Foot orthotics are devices which alter the biomechanics of your feet to correct, offload and/or support your feet to reduce pain, heal an injury and generally increase your quality of life.
Most of our patients present to us because of pain. If this is the case, the primary aim of the orthosis is to reduce pain and the success of the orthotic intervention is largely measured by this result.
Other patients present to us seeking to improve physical performance, heal an acute injury, make their day to day footwear feel more comfortable, or proactively prevent issues from occurring.
Foot orthotics can be custom made or pre-fabricated. The most suitable device will depend on your condition.
Custom foot orthotics are bespoke devices made specifically for your foot and your condition. This means they will be tailored exactly to you and not created based on a generic template.
We are able to customise the foot orthotic to suit your footwear, lifestyle and presentation depending on the outcome of the assessment we provide. Foot orthotics can be broken into 3 sections and the options
available at each segment can be used in combination. The design and features used will depend on your assessment and what we are aiming to achieve.
Here are some common features of a foot orthotic.
Hindfoot
Heel cupping, selective offloading (ie for heel spurs), wedging, height increase (to alter ankle pitch or accommodate for a leg length discrepancy)
Midfoot
Selective offloading (ie plantar fascia grooves), medial arch support, arch control, lateral arch support, transverse arch support
Forefoot
Forefoot wedging, metatarsal domes, selective offloading, metatarsal cut outs, hallux cut outs
The density of the material we use for the device will also vary according to height, weight, age, activity and clinical presentation.
The human foot is made up of 26 bones, 33 joints and over one hundred tendons, ligaments and muscles. This structure is remarkable in its function, however things do go wrong. The result may be acute pain,
inefficient biomechanics, stress injuries, chronic issues or bad posture of the foot leading to ankle, knee, hip and back pain amongst other problems.
If we provide support and correction to the foot, we can address many issues by protecting or reducing load on the stressed tissues. By supporting the bony structures of the foot we can offload tired overworked
muscles and encourage the activation of other muscles which may not be as active due to the malalignment.
Foot orthotics will not magically heal your issue, only your body can do that, but we will encourage an environment which will make this possible. Most patients do notice immediate pain relief when wearing their
foot orthotics.
Everything is connected! For example, a flat foot which overly pronates (rolls inwards) may suffer from aching arches and lateral (outside) ankle impingements locally, but the flow on effect internally rotates the
tibia, causes the knees to dip inwards (valgus malalignment) and the pelvis to drop. The gluteal muscles are then required to work harder to prevent internal rotation and adduction at the femur which could
aggravate lower back pain.
Some patients with knee osteoarthritis find foot orthotics and suitable footwear will reduce some pain in their knees as the ground reaction force is shifted to the less damaged region of their knee.
Foot orthotics are best used in conjunction with suitable footwear, which your orthotist can advise you on.
The answer to this question is generally based on these factors:
Pain – If you have a high level of lower limb and foot pain, your pain is worsening, or your foot pain has been persisting for a longer time we may be more inclined to suggest foot orthotics. If your foot pain is low and reducing then we may suggest other options first.
Age – If you are younger and growing, or older and not healing as well or the pain is limiting your mobility foot orthotics may be required.
Biomechanics – An assessment of the structure and function of your foot will assist this decision. If during the assessment and gait analysis we note issues we can immediately address, foot orthotics may be a good option for you. (e.g. hyper mobility, flat feet, very high arched feet, pronated foot posture, bony prominences, painful rigid joints, osteoarthritis, foot structures which cause torsional forces in the foot).
History -What have you done previously? Have you tried other options or changed your footwear recently? Have you recently started training for a marathon? Are you noticing your feet change shape? The answers to these questions will assist us to determine a course of action. If there are things we can modify in your life such as activity level we will advise accordingly.
Diagnosed conditions- If you have a particular condition which we know responds well to foot orthotics we will be more inclined to suggest foot orthotics as a treatment.
We will ensure your foot orthotics are comfortable. We offer unlimited appointments for 3 months after fitting to solve any fitting and comfort issues. Our orthotists can adjust the devices on the spot without the orthotics being sent away, so it will not require excess appointments or long wait times to fix issues.
If it is required they are remade due to an error on our behalf, there will be no charge for this.
