Education is key when it comes to taking power over your own health and wellness. I look at the role movement can play in your health, wellness and recovery to full and optimal function. The articles are not meant to take the place of medical advice and should not be used as such.

Foot Orthotics - Do You Actually Need Them?

Posted On Apr 26, 2023 |

Do flat feet really need orthotics? You can restore your foot mechanics to decrease your need for supplemental arch support.

Orthotics - Good or Bad?

Recently, an article in the Atlantic glorified bulky, highly cushioned, supportive orthopaedic shoes. The author, a millennial, suffers from plantar fasciitis. Millennials are those people born between 1981 and 1996 (both my children qualify as members). Why would this group need orthopaedic shoes so much earlier than one would expect?

The millennial generation coincided with the onset of the personal computer. They were the first group to have access to screens regularly from an early age. We all know what happened the last three years, and how that changed our commuting needs and movement habits. People who spend less time on their feet and less time walking, particularly at an early age when movement is so integral to development, are more likely to have weaker feet overall. Then, spending three years moving even less, may result in a foot that started out less robust exhibiting problems that one would expect to show up only much later in life. As this is happening at a time (early 30s) when comfort starts becoming more important than aesthetics, so it only makes sense that these types of shoes are becoming more popular.

I’m often asked about orthotics. So many people wear them inside their shoes. What I usually ask them is: who prescribed them and why? (There are valid reasons for orthotics and this article does not presume that everyone who has them can or should transition out of them.) Most of my clients who have orthotics assume they need to wear them all the time for life. There is a fear that if they take them away, pain may result, or the foot will fail to function properly. They were probably originally prescribed after seeking a solution for some foot (or knee) problem that they feel is kept at bay by the orthotic alone.

If it transpires that the orthotic was not prescribed by a doctor, or if the original problem has long passed, particularly if the orthotic is off-the-rack, you might want to consider decreasing your dependence on it. Placing a shape under your foot that is unchanging for most of that foot’s daily experience creates a situation where the bones and muscles move less and therefore the possibility of atrophy is increased. So ironically, the longer you wear an orthotic, the more you need one. The orthotic is essentially a cast!

In both these instances; orthopaedic shoes for foot discomfort/weakness, or orthotics for the same reason, the solution might be developing the feet with a movement and strength program to improve function, decreasing the need for this support over time.

Most people I know who use orthotics use them only for going out walking or spending higher amounts of time on their feet. They don’t typically wear them in the house or in their slippers so they are already practicing time on their feet without this support. I have found in my movement practice that most people are prescribed orthotics for flat feet, weak feet, over-pronated feet or collapsed arches - there are many ways to describe what is essentially the same or similar issue.

An orthotic support on the medial (inside) edge of the foot lifts this arch and props the foot upright. So why is this such a common problem in our modern population? Is it entirely due to poor shoe wear choices in our youth (as the author of the Atlantic article blamed for her problem)? Is it just an inherent human weakness (the foot is a short segment that has to support a very long segment)? Or could it be due to behaviours common to many people growing up in the same environment?

I would argue the latter theory has more to do with our current epidemic of flat, over-pronated, weak feet. Most (all?) of us have grown up wearing stiff soled shoes, with heels (low or high), and narrow toe boxes. Most (all?) of us have grown up sitting in chairs to eat, commute, study, relax, and subsequently have spent a lot of our lives in that position. Both of these things affect the feet - the shoes more obviously, but the chair also. If you consider that the achilles tendon which attaches to the heel bone is part of the calf musculature that crosses the back of the knee, it is understandable that sitting with the knee bent for a large proportion of our days means that these muscles are shortened. Both heeled shoes and prolonged bouts of sitting will contribute to an adaptive shortening of the calf musculature, so instead of a muscle at resting length when the foot and ankle are in a neutral position, there is now excessive tension on the achilles tendon and its attachment at the heel bone.

The heel bone (calcaneus) is a long bone that sits at the bottom/back of the foot, but also travels forward and articulates above with a bone of the ankle (talus) and forward with the bones of the mid foot. The effect of the tight calf muscles on this bone causes it to tip up at the back, and down at the front, which is a legitimate movement of this bone within our gait pattern, but in this case, it might get stuck in this position, where it is lower at the front end and higher at the back end to accommodate that tighter achilles/calf muscle. When the calcaneus is in this position, it creates the environment for what’s called pronation of the foot. This is part of a normal gait cycle as the foot cycles between pronation and supination (opposite ends of the scale), but it becomes “stuck” in this pronated position, where the middle of the foot is lengthened and lowered toward the ground, and all the associated tissues on the sole of the foot are now under tension.

Lifting the medial arch with an orthotic seems like a good idea, but it doesn’t change the fact that the calcaneus is out of position, and now you are propping up bones in the middle in a way that doesn’t jive with what is happening in the back of the foot. This is only one aspect of the flat-foot, over-pronated, weak or collapsed arch situation.

Other contributing factors are the turned out position of the feet that we all seem to adopt as we are walking forward. This turn out may be subtle or extreme but the fact that the foot is angled out relative to the direction of travel introduces a rotational element to the foot where instead of rolling through the central axis of the foot as you walk (through the motions of heel strike, foot flat, heel off, toe off) you now walk from the outside edge of the heel to the ball of the big toe, diagonally through the foot. This adds to the rolling in and down of the medial arch, and the excess loads cause the foot bones to also roll in and down (formally called eversion).

This toe out walking position is mainly due to the lack of ankle dorsiflexion that results from that tight calf musculature (remember, that was caused by heeled shoes and excessive amounts of sitting). Many people are told to “stretch your calves” - but this doesn’t change the fact that your muscles and tendons have adapted to your behaviour and if you can change that behaviour it will go a lot further to resolve these issues. For example, you can purchase “zero drop shoes” the next time you replace your current shoes, and gradually replacing your shoe closet with their heel-less counterparts (work, run, rain, winter, etc.). The harder thing to change (in our culture) is the excessive sitting habits. Chairs are just a part of our culture, at work, schools, in restaurants, theatres and so on. So the less time you spend sitting when you have a choice, the better. This might look like standing sometimes, pacing or walking to take calls, standing up more often for breaks and walking instead of commuting in a car or transit (for even part of that journey).

The long game for addressing these common foot problems involves not only these lifestyle changes, but also reeducating the foot to dorsiflex and pronate properly and eventually making sure the foot can cycle between pronation (which involves the entire foot-to-hip, pelvis and spine mechanics) and supination (ditto!). Muscle strengthening exercises for the foot and leg muscles is also recommended, although to an extent, simply using your feet more in these restored ways will add to their strength, so the isolated exercises are probably secondary to the first recommendations of lifestyle changes and gait reeducation.

My course Lower Body Biomechanics might be of interest to those of you who wish to pursue this further.

Lower Body Biomechanics

Zero drop: no difference between the height of the heel or the ball of the foot from the ground.

Categories: : Feet

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