Picking the right orthotic for your tennis shoes- custom or over the counter?

Orthotics have been a “catch all” for treatment of an array of orthopedic sports medicine ailments from the toes to the cranium. With the vast array of OTC (over the counter) and custom foot orthotics (CFO) being marketed it is difficult for people to piece through marketing to find the optimal device for her or him given the unique demands each person imparts on the body during their daily activities

The standard tennis shoe insert is a flexible liner which does not provide any rotational or motion control (1) therefore any excessive forces on the lower extremity will be borne by the shoe and the body’s locomotor system when using a simple, factory insole. While playing tennis, the single limb can be consistently responsible for 6 times the players body weight while making unique movements, this has lead players to seek orthoses out for prophylactic as well as therapeutic purposes (1,9)

There is constant debate over the merits of custom orthotics and OTC. There are countless points of view as to the most effective orthotic design and method of method of action. There are several reasons for this lack of consensus over CFO including inter-practitioner variability when casting the device, method of capture of the foot, method of measuring the foot, device materials, and variability of the human foot.

Despite the myriad of options available, potential pitfalls and discrepancies in research dealing with foot orthotics, patient satisfaction remains high with these devices. A recent study of 275 patients prescribed custom foot orthotics found high patient satisfaction with only 9% of respondents reporting no symptom relief (29). Anecdotally, both custom and OTC devices in my clinic have provided patients good pain relief irrespective of casting techniques, brands, and materials used. Ultimately, it is up to the preference of patient and practitioner to find the right device for the specific indication and situation.

Ferber and Hettinga tested 3 commercially available OTC orthotics’ effects on plantar fascia strain using retroflective markers. They found that all 3 brands did decrease plantar fascial strain, however they found one brand (Power step) also had a significant impact on decreasing rearfoot eversion(13). Other studies have shown that the difference in plantar pressure reduction is not significant between CFO and OTC. Redmund et al found no statistical significance in plantar pressure reduction across 15 flatfooted individuals that were dispensed a semi rigid custom or semi rigid OTC orthotic, however this study was performed after only 14 days, which did not take into consideration the wear characteristics of the OTC vs custom device over a longer period of time (26).

Recomendations :

1. If an OTC orthotic is to be used , we recommend Powerstep, Spenco, or Superfeet as these have been tested the most clinically and have the best results in our clinic
2. Custom orthotics are to Cadillac as OTC are to Chevy- they will both get you where you need to go, one will just do it more comfortably.
3. Full length orthotics are best to prevent sliding
4. Top covers should be made of a material with high coefficient of friction to prevent sliding- ie. Spenco, EVA, Poron.
5. OTC orthotics will last about 6-8 months depending on use and patient weight- more activity, less time to change. Custom will last 1-5 years depending on thickness, patient weight and activity.
6. Make sure the orthotic matches the arch height, if the arch falls while the orthotic is in the shoe, it is worthless.

Disclosure: The author received no compensation from any device company in the preparation of this article.

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