- Pes planovalgus (painful flat feet)
- Pes cavus (rigid high arched feet)
- Osteoarthritis
- Rheumatoid arthritis
- Plantar fasciitis
- Achilles tendinopathy
- Stress fractures
- Metatarsalgia
- Ankle pain and impingement
- Midfoot collapse
- Diabetic ulcers
- Lateral column overload
- Medial column overload
- Shin splints
Custom made foot orthotics can be fit into most shoes. We have made foot orthotics to suit business/dress shoes, women’s fashion shoes, football boots, running shoes and flats.
Having said that, we will generally advise a style of shoe without a high heel and some structure to the shoe. We understand that for the shoes and foot orthotics to be worn they must suit your lifestyle and looks are important to most people. This can all be discussed in the appointment and factored into our shoe selection advice.
We do keep a limited range of shoes in stock for trial and purchase at our Melbourne foot orthotic clinics.
What are foot orthotics and when are they used?
Foot orthotics are devices which alter the biomechanics of your feet to correct, offload and/or support your feet to reduce pain, heal an injury and generally increase your quality of life.
Most of our patients present to us because of pain. If this is the case, the primary aim of the orthosis is to reduce pain and the success of the orthotic intervention is largely measured by this result.
Other patients present to us seeking to improve physical performance, heal an acute injury, make their day to day footwear feel more comfortable, or proactively prevent issues from occurring.
Foot orthotics can be custom made or pre-fabricated. The most suitable device will depend on your condition.
What are custom foot orthotics?
Custom foot orthotics are bespoke devices made specifically for your foot and your condition. This means they will be tailored exactly to you and not created based on a generic template.
We are able to customise the foot orthotic to suit your footwear, lifestyle and presentation depending on the outcome of the assessment we provide. Foot orthotics can be broken into 3 sections and the options
available at each segment can be used in combination. The design and features used will depend on your assessment and what we are aiming to achieve.
Here are some common features of a foot orthotic.
Hindfoot
Heel cupping, selective offloading (ie for heel spurs), wedging, height increase (to alter ankle pitch or accommodate for a leg length discrepancy)
Midfoot
Selective offloading (ie plantar fascia grooves), medial arch support, arch control, lateral arch support, transverse arch support
Forefoot
Forefoot wedging, metatarsal domes, selective offloading, metatarsal cut outs, hallux cut outs
The density of the material we use for the device will also vary according to height, weight, age, activity and clinical presentation.
How do foot orthotics work?
The human foot is made up of 26 bones, 33 joints and over one hundred tendons, ligaments and muscles. This structure is remarkable in its function, however things do go wrong. The result may be acute pain,
inefficient biomechanics, stress injuries, chronic issues or bad posture of the foot leading to ankle, knee, hip and back pain amongst other problems.
If we provide support and correction to the foot, we can address many issues by protecting or reducing load on the stressed tissues. By supporting the bony structures of the foot we can offload tired overworked
muscles and encourage the activation of other muscles which may not be as active due to the malalignment.
Foot orthotics will not magically heal your issue, only your body can do that, but we will encourage an environment which will make this possible. Most patients do notice immediate pain relief when wearing their
foot orthotics.
Everything is connected! For example, a flat foot which overly pronates (rolls inwards) may suffer from aching arches and lateral (outside) ankle impingements locally, but the flow on effect internally rotates the
tibia, causes the knees to dip inwards (valgus malalignment) and the pelvis to drop. The gluteal muscles are then required to work harder to prevent internal rotation and adduction at the femur which could
aggravate lower back pain.
Some patients with knee osteoarthritis find foot orthotics and suitable footwear will reduce some pain in their knees as the ground reaction force is shifted to the less damaged region of their knee.
Foot orthotics are best used in conjunction with suitable footwear, which your orthotist can advise you on.
Do I need foot orthotics?
The answer to this question is generally based on these factors:
Pain – If you have a high level of lower limb and foot pain, your pain is worsening, or your foot pain has been persisting for a longer time we may be more inclined to suggest foot orthotics. If your foot pain is low and reducing then we may suggest other options first.
Age – If you are younger and growing, or older and not healing as well or the pain is limiting your mobility foot orthotics may be required.
Biomechanics – An assessment of the structure and function of your foot will assist this decision. If during the assessment and gait analysis we note issues we can immediately address, foot orthotics may be a good option for you. (e.g. hyper mobility, flat feet, very high arched feet, pronated foot posture, bony prominences, painful rigid joints, osteoarthritis, foot structures which cause torsional forces in the foot).
History -What have you done previously? Have you tried other options or changed your footwear recently? Have you recently started training for a marathon? Are you noticing your feet change shape? The answers to these questions will assist us to determine a course of action. If there are things we can modify in your life such as activity level we will advise accordingly.
