Choosing a Knee Brace - Everything You Need to Know

In This Guide:

Finding the right knee brace can make a significant difference in managing knee pain, instability, or injury recovery. With so many knee brace types available, understanding their functions is essential for selecting the best one for your needs. This guide explores the different types of knee braces, including hinged and compression braces, and explains how each can help with various conditions such as knee buckling and ligament injuries. Whether you need support for daily activities or sports performance, knowing what kinds of knee braces work best for your situation will help you make an informed decision.

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Introduction

Knee braces are an excellent choice of treatment option for a variety of knee injuries and conditions. They are generally non-invasive, low-risk, and cost-effective. The best knee braces can provide significant benefits by helping to support the joint, reduce pain, and improve stability and mobility. However, brace design, function, and quality vary widely. Choosing the right brace for your needs can be difficult, especially with the overwhelming amount of information on the internet. That’s why we’ve put together this comprehensive guide to answer all of your knee brace-related questions. We’ll break down everything you need to know about choosing a knee brace, so you can make an informed decision about which brace is best for you.

Kinds of Knee Braces

Before choosing a knee brace, it may be helpful to learn about the different types of braces available. Understanding the various types of knee braces can help you select the most appropriate one for your condition. Most knee braces can be broadly categorized as hinged or non-hinged. As the name suggests, hinged braces incorporate hinges, which allow the brace to provide more support and stability to the knee, and promote proper alignment. Non-hinged braces offer less support but are still useful in many situations. These kinds of knee braces are often recommended for mild injuries or as a preventive measure during physical activities. Within these two categories, there are several different types of braces, each designed for a more specific purpose.

Hinged Knee Braces

• Prophylactic braces: Typically worn by athletes to prevent knee injuries, they are designed to help stabilize the joint and protect the knee ligaments. 
• Functional braces: Protect and support the knees after injury or reconstructive surgery. Some are designed to treat specific injuries (ex. an ACL functional brace is designed to support the ACL and prevent movements that could cause re-injury). This type of knee brace is crucial for individuals aiming to regain stability and confidence during rehabilitation.
• Offloader braces: Specifically designed to treat knee osteoarthritis, offloaders are designed to redistribute and/or reduce forces in the joint to protect damaged bone cartilage. They can also be used to help treat meniscus injuries.
• Spring braces: Incorporate springs into the hinge to absorb body weight as the knee bends. The most powerful spring braces also assist your leg muscles by releasing stored energy as you straighten your leg. Some of the best offloader braces use spring technology to reduce load across the entire the knee.

More information about hinged braces can be found in this resource – The Best Hinged Knee Brace for Your Needs.

Non-Hinged Knee Braces

• Compression sleeves: Provide warmth and compression to support the knee, increase proprioception, and decrease pain, stiffness, and inflammation. They are mainly used by individuals with mild knee pain or injury who want to stay active. They may also be used in the final stages of injury rehabilitation when returning to exercise and sports. You can learn all about compression braces here.
• Knee straps: Apply pressure to the patellar tendon (just below the knee cap) to relieve pain from injuries such as jumper’s knee and runner’s knee.

For more information on how all of these braces can help relieve knee pain, check out this resource – The Best Knee Brace for Pain.

Features of a High Quality Knee Brace

Here are a few important things to look for in any knee brace:

• Comfort and Breathability: You should be able to wear a brace comfortably for extended periods. A brace should also use breathable materials for use during exercise or sports activities.
• Lightweight and Streamlined Design: High quality braces are neither heavy or bulky, and can be fitted properly to your leg dimensions to help avoid discomfort. The best knee braces will feel almost like an extension of your leg so that after a while, you forget it’s even there.
• Adjustability and Customization: Some of the more expensive braces can be custom-fitted to your leg for a perfect fit. However, any high-quality brace should have adjustable features like straps, dials, or different options for padding so you can customize the brace for your needs.

Tip from our knee bracing specialists

When selecting a knee brace for knee buckling, it’s important to choose one that provides stability without limiting mobility. Hinged knee braces are commonly used for extra support, while compression sleeves offer lightweight reinforcement. Understanding the different types of knee braces can help determine which option best suits your needs, whether you’re managing instability, recovering from an injury, or looking for preventive support.

What's Causing Your Knee Pain?

The next sections outline the best type of knee brace for various common knee problems. Select from the list below to jump to the section most relevant to you.

• Knee Osteoarthritis
• Meniscus Injuries
• Ligament Injuries
  • Anterior Cruciate Ligament (ACL)
  • Posterior Cruciate Ligament (PCL)
  • Collateral Ligament (MCL or LCL)
• Patellofemoral Pain
  • Patellar Tendinopathy
  • Patellofemoral Pain Syndrome

Knee Osteoarthritis

There are a few different types of knee brace that can help you manage your knee osteoarthritis (OA). Below, we break down which one to choose depending on the severity and pattern of your OA.

BEST KNEE BRACE FOR MILD OA: COMPRESSION SLEEVE

Research shows that compression sleeves can relieve pain and improve function for OA patients [1], so it’s a good option to help manage your symptoms if you have mild OA. The warmth and compression it provides can reduce pain and stiffness and improve your sense of stability, especially during and after exercise. A sleeve will not provide as much support or pain relief as an offloader knee brace because it lacks a hinge, so for moderate to severe OA it probably won’t be very effective.

Best Knee Brace for Moderate or Severe OA: Offloader Brace

Reducing joint load is one of the preferred treatments for knee osteoarthritis. As a result, OA knee braces are designed to offload your knee by reducing or redistributing pressure in the joint. This protects the cartilage and decreases bone on bone contact, which helps to relieve pain and restore mobility.

There are three compartments of the knee where osteoarthritis can occur. OA can affect one compartment or multiple compartments at the same time. It’s important to understand which compartments of your knee are damaged because that will determine which type of offloader brace you need.

There are 2 main types of offloader braces:

• Uni-compartment offloader – reduces pressure on one side of the knee by shifting weight to the other side
• Tri-compartment offloader – reduces pressure across the entire knee, including under the knee cap, by absorbing body weight as the knee bends.

We have a couple of useful resources if you want to read in-depth about knee braces for osteoarthritis:

• The Best Knee Brace for Osteoarthritis
• The Best Knee Brace for Bone on Bone Pain
• The Best Anti-Gravity Knee Brace

Which Offloader Brace is Right for You?

It depends on what pattern of OA you have. The best offloader knee brace for each pattern of OA is outlined below.

Uni-compartmental Tibiofemoral OA

In this case, only one tibiofemoral compartment of the knee is damaged. A uni-compartment offloader brace shifts pressure away from the damaged compartment towards the healthy knee compartments. This provides relief from symptoms and can allow you to move more freely without experiencing painful bone on bone contact. Offloaders are a cost-effective and non-invasive way of reducing pain and improving functional ability [2,3].

The diagram above shows how an offloader brace alters knee alignment and the distribution of force in the joint. In this case, the brace is relieving pressure on the medial tibiofemoral compartment and shifting pressure to the lateral side of the knee.

Patellofemoral OA

Over half of knee OA cases involve the patellofemoral (PF) compartment [4] which is located under the knee cap. Conventional offloader braces can’t relieve pressure under the knee cap, so a tri-compartment offloader (TCO) is the best (and only) brace for PF OA. Using a powerful bionic hinge, a TCO brace absorbs body weight as the knee bends, reducing joint forces in the PF compartment by up to 46% [5]. This typically results in significant pain relief and improved mobility. If you have PF OA, a tri-compartment offloader can help you manage your symptoms and get back to your favourite activities.

In the diagram above, you can see how wearing a TCO knee brace can reduce the forces (represented by the arrows) acting on the PF compartment.

Multi-compartmental OA

A tri-compartment offloader is also the best knee brace if you have OA in multiple compartments of your knee, which most OA patients do. That’s because it can offload all three knee compartments at once, reducing bone on bone contact and pain across the entire joint. The bionic hinge acts like a shock absorption system for your knee. Instead of redistributing body weight like an offloader brace, a TCO works against the force of gravity, absorbing a large amount of your body weight so your knee doesn’t have to. It also returns some of that energy to help power your leg muscles as you straighten your leg (a feature known as “knee extension assist”). Overall, a TCO is an excellent choice of brace if you’re struggling with any pattern of OA and want to reduce pain, regain mobility, and return to an active lifestyle.

