Common Foot and Ankle Problems & Treatments
Custom Foot Orthotics

General Information

The normal arch functions as a shock absorber for our entire body. With every foot strike, we place up to five times our body weight onto the foot, depending on whether we are walking, running, or jumping. Some foot types are not naturally good shock absorbers and the result is pain in the foot that can radiate up the entire leg, knee and lower back. Some people may have structural issues such as flexible/ hypermobile flatfeet, severe pronation, bone growth issues in children or one leg longer than the other (e.g. after hip surgery or traumatic injuries) or be prone to overuse injuries (e.g. plantar fasciitis, achilles tendonitis, metatarsal stress fractures) that would benefit from over the counter arch supports or with recalcitrant or more serious issues, custom foot orthotics. An apt analogy compares OTC arch supports with generic store bought reading glasses and custom orthotics with prescription eyeglasses.

Problems caused by flat feet

Structural defects are foot problems that may occur because the bones and joints of the foot are not held together with the normal amount of tension. This allows the bones and joints to move into abnormal positions, causing bunions, hammer toe, neuromas, calluses, and corns.

If these problems are left untreated, they become progressively more painful and debilitating.

Pronation is the most common and damaging medical problem that may occur as a result of flat arches. Pronation is a turning outward of the foot at the ankle, so that one has a tendency to walk on the inner border of the foot.

You can test for pronation by looking at the leg and foot from the back. Normally, you can see the Achilles Tendon run straight down the leg into the heel. If the foot is pronated, the tendon runs straight down the leg, but, when it lies on the heel, it twists outward. This makes the inner ankle bone much more prominent than the outer ankle bone.

Because pronation is a twisting of the foot, all the muscles and tendons which run from the leg and ankle into the foot are twisted.

If left untreated, pronation may be the cause of heel spurs, plantar fasciitis, frequent ankle sprains, shin splints, weak and painful arches, and, eventually, knee, hip and lower back pain.


Not all custom orthotics are the same!

Your podiatrist will help determine if your problem would benefit from a prescription custom orthotic. In order for the orthotic to be effective, a precise impression of your foot must be obtained and then designed to address your specific diagnosis.  Many different materials (hard or soft) can be chosen and a quality lab must be employed.  A discussion of your proposed uses for the orthotic (soccer vs. leisurely walking) and what shoes they will be used in (sport vs. dress) is crucial to ensure that the orthotic will work for you.  Many FASMA offices use plaster molds or utilize a new 3-dimensional scanner to obtain precise foot impressions and work with a state-of-art lab to produce a superior custom orthotic.  

Custom orthotics are covered by many insurance plans and are often an integral part of treating many foot and lower extremity problems.

What causes flat feet?

The normal arch is made up of bones and joints which are held together tightly in a precise relationship. For the arch to flatten, the ligaments and tendons which hold the bones and joints together are more flexible than normal.

This abnormal flexibility may be a result of: the genes we inherit from our parents; the weakening of muscles and ligaments, caused by advancing age; neuromuscular diseases; or injury.

Injuries may include one severe trauma, or years of standing for long periods of time in the wrong types of shoes (those with high heels or those with poor support). This flexibility of the bones, joints, and soft tissues is what causes the foot problems which are related to flat arches or feet.


How can flat feet be treated?

First and foremost, if you have a flat foot or feet, it is medically acceptable to do nothing.

If you are symptomatic, then good shoes, with an arch and a strong heel counter, to keep your foot in a more normal position, may help. If not, orthotics can often provide great relief. They may range from a soft support to one that is very rigid. This can be determined after a thorough examination.

Occasionally, support isn't enough, and surgery can be required to alleviate symptoms.

Foot & Ankle Specialists of the Mid-Atlantic offer reconstructive surgical options that can ultimately decrease pain and improve ambulation. A comprehensive biomechanical examination, along with diagnostic imaging, will determine the procedure that makes sense for you.

Fortunately, some flat feet benefit from a newer procedure, called sub-talar arthroeresis.
This involves the insertion of a bullet-shaped implant between your heel bone and the talus (located between the ankle bones). This blocks the foot's ability to roll inward, without the significant recovery period required for the procedures described previously.

Please contact us to find out if your feet would benefit from treatment.