Diagnosed conditions- If you have a particular condition which we know responds well to foot orthotics we will be more inclined to suggest foot orthotics as a treatment.
What is the comfort guarantee?
We will ensure your foot orthotics are comfortable. We offer unlimited appointments for 3 months after fitting to solve any fitting and comfort issues. Our orthotists can adjust the devices on the spot without the orthotics being sent away, so it will not require excess appointments or long wait times to fix issues.
If it is required they are remade due to an error on our behalf, there will be no charge for this.
What are some common conditions?
- Pes planovalgus (painful flat feet)
- Pes cavus (rigid high arched feet)
- Osteoarthritis
- Rheumatoid arthritis
- Plantar fasciitis
- Achilles tendinopathy
- Stress fractures
- Metatarsalgia
- Ankle pain and impingement
- Midfoot collapse
- Diabetic ulcers
- Lateral column overload
- Medial column overload
- Shin splints
What shoes can you wear with foot orthotics?
Custom made foot orthotics can be fit into most shoes. We have made foot orthotics to suit business/dress shoes, women’s fashion shoes, football boots, running shoes and flats.
Having said that, we will generally advise a style of shoe without a high heel and some structure to the shoe. We understand that for the shoes and foot orthotics to be worn they must suit your lifestyle and looks are important to most people. This can all be discussed in the appointment and factored into our shoe selection advice.
We do keep a limited range of shoes in stock for trial and purchase at our Melbourne foot orthotic clinics.
Why should I choose Orthotics Plus?
Expertise & Experience
We are the custom foot orthotics experts. We stand behind our product and will offer honest advice from a wealth of experience. All orthotists in our clinic have been actively working for over 10 years
A Trusted Clinic
We are the clinic of choice for many of Melbourne’s leading orthopaedic foot & ankle surgeons. Approximately 60% of our custom foot and ankle work comes on referral from people in the know.
We Make our Own
The clinician who takes your measurements and conducts the assessment will be the clinician who designs and makes your orthotics.
Fast Turnaround
We understand that you don’t want to put up with pain any longer than you need to. Our devices can be finished and ready for fitting within a week.
Handmade Orthotics
We do it by hand. Our foot orthotics are made in our own workshops and never centrally fabricated.
What is the Orthotics Plus Difference?
We never use hard plastics! We manufacture our foot orthotics from EVA (Ethyl Viny Acetate). This shock absorbing material is much more comfortable for the foot whilst still allowing excellent support and control to be built into the orthotic.
The properties of EVA allow us to make small modifications during your fitting appointments to completely tailor the foot orthotics to your footwear and your feet. Most other clinics choose to use plastic as it is cheaper and more easily able to be made at a central fabrication clinic.
We manufacture all custom foot orthotics on site and use the highest quality EVA materials. It is more time consuming to manufacture foot orthotics this way however the results are superior in comfort and function.
We will never leave you with a pair of uncomfortable and intolerable foot orthotics. We can modify them during fitting and during your free follow up period to ensure they are comfortable and functional.
How do I get started?
We will start by asking you about your history and lifestyle, progressing to a thorough assessment of the foot, ankle, knee and hip and some gentle palpation of the affected/painful areas.
Measurements may be taken at this point, particularly joint angles.
We will then conduct a full gait analysis and report in plain terms our assessment and findings and begin to formulate our prescription.
Based on the assessment, we will capture a physical or digital impression of your foot. For particularly troublesome feet we will manipulate the foot into a corrected position and take a physical impression and sometimes even cast the feet in the position we need using plaster.
We will create either a plaster or digital representation of your foot and modify
accordingly. This is dependent on the assessment but usually involves increasing the arch height, correcting the hindfoot, offloading any prominent or painful areas and generally correcting the biomechanics of the foot to resolve the issue you presented with. This is done by a tertiary educated professional orthotist who has studied in depth, lower limb anatomy and biomechanics.
Our orthotics are made in Orthotics Plus’ onsite workshop laboratory. Unlike the vast
majority of podiatry groups in Australia, we will never outsource our custom foot orthotics to be made by a central fabrication group. The clinician who assessed your foot will be the clinician who creates your orthoses.
We use high density EVA in our orthotics. This material is more expensive than plastic, increasing our cost of manufacture and the time required, but it has excellent properties which lend to foot orthotics perfectly.
The EVA is either milled by our carving machine into the design created by the orthotist or heated
and vacuum formed over the cast in multiple layers to capture the shape required.