Who Makes the Best Offloader Knee Brace?

Donjoy and Breg make some of the best uni-compartment offloader knee braces. Spring Loaded Technology’s Levitation knee brace is the world’s first tri-compartment offloader. For your convenience, we’ve made a resource comparing the Top 5 Offloader Knee Braces, which includes braces made by these brands. If you’re trying to decide which brace is best for you and want to see more detailed comparisons, the following resources might be helpful:

• The Donjoy Knee Brace vs Levitation
• The Breg Knee Brace vs Levitation

Clinical Benefits of a TCO Knee Brace

Spring Loaded’s Levitation knee brace is a tri-compartment offloader with a lightweight and compact design that’s already helped thousands of people overcome knee pain. Preliminary research findings show that wearing Levitation results in significant benefits for OA patients.

The following data is from a systematic survey of Levitation users with knee OA:

• 95% reported a significant decrease in pain symptoms after using the brace.
• 85% experienced mobility improvements.
• 86% reported an improvement in their quality of life.
• On average, Levitation users were able to increase their physical activity levels by 8 hours per week.

You can learn more about the benefits of Levitation here.

Meniscus Injuries

Meniscus injuries can cause pain, swelling, and a loss of mobility. They can result from a sudden injury (acute meniscus tear) or can develop over time from wear and tear (degenerative meniscus tear). Either way, a knee brace can help limit stress and pressure on a torn meniscus to allow it to heal properly.

BEST KNEE BRACE: OFFLOADER BRACE

While offloader braces are commonly used to treat osteoarthritis, they are also effective for treating meniscus injuries. Research shows that they can reduce meniscus strain if the ACL is intact [6]. There are two different types of offloader brace that you could use depending on your situation.

Uni-compartment Offloader

If just one meniscus is torn, then you probably only need to relieve pressure on that side of your knee. A uni-compartment offloader can help by shifting pressure away from the injured side so that the healthy side of your knee absorbs most of the force. This may help to reduce pain and relieve strain on the injured meniscus so it can heal.

Tri-compartment Offloader (TCO)

Unlike an offloader brace, a TCO brace can reduce pressure across the entire knee. This type of offloader may be more useful if both of the menisci in your knee are damaged. A TCO is also a great choice for those with degenerative meniscus tears, which occur as the meniscus cartilage wears thin over time. Degenerative tears are typically seen in older individuals and are often associated with knee osteoarthritis [7-10]. Since a TCO brace can offload the entire knee joint at once, it can protect both the meniscus cartilage and the articular cartilage (bone cartilage) from further damage. This makes it a unique solution for those with knee osteoarthritis and/or degenerative meniscus tears who are hoping to improve pain and mobility while avoiding surgery.

For more information on how to choose a knee brace for meniscus tears, check out this resource – The Best Knee Brace for Meniscus Tears.

Ligament Injuries

Anterior Cruciate Ligament (ACL) Injury

ACL injuries can be quite serious and usually require extensive rehabilitation, especially if surgery is required. A knee brace can be used before or after surgery to provide stability and protect against re-injury.

BEST KNEE BRACE: FUNCTIONAL ACL BRACE

A hinged functional knee brace specifically designed for ACL rehabilitation can be useful before or after surgery. Functional ACL knee braces are designed to protect the anterior cruciate ligament and provide stability for the knee during recovery. They also prevent twisting and hyperextension, which helps ensure that you don’t accidentally re-injure the ligament.

Unlike other ACL knee braces, those that use a dynamic tensioning system (DTS) – like Ossur’s Rebound ACL Knee Brace – can reduce strain on both the ACL and meniscus [11]. Since the meniscus is at risk of injury in ACL-deficient knees, a DTS brace may be able to help prevent a meniscus tear from occurring if you’re waiting for surgery or have a chronic ACL deficiency [11]. A DTS brace is also a good choice post-surgery because it can provide a larger unloading force than other ACL braces, meaning it may provide better protection for the ACL graft [11]. More information on ACL braces and DTS braces can be found here.

Alternatives

• Tri-compartment offloader (TCO) brace – A TCO brace can help you return to weight bearing activities after a ligament injury. It reduces the forces going through your knee joint by absorbing body weight as your knee bends and assisting knee extension when you straighten your leg. This can help relieve pain and increase stability, and allow you to regain muscle strength and control while limiting strain on knee ligaments. By offloading the entire knee, a TCO can also protect against meniscus injuries during rehabilitation.

• No brace – While wearing a knee brace may reduce pain and provide stability and protection, you can still regain full knee function without using a brace [23]. It is not a requirement for a proper recovery.

Posterior Cruciate Ligament (PCL) Injury

PCL injuries are less common than ACL injuries but can be equally as severe. Some functional knee braces are designed specifically for PCL injury rehabilitation and are often recommended as a supplementary treatment.

Best Knee Brace: Dynamic PCL Brace

The function of the PCL is to stabilize the knee and prevent the shin bone from moving too far backwards. A PCL brace can reduce unwanted forces on the injured or reconstructed ligament by limiting rotation and backwards movement of the shin bone during bending and straightening. Static PCL braces do this by providing a constant force to the knee during the entire range of motion. While this has its benefits, there is evidence to suggest that knee stability is not adequately restored following management with a static brace [12].

A dynamic PCL brace provides more force the more the knee bends, so it provides the most support during a deep knee bend when the PCL is maximally loaded [13]. In addition to protecting the PCL, this also enhances stability and can reduce pressure in other parts of the knee. This means a dynamic brace is likely a better option than a static brace for protecting the PCL before or after surgery [12]. More information on the best PCL braces can be found here.

Alternatives

• Tri-compartment offloader brace or no brace – see ACL brace alternatives above.

Collateral Ligament Injury

The medial collateral ligament (MCL) and lateral collateral ligament (LCL) run along the inside and outside of the knee, respectively. These ligaments keep the knee from buckling inwards and outwards, so when either one gets injured the knee can lose a lot of its side-to-side stability. Wearing a knee brace can help restore some of that stability while the ligament heals.

Best Knee Brace: Functional Brace

If you have an injured MCL or LCL, a functional knee brace that provides side-to-side stability is likely your best option. All functional braces have hinges to help stabilize and support the knee, but in this case, make sure you look for one that’s designed to prevent the knee from buckling inwards (for MCL injuries) or outwards (for LCL injuries). The more severe your ligament injury, the more unstable your knee will be and the more support you’ll probably need. A functional brace with soft hinges can be used for milder ligament injuries, while a brace with rigid hinges may be better for more severe ones because it will provide more support. Try to choose a brace to provide adequate protection for your knee based on the severity of your injury and the amount and type of physical activity you want to do.

Patellofemoral Injuries

The patellofemoral compartment of the knee is located where the patella (knee cap) meets your femur. Several different knee problems can affect this area and/or the tendons that attach to the knee cap. Below is an overview of some of the knee braces that can help. For more of an in-depth look at patellofemoral knee pain and knee braces, click here.

Patellar Tendinopathy (Jumper’s Knee)

Patellar tendinopathy (also known as patellar tendinosis or jumper’s knee) is a chronic overuse injury caused by repetitive loading of the patellar tendon. It causes pain and tenderness on the front of your joint just below the knee cap, and if not treated properly can get progressively worse over time.

BEST KNEE BRACE: PATELLAR KNEE STRAP

Wearing a patellar knee strap is one of the best ways to relieve pain from patellar tendinopathy (PT). Typically, pain is aggravated by activities that load the patellar tendon (like squatting, jumping, and running). Knee straps can decrease patellar tendon strain [14], and can be quite effective at relieving pain symptoms during these activities. As such, they are often recommended for use during physical activity and sports. Some research shows that knee straps can reduce pain in those with PT during functional movements (ex. single leg squat or jump) and during and after sports [15]. There is also evidence supporting the use of knee straps to decrease pain in basketball and volleyball athletes [16]. However, despite these promising results, keep in mind that the effectiveness of knee straps is still being studied. The good news is that they are very cost-effective, so there is relatively lower risk in trying one out to see if it benefits you. In many cases, it can be a great addition to a rehabilitation program that also includes physiotherapy, stretching, and eccentric strength exercises. 

