Using Insoles in Podiatry – An Overview

A simple search online for foot insoles or orthoses will reveal thousands of results, many of which are product pages highlighting the benefits of individual designs. These often promise to “cure all foot pain” or “banish plantar fasciitis.” Before exploring this field further, it is helpful to clarify some terminology. The words “insole” and “orthotic” are often used interchangeably. According to the dictionary, an insole is “a piece of material inside a shoe on which your foot rests, or a piece of material that you put in a shoe to make it warmer or more comfortable.” In contrast, a foot orthotic is defined as “custom or prefabricated inserts designed to support and align the feet, improving comfort and function. These devices help distribute pressure evenly, reduce strain on muscles and joints, and correct abnormal foot mechanics.” The latter definition is more familiar to podiatrists and foot health practitioners.

Categories of Foot Insoles and Orthoses

Foot insoles and orthoses are generally divided into two categories: accommodative devices and functional devices. Based on definitions, practitioners may provide accommodative insoles or prescribe functional orthoses.

Accommodative Insoles

Accommodative insoles are basic devices that patients can often buy online, on the high street, or after consultation with their podiatrist or foot health practitioner. These insoles vary greatly in design and materials, ranging from wool-based insoles for warmth to closed cell polyurethane insoles that provide cushioning. Many feature multiple layers designed to enhance performance, while others are contoured to fit the foot comfortably. It’s common for patients to report, “I’ve tried everything,” due to the overwhelming variety available.

Despite this, accommodative insoles have a place in modern podiatry. Sometimes, all a patient needs is simple cushioning. For example, closed cell polyurethane insoles like Poron have been shown to reduce pain. A 2020 systematic review by Gerrard et al. found that accommodative insoles can help lower plantar peak pressures (Effect of different orthotic materials on plantar pressures: a systematic review. Gerrard JM, Bonanno DR, Whittaker GA & Landorf KB. Journal of Foot & Ankle Research, June 2020).

Functional Orthoses

Functional orthoses encompass a wide range of devices, both prefabricated and custom-made. In recent years, technological advances such as foot scanners have made it easier for clinicians to prescribe orthoses. Innovation in materials and design continues to offer new options for podiatrists. However, no orthosis is effective unless the patient actually wears it. When prescribing these devices, the podiatrist must consider patient suitability and willingness to follow any accompanying stretching or strengthening routines.

Another critical factor is the patient’s footwear. Prescribing an orthosis serves little purpose if it is placed in worn-out shoes, or shoes that don’t fit well. The shoe must have enough space for the orthotic and be appropriate for the patient’s activities.

Importantly, functional orthoses adjust foot posture, altering how the foot interacts with the ground. Many patients need time to adapt to these changes, so a break-in period is often recommended. Regular check-ups are essential for tracking progress and ensuring symptoms are improving.

Conclusion

Insoles and orthoses both play important roles in contemporary podiatric practice. The choice of device depends on the needs of the patient and the symptoms presented. The practitioner’s decision of what device to use depends on their training, their experience, and their attention to current evidence supporting the use of in-shoe devices.