The foot orthotic is then hand finished by the orthotist to fit your shoe and comfortably correct and support your foot.
After the fitting has been deemed successful, we will generally cover the device with a material (usually fabric, leather or synthetic) for hygiene and aesthetic purposes.
Why do we make orthotics with EVA and not plastic?
We don’t believe in hard plastic foot orthotics for the reasons below:
Plastic reduces mobility
The foot is a mobile structure with many joints and the body’s primary shock absorber. We don’t want to take away the mobility of the foot as we are likely to create other problems higher up the chain. Using a dense foam/EVA allows the foot to continue to be a shock absorber whilst correcting biomechanics.
Plastic orthotics are painful
Many patients find them to be unforgiving and painful, requiring a long wearing in period and can be the cause of many issues. We regularly see patients in our clinic with previously made hard plastic foot orthotics complaining of bruises and even blood blisters from stepping on the sharp heel cup of the plastic foot orthotics.
Plastic is difficult to modify
Hard plastic foot orthotics are difficult to modify by the clinician during the appointment. This may lead to the incorrect prescription or an uncomfortable device being encouraged to be kept as the re-manufacturing process is time consuming and potentially expensive.
Plastic will wear quickly
The covers of hard plastic foot orthotics generally wear very quickly as they are guillotined between the foot and a hard plastic shell. Even when topped with foam for softness, we find this material disintegrates within a few months, requiring repair or most commonly the patient just ends up walking on a hard plastic base with no cover.
We are yet to see a patient prefer a hard plastic foot orthotic over an Orthotics Plus EVA device
Reasons for the continuing popularity of plastic foot orthotics is they are cheaper and easier to produce and are often made ‘en masse’ at a central location by machine.
At Orthotics Plus we use varying densities of foam EVA as this allows the foot to be supported, while providing the comfortable relieving shock absorbing values most suited. Many of our older patients need a soft EVA, while our heavier and more athletic patients use a higher density material.
As we don’t outsource to external technicians or manufacturing hubs we can modify the foot orthotics on the spot and customise it to you. This means we can fit the orthotic in nearly all shoes and modify the device without the need for multiple annoying trial and error style appointments.
FAQ's for Foot Orthotics
Please see below for some other frequently asked questions, if you would like further clarification or can’t find your answer then please call our friendly team.
It’s normal for foot orthotics to require a wearing in period and there to be some discomfort.
This discomfort is generally muscular as patterns are broken and different (often neglected) muscle groups are used. There may also be some light skin rubbing as areas which were previously non-weightbearing take load and the tissue adapts. This is normal. This usually resolves in a short time frame and many people forget they’re even wearing them.
For the cases when issues do not resolve quickly, we will offer unlimited (within reason!) appointments in the following 3 months after prescription until the foot orthotics are deemed satisfactory to you.
No. This is a common myth. When used correctly foot orthotics do not ‘take over’ the role of muscles in your feet, leaving them lazy and ineffective. They correct a biomechanical issue and rebalance and normalise the muscle activity in your feet. Many studies and even a systematic review have found a more normalised muscle activity in patients with a flat foot deformity when using foot orthotics.
When aligned correctly the foot will work more efficiently as the muscles and joints are not at the extreme end range of their possible range of motion. Muscles generally work more efficiently and can produce more strength during the middle of the range of motion of the respective joint they
control.
Additionally a foot which has a corrected posture will provide a better and efficient structure for human gait during running, walking or sports.
Many elite athletes wear foot orthotics and we regularly see athletes to assist with their chosen sports.
Foot orthotics may be a piece of the puzzle but are rarely the entire solution. We will discuss all the other factors which have contributed to the pain or issue and advise as such.
This may be better selection of footwear, behavioural modifications and lifestyle modifications just to name a few.
We may also prescribe a lower limb stretching and strengthening regime where indicated to assist with the orthotic management and support your recovery, particularly in the case of plantar fasciitis.
When required we will refer you to a specialist if it is outside of our scope of practice. i.e. dietary advice or surgical intervention.
The structure of our foot orthotics will last almost indefinitely, the shape may begin to change after a couple of years though, so we suggest a review appointment if you feel like you require more support or things have changed.
Top covers which are primarily aesthetic and used for hygiene tend
to wear out more quickly and we can re-cover them for you in one 10-15 minute appointment.
We will ensure your foot orthotics are comfortable. We offer unlimited appointments for 3 months after fitting to solve any issues. Our orthotists can adjust the devices on the spot without the orthotics being sent away, so it will not require excess appointments or long wait times to fix issues.