How Do Knee Straps Work?

The strap changes the angle at which the tendon inserts into the patella (knee cap) and decreases the tendon’s length, which decreases strain on the tendon [14]. Reducing stress on the tendon alleviates a lot of the discomfort associated with PT. However, a knee strap probably won’t solve the problem all on its own. A combination of treatments and a structured rehabilitation plan will help ensure that the tendon heals properly.

Alternatives

• Rest and rehabilitation – If you can afford to take time off from sports and other painful activities, it may benefit you in the long run because the tendon will have time to heal. Following a rehabilitation program under the guidance of a physiotherapist is also a great idea, whether you decide to wear a knee strap or not.
• Patellar taping – Sports taping can replicate the effect of a knee strap [15]. However, it’s important that the tape is applied properly or you won’t get the benefit. Before you buy a knee strap, try asking your physiotherapist if they can tape your knee so you can see what it feels like. If you notice a difference, then a knee strap will probably work for you as well. You could also ask your physio to teach you how to apply the tape yourself. If you’re an athlete with regular access to a therapist, they may be willing to tape your knee before training or competition if you don’t want to wear a knee strap.

Patellofemoral Pain Syndrome (Runner’s Knee)

Another common injury that can cause pain in the front of the knee is patellofemoral pain syndrome (PFPS). It’s an overuse injury that develops over time due to a variety of factors and causes pain in the patellofemoral compartment of the knee (under the knee cap). It’s also known as runner’s knee because it commonly affects runners and other athletes or highly active people that repeatedly stress their knee joints.

BEST KNEE BRACE: PATELLAR STABILIZER OR REALIGNMENT BRACE

The underlying cause of PFPS is thought to be abnormal movement of the patella (knee cap), also known as patellar maltracking [17]. A patellar stabilizer brace (or patellar realignment brace) is a type of functional brace that counters patellar maltracking. The brace stabilizes and controls the position of the knee cap to make sure that it is aligned properly throughout your range of motion. By correcting patellar alignment, the brace can help to relieve the symptoms of PFPS.

Studies examining the benefits of patellar stabilizer braces for PFPS have produced varying results [18]. Overall, there is not a lot of high-quality evidence to support the use of these braces for PFPS [17]. However, some research suggests that they are effective at relieving pain from PFPS [19,20] and that those with patellar maltracking can benefit from wearing a brace to complement a physical therapy program [18]. In most cases, the patella tracks towards the outside of the knee (lateral maltracking) [17]. Using a brace that directs the patella towards the inside of the knee (medially) to correct lateral maltracking has been shown to lead to better outcomes and pain relief when combined with physiotherapy exercises [21]. This suggests that patellar stabilizers should not be viewed as an instant solution to PFPS, but as one of many tools in a more comprehensive rehabilitation plan.

What is Patellar Maltracking?

The patella is supposed to be centrally aligned in the femoral groove. However, various factors (such as leg muscle imbalances and weaknesses, or abnormal movement patterns) can cause altered alignment or instability. A patella that is not tracking properly will glide to one side of the femoral groove, which increases pressure in the joint where the patella contacts the femur. This becomes an issue for highly active individuals or athletes that put a lot of stress on their knees. Maltracking combined with repeated overuse can lead to the symptoms of pain, discomfort, and irritation associated with PFPS.

Alternatives

• Strengthening and stretching – The quadriceps and hip muscles play a critical role in stabilizing the patella. Weakness, imbalances, or a lack of flexibility can contribute to improper alignment and the development of PFPS [17,18]. Physical therapy exercises that improve muscle strength, control, and flexibility are one of the best ways to treat PFPS and its underlying causes [18].
• Knee compression sleeve – While they offer less support than a patellar stabilizer brace, compression sleeves can still help stabilize the patella and reduce patellar maltracking [18], which could help to manage PFPS along with the types of exercises mentioned above.
• Tri-compartment offloader – A TCO brace is the only type of knee brace that can offload the patellofemoral compartment. This means it can reduce pressure where the patella contacts the femur, which could relieve pain and discomfort from PFPS. A TCO can also help power your leg muscles by assisting knee extension, allowing you to improve your muscle strength and control without aggravating your symptoms. Strengthening will help improve patellar tracking and reduce your pain in the long run.

To learn more about different knee braces for patellofemoral pain, check out this resource – The Best Patellofemoral Knee Brace.

Levitation 2 - A Bionic Knee Brace for Your Needs

Frequently Asked Questions (FAQ)

1. What are the different types of knee braces and their uses?
Knee braces come in several forms, including functional, rehabilitative, prophylactic, and unloader braces. Each serves a different purpose, such as supporting injured ligaments, aiding post-surgical recovery, preventing injuries, or reducing pressure on arthritic joints. Choosing the right type of knee brace depends on your specific knee condition and activity level.

2. How do I know which knee brace type is right for me?
The best knee brace type for you depends on your specific condition. If you have knee instability or ligament injuries, a hinged brace may be the best option. For mild pain or swelling, a compression sleeve can provide relief. Consulting with a medical professional can help you determine which brace offers the most appropriate support.

3. What kinds of knee braces provide the most support?
The most supportive kinds of knee braces include hinged and rigid braces, which are commonly used for post-injury recovery or after surgery. These braces help stabilize the knee joint and prevent excessive movement that could lead to further damage. Athletes or individuals with severe knee instability often benefit from these types of braces.

4. Are there specific types of knee braces for knee buckling?
Yes, a knee brace for knee buckling is designed to provide extra stability and prevent sudden collapses. Hinged braces and wraparound braces are commonly used to support weakened knee structures and improve confidence in movement, especially for individuals with conditions like arthritis or ligament injuries.

5. What is the difference between types of knee braces and their functions?
Different types of knee braces serve different purposes. Functional braces support injured knees, unloader braces relieve arthritis pain, and rehabilitative braces protect the knee during post-surgical healing. Understanding these differences helps in selecting the right brace for your condition.

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or give us a call at 1.877.209.

Custom foot orthotics

A customised foot orthotic provides the best and most advanced means of correcting and controlling your foot function. This is the most effective type of orthotic to address pain in your feet, ankles, knees, hips and lower back.

Based on studies it has been shown that the most effective custom orthotics are made using state-of-the-art 3D scanning technology.  At Entire Podiatry a 3D scan is taken of your foot; this scan perfectly captures the shape and size of your foot and will capture any individual ‘quirks’ of your feet.  This degree of customisation allows the orthotic to conform perfectly against your foot to ensure the pressure is spread evenly across the entire surface of the foot.  A study in compared two foot imaging techniques and it showed that non-weight bearing foot imaging was the most reliable method for making custom orthotics.1

Do not get confused by some podiatrists who use a 3-D pressure map of the foot as this unfortunately is not the best technique to capture the image. Patients in this instance are asked to walk across a force plate and a pressure map is produced on the computer.  This method does not accurately capture the correct shape of the foot and subsequently the orthotics that are produced are inferior.

Once the 3-D scan is taken at Entire Podiatry the orthotic is then manufactured. The orthotic is designed and built in a specific way based on your ‘prescription’. Similar to an optical prescription, no two people’s custom orthotic prescription will be the same. Your podiatrist develops your prescription after they have assessed your feet and gait based on your clinic needs.

The result is a perfectly customised orthotic device created from your exact foot shape and your precise mechanics to give the best biomechanical correction and comfort.

Article citation:

1 A comparison of four methods of obtaining a negative impression of the foot. McClay-Davis I, Laughton C, Williams, DS. J Am Podiatr Med Assoc. May;92(5):261-8

Semi-customised orthotics or CFA (Cast and Foot Adjusted) orthotics

Cast and Foot Adjusted (CFA) orthotics offer a lower cost alternative to custom orthotics. While CFA orthotics incorporate an element of individual modification, they are less precisely matched to your individual foot than custom foot orthotics.

