When medical office manager Kim Becktold developed an inflamed foot after hip-replacement surgery, she didn't need to look far for help. Her boss, North Shore University Hospital's chief of podiatry, Dr. Michael Pliskin, came to the rescue.

He molded custom orthotics for her feet so one leg wouldn't put too much pressure on the outside of her right foot and cause a painful condition known as plantar fasciitis. Thanks to the orthotics and new sneakers that fit just right, Becktold said her feet are fine. "I feel so much better," she said.

Not everyone needs to visit a podiatrist, a foot doctor, to get relief for a tender foot. Inexpensive over-the-counter inserts, such as cushions and insoles, can help in some cases, and it's unlikely they would actually be harmful to the foot, said Dr. Warren Kent, chief of the department of podiatry at St. Charles Hospital in Port Jefferson.

In fact, studies have shown that over-the-counter insoles, inserts and arch supports can help with heel, foot and back pain from standing for long periods, and they may help some people who need arch support because of conditions such as hyperpronation, in which the foot slumps inward. Inexpensive "heel pads" or "heel cups" also can cushion the heel and prevent heel pain. (Read the labels and compare what they claim to do with the symptoms you want to address.)

But custom-made orthotics, specially designed to fit a specific individual's feet, are often necessary. "If an over-the-counter product doesn't give relief to symptoms, they need to see a professional," Kent said.

Orthotic inserts, which can be made of a variety of materials, including plastics, leather and cork, are placed in shoes to adjust the distribution of weight and can provide support and cushioning for the foot. Kent said they're used to treat a variety of conditions, from poor foot alignment and inflammation to diabetic ulcers, nerve pain, hammertoes and bunions.


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Custom-made orthotics aren't cheap, however, and insurance companies often don't cover them, he said. Kent said he provides orthotics for $295 each, and Pliskin said the price can be as high as $500 for each foot. However, orthotics usually last for many years and sometimes can be refurbished at a much lower cost than getting a replacement, Kent said.

Though custom-made orthotics are available online, Pliskin doesn't recommend them. "Online foot orthotic devices do not incorporate a doctor's evaluation and treatment," he said. "If a patient orders a device online, they may not get the proper materials or correct device for their condition. The device may not fit, and the patient may not benefit from the device."

There's no regulation of orthotics, Pliskin said.


Once a podiatrist fits you for an orthotic device, he said, it still takes three weeks or so to break it in so it doesn't feel out of place. That usually means wearing it just a few hours a day at first and gradually increasing to full-time use. "Custom-made foot orthotic devices should be worn as much as possible, [though they] may not fit in every shoe that a patient wants to wear," he said.

Also, even a perfectly fitted orthotic that's doing the job it was designed to do may need to be changed over time.

"The foot changes every three to five years," Pliskin said, "so it's recommended that a patient get evaluated after three years to ensure proper fit." That might mean a new orthotic, but "some devices have cushioning that may need to be replaced instead of making an entire new device," he said.