If it is required they are remade, there will be no charge for this
For all initial appointments we charge a $70 consultation, where we can openly discuss what is required and the costs involved prior to committing to purchasing orthotics.
The cost for your initial pair of custom made foot orthotics is $590. This includes the following:
- Scanning and modifying
- Fabricating
- Fitting
- Reviews for up to 3 months
If you would like a second pair of foot orthotics identical to your first for convenience or to suit other shoes, they are $390.
If you are uncertain as to whether we can assist with your foot condition, we would recommend coming in for the initial consultation to discuss.
For kids who are growing and changing regularly, we have some “off-the-shelf” options that are more affordable considering they will need to be replaced more regularly.
What if I don’t find them comfortable?
It’s normal for foot orthotics to require a wearing in period and there to be some discomfort.
This discomfort is generally muscular as patterns are broken and different (often neglected) muscle groups are used. There may also be some light skin rubbing as areas which were previously non-weightbearing take load and the tissue adapts. This is normal. This usually resolves in a short time frame and many people forget they’re even wearing them.
For the cases when issues do not resolve quickly, we will offer unlimited (within reason!) appointments in the following 3 months after prescription until the foot orthotics are deemed satisfactory to you.
Will foot orthotics weaken my feet?
No. This is a common myth. When used correctly foot orthotics do not ‘take over’ the role of muscles in your feet, leaving them lazy and ineffective. They correct a biomechanical issue and rebalance and normalise the muscle activity in your feet. Many studies and even a systematic review have found a more normalised muscle activity in patients with a flat foot deformity when using foot orthotics.
When aligned correctly the foot will work more efficiently as the muscles and joints are not at the extreme end range of their possible range of motion. Muscles generally work more efficiently and can produce more strength during the middle of the range of motion of the respective joint they
control.
Additionally a foot which has a corrected posture will provide a better and efficient structure for human gait during running, walking or sports.
Many elite athletes wear foot orthotics and we regularly see athletes to assist with their chosen sports.
Are foot orthotics the entire answer?
Foot orthotics may be a piece of the puzzle but are rarely the entire solution. We will discuss all the other factors which have contributed to the pain or issue and advise as such.
This may be better selection of footwear, behavioural modifications and lifestyle modifications just to name a few.
We may also prescribe a lower limb stretching and strengthening regime where indicated to assist with the orthotic management and support your recovery, particularly in the case of plantar fasciitis.
When required we will refer you to a specialist if it is outside of our scope of practice. i.e. dietary advice or surgical intervention.
How long will my orthotics last?
The structure of our foot orthotics will last almost indefinitely, the shape may begin to change after a couple of years though, so we suggest a review appointment if you feel like you require more support or things have changed.
Top covers which are primarily aesthetic and used for hygiene tend
to wear out more quickly and we can re-cover them for you in one 10-15 minute appointment.
What is the Comfort Guarantee?
We will ensure your foot orthotics are comfortable. We offer unlimited appointments for 3 months after fitting to solve any issues. Our orthotists can adjust the devices on the spot without the orthotics being sent away, so it will not require excess appointments or long wait times to fix issues.
If it is required they are remade, there will be no charge for this
How much do foot orthotics cost?
For all initial appointments we charge a $70 consultation, where we can openly discuss what is required and the costs involved prior to committing to purchasing orthotics.
The cost for your initial pair of custom made foot orthotics is $590. This includes the following:
- Scanning and modifying
- Fabricating
- Fitting
- Reviews for up to 3 months
If you would like a second pair of foot orthotics identical to your first for convenience or to suit other shoes, they are $390.
If you are uncertain as to whether we can assist with your foot condition, we would recommend coming in for the initial consultation to discuss.
For kids who are growing and changing regularly, we have some “off-the-shelf” options that are more affordable considering they will need to be replaced more regularly.
Foot Fitting Services
Foot Orthoses can be custom made or pre-fabricated. To ensure maximum functionality almost all foot orthoses are custom made. At Orthotics Plus we fabricate full length and ¾ foot orthoses from Ethyl Vinyl Acetate (EVA) – a dense foam.
Foot Orthoses will vary from person to person depending on the pathology that needs to be treated. Features of custom foot Orthotics may include:
- Medial wedge
- Lateral wedge
- Medial arch support
- Metatarsal domes
- Reliefs for bony or painful prominence
- Ledge for an elevated first ray
- Soft spots in the heel
- Plantar fascia groove
Foot orthoses are used to treat a wide variety of conditions. These are referred to in the ‘conditions’ section of the website.