CFA orthotics are made from a library of standard foot moulds/shapes. The standard foot mould that matches your foot most closely will be used to manufacture your orthotics. This is determined after your podiatrist has taken an outline of your feet, and conducted a biomechanical assessment to prescribe the type of correction your feet require.

There are many options for the type of orthotic shell used within the range of CFA orthotics, which enables this to be matched as closely as possible to your foot type. However, if you have a unique foot type, such as very flat feet, high arched feet, wide or narrow feet, then CFA orthotics are unlikely to be a suitable option for you. CFA orthotics are made based on a closely matched indication of foot type, but they do not detect discrete, unique specifications of your feet. As such, we don’t expect CFA orthotics to achieve the same level of improvement in foot function as custom orthotics, but in some cases they are a worthwhile option.

Minimally customised orthotics or off-the-shelf professional orthotics

Minimally customised orthotics or professional OTS (off-the-shelf) orthotics are another option that Entire Podiatry offer our patients. These devices are a lower-cost option but have a lesser element of customisation. There is a range of OTS orthotics for both adults and children.

It’s important to note that not everyone may be suited to this range of orthotics. For example if you have a very high arch or a very flat foot, you will likely not be suited to this type of orthotic. If you are planning on wearing the orthotics into dress shoes, football boots or sandals then this type of orthotic is also less likely to be suitable as these orthotics are typically bulkier and we are unable to modify them to compliment certain shoes. If you have a particular pain or symptom which requires a certain type of biomechanical correction to resolve, then these OTS orthotics may offer insufficient correction and you may find more benefit from an orthotic with a higher degree of customisation in order to address your requirements.

You may have heard the term ‘rigid foot orthotics’. These orthotics are typically made from a plastic such as polypropelyne or subortholene. Don’t be put off by the term ‘rigid’ used to describe these orthotics. The shells can be made from flexible, semi-flexible, semi-rigid or rigid materials and your podiatrist can dictate the amount of rigidity required in their prescription.

Recently, new developments in orthotic manufacturing and material creation have led to the development of new carbon orthotics. These orthotics are made from carbon fibre and are the most ultra-lightweight and thin devices on the market. Carbon fibre orthotics are perfect for fitting into tighter footwear that may have difficulty accommodating a traditional orthotic.

At Entire Podiatry we also manufacture our orthotics from a foam/rubber material called EVA (Ethyl Vinyl Acetate). The EVA material comes also comes in three different densities depending on the patient’s requirements. EVA orthotics have great cushioning effects and are very easily modified or adjusted. A popular option for those who require a very cushioned custom soft foot orthotic is low-density EVA. This material is incredibly soft and cushioned beneath the foot, perfect for those with sensitive feet or with painful conditions beneath the feet that require lots of cushioning.

After the material of the shell has been chosen, most orthotics are made with an additional layer of material over the top of the device. This acts as a cover and increases the longevity of the orthotic and provides cushioning. We have numerous different types of cover materials depending on your needs and preferences. For example, we have a natural leather orthotic material that is perfect for those with allergies to synthetic materials. We have extra absorbent and quick drying material perfect for those prone to sweaty feet. We also have a range of bright and fun colours and patterns for kids to choose from.

Other types of orthotics you may have heard of

Gel orthotics

Gel orthotics can be purchased from the chemist or supermarket and claim to fix many different foot problems.

“People may receive a small amount of benefit from such purchases, but they usually find their pain is not resolved adequately.” – Chris Hope, Podiatrist

This is because these gel innersoles fail to provide adequate support and are not correcting biomechanical abnormalities. This is because the gel ‘orthotics’ purchased from the chemist are a ‘one size fit all’ approach. Whilst they provide some additional cushioning beneath the foot they do not take into consideration how much support is required for your specific foot and your specific pain, injury or requirement.

Original copper heeler orthotics

Original Copper Heeler Orthotics are a brand of insoles which claim to relieve pain from arthritis. The copper is said to be absorbed through the skin and circulates through the body to reduce joint discomfort.  There has been no scientific studies and no evidence to support this claim. It could simply be the fact that these orthotics support the arch and this support reduces the arthritis pain rather than the effect of the copper, or the effects could be a placebo. Either way, further research needs to be undertaken to support their claim and most modern podiatry clinics do not support these or manufacture their orthotics from copper materials.

Orthotics & foot pain

Orthotics for Achilles tendon pain

Achilles tendinopathy is a painful condition which affects the back of the heel at the Achilles tendon. The pain may occur in the tendon, or the pain may be lower at the back of the heel bone, where the tendon attaches to the heel. (Click here for more information on Achilles Tendinopathy). Typically the pain begins during or after exercise or when you stand up and get moving after while of being off your feet. If the condition is left untreated then the pain can be present almost constantly.

Treatment for Achilles tendinopathy includes a combination of rest, pain relief, changes to footwear, stretches/strengthening and often orthotics.

Most people receive benefit from a pair of orthotics for Achilles tendonitis treatment. Improper foot function or poor foot mechanics is a lead cause of Achilles Tendinopathy. For example, a foot that rolls in or pronates excessively, or a foot with a very rigid and high arch can cause the Achilles tendon to be overloaded.

The best orthotics for Achilles tendonitis is a device which conforms well through your foot and is designed in such a way to reduce the strain going through your overloaded Achilles. Orthotics for Achilles tendonitis can provide a rapid reduction in symptoms, can encourage the tendon to heal and can reduce the likelihood of the problem reoccurring.

Can orthotics cause Achilles pain?

At Entire Podiatry we have sometimes been asked “can orthotics cause Achilles pain?”.  We believe that orthotics can be incredibly useful, but if they are not prescribed correctly they may cause discomfort.  When prescribed properly however, by a qualified podiatrist, orthotics can be highly valuable to the wearer.

A study in observed the effect of using orthotics on the Achilles tendon.  They found that running with foot orthotics resulted in a reduction in Achilles tendon load compared to running without orthotics. This study suggest that foot orthotics significantly reduce the stress on the Achilles tendon in runners.1

“A study…found that running with foot orthotics resulted in a reduction in Achilles tendon load compared to running without orthotics”

When prescribed unnecessarily or incorrectly, orthotics can be unsafe and may aggravate an underlying pre-existing medical condition.  People at particular risk are those with Achilles tendon pain, heel pain, knee or back problems, or those who have flat feet or a high arch foot type. So it is important to obtain professionally fitted orthotics. If you are experiencing pain in your heels or any of the aforementioned pain, contact us at Entire Podiatry today. We can help determine the best solutions to reduce your pain.

Orthotics for flat feet and medial arch support

Many people have flat feet, where the feet tend to roll in and the arch of the foot drops to the ground (otherwise known as fallen arches). While this is a common foot type, lacking a natural arch in the foot can place strain on surrounding soft tissues, and the biomechanics associated with a flat foot type can lead to pain through the feet, ankles, knees, hips or even the lower back.

Not everyone who has flat feet will experience symptoms. But for some people, particularly those who enjoy an active lifestyle, having flat feet can be problematic and unnecessarily limiting.

There are a range of different treatment options for people with flat feet, one of which is orthotics. But while many of us have heard of orthotics before, you may be unsure of how orthotics can help with flat feet.

How do orthotics help with flat feet?

Orthotics optimise the position and alignment of the feet to improve posture, stability and foot function. In the case of flat feet, where the feet have a tendency to roll in, orthotics support the arch of the foot to reduce excessive weight-bearing forces on the inside of the feet. This promotes a more natural curve in the arches of the feet and reduces strain being placed on surrounding muscles, ligaments and tendons.

There are a few different types of orthotics available on the market, each offering varying levels of support. Total Contact Orthotics, which are custom-made to suit an individual’s foot, generally are the best orthotics for arch support and the best orthotics for fallen arches.

