How do I obtain lateral subtalar insole wedges?

How to Obtain Lateral Subtalar Insole Wedges

Lateral wedged insoles are available off-the-shelf from multiple vendors, can be formed in-office, or incorporated into custom-molded insoles, with the most effective versions including subtalar strapping for enhanced biomechanical correction. 1

Acquisition Methods

Off-the-Shelf Options

• Purchase ready-made lateral wedged insoles from various commercial vendors that specialize in orthotic devices 1
• These are immediately available without prescription requirements in most cases 1

In-Office Fabrication

• Clinicians can form lateral wedged insoles directly in the office setting using appropriate materials and molding techniques 1
• This allows for immediate fitting and customization to patient needs 1

Custom-Molded Insoles

• Work with an orthotist or podiatrist to incorporate lateral wedging into custom-molded insoles with additional supportive features 1
• This approach is particularly useful when patients require multiple corrective features beyond simple wedging 1

Optimal Specifications Based on Evidence

Wedge Configuration

• Select full-length wedged insoles rather than heel-only or two-thirds length versions, as full-length designs demonstrate more consistent biomechanical effects in reducing knee loading 1
• Choose wedge heights between 8-12 mm elevation for optimal balance of effectiveness and tolerability 1
• Avoid 16-mm thick wedges, as more than 40% of patients report worsening symptoms at this height 1, 2

Critical Enhancement: Subtalar Strapping

• Strongly prioritize insoles with elastic subtalar strapping, as this design significantly outperforms conventional lateral wedges alone 3, 4, 5
• Subtalar strapping reduces peak knee varus moment by 13% compared to only 8% with conventional wedges 4
• This design corrects femorotibial angle by an average of 3.1° versus only 0.4° without strapping 5
• Patients with moderate knee OA (Kellgren-Lawrence grades 2-3) show significantly better outcomes with strapping versus conventional wedges 4

Material Considerations

• Available materials include rubber, cork, and foam, each with different compressibility and durability characteristics 1
• Silicon rubber with 10mm elevation combined with subtalar strapping has demonstrated superior biomechanical effects 4
• Consider anti-pronatory support features to reduce excessive ankle eversion and improve comfort 6

Important Clinical Caveats

Patient Selection Factors

• Avoid prescribing lateral wedges to patients with excessive subtalar joint valgus angle, as they receive no analgesic or functional benefit 1
• Not appropriate for tri-compartmental knee OA—only effective for medial compartment disease 1
• Some patients paradoxically experience increased knee loading with lateral wedges due to biomechanical variability 1

Adverse Effects to Monitor

• Do not add ankle strapping to lateral wedges, as this increases adverse effects including popliteal pain, low back pain, and plantar foot pain 1
• Higher tilt angles (10° vs 5°) produce greater realignment but significantly reduced tolerability due to pain 1
• The 12-mm elevation provides better remission scores than 16-mm elevation while maintaining tolerability 2

Expected Outcomes

• Lateral wedged insoles may reduce oral analgesic use at 6 months and 2 years despite lack of improvement in self-reported pain scores 1
• Effects are most pronounced in mild to moderate medial compartment OA, with diminishing returns in severe disease 1
• Biomechanical benefits appear within 1-3 months of consistent use 1