A rigid soled post-operative shoe (RSS) is an off-the-shelf shoe which has a completely rigid sole. It is held onto the foot using two Velcro straps.
The aim of the RSS is to immobilize the foot post-operatively or for some small, stable foot fractures. Surgeries which often require a RSS post-operatively include bunion surgery, mortons neuroma and plantar fascia release.
Carbon fiber plate stiffening is used to immobilise the foot. It is extremely effective in treating a variety of conditions including midfoot arthritis, severe metatarsalgia, stress fractures in the foot and sesamoiditis.
For carbon fibre stiffening, it is preferable to embed it into the sole of the shoe so it is further away from the foot itself. However, there are some situations where it may be appropriate to create a removable carbon fibre plate which sits inside the actual shoe. This also allows it to be moved between shoes
At Orthotics Plus we cut the sole of the shoes, position the carbon fibre and glue the shoe back together. Most people can’t even tell that the shoe has been cut.
There are certain shoes that carbon fibre stiffening cannot be added to. The sole of the shoe must be thick enough to be able to cut through it and it must be made from an Ethyl Vinyl Acetate or leather sole to ensure we are able to glue to it. Cheap shoes are often made from left-over type materials and we are generally unable to glue to this type of sole.
The shoe needs to be a lace-up design or at least have a strong Velcro closure or buckle to ensure the mechanics of the Carbon Fibre Stiffener are effective for the foot condition.
Silicone heel cushions are used for height and cushioning under the heel area. There are many different types available. At Orthotics Plus we use cushions that are 12mm thick which provides maximum cushioning for maximum effect.
Since the material is silicone, there is no collapse in height of the cushion which means they are long lasting. These are commonly used for plantar fasciitis and/or Achilles tendon pathologies.
The silicone heel cushions can be worn in most shoes.
Foot Treatment Services
Claw toes can develop in many people as they age. It is caused by a muscle imbalance. The long muscles that originate from the lower leg overpower the smaller muscles within the foot. This muscle imbalance leads to the clawing effect of the toes. Claw toes typically involve all four lesser toes, and rarely involve the great toe. The term ‘hammer toe’ (although a slightly different condition) can be used interchangeably with the term claw toes.
Claw toes can create multiple problems for patients. These include:
- Rubbing on the top of the toes from shoes
- Rubbing on the tip of the toes as they jam into the sole of the shoes
- Pain under the “ball of the foot” due to partial displacement of the metatarsophalangeal joints
The treatment will vary slightly depending on the exact symptoms, but may include:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
One of the most common sites for arthritis is at the base of the great toe in the metatarsophalangeal joint. This joint is regularly flexed with each step we take. A bony spur on the top of the bone may develop, making the joint stiff and painful when walking. This is called Hallux Rigidus.
The symptoms of Hallux Rigidus include:
- Pain in the joint when walking, particularly during push off
- Swelling around the joint area
- A bump on the top of the foot
- Severe stiffness in the great toe, particularly when bending upwards
With Hallux Rigidus, patients may require:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
A bunion is clinically known as hallux valgus. A bunion occurs when the joint at the base of the big toe becomes enlarged, sore and swollen, and often angles toward your second toe. Bunions are mostly genetic, but can be particularly prominent in females due to narrow, tapered toe, high-healed shoes.
A bunion develops as the metatarsal (long bone) of the great toe elevates and rotates. This causes excessive pressure through the 2nd metatarsal head and often presents with pain and callousing under the 2nd metatarsal head and within the big toe joint itself.
There is no conservative management that can correct the bunion or position of the great toe. The aim of conservative management is to reduce pain levels. This can be achieved by using:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
There are many bones and joints in the midfoot area. It is not uncommon that people develop midfoot arthritis in these joints. The pain experienced is commonly worse when walking, standing or laying in bed at night. This pain can be extremely debilitating and make everyday function very difficult.
With each step the joints of the midfoot collapse slightly and flex as you push off during gait. To counteract this, common treatment includes:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
The tibialis posterior runs down the medial (inside) and posterior (back) of the ankle. The tibialis posterior tendon functions to stop the ankle from rolling inwards and the medial arch collapsing. This tendon can either completely rupture or develop tears along the length of it (tendonitis/dysfunction).