As the name implies, Total Contact Orthotics are designed to offer a high level of contact between the sole of the foot and the orthotic. This is best achieved through a process of conducting a comprehensive biomechanical assessment and taking a scan of the feet, following which the podiatrist writes a script so that orthotics are made in accordance with the podiatrist’s specifications.

Do I need orthotics for fallen arches or flat feet?

Not all flat feet will require orthotics, and depending on the cause of your symptoms, other treatment methods can also provide relief. For example, supportive footwear (with or without orthotics) and specific stretching and strengthening exercises, may assist to minimise symptoms associated with flat feet. However, many people with flat feet do experience improved comfort and symptom relief from orthotics for arch pain, heel pain, generalised foot pain, and pain in the ankles, knees and legs.  A full length pair of foot arch orthotics can be manufactured specifically for those individuals seeking additional support and comfort.

If you have a very low arch, we recommend custom foot orthotics. A customised low arch orthotic will ensure the appropriate amount of support, without irritating the foot, and provide an arch fill to create your perfect arch orthotics.  The amount of fill used when making an arch fill orthotic is a specific criteria that a podiatrist uses to determine how much support is given to the patient’s foot.

There are many studies which have shown how orthotics are beneficial for people with flat feet. For specific advice and individual assessment of your flat feet, make an appointment to see one of our podiatrists at Entire Podiatry. 123

Orthotics for high arches

A ‘high arched foot’ simply means that the foot’s arch is quite high creating a large area between the inside of the foot and the ground. Because there is less of your foot touching the ground, the pressure from bodyweight is spread over a smaller area. A study showed that a lot more pressure occurs under the ball and heel of the foot in a high arched foot and this pressure is significantly related to foot pain. 1 A high-arched foot is typically prone to injuries under the ball of the foot such as corns and callus, Morton’s neuroma, joint injuries and arthritis amongst others.

Orthotics for high arched feet can benefit the wearer in a number of ways.  Custom orthotics for high arches are typically preferred to an orthotic purchased off- the-shelf or a ‘non-custom’ orthotic. Studies have shown that the best outcomes are achieved when orthotics are made to match the exact profile of the foot.  When orthotics don’t conform to the arches very well then the patient will not have as much reduction in pain. The best orthotics for high arches will spread the pressure evenly across the foot, alleviating the high-pressure areas.

“Studies have shown that the best outcomes are achieved when orthotics are made to match the exact profile of the foot. When the orthotics don’t conform to the arches very well then the patient will not have as much reduction in pain” – Chris Hope, Podiatrist

People with high-arched feet often have difficulty absorbing shock and often experience pain or discomfort when running or walking long distances. At Entire Podiatry we offer running orthotics for high arches. These orthotics help the wearer to better absorb shock, provide cushioning and address certain biomechanical faults in order to optimise their running gait.

Some people with a high arched foot tend walk and stand with the pressure on the outside of their foot. This can predispose to ankle instability and ankle sprains. Orthotics can be designed to improve the way the foot functions to reduce the chance of injuries such as ankle sprains.

Orthotics for arthritis in feet

Orthotics can reduce the pain of arthritis by supporting and realigning the joints and may even slow down the progression of arthritic degeneration.

Orthotics for arthritis in the big toe and bunion pain

The big toe the most common joint in the foot to develop arthritis. Arthritis degrades the cartilage from the surface of the joints and this causes pain and inflammation. Bony spurs, known as osteophytes, also develop around the joint which causes the joint to become thickened and the movement to become restricted. Arthritis in the big toe may also exist with a bunion. A bunion or ‘hallux abductovalgus’ is a joint deformity where the big toe deviates towards the second toe and the joint becomes enlarged.

Arthritis and bunions at the big toe can have effects higher up the body. For example, with a painful arthritic big toe people often subconsciously walk on the outside of their feet to avoid moving the joint. Or they may overuse their ankles and knees to avoid bending the affected joint. Changing our walking gait to avoid pain is known as compensation, and it frequently leads to pain and overuse injuries elsewhere in the body.

Do orthotics help bunions?

It is important to note that once a bunion has developed then the only way of ‘fixing’ or ‘straightening’ the toe is through surgical correction. However there are other treatment options available to slow the rate of the bunion progression and to control the pain.

A pair of bunion orthotics may be beneficial in delaying the progression or reducing the onset of bunions or arthritis in the big toe. To ensure successful bunion treatment with orthotics, the patient’s whole foot must be considered. The best orthotics for bunions will be designed based on your individual biomechanics and taking into consideration the extent of your bunion and arthritis.

Foot orthotics for bunions can be designed in such a way to reduce the pressure on the painful joint by closely supporting the arch. Bunions often occur in those with flat feet, as the inside part of the foot at the big toe is overloaded. Orthotics for bunions and flat feet will support the arch and improve the function of the big toe.

Studies have shown that the bone just before the big toe, the first metatarsal, carries less pressure when it sits in a lower position compared to the rest of the metatarsals. If custom orthotics for bunions are designed and manufactured in a way that reduces pressure in the big toe joint this can help prevent arthritis in the big toe joint, hallux limitus, bunions and hammertoes. 1,2. Depending on the extent of the arthritis the orthotics can be designed in a way to reduce the movement at the big toe during walking to essentially immobilise the joint to provide pain relief.

Article citations:

1 Scherer P, Sanders J, Eldredge D, Duffy S, Lee R. Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait. Journal of the American Podiatric Medical Association. ;96(6):474-481.

2 Roukis TS, Scherer PR, Anderson CF. Position of the first ray and motion of the first metatarsophalangeal joint. J Am Podiatr Med Assoc 86:538-546, .

Midfoot arthritis orthotics and pain on the top of the foot

Midfoot arthritis affects the top of the foot between the front of the ankle and the toes. The midfoot is a less common location to experience arthritis but is still prevalent.  Midfoot arthritis often occurs secondary to an injury or trauma to this part of the foot, such as a fracture. Arthritis may also develop secondary to abnormally high stresses to this part of the foot. For example if you have a very high arch, a lot of stress and pressure is placed at this part of the foot. There is also evidence to suggest that longstanding high-heel use may also increase the risk of developing midfoot arthritis.

An orthotic may provide relief to suffers of midfoot arthritis by supporting the arch of the foot and stabilising the midfoot. This stabilisation reduces the forces going through the midfoot and effectively works to immobilise the midfoot reducing the pain.

A study in showed symptomatic improvement in patients with midfoot arthritis treated with an orthotic 1. Another study in showed wearing custom orthotics over 12 weeks provided some benefit in treating painful midfoot arthritis 2 . This suggests that an orthotic is a viable alternative in the conservative management of patients with midfoot arthritis.

Dorsal Compression Syndrome

Dorsal Midfoot Interossseus Compression Syndrome (DMICS) is a condition whereby the ligaments along the top of the foot (the dorsal foot) are inflamed. This causes pain across the top of the foot.

The company is the world’s best orthotic knee joint supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.

DMICS is caused by too much force through the joints along the top of the foot. Any factor that causes flattening of the arches of the feet can increase these compressive forces. For example, low heeled shoes, a tight Achilles tendon and increased body weight can all contribute to the development of DMICS.

Treatment for DMICS typically involves reducing the pain and inflammation through the use of ice and anti-inflammatories. Stretching and strengthening may also be prescribed to address any problems that may be present here.

Long-term management of DMICS is generally best achieved through the use of orthotics which support the entire length of the foot. By supporting the foot, the arch is lifted and stabilised which reduced the strain through the joints on the top of the foot.

Orthotics for knee arthritis

One third of the older adult population suffers from osteoarthritis of the knee. In an osteoarthritic knee, the cartilage that cushions and protects the bones wears away. A lack of cartilage causes the bones to essentially rub against each other, which is painful. The cartilage will wear away faster if there is a malalignment in the compartments of the knee. If there is more compression and pressure within a particular part of the joint there can be more deterioration.

This alignment can be addressed and minimised with the use of a foot orthotic 1,2. Correctly designed orthotics for knee osteoarthritis can change the position of the shin bone (the tibia) which can correct and alter the position of the knee to reduce the malalignment and reduce the pain. Evidence suggests that the earlier this orthotic intervention is begun the more effective it is.

