I’m doing a Foot Workshop this Sunday and every time I do a foot workshop I get this question: “What’s your take on orthotics?”
The answer always is: “it depends.” It depends on what the orthotic was prescribed for of course, but it also depends on what your goals and priorities are. For example, if I told you to fix a fallen or collapsed arch caused by excessive pronation, or perhaps relieve a plantar fasciitis issue, you would need to:
- change your shoe selection to a shoe with no heel or less heel than you currently wear and more room for the toes
- work on mobilizing the joints in your feet using tools such as various sizes of balls, cobblestone mats, non-level and uneven ground surfaces
- go shoeless when possible inside and out to develop callouses and revive the proprioceptors and sensory nerves on the soles of your feet
- work on strengthening the intrinsic musculature of your feet and toes
- change your gait (walking pattern)
- walk far more than you currently do, working up to a 5 mile walk several x a week
- work on internally rotating your shank to get your feet back in line
- change the way you organize your centre of mass (pelvis) and how far apart you keep your feet
- change the direction your feet are pointing when you are walking
- work at increasing the mass (literally the # of units that make up a muscle) in the calf group using tools such as half domes
- externally rotate the hips to get the knee and ankle and foot joints back in alignment
- work on muscles all around the hips to increase balance and take excess work from ankles
- restore hip extension
- sit less/move more
and if you did all that, in about one or two years you might have stronger arches and better feet, would you be willing to take that on? If someone could promise you pain free feet in moments just by putting an orthotic in your shoe, doesn’t that sound like a much easier, much faster choice?
Of course I understand why someone would choose an orthotic over such a long and daunting list of chores. So let me try to convince you otherwise
Putting a platform under the foot that is unchanging will over time create a weaker foot, not a stronger one. What happens when you put a cast on an arm or leg, and hold the limb in one unchanging position for a spell? The muscles don’t have to do any work to hold a position or (in the case of feet) adapt to a changing surface and thus, they atrophy. Feet were meant to have many potential joint movements to adapt to various surfaces, and providing only one unchanging surface means none of the joints of the feet (there are 33) have to do much when you are standing on your orthotic. Most people move their orthotic from shoe to shoe, so the surface that the foot experiences virtually never changes.
There is no bone in the foot that is arch shaped – the arches are created by the muscles and ligaments, so taking work away from them will mean the foot is likely to weaken progressively over time. You may find that an orthotic “stops working” and you need succe$$ive orthotics to deal with a problem that is not resolved.
Placing an orthotic under your foot might help the positioning of the knee and hip, relieving knee and hip pain in the short term, but as we have learned, when we remove the orthotic and walk around the house, the feet are weaker and the knee and hip are not really any different (and may in fact be worse due to a less supportive foot). Using an external device to prop the leg into better alignment only works when the device is in place. Any real change in the knees and hips must be addressed as a separate issue that is contributing or caused by foot issues.
Here’s what I tell people who ask me if they should be wearing an orthotic, and I think this is a good compromise:
If foot pain is affecting your ability to move and walk, by all means use an orthotic so that you can get some movement into your day. But then do whatever work you need to do to NOT NEED that orthotic!
I think the same advice is good for things like nutritional supplements and prescription drugs too, but that’s another post.
If you want to learn the steps to take to have strong healthy pain free feet, consider joining us this Sunday at Yuri’s Village, 663 Greenwood at Danforth 12:30-2:30. Email me to reserve a spot.