Symptoms of Tibailis posterior dysfunction/tendonitis or rupture include:
- Severe pes planus (flat foot deformity)
- Pain on the medial (inside) of the ankle
- Swelling on the medial side of the ankle
- Pain on the lateral (outside) of the ankle
- Inability or difficulty doing a single leg calf raise
There are many different orthotic treatments available depending on the grade of deformity. These include:
- Custom foot orthoses
- Supportive footwear
- Arizona lace-up ankle brace
- Posterior shell ankle foot orthosis
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
Flat feet or pes planus is a very common condition associated with medial arch collapse. The symptoms of flat feet include:
- Physical signs of medial arch collapse
- Pain along the tibialis posterior tendon which runs down the inside (medial side) of the leg and ankle
- Pain on the outside of the ankle where the heel bone (calcaneus) and the fibula compress together
- Knee pain, particularly on the inside (medial side) of the knee joint
Some common causes of flat feet include:
- Injury to the tibialis posterior tendon.
- Arthritis in the foot and ankle destroys the cartilage between the joints and the ligaments that support these joints. This can cause the joints to shift and develop a flat foot deformity
- Injury to the bones or ligaments in the midfoot area (lisfranc injury) can result in a flat foot deformity
- Diabetics with peripheral neuropathy can develop a charcot foot. The bones and ligaments in a charcot foot are basically destroyed and almost crumble. This can result in a severe flat foot and often unusual deformities which puts them in a high risk category for developing ulcers
The most common treatment for a flat foot is:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
Plantar fasciitis is the most common cause of heel pain. The plantar fascia is a thick band of tissue which runs along the sole of the foot. The plantar fascia creates the medial arch of the foot. When sitting, the plantar fascia is shortened and the medial arch is high. When we stand, the plantar fascia stretches, allowing the medial arch to collapse slightly.
When someone has plantar fasciitis, they have a very tight plantar fascia. During standing, instead of the plantar fascia stretching to allow the arch to collapse, it has to tear along the length of the fascia and pull away from where it inserts into the heel bone. This causes pain, particularly first thing in the morning or when standing up after sitting for a period of time. As a result of the pulling in the heel bone, a heel spur can develop however is not always present in patients with plantar fasciitis. Plantar fasciitis is also exacerbated by tightness in the calf muscle and Achilles tendon.
Symptoms of plantar fasciitis include:
- Pain in the heel area, particularly first thing in the morning
- Tenderness along the sole of the foot
- Pain when palpating the heel area
- Calf cramps and tightness
Depending on the specific symptoms and the biomechanics of the foot and ankle, plantar fasciitis can be treated with:
- Heel cushions
- Custom foot orthoses
- Night splints (ie: strassburg sock)
- Calf and plantar fascia stretches
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
Morton’s Neuroma presents as pain in the ball of the foot, commonly between the 3rd and 4th metatarsal heads. There are many nerves which pass from the foot to the toes. The major nerve is called the plantar digital nerve. A neuroma is a thickening of the tissue which surrounds this nerve. A Mortons Neuroma is a neuroma in the plantar digital nerve. Symptoms which develop include:
- Burning pain in the ball of the foot which may radiate to the toes
- Numbness or strange sensation in the toes
- Pain which worsens when wearing tight footwear
Morton’s Neuroma can be clearly identified by doing the squeeze test. This compresses the painful nerve and simulates the pain that is felt.
Morton’s Neuroma can commonly be treated using:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
Metatarsalgia is characterised by pain in the forefoot area, under the ball of the foot. The most common area for pain is under the 2nd and 3rd metatarsal heads. This could be due to the wearing of the fat pads underneath the metatarsal heads or due to synovitis (inflammation) in the joints of the forefoot. People sometimes describe the feeling as walking on a stone or a rolled up sock. Factors that may predispose patients to the development of Metatarsalgia include:
- A bunion deformity
- Arthritis of the great toe
- Ligament instability of the midfoot
- An extremely tight calf muscle
- Claw toes
Treatment for this condition may include:
To determine the most appropriate treatment for you, we recommend booking an initial consultation to discuss your concerns in more detail.
Orthotics Plus - Case Studies
Case Study 1
John
Age
53
John (an active 53 year old male) visited Orthotics Plus for a second opinion about his newly made hard plastic foot orthoses. His newly purchased and rather expensive orthotics weren’t providing him any pain relief from his lateral ankle impingement and pain down the lateral (outside) aspect of his foot, despite multiple follow up appointments.