Article citations:

1 Parkes M, Maricar N, Lunt M, LaValley M, Jones R, Segal N et al. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis. JAMA. ;310(7):722.

2 Raja K, Dewan N. Efficacy of Knee Braces and Foot Orthoses in Conservative Management of Knee Osteoarthritis. American Journal of Physical Medicine & Rehabilitation. ;90(3):247-262.

Orthotics for rheumatoid arthritis

Custom foot orthotics may be helpful for patients suffering from rheumatoid arthritis. Foot pain is very common in patients with rheumatoid arthritis, with over 85% of rheumatoid sufferers experiencing pain in the feet or ankles.

Rheumatoid arthritis causes the feet to undergo considerable changes including inflammation, swelling and changes to the bone and joint position. This leads to ‘foot deformities’ where painful prominences develop such as bunions, hammertoes, claw toes, joint erosions and even dislocations. These ‘deformities’ result in areas of increased pressure beneath the foot. These high-pressure areas can lead to further problems such as corns and callus formation and skin break-down leading to a foot ulcer.

The goal of custom foot orthotics for patients with rheumatoid arthritis is to support, cushion and accommodate any ‘foot deformities’ that may be present. This helps to relieve the pain, reduce the pressure and minimise further damage from pressure overload. Due to the inflammation of the structures beneath the rheumatic foot, patients often benefit from a soft cushioned material over the orthotic to improve comfort.

Rheumatoid arthritis can also affect the ankle joint and the subtalar joint. If the ankle and subtalar joints are arthritic it can affect the patients ‘biomechanics’. An arthritic subtalar or ankle joint can significantly alter the position of the ankle and the foot, and will change the way that the feet move and function. Subtalar arthritis orthotics can stabilise the foot and the ankle in order to reduce these deformities and improve pain and restore appropriate function.

Foot orthotics for cerebral palsy

Foot orthotics, or ankle-foot orthotics (AFO) may be beneficial to patients with cerebral palsy. Standard foot orthotics provide support from underneath the foot to assist in stabilising the arch and heel. A pair of ankle-foot orthotics are similar to a regular orthotic but extend higher up the ankle and leg to increase the stability and control higher up the body.

Ankle foot orthotics for cerebral palsy can assist the wearer in improving gross motor skills such as walking, running and jumping in a number of ways.

Cerebral palsy may present with joint deformities at the feet and ankles such as contracture of the Achilles tendon and other muscular imbalances. This can be accommodated for with a pair of ankle-foot orthoses. AFOs can assist in improving the alignment of the foot and ankle. This can optimise and encourage a more balanced muscle function.

Patients with cerebral palsy often have difficulty in ensuring their feet clear the ground when walking. This can lead to frequent trips and falls. AFOs assist in achieving better ground clearance as well as encouraging a more efficient gait pattern to stabilise the centre of gravity and reduce energy expenditure when walking.
Foot orthotics may also assist in improving balance by proving a stable base of support and increasing the sensory input.

Cerebral palsy orthotics are highly specialised and individualised and an appropriate assessment will be required to ensure an appropriate device is designed to optimise the patient’s function.

Orthotics and hip pain

There are many different causes of pain in the hip including arthritis, a muscle or ligament strain, tendonitis, bursitis, a fracture or a cartilage tear. Some of these conditions can develop due to misalignment of the hip. This misalignment may be the result of poor foot posture and its associated carry-on effects higher up the body.

Often, treatment of hip pain is most effective when the entire body is considered, including an assessment from the ground up to ensure a holistic approach, rather than addressing purely the inflamed or injured tissue. Figuring out how and why the hip has been overloaded will ensure the cause of the problem is addressed, rather than just the symptoms. For example, over-pronation which is excessive ‘rolling in’ or flattening of the feet causes an internal rotation of the tibia and leg, instability around the knee and altered position of the hip. This altered position of the hip may be a contributing cause of your hip pain.

If your foot posture is deemed to be contributing to the poor mechanics and alignment of your hip then a pair of orthotics can help your hip pain. Orthotics for hip pain will be individually designed in order to reduce the strain from the affected tissue.

Can orthotics cause hip pain?

A correctly designed pair of custom foot orthotics should not cause hip pain. A new pair of orthotics can take some time to get used to as the body adjusts to the new alignment and the joints and muscles begin to work in a different way. Whilst orthotics should ultimately improve structure and function in the long term, some people may experience some discomfort during the first days or weeks of wear. If this occurs it is important that you speak to your podiatrist.

If you are wearing a pair of orthotics that are not customised, for example a pair purchased from a store or a chemist or orthotics that were not designed for you, then there is a possibility that they are not working in the correct way and they could potentially be causing pain higher up the body.

Hip pain and leg length discrepancy

A common cause of hip and lower back pain is a leg length discrepancy. This means that one leg is shorter or longer than the other.

This can be a condition that one is born with where the bones are different lengths. Or it can be the result of asymmetrical muscle tightness or strength around the gluteals, hips and lower back. This can pull and misalign the lower back, pelvis or hips causing one leg to function as a longer/shorter leg. It’s not uncommon for a leg length difference to occur after surgery, for example following a hip or knee replacement.

A leg length difference can cause uneven loading of the joints and facets of the hips, knees and lower back which can create pain and can increase the likelihood of arthritis developing. A leg length difference often changes the way that you walk and move so the body must then ‘compensate’ i.e. find a different (and often less effective) way of moving, and this compensation is often the cause of the pain.

A CT scanogram can reveal the exact length of the legs to determine the precise difference in length. Often, a professional is able to assess this without the use of CT scans, simply by measuring the legs and assessing the position of the hips and pelvis.

If your pain is deemed to be resulting from a leg length difference then foot insoles, either in the form of orthotics or a raise added to the shoes can be very beneficial to ‘balance out’ this leg difference. This, in turn, can encourage a better walking and movement pattern and can prevent any abnormal compensation by the body which is often the source of pain.

There has not been much evidence published about the use of orthotics to treat hip pain. However, at Entire Podiatry, we have found from clinical experience that many patients do respond very well to orthotics to treat hip pain.

Can orthotics help with back pain?

Lower back pain can be the result of poor alignment throughout the body. It is not uncommon to find that people who experience back pain also have abnormal gait or foot asymmetry. Abnormal biomechanics of the feet can lead to pain in other parts of the body, including the knees, hips and lower back.

For example, if your feet roll in excessively (flat feet) or if there is asymmetry between your right and left feet, then these factors can affect your posture and contribute to back pain. Back pain can also be associated with a Leg Length Discrepancy (LLD) where one leg is shorter than the other. A leg length discrepancy can change the position and alignment of the lower back and the hips and can change the way that the muscles and joints work and move. This is often a cause of lower back pain.

How do orthotics work for lower back pain?

In some cases, a pair of orthotics can help to realign the feet and legs, which can help to reduce the pain in the lower back.

“A more recent study found that those participants wearing custom-made orthotics had twice the improvement in lower back pain and for twice as long compared with the subjects using traditional lower-back pain treatments”

A podiatrist will be able to assess your foot function to determine whether your feet may be contributing to your back pain. This will involve an initial examination including history of symptoms, biomechanical assessment and gait evaluation. In order to confirm whether your foot function is contributing to back pain, we may use temporary measures (such as taping or temporary full length raises) to test whether this helps to reduce your back pain.

Following an assessment, if your podiatrist does not think your back pain is related to foot function then we will endeavour to refer you to another health care professional who will be able to assist further with your specific problem.

If your foot function is deemed to be playing a role in your back pain, then your podiatrist can offer treatment to correct the biomechanical function of your feet and legs. In many cases of back pain associated with foot function, custom foot orthotics is the most effective treatment to improve foot function. Orthotics for back pain are designed to limit any excessive motion of the feet, and to improve symmetry between the left and right feet.

The best orthotics for back pain are custom orthotics because they are designed to fit your feet exactly and are designed in a specific way to improve your alignment and function.

