Orthotics are medical devices placed inside footwear to align the foot and ankle, correct gait abnormalities, and alleviate pain from various conditions like plantar fasciitis or flat feet. These devices come in two main forms: custom orthotics, which are prescription appliances meticulously molded to the exact contours of an individual’s foot, and over-the-counter (OTC) inserts, which are mass-produced for general cushioning or mild support. Most people do not require therapeutic, specialized footwear, but they do need shoes with specific structural features to ensure the orthotic can function correctly. Forcing an orthotic into a shoe that lacks the necessary interior space will compromise both the device’s effectiveness and the wearer’s comfort.
Essential Footwear Features for Orthotic Compatibility
The majority of individuals using orthotics can successfully wear them in high-quality, standard footwear by seeking out several key features. The single most important feature is a removable insole or footbed, as this creates the necessary depth for the orthotic to sit properly inside the shoe. Orthotics are designed to replace the shoe’s existing liner, not sit on top of it, which would otherwise lift the foot too high, leading to instability.
Adequate interior volume, particularly in the toe box and instep area, is also important to accommodate the orthotic’s added height without crowding the foot. A shoe that fits well without the orthotic may become too tight once the device is inserted, potentially causing pressure points or toe impingement. Look for shoes that are described as having a generous toe box and deep fit.
Stability features within the shoe are necessary to allow the orthotic to perform its function of controlling foot motion. This includes a firm heel counter, which is the rigid cup surrounding the heel area, designed to secure the rearfoot and prevent excessive movement. Furthermore, the shoe’s midsole should possess high torsional rigidity, meaning it resists twisting, providing a stable foundation that prevents the orthotic from collapsing during the gait cycle. Neutral running shoes or walking shoes often meet these criteria.
Situations Requiring Specialized Depth or Width
While many people can use orthotics with standard quality shoes, certain medical conditions or the nature of the orthotic itself necessitate specialized footwear. These specialized shoes are often referred to as “extra-depth” or “therapeutic” footwear, and they provide significantly more interior space than typical orthotic-compatible shoes. This extra depth is crucial for accommodating severe foot deformities.
Accommodating Deformities
Conditions like severe bunions, hammertoes, or rigid flat feet cause the foot to take up more space. Forcing them into a standard shoe, even one with a removable insole, can lead to painful pressure and friction. Extra-depth shoes are designed with a wider and deeper toe box to prevent this painful rubbing, allowing the toes to spread naturally. Specialized shoes may also be required when dealing with high-volume or bulky orthotics, such as custom-molded devices that are thicker than average.
Therapeutic Footwear for Medical Conditions
A separate category of specialized footwear is medically mandated for individuals with severe diabetes or peripheral neuropathy. These patients require therapeutic shoes that are specifically designed to reduce the risk of foot ulcers and infection. Such shoes feature seamless, non-abrasive interiors to eliminate potential pressure points, along with extra depth and width to accommodate diabetic insoles or swollen feet. In these cases, the shoe is an integral part of the medical treatment to protect a compromised foot.
Checking the Fit and Function of the Orthotic
Once a shoe with the necessary features has been selected, the first practical step is to always remove the existing manufacturer’s sock liner or footbed. This is the layer your foot rests on, and its removal provides the essential space for the orthotic to sit directly against the shoe’s midsole. Failure to remove this original insole can lift the foot too high, leading to heel slippage or a tight fit across the instep.
After insertion, the orthotic should sit flush and securely against the bottom of the shoe, extending all the way back into the heel counter. The device should not move, tip, or rock when pressed, as this indicates a mismatch in shape or width between the orthotic and the shoe’s interior last. A stable base is necessary for the orthotic to effectively control foot mechanics.
The final check involves ensuring the foot is not cramped inside the shoe. With the orthotic in place and the shoe laced up, check that the foot is not being pushed up against the top of the shoe, which would create pressure on the toes and the instep. There should be sufficient vertical space, known as depth, and horizontal space, or volume, to allow the toes to move freely.