Functional versus Accommodative Custom Orthotics

I recently saw a commercial that was advertising a ‘Dr. Scholl’s Custom Fit Orthotic Insert Kiosk’ and I wondered, how exactly they were custom fit if there were only several inserts to chose from?  It started me thinking about orthotics and how often the general public makes mention of them, but how little they generally know about their specifics.  I wanted to take the opportunity, over the next several weeks to discuss what custom orthotics are and what you would be getting when you purchase something over the counter or from a Kiosk.

As Podiatrist we prescribe patients custom molded orthotics for a variety of foot ailments, but often, if we feel as though their condition would benefit from an over the counter orthotic insert, we start there.  The one thing all patients and members of the general public can agree on is that custom molded orthotics can be expensive and are often uncovered by insurance companies.  As Podiatrist’s we are not in the business of bankrupting our patients and thus if we feel that an over the counter orthotic would be sufficient enough to help your current condition, that is our first recommendation.  However, there instances where we know that custom molded orthotics are the best option for you and the one that will provide the greatest relief, so in some circumstances they are our first recommendation.

There are two main types of custom molded orthotics that we prescribe, known as Functional and Accommodative orthotics.  What people typically think of when they think of orthotics are those that are functional; coincidentally that type is the most often prescribed.

The general objective of any functional orthotic, regardless of the condition it is prescribed for, is to allow the foot to sit in as neutral a position as possible.  By neutral position, what I’m referring to is the position of your foot where the tendons and ligaments surrounding the ankle are aligned in their most advantageous position, allowing the foot to function as “normally” as possible while eliminating compensation for any abnormality.  In many conditions the orthotic is indicated to block abnormal motion of the foot by bringing the ground up to the foot (via the orthotic material) helping to decrease pain and deformity.   To show the diversity of conditions for which functional orthotics can be utilized, a very limited list of conditions is detailed below:

Hallux limitus/rigidus

Pes plano valgus (collapsing/flat foot)

Cavus foot (high arched)

Limb-length discrepancies

Bunion deformities

Plantar fasciitis


Neuromuscular conditions

The objective of an accommodative orthotics is to accommodate the foot rather than to place the foot in a neutral position.  These are often utilized in patients who have rigid conditions where the foot would not benefit from repositioning.  Therefore, accommodative orthotic devices are prescribed for patients who need pressure alleviation at areas of high-pressure, such as diabetic patients with areas prone to ulceration.  In such situations realigning the foot via the use of functional orthotics may do more harm to the patient than good.

Regardless of whether the functional custom orthotic or the accommodative function orthotic is utilized, they are both manufactured from a cast and/or digital image of your foot.  Those casts or images are sent to a laboratory specializing in orthotic manufacturing and the custom orthotics come to life with adherence to specific manufacturing instructions from your Podiatrists.  Custom orthotics are exactly that: custom to your foot through the cast or images sent to the orthotic laboratory.  As we’ll discuss in the coming weeks, anything purchased over the counter cannot be custom if there are only a few varieties to choose from and if your “foot images” were not sent to a specialized orthotic laboratory for manufacturing of your orthotic devices from those images.

In efforts not to overwhelm you with the wealth of information regarding orthotics, we will stop here for this week.  Next week, we will tackle the topic of over the counter orthotics versus those that are custom molded; how they differ and what those over the counter ‘custom fit orthotics’ really are.

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