Insoles and Orthotics for Foot and Heel Pain

What an insole can do

Insoles can:

• Cushion the heel and forefoot, reducing impact, which helps thin, tender soles.
• Support the arch, helping flat or high-arched feet to carry weight more evenly.
• Redistribute pressure, moving load away from a painful spot, such as a corn, a callus or a sore metatarsal head.
• Stabilise the heel, with a heel cup, reducing wobble and strain on the heel and Achilles tendon.
• Improve comfort and endurance, so a person can walk further with less pain.
• Change the way the foot moves, which may reduce strain on the ankle, knee and hip in some people.

Insoles do not repair worn joints, heal a torn tendon or replace good footwear and strengthening. Evidence for pain relief is stronger in some conditions, such as plantar heel pain and some arch problems, and weaker in others; response varies from person to person. A cheap insole in a bad shoe may do little. See choosing shoes for older feet.

Common reasons for foot pain in older adults

• Plantar fasciitis and heel pain, with stabbing pain under the heel on the first steps in the morning; see heel pain and plantar fasciitis after 60.
• Flat feet or fallen arches, with ache along the arch and inner ankle.
• High arches, with pain under the heel and ball of the foot.
• Forefoot pain (metatarsalgia), burning or bruised feeling under the ball of the foot.
• Bunions, hammer toes and corns; see bunion correctors: what they can and cannot do.
• Arthritis in foot and ankle joints.
• Thinning fat pad, with pain on hard floors.
• Neuropathy, with numbness, burning or tingling; see neuropathy foot care.
• Achilles tendon pain.
• Gout of the big toe; see gout in older adults.
• Stress fractures, more likely in osteoporosis, with pain on weight bearing that does not settle.
• Poor circulation, with leg and foot pain on walking.

Pain that is severe, sudden, in one foot with swelling, redness or heat, or with numbness needs a doctor, not an insole.

Types of insoles

Soft cushioning insoles (foam, gel, sorbothane). Provide shock absorption and comfort for sore, thin soles. Good for general fatigue and mild forefoot or heel pain. They add little support to the arch.

Arch supports. Firm or semi-firm inserts shaped to the arch, made from plastic, foam or cork. For flat feet, fallen arches and plantar fascia strain.

Heel cups and heel cushions. Small inserts under the heel for heel pain, with a raised rim to hold the fat pad. Easy to try, and can fit in many shoes.

Metatarsal pads and domes. Small pads placed behind the ball of the foot to offload sore metatarsal heads.

Full-length semi-rigid orthotic insoles. A firmer base with a cushioned top layer, often sold as "orthotic insoles", which support the arch and control foot motion.

Heel lifts. A raised pad to ease Achilles or heel strain, or to even out a small leg length difference; use only with advice, since lifts can change balance.

Diabetic insoles. Soft, multi-density, seamless insoles designed to reduce pressure, used with proper shoes; usually prescribed by a podiatrist.

Custom-made orthoses. Made from a mould or scan of your foot by a podiatrist or orthotist, tailored to the foot's shape and condition. They are best for complex deformity, diabetes with foot risk, or when ready-made inserts have failed. They are more costly but more specific.

Heat-moulded insoles. Some ready-made insoles can be warmed and moulded to the foot, a middle path between off-the-shelf and custom.

Copper or magnetic insoles. Marketed with special claims; evidence of added benefit is poor.

Choosing an insole

1. Know the problem. Get a diagnosis if pain is new or persistent. 2. Match type to problem. Cushioning for sore soles; arch support for flat feet; heel cup for heel pain; metatarsal pad for forefoot pain. 3. Check your shoes first. An insole needs space. A shoe that is already tight cannot take one without crowding the toes. Removable factory insoles can be replaced. Shoes with a deep heel, a roomy toe box and a firm heel counter work best; see walking aids and footwear. 4. Size. Most insoles are full-length and can be trimmed to size by following the outline of the shoe's own insole. Three-quarter-length insoles end behind the toes and suit tight shoes. 5. Materials. Breathable, moisture-wicking topcovers help in warm climates. Look for materials that rebound and do not flatten quickly. 6. Firmness. Very soft insoles can flatten and give little support; very firm insoles can be uncomfortable for sensitive feet. Start with medium. 7. Try them. Walk around in the shop with your shoes if possible, and look for a seller that allows returns; see equipment returns, warranty and servicing. 8. One pair per shoe. Buy more than one pair if you wear several shoes.

Fitting and breaking in

• Remove the shoe's own insole if it is removable, and use it as a template to trim the new one, cutting a little at a time.
• Place the insole flat, with the heel seated firmly in the back of the shoe, and no wrinkles or curled edges.
• Break in gradually. Wear them for one to two hours the first day and increase over a week or two. Mild aching as the foot adapts is common; sharp pain, blisters or numbness mean stop and seek advice.
• Check the fit of the shoe with the insole; the heel should not slip, and the toes should not touch the front.
• Check your feet after wearing, especially if you have reduced feeling, for redness, rubbing and blisters.
• Wear with socks that are smooth and cotton-rich, without thick seams.
• Do not share insoles.

Cautions

• Diabetes and numb feet. Insoles that press unevenly or rub can cause ulcers. Use only on advice from a podiatrist or doctor; see diabetic foot care at home.
• Poor circulation or a history of foot ulcers.
• Swollen feet. Shoes plus insoles may be too tight; see swollen legs in older adults.
• Fragile skin or skin disease.
• Balance problems. Thick insoles and lifts can change balance and raise falls risk; see balance exercises for seniors.
• Heel lifts and lifts for leg length difference only with professional advice.
• Pain that is worse with the insole, or causes new knee, hip or back pain; stop and review.
• Hot, red, swollen toe or foot: see a doctor.

Looking after insoles

• Remove and air them each night, since sweat and humidity promote odour and fungus.
• Wipe with a damp cloth and mild soap; air dry away from heat and direct sun.
• Replace when the cushioning flattens, the cover wears or cracks, or pain returns. Many last three to twelve months with daily use. Custom orthoses last longer, but should be reviewed.
• Keep feet clean and dry, and treat athlete's foot early; see skin conditions in older adults.

Other measures for foot pain

• Supportive footwear with cushioned soles, wide toe box and a firm heel.
• Calf and foot stretches, as taught by a physiotherapist or podiatrist.
• Strengthening foot muscles, such as towel scrunches and toe lifts.
• Weight management to reduce load.
• Rest and ice in flare-ups, wrapped in cloth; see heat or cold for joint pain.
• Foot massage, with caution; see foot massagers guide.
• A stick for stability; see how to choose a walking stick.
• Pain medicines as advised by a doctor or pharmacist; see painkillers and older adults.
• Walking on soft surfaces where possible, not barefoot on marble.
• Footwear at home: avoid going barefoot on hard floors; wear soft, supportive slippers with a grip.

When to ask a professional

See a podiatrist for persistent foot pain, heel pain, corns and callus, deformities, diabetes, and for custom orthoses. See a doctor for sudden, severe or one-sided foot pain, redness, heat, swelling, wounds, numbness, colour changes, or pain after a fall. A physiotherapist can assess walking and teach exercises. An orthotist can make custom devices. Seek urgent care for a cold, pale or blue foot, severe pain or signs of infection such as spreading redness or fever.