How to Choose Orthotics

Improper foot alignment can cause pain anywhere in the foot, legs, and back. Over time, these aches and pains may potentially result in overuse injuries such as shin splints, tendonitis, and stress fractures. Some lower extremity pain and injuries may be helped and/or prevented by orthotics.

What Are Orthotics?

Some people refer to orthotics as “arch supports,” but they do more than that! Orthotics are shoe inserts that help to correct improper foot alignment during activities like walking and running. Even though orthotics work directly on foot position, they also affect the alignment of ankles, knees, hips, and the low back, because everything is linked together in a biomechanical chain! The guide below will help you determine how to find the right pair of over-the-counter orthotics for your foot type.

Foot Types and Orthotic Qualities

  • Low arched feet or flat feet are those that do not have much of a gap between the floor and the arch of the foot when standing. This foot type is very flexible and needs a rigid orthotic.
    • Rigid Orthotic: This type of orthotic controls the motion in the foot. Look for an orthotic that is inflexible with good arch support. Push down on the arch. If it collapses under finger pressure, it is not rigid enough. Note that this type of orthotic may feel strange when first worn because of its rigidity and shape.
  • High arched feet are those that have a large gap between the floor and the arch of the foot when standing. This foot type tends to be rigid and needs a soft orthotic.
    • Soft Orthotic: This type of orthotic is somewhat flexible and is cushioned so it can absorb the shock of running. Look for an orthotic that has flexibility and cushioning, but that still supports the arch and has some stiffness. Note that this type of orthotic may need to be replaced more often once the shock absorption capabilities have worn out.

How to Tell if it’s the Right Fit

Once you have selected a pair of orthotics, take them out of the packaging and place them on the floor. While barefoot or in just stocks, stand on both pieces before you place them in shoes. If you are shopping for an orthotic for flat feet, note the arch support in the orthotic: does it work? If you are shopping for a soft orthotic, does it seem to absorb shock and provide enough cushioning?

Fitting the Orthotics to Your Shoes

Your orthotics may have to be trimmed down around the toe area in order to fit into your shoes. Follow the instructions on the package, trimming off only small sections at a time, following the curve from the ball of the foot all the way around the toes. After trimming a small section, attempt to insert them in your shoes. If they still do not fit, repeat. Remember: you can easily trim more off, but you can’t put it back if you trim too much!

How to Break In Orthotics

Sometimes, when people start wearing orthotics, they may experience soreness in their feet, legs, or low back. A short period of soreness is normal, but can be reduced and/or eliminated if you gradually get your body used to your new orthotics. Follow these steps to break in new orthotics:

  • Get used to your new orthotics during activities of daily living, such as school and shopping. Wear your orthotics in the shoes that you will be using them in the most (if possible).
  • Increase your wear time by 2 hours each day. For example, on the first day, wear your orthotics for 2 hours, and then remove them from your shoes. On the second day, wear them for 4 hours and then remove them, and so on.
  • If you notice soreness, you can remain on the same level of wear time for a few days until the soreness subsides. Then, continue increasing wear time by 2 hours each day.
  • Wait to use your orthotics in your sport shoes until you can wear them comfortably for a full day during activities of daily living. Then gradually increase the use of the orthotics in your sport shoes over a few days. Start by just using them for running, and then increase the amount and type of activity performed while wearing them.

A Note About Shoes

A good pair of sport-specific athletic shoes is essential to injury prevention. To learn more read our informational article, How to Choose Running Shoes.

Choosing a Store

If you are unsure how to shop for orthotics, specialty running shoe stores have experienced salespeople that can help you find the proper fit. Your coach or sports medicine specialist may be able to recommend specific stores in your area that will meet your needs and budget.


For More Information

Please note that not all aches and pains can be attributed solely to foot mechanics, nor can all injuries be completely fixed or prevented by orthotics. If you have persistent problems, consult your sports medicine specialist in a timely manner before the issue becomes worse. 

As an added resource, the staff at Nationwide Children’s Hospital Sports Medicine is available to diagnose and treat sport-related injuries in youth and adolescents. For more information about our services, visit our website or call (614) 355-6000.

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Nationwide Children’s Hospital Sports Medicine is available to diagnose and treat sports-related injuries for youth or adolescent athletes. Services are now available in five locations. To make an appointment, call (614) 355-6000 or request an appointment online.

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