A close look at the human foot reveals a marvel of design and efficiency. No less than 26 bones work with the foot's ligaments, muscles and tendons in two very small structures to support and balance the weight of the entire body. The force through a foot during normal walking is enormous. Walking puts up to 1.5 times one's bodyweight on the foot. On average, our feet log 1,600 kilometres per year.

Foot pain is not normal and should not be ignored. The presence of foot problems can affect the proper functioning of other parts of the body, including the hip, knee and back.

Foot problems are often treated with orthotics. Custom-made orthotics are medical devices inserted into the shoe to correct an abnormal or irregular walking pattern. They are prescribed to reduce pain, to provide support, to prevent foot deformity or keep it from getting worse, to provide better positioning, to relieve pressure on a certain area of the foot, and to improve the overall biomechanical function of the foot and lower extremity.

Orthotics work like shock absorbers, removing pressure and stress from painful areas in the foot and ankle. Orthotics also promote the proper alignment of the feet. They can restore balance, improve sports performance and even alleviate pain in the knee, hip and lower back. Research shows that back problems, the most common form of chronic pain, can often be traced to a foot imbalance.

Custom orthotics prescribed by a podiatrist should not be confused with the prefabricated models found in shoe stores, ski and skate shops, pharmacies, sporting goods stores or mail order catalogues. There is a significant difference in quality and effectiveness. Anyone who provides orthotics as a sideline business may not have the proper training and qualifications.

Prefabricated orthotics, mass-produced to fit an "average" foot, may cost less, but usually do not properly correct the specific problems found in an individual's foot and may end up doing more harm than good. Many times, this type of orthotic can actually worsen a condition and create orthopedic problems elsewhere in the body. Those at particular risk are people with heel pain, achilles tendon pain, back or knee problems or those who have a high arch foot type or flat feet.

Custom-made orthotics can provide relief for many different types of foot pain including heel pain and plantar fasciitis; arch pain; pain caused by bunions, an injury or a sprain; pain caused by running, walking and sports; pain related to diabetes; and pain experienced by senior citizens whose feet change as they grow older. Foot orthotics do not actually correct foot or ankle problems, such as fallen arches. But orthotics can reposition the structures in the foot to optimize biomechanical function and reduce the chance of injury.

A podiatrist, who has extensive knowledge of lower extremity biomechanics and orthopedic foot function, prescribes orthotics after a thorough consultation and evaluation of a patient's particular problem. This health professional will ask about any medical problems or pain a patient may be experiencing. The podiatrist will also conduct a gait analysis and consider orthopedic issues, level of activity, the type of activity, foot type, and biomechanics, which refers to ankle, knee and hip movement. X-rays may be taken, as well.

Based on an individual's particular problem or needs, the podiatrist makes a judgement about whether orthotics will be helpful or if some other treatment is warranted. When prescribed responsibly and used correctly, orthotics can be extremely beneficial.

Prescription orthotics require a minimal number of office visits and allow the patient to wear different shoes while providing pain relief. The custom-made orthotic is prescribed by the podiatrist to make the foot function more effectively as a "machine." In addition, orthotics are made to remove abnormal pressure and stress from painful areas in the foot, ankle and lower extremity. It is not uncommon for a podiatrist to prescribe custom orthotic devices to address problems elsewhere in the body, such as the knee, hip and lower back. It is important for patients to follow the podiatrist’s instructions on when to wear them to obtain the greatest benefit.

In addition to providing relief for painful foot problems or an injury, those who may benefit from orthotics include people who must walk or stand excessively on the job. For those who are active in sports, orthotics will often increase endurance, performance and strength. For overweight individuals, orthotics can help to counteract the extra stress on the feet, as minor problems are often magnified due to the increased weight.

Orthotics are particularly effective in relieving foot fatigue and discomfort experienced by older adults, who may have developed arthritis in their feet. Orthotics may also be prescribed for children who have a foot deformity.

In athletic individuals, sports activities result in a great deal of movement and pressure on the foot. Slight imbalances in the foot that are not harmful or even detectable under usual circumstances may make one more vulnerable to injury with the extra stress of sports activity. By eliminating the need for one's muscles to compensate for imperceptible imbalances, orthotics can reduce fatigue and promote efficient muscle function to enhance performance.

While orthotics can be made by several different processes, most podiatrists make a plaster mold of the patient's foot and send it to a laboratory with a prescription. At the lab, technicians pour plaster into the mold, and when it hardens, it exactly reproduces the bottom of the individual's foot. Based on the doctor's prescription, the technicians then custom-make a device to meet the patient's specific needs.

To summarize, orthotics allow the muscles, tendons and bones of the feet and lower legs to function at their highest potential. When appropriately prescribed, orthotics can decrease pain, not only in the foot, but also in other parts of the body such as the lower back. They can also increase stability in an unstable joint, prevent a deformed foot from developing additional problems, and improve quality of life overall.