Multiple research studies have shown that custom foot orthotics are useful in the treatment of lower back pain. A study in found that patients with chronic lower back pain who wore custom foot orthotics had a greater improvement in their outcomes compared to those who did not wear custom foot orthotics 1. A more recent study found that those participants wearing custom-made orthotics had a twice the improvement in lower back pain and for twice as long compared with the subjects using traditional lower-back pain treatments 2.

Article citation:

1 Dananberg H, Guiliano M. Chronic low-back pain and its response to custom-made foot orthoses. Journal of the American Podiatric Medical Association. ;89(3):109-117.

2 Ferrari R. Effect of Customized Foot Orthotics in Addition to Usual Care for the Management of Chronic Low Back Pain Following Work-Related Low Back Injury. Journal of Manipulative and Physiological Therapeutics. ;36(6):359-363.

How can orthotics help with knee pain?

There are many different causes of knee pain and often the pain can be treated with a pair of foot orthotics for knee pain relief. The way that your foot functions can have a carry-on effect higher up the body and can affect your knees, hips and lower back.

Try this simple experiment to see the impact of foot position on your knees:

• Stand with your shoes off and feet flat on the ground. Notice the position of your knees.
• Roll your feet outward so that you are standing on the outside of your feet. Notice that your knees move outwards when you stand on the outside of your feet.
• Then try rolling your feet in. Notice that your knees tend to face inward again.

If your feet naturally tend to roll in or out too much, this places increased stress on the knee and can cause knee pain. People with high arched feet may also have knee pain, due to the feet not absorbing shock very well during gait.

Foot orthotics for knee pain work by controlling and improving your foot function which in turn improves the position and function of the knee.

Orthotics for medial knee osteoarthritis (OA)

Knee OA is a very prevalent condition and affects one third of the older adult population. There are many contributing factors to the development of OA in the knee including obesity, previous knee injury, working in a job that involves lots of bending and carrying.

OA may affect anywhere in the knee but the medial (inside) compartment is more common. This is because there are more compressive forces within the medial (inside) compartment of the knee than the lateral (outside) compartment. The excessive force causes wear down and thinning of the cartilage which sits between the bones to protect and cushion them. This is the effect of degenerative OA where the joints are no longer protected by cartilage and the knee joint is ‘bone on bone’.

There is evidence demonstrating positive effects of orthotics for medial knee pain1. A pair of orthotics can be designed in such a way to reduce compression in the inner knee, better aligning the joint spaces, evening out the loading and reducing the pain.

“A pair of orthotics can be designed in such a way to reduce compression in the inner knee, better aligning the joint spaces, evening out the loading and reducing the pain” – Chris Hope, Podiatrist

Studies have shown that using custom orthotics can decrease discomfort and stress in the medial compartment of the knee. A study in looked at 30 subjects with medial knee osteoarthritis.  The subjects were given custom foot orthotics with a 5 degree lateral wedge for a 6 week period.  The study found that patients with mild to moderate medial osteoarthritis had some pain relief and 28 out of 30 patients found the orthotics were comfortable. 2 

These orthotics are specialised, and standard foot orthotics can make knee pain worse. Entire Podiatry are specialists in designing orthotics for patients with medial knee arthritis. It is important that whoever makes your orthotics is a specialist in biomechanics and orthotic therapy. The orthotics must be designed only after the podiatrist has conducted a thorough ‘biomechanical’ assessment of your feet and knees as well as a gait analysis. This is why custom foot orthotics are generally the best orthotics for knee pain.

Article citations:

1 Parkes M, Maricar N, Lunt M, LaValley M, Jones R, Segal N et al. Lateral Wedge Insoles as a Conservative Treatment for Pain in Patients With Medial Knee Osteoarthritis. .

2 Rubin R, Menz H. Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis. Journal of the American Podiatric Medical Association. ;95(4):347-352.

Orthotics for Runner’s Knee (Patellofemoral Pain Syndrome)

The term Runner’s Knee is a broad term used to describe pain typically felt around the front of the knee and the kneecap when running.

Runner’s knee can encompass many different diagnoses, however a common cause of runner’s knee is a condition known as Patellofemoral Pain Syndrome (PFPS). PFPS is a term used to classify pain in the front of the knee and behind the patella that occurs during activities which places force through the knee.

Risk Factors that can predispose an individual to PFPS include

• Large body weight
• Incorrect footwear
• Running and jumping activities, especially on hard surfaces
• Tight muscles around the knees and hips
• Imbalance of muscle strength of the inside and outside quadriceps muscles around the knee.
  Your biomechanics: E.g. the way that your feet and legs move and work.
  • Internal rotation of the femur/thigh. This can be referred to as a ‘squinting patella’ where the kneecaps are facing slightly inwards when standing and walking.
  • Valgus position of the knee. Can also be seen as an inward collapse of the knee when standing or walking or ‘knocked-knees’
  • Pronated or a ‘flat foot’. A pronated or a ‘rolled in’ foot causes the shinbone, the tibia, to rotate inwards which can pace excessive stress at the knee.

These biomechanical factors can be controlled with a pair of custom foot orthotics. For example, if over-pronation is deemed to be a risk factor for the development of your PFPS then a pair of custom foot orthoses may be beneficial for your knee pain. Orthotics that are designed to prevent excessive pronation have been found to reduce pain in PFPS. A recent study found significantly greater improvements from those participants wearing orthoses compared to those without orthotics.

A study in looked at 16 patients with patellofemoral pain syndrome, who also had flat feet, and they compared the quality of life before and after wearing orthotics. There was significant improvement of patellofemoral pain with the use of custom fitted orthotics 1.

Article citation:

1 Johnston L. Effects of Foot Orthoses on Quality of Life for Individuals With Patellofemoral Pain Syndrome. Journal of Orthopaedic and Sports Physical Therapy. .

Orthotics to prevent ACL injury

The ACL, or the anterior cruciate ligament is a very important ligament responsible for holding the knee in a stable position. The ACL is very prone to injury, especially in high impact and jumping sports that involve frequent change in direction such as basketball, netball, rugby, soccer and downhill skiing. A severe injury to the ACL often requires surgery and can be career ending for high-level athletes. Therefore, prevention of this type of injury is paramount.

A study published in looked at the effect of foot orthotics in knee injuries in female basketball players 1. The study found that the group of athletes who did not wear foot orthotics were 1.7 times more likely to sustain an injury to their collateral ligament and 7.14 times more likely to sustain an injury to their ACL compared to the group wearing foot orthotics.

“The study found that the group of athletes who did not wear foot orthotics were 1.7 times more likely to sustain an injury to their collateral ligament and 7.14 times more likely to sustain an injury to their ACL compared to the group wearing foot orthotics.”

At Entire Podiatry, we are experts in all types of orthotic design and prescription and we understand the demands that different sports have on the body and how to correctly consider this when designing a pair of foot orthotics.

Article citation:

1 Jenkins W, Raedeke S, Williams D. The Relationship Between the Use of Foot Orthoses and Knee Ligament Injury in Female Collegiate Basketball Players. Journal of the American Podiatric Medical Association. ;98(3):207-211.

Orthotics for knock-knees

Knock knees, also known as genu valgum is a condition of the legs and knees whereby there is excessive inwards bending of the knees. When standing, a person with knock knees will have a wider gap between their feet and their knees will be closer together. It is a common presentation in children under the age of 4, and most kids should grow out of this. However if knock-knees are present into adulthood then treatment may be required. The goal of treatment is not usually to ‘straighten’ the legs and knees but rather to improve the way the forces go through the knee to reduce injury and pain.

Pronated or ‘flat feet’ can contribute to knock-knees and may worsen the condition. A pair of foot orthotics can help to improve the posture and alignment of the feet, which can improve the position of the shinbone and reduce strain from the knees. The best orthotics for knock knees are a pair which are designed after conducting a thorough assessment and gait analysis by someone with an understanding of biomechanics and how the orthotic design will affect the not only the knee but the feet, ankles and hips as well.

