that rigid orthotics may cause sesamoiditis or benign tumors that form from pinched nerves.
Soft Orthotics.
Soft orthotics are designed to absorb shock, improve balance, and remove pressure from painful areas. They are made from a lightweight material and are often beneficial for people with diabetes or arthritis. They need to be replaced periodically, and because they are bulkier than rigid orthotics, they may require larger shoes.
Semi-Rigid Orthotics.
Semi-rigid orthotics are designed to provide balance, often for a specific sport. They are typically made of layers of leather and cork reinforced by silastic.
Orthotics vs. Insoles.
Before seeking prescription orthotics, people with less severe problems should consider testing the lower-priced over-the-counter insoles. One study found that 72% of people reported less foot pain from store-purchased insoles compared to 68% of those who had them custom made.
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Review Date: 12/4/2006
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Reviewed By: Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
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