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Identify the Cause continued...

Even if the patient's foot has some biomechanical abnormalities, it could be the ground surface or the patient's shoes that are actually causing the problem.

"One fellow ran a marathon on a crowned highway, so one foot was turning in for 26 miles," Olson says. "To make orthotics for that person would be a mistake. I told him why he was injured and to avoid circumstances like that."

Worn-out shoes can cause similar trouble. Most people don't wear down their shoes perfectly evenly. As times goes on, the uneven wear causes the whole foot to tilt, and could lead to an injury.

Making Corrections

Once podiatrists rule out other causes, they can then focus on correcting the athlete's biomechanical makeup. To do that, they often suggest specific shoes that can help control some of the causes of the abnormal biomechanical function.

A committee of the American Academy of Podiatric Sports Medicine evaluates shoes and maintains an online list of the best ones for different sports at

Over-the-counter arch supports can also help. But when the standard sizes don't work, Olson prescribes custom orthotics to correct the athlete's specific biomechanical deficits.

Custom Orthotics

To design an orthotic insole, the podiatrist takes an impression of a person's feet and makes models of them, which the podiatrist then alters to counteract any problems the person is having.

Orthotics can be made from a hard material such as graphite or a softer, rubber-like material. The choice of materials is an economic decision, not a medical decision, Olson says. Harder orthotics last longer, but are more expensive. The total cost can range from $300 to $500.

Spending the money could make a big difference in the game, says orthopedic surgeon James Garrick, M.D., Orthopedic Consultant for the San Francisco Giants and Director of the Center for Sports Medicine at Saint Francis Memorial Hospital in San Francisco.

"There's no question in my mind that in some cases, custom-made orthotics can make a big difference and even cure some problems," Garrick says.

But only if you really need it, says sports podiatrist Perry Julien, D.P.M. -- the Atlanta sports podiatrist who coordinated the podiatry services for the 1996 Summer Olympics. "It's the single most promising treatment I can offer patients," Julien says. But he adds, "I don't need to offer it to every patient."

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