What is the orthopedic insole for and when to use it?

Orthopedic insoles are custom-made medical devices used to improve walking, correct improper postural habits at any age, and address deformities in children.

There are various types of insoles, each with different features and objectives:

• Accommodative: These insoles do not alter biomechanics (movement and walking) but reduce pressure from calluses and relieve ulcerations. They are particularly recommended for diabetic or elderly patients.
• Semi-functional: These insoles offer a biomechanical effect combined with an accommodating effect, without significantly altering foot support and movement.
• Functional: These insoles enhance biomechanical correction using rigid materials, recommended in cases of deformities to benefit the arch angle or the subtalar joint (located below the ankle).
• Pediatric: These insoles are designed to correct deformities and improve the biomechanics and structure of the foot in children aged 5-10. Corrective insoles are typically worn until around age 10, after which further intervention is evaluated if the issue hasn’t been fully corrected.
• Proprioceptive: These insoles work on the muscle chains in the superficial part of the insole, acting on active systems to improve posture.

“There are multiple methods for creating an insole, from plaster casting to scanners that enable the production of 3D-printed insoles and products developed using CAD CAM numerical control. Depending on the type of foot, the pathology, and the patient's age, a specific insole will be chosen to improve foot support and walking,” explains Dr. Meminaj.

Recent guidelines have increasingly expanded the range of conditions for which orthopedic insoles are strongly recommended. These aids are prescribed for various pre- and post-operative conditions, such as:

• Overload metatarsalgia (pain in the sole of the foot), plantar calluses, heel pain due to heel spurs, insertional fasciitis, and overload tendinopathies, as well as deformities such as hallux valgus, hallux limitus/rigidus, and hammer toes. In these cases, insoles relieve pressure in the affected areas.
• Pronated flat foot and pronation syndrome: Semi-functional or functional insoles are recommended to prevent symptoms from worsening to severe arthritic states that could require ankle replacement surgery.
• High-arched supinated foot: Insoles prevent excessive foot rotation in forced supination.
• Knee valgus or varus and patellar syndromes: Insoles play an important role in internal and external rotations, helping preserve knee functionality.
• Arthritic processes.
• Real and apparent leg length discrepancies.

Orthopedic insoles are prescribed by an orthopedic specialist or podiatrist after a thorough examination or instrumental tests, in cases of:

• Pain;
• Impaired movement;
• Incorrect gait.

"Orthopedic insoles should be customized and tailored to the specific condition, following the specialist's instructions. Using generic off-the-shelf inserts or not closely following the prescriber’s directions may fail to address the problem and could worsen the severity of the condition," concludes Dr. Meminaj.