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Orthotics: Good or Bad?

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.

For a great start on foot positioning and strengthening, check out this course. It’s specifically for bunions but if everyone did it, no one would have bunions right? It’s a good all purpose foot strengthening course!

 

Comments

7 thoughts on “Orthotics: Good or Bad?

  • Hi before I read this I was gonna ask you A few things below to tell my story but now no you make sense of it, lol, l live in the uk, my orthotics are wearing out again hence why I tried to find some more info on the Internet of always been a bit sceptical myself so I’m asking you is there any techniques I can do? if I do throw my orthotics out 🙂 or is it too late for me ? now because I’ve been wearing them five years maybe

    Hi
    I come across your website by typing in orthotics in Google hope you can help I have specially made Orthotics i’ve had them about 4 to 5 years now they do work I don’t get as much pain every 1-2 years depends I have to have them refurbished I can just feel when they need refurbishing because I start to feel a bit of pain from the ankle then then works on to the hip later. but do I really need them is there other alternative I can do I’m told by a physiotherapist that he can fix this. I’m not sure he basically says Orthotics just prop you up they don’t solve the underlying problem, I suppose it makes sense but Is he just saying that to get money out of me ;( The reason I asked you this now and look on the Internet for advice is because my orthotics need refurbishing again hope you can help

    Thanks

    Daley

  • Hi Daley, thanks for your comment. I suggest the book “Every Woman’s Guide to Foot Pain Relief” by Katy Bowman. Despite the title, it’s good for every foot owner, not just women. It will give you lots of foot exercises to start to strengthen your feet. Most orthotics are for holding up the arch, but you can strengthen these muscles over time. If your orthotics are for something more serious I would defer to your health care provider, but you are the best judge of what’s best for you! Good luck.

  • hAVE SEVERE FEET PAIN.hAD NUEROMAS REMOVED FROM LEFT FOOT 15 YEARS AGO NOW THE PAIN ON THE BOTTOM OF THE LEFT IS UNBEARABLE IT HAS CREATED PROBLEMS ON MY RIGHT FOOT DUE TO WALKING PATTERN BEING OFF.iVE WORN INSERTS FOR YEARS NOW FOR THE LAST 4 MONTHS WEVE BEEN SCREWING AROUND WITH ORTODIC NOT GETTING THEM RIGHT IS NOW SCREWING WITH BOTH FEET AND MY HEELS.tHEY SAY MY PROBLEM IS BONEY FEET AND NO PADDING IN BALLS OF MY FEET.iM LOST TO KNOW WHAT TO DO.aNY HELP WOULD BE SO WELCOMED. THANK YOU KAREN

  • Karen, you should look for Katy’s books on feet: Every Woman’s Guide to Foot Pain Relief, and Whole Body Barefoot.
    Good luck!

  • I just came across this article and advice. For the last 2-3 months I have had minor pain in my hip and random numbness in my thigh. I have had 7 adjustments by my Chiropractor and he wants to get me orthotics. Based off this article I don’t have daily disabilitating pain therefore an orthotic is not the wisest choice but I need to work on the biomechanics of my muscles. I would love to get more information. I was also considering going to a muscle activation specialist.

  • Hi John, I updated that blog post to add my course at the bottom, which is a good place to start for overall foot strength. Katy Bowman has a few good foot books out too. I actually took the MAT courses and didn’t find them as effective as what I do now, but maybe it just didn’t jive with me.

  • My daughter has developmental delays (she is currently still undiagnosed). She can walk with a walker, but not yet on her own. I have received conflicting information about using orthotics. She has severe pronation, so her PT says she needs them. I’m not sure, but the pronation only seems to be getting worse with her orthotics. What would your recommendation be for this situation…limited though the given information may be?

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