Orthotics, shoes, and braces

Management of problems of the foot by using orthotics, braces, and shoes requires an understanding of both the foot as a functional unit and its components. Orthotic devices are divided into the following types: (1) those that reduce impact and cushion the foot, such as nitrogen-filled rubber or thermoplastic foam; (2) those that release pressure, as relief areas or support adjacent to an area of pressure by adhesive felt or foam, custom innersoles, or combinations of pads and innersoles; and (3) those that reduce abnormal pressures and strains on the foot, thereby allowing the foot to function more normally and relieving pressure areas and foot strain. "Posting" generally is used to allow the subtalar joint to function in the neutral position. Shoes now are being used not only to cover and protect the foot, but also to correct abnormalities and improve foot function. It is important to realize that a shoe is made over a last, which is a concept of the shape of a foot, and the shoe should be made the same shape as the foot. Bracing of the foot should take into account the shape of the foot; it should relieve the abnormality and allow the lower extremity to function during gait.