Our orthotists conducted an assessment and a full gait analysis. On observation it was noted he had a normal hindfoot posture on heel strike with a varus forefoot posture. From heel strike to foot flat the lateral aspect of his foot would strike the ground first and his 1st metatarsal was elevated. As his weight was accepted by the forefoot, his midfoot would rotate to allow his forefoot to reach the ground which would cause his hindfoot to violently evert (resulting in a valgus calcaneus> causing his lateral ankle impingement) to allow the more medial aspect of his forefoot and finally 1st metatarsal to eventually make contact with the ground until toe off, when the process would start again.
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The hard plastic foot orthotics were little more than an arch support which in this case was not the prescription needed. John’s predominant issue was a varus forefoot, led by a dropped 5th metatarsal and an elevated 1st metatarsal.
Orthotics Plus manufactured a custom foot orthosis which cushioned the hindfoot and cradled the heel, supported the arch during foot flat, restored the midfoot transverse arch and using a forefoot wedge and 5th ray cut out controlled the forefoot to prevent the rotative force driven through the foot as the 5th metatarsal made contact with the ground. We also offloaded the metatarsal heads. John had previously been suggested to wear a strong pronation control shoe. We strongly suggested a neutral soled shoe to avoid extra stress being placed through the lateral forefoot.
John’s lateral ankle pain was resolved very quickly and on review 2 weeks later the pain in his lateral foot had also resolved. John felt he was able to run for longer periods and felt like his gait was more efficient with less internal rotation transmitting up his tibia into his knees.
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Case Study 2
Judy
Age
75
Judy (a moderately active 75 year old female) presented to the clinic with generalised midfoot pain (Right>Left), a hot ache down the medial right ankle and a feeling of instability on her right side. She felt like her feet has started to change shape. She had never worn foot orthotics before and presented to the clinic wearing flat unsupportive footwear.
Our orthotists conducted a full assessment and gait analysis. It was noted that the right medial longitudinal arch collapsed more during transition to foot flat and toe off than the left side. Judy was unable to perform a single leg heel raise on her right side but was able to do so partially on her left side.
Judy also felt that when she was walking unshod on hard surfaces or with unsupportive shoes it felt like she was ‘walking on marbles’.
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It was concluded that Judy was experiencing tibialis posterior tendon dysfunction, bilaterally with the right side worse than the left. Secondarily the loculated fat padding underneath her metatarsal heads had diminished which caused her sensation of ‘walking on marbles’.
A mould was taken of her feet in the corrected position of subtalar neutral with the great toe extended to engage the windlass mechanism of the plantar aponeurosis and induce as much arch as possible. In a fantastic display of customer service, our orthotist then went to the shoe shop with Judy and her daughter to help select a pair of shoes which would be suitable.
During modifications the arch height did not need to be increased as this was captured during the impression. The foot orthotics were made of dual density EVA so the arch and hindfoot would experience as much support as possible while the forefoot bony prominences would be comfortably padded. A gentle metatarsal dome was added to help alleviate the forefoot pressures.
Judy had reduced pain in her right midfoot and medial ankle when wearing the foot orthotics and felt she had reduced symptoms related to a feeling of instability. It was explained to Judy the progression of the foot deformity can be treated and slowed or ceased with correct prescription of foot orthotics and selection of footwear and a correct wearing regime.
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Case Study 3
Luke
Age
28
Luke (an active 28 year old male weighing approx. 105kgs and working as an electrician) presented to the clinic due to persistent arch pain and general foot soreness after playing football or working on his feet all day. He had never worn foot orthotics before but had tried purchasing insoles from the Chemist. He presented wearing flat casual shoes but said he generally wore lace up work boots.
The clinician performed a full gait analysis and assessment. On observation it was noted Luke had extremely flat feet (pes planovalgus) and was experiencing hyper-pronation.
The foot was passively corrected into a position with an increased arch height via manual manipulation and an impression was taken of both feet.
During the modification process Luke’s medial arch height was increased further, and an inbuilt metatarsal dome to offload the forefoot was added.
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Due to Luke’s high activity level and weight, a higher density EVA was selected. Hindfoot medial wedging was added to attempt to straighten the hindfoot.
On fitting the foot orthotic was customised to suit his football boots and workboots. It was strongly suggested that a more supportive pair of casual shoes were sourced which had a better structure and more support.
On review Luke was extremely happy with the results. He was able to work a full day on his feet without the arch pain and felt much less discomfort in his feet. After a wearing in period he was able to play out a full game of football without pain and felt that his balance and ability to run and change direction more quickly was improved. He stated that he felt like he would run and stand ‘flat footed’ prior to fitting and felt more ‘dynamic’ when wearing the foot orthotics.
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