Orthotics for bowed legs

Bow-legs is a condition where the legs appear ‘bowed’. This means that when standing there is a wider distance between the knees and the shins than there is at the feet.

People often want to know, can orthotics help with bow legs? The answer to that will depend on a few things:

The age at which the bowed-legs are appearing is important. For example, it is normal for young infants to have bowed-legs until the age of two. If the legs are remaining bowed after this age then we recommend your child is assessed by a paediatric professional as tibial bowing can also be a sign of other more serious, although thankfully rare, conditions such as:

• Blount’s disease
• Rickets
• Paget’s disease
• Fractures or bone injury
• Poisoning

In the adult population, the goal of foot orthotics for bow legs is not to “straighten” the legs and knees but rather to assist in reducing pain and improving function. Bowlegs can cause pain in the hip, knees and ankles due to the incorrect alignment of the tibia. Knee arthritis is very common in patients with bowlegs as there is more force going through the inner compartment of the knee. Knee arthritis can be a debilitating condition and this deformity can bring the onset of knee OA much earlier in life.

Bow-legs can also lead to instability around the ankles which can cause frequent ankle sprains.

Orthotics can assist in improving the alignment and forces going through the legs by improving and supporting the position of the foot. The effects of this can indirectly improve the alignment and pain further up the body to the ankles, legs, knees and hips.

Orthotics for ankle instability/ankle sprains

Some people are susceptible to recurrent ankle sprains. This is known as chronic ankle instability. This may be due to:

• Hypermobility or excessive flexibility of the joints in the foot
• A ‘cavus’ or high arched foot
• Following a previous ankle injury. An injury may weaken the ligaments and tendons that support and stabilise the ankle joint.

Following an ankle sprain, pain and swelling can remain around the outside of the ankle and the outside of the foot. Orthotics, specifically lateral heel wedge orthotics, can be a very useful way to support the foot and reduce the chance of more ankle sprains as well as allowing healing of injuries.

A study in found an increase in ankle stability from wearing custom orthotics1. Correctly prescribed orthotics should:

• Increase sensory input from the bottom of the foot. This allows your brain to better understand the position of your foot.
• Reduce the strain from the muscles and tendons that support the ankle
• Improve the range of motion available at the ankle.

A common biomechanical presentation is a ‘cavus’ or high arched foot. In this foot the pressure is carried more on the outside of the foot. This causes the muscles, tendons and ligaments on the outside of the leg to be overused. This overuse often leads to injury and tendinopathy. Orthotics for lateral foot pain are designed to reduce the strain on these muscles and tendons on the outside of the foot. These have become known as lateral column overload orthotics. These orthotics will spread the pressure evenly across the whole foot, reducing the chance of ankle sprains and injuring the structures on the outside of the foot, ankle and leg.

If you have injured just the one ankle, we still recommend a pair of bilateral orthotics i.e. orthotics for both feet to ensure your biomechanics are corrected and addressed on both sides of your body.

Article citation:

1 Richie D. Effects of Foot Orthoses on Patients with Chronic Ankle Instability. Journal of the American Podiatric Medical Association. ;97(1):19-30.

Orthotics for ball of foot pain

Pain in the ball of the foot is a common presentation to podiatrists. The ball of the foot is a complex area with many different tissues that can get injured.

Orthotics are a fantastic way to address your forefoot pain. A pair of custom foot orthotics allow the podiatrist the design the orthotics in a very individualised way to address your forefoot pain. Research has shown that orthotics with good arch support and contour reduces the pressure that is carried beneath the ball of the foot, which can reduce the chance of injury occurring here1.

Ball of foot orthotics typically tend to be quite cushioned and have good arch support to spread the pressure evenly across the foot. Depending on the particular diagnoses of your forefoot pain, the part of the orthotic under the ball of your foot will be customised to address this. For example orthotics for neuroma pain will typically include a metatarsal dome. This is a small circular area of support that sits under the ball of your foot to support and lift the arch that runs across the front of your foot to open up the spaces between the bones to prevent this neuroma from being pinched and irritated. A study in showed that custom foot orthotics provided a reduction in pain for Morton’s neuroma in 63% of patients 2.

Foot orthotics for plantar fasciitis

Plantar fasciitis is a common condition that causes pain beneath the heel or the arch of the foot. The plantar fascia is the name given to the main ligament under our foot which essentially creates our arch. When this ligament is over-worked then it starts to become painful either along the body of the ligament or where it attaches to the heel bone.

Plantar fasciitis usually develops because there is more strain going through the ligament than it can tolerate. There are many different treatment options available for plantar fasciitis.

One of the most effective treatments is a pair of foot orthotics, or sole orthotics for plantar fasciitis.

Do orthotics work for plantar fasciitis?

Yes. Studies have shown that orthotics, reduce pain and improve function in adults with plantar fasciitis with few risks or side effects 1,2,3. Used alone or in addition to conventional therapy (anti-inflammatory medication, stretching and strengthening, footwear modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function1,2,3.

There is no one single ‘cure’ for plantar fasciitis, rather the most effective treatment comes from the combination of changes to footwear, rest, specific exercises and stretches and adequate arch support.

There are a number of different ways that you can support your arch, including changing to more supportive footwear, strapping your foot, purchasing over the counter orthotics for plantar fasciitis or custom orthotics for plantar fasciitis from a podiatrist. Generally, customised innersoles provide the most accurate and appropriate amount of support for your foot.

For example if you are considering a pair of orthotics for high arches and plantar fasciitis you are likely to find that there you are unable to get enough arch support from an off-the-shelf device as your arch is too high for this standard fit. In this case, we recommend you consider a customised device that will provide you with sufficient arch support.

Running is an activity that puts a lot of stress through the plantar fascia, this is why plantar fasciitis is a common presentation in runners. It is important that runners see a podiatrist for an assessment of their running shoes, as this may be contributing to the overload of the fascia. Once it is known that the running shoes are appropriate then it may be a good idea to include running orthotics for plantar fasciitis into the treatment plan. Orthotics help to support the foot and the plantar fasciitis to allow the ligament to heal up correctly and to reduce the chance of this problem occurring again.

“It is important that runners see a podiatrist for an assessment of their running shoes, as this may be contributing to the overload of the fascia” – Chris Hope, Podiatrist

In recent times there has been a significant improvement to the range of the orthotic material available, in the past there was only rigid orthotics for plantar fasciitis. However, now there is a range of other material options available. This often begs the question hard or soft orthotics for plantar fasciitis? The answer to this will depend of a number of things that your podiatrist will help you to consider and understand including:

• The activity you will be doing in the orthotics
• The footwear you will be wearing the orthotics with
• Your body weight
• Your clinical presentation
• The shape and ‘type’ of your foot
• How long you expect the orthotics to last for
• Your preferences

It is important to note that hard orthotics for plantar fasciitis will usually come with a soft and cushioned protective cover over the top of the device so there will still be a soft feel under the foot.

Where to buy orthotics for plantar fasciitis?

Non-customised or off-the-shelf orthotics can be purchased from a number of different sport stores, supermarkets or chemists. However, if you want to give your feet the best chance at recovering we strongly recommend that you make an appointment with one of our podiatrists at Entire Podiatry.

Plantar fasciitis is one of the most common foot conditions we treat.

Over the past 20 years, Entire Podiatry has helped thousands of people recover from heel pain and plantar fasciitis.

We will assess your pain, develop a clear diagnosis, provide you with a range of tailored treatment options and can happily assist you with a pair of foot orthotics should this be appropriate. Contact us today for a confidential discussion. 

Article citations:

1 Lewis R, Wright P, McCarthy L. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis. J Okla State Med Assoc. Dec; 108(12): 596–598.

2 Drake M, Bittenbender C, Boyles R. The Short-Term Effects of Treating Plantar Fasciitis With a Temporary Custom Foot Orthosis and Stretching. Journal of Orthopaedic & Sports Physical Therapy. ;41(4):221-231.

3 Whittaker G, Munteanu S, Menz H, Tan J, Rabusin C, Landorf K. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. British Journal of Sports Medicine. ;52(5):322-328.

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