As a biomechanical specialist that has made endurance sports my life, I’m often asked the question by my clients, “Do I need orthotics?”
Let me disclose that I personally use custom orthotics, and have found them to be one of the BEST ways to rid myself of chronic shin and foot pain. I’ll explain why later in the post. To help you decide if orthotics are right for you, here are five questions to answer and discuss with your practitioner/orthotics fitter:
1. Are orthotics something you plan to use to improve performance?
Some people don’t have pain, but have poor foot foundation, causing their balance and proprioception to suffer. Perhaps you have diabetes or a heart condition that limits the amount of blood flow reaching your feet. Poor sensation can lead to poor balance and faulty mechanics. This population can benefit immensely from using custom orthotics regularly, in all of their footwear, to improve balance and reduce the risk of falling.Athletes can benefit from orthotics, too, by correcting faulty loading mechanics at the foot, ankle, knee, and pelvis. These mechanical deficits are oftentimes the result of improper foot positioning, and thus shock absorption, when the foots hits the ground.So what’s causing an improper foot position? The answer is feet that are too rigid, or too soft.Orthotics can help your feet achieve a more beneficial platform, allowing your body to disperse forces more evenly to the neighboring muscle and joint systems.
2. Do you have pain?
Consider this: Where is your pain? How long have you had it? Does anything make it better or worse?For example, do you feel that every time you buy a fresh pair of running shoes the pain decreases? This may be an indicator that your foot craves more stability and needs assistance from an orthotic.If your pain has only recently started, then I’d recommend getting more bodywork (massage), and being seen by a specialist that can assess your biomechanics, flexibility, strength, and tissue “feel” to determine if your pain can be reduced without an orthotic.If your pain is chronic and you’ve already tried seeing a specialist with no improvement in symptoms, then it’s possible a custom orthotic can be used to decrease your pain. That said, the orthotic should be prescribed ONLY after watching your mechanics and assessing your foot properly. This ensures you get the correct style of orthotic, as well as a good prescription for bodywork that will help correct any imbalances within your muscle structure.
3. What type of foot do you have in non-weight bearing, and weight bearing positions?
If you have extremely flat feet, but no pain, then I wouldn’t recommend an orthotic unless you’re involved in a high-risk sport like soccer that has a ton of cutting, and you can’t control how far your knee dives in or out.If you have regular arches while sitting (you can see a crescent shape in the arch) but they drop largely with full weight bearing, then you might have a high amount of pronation and require assistance with controlling the speed of collapse.If you have high arches in both seated and standing positions, then you might have a high degree of supination that limits your success with dispersing forces in the ankle, knee, and ultimately the hip and spine.Again, having a qualified practitioner that understands how to measure and assess these different foot types will be necessary. I’ve seen plenty of over-pronators and over-supinators for whom I didn’t recommend getting custom orthotics because they have effectively compensated for their foot structure. It’s the people with poor foot structure, plus recurring injuries or pain that often need custom orthotics.
4. Are you willing to perform exercises most days of the week to improve your foot structure?
If you’re one of the unlucky people that have poor foot mechanics, pain, and hobbies/work that involve heavy impact, you still may not have to get custom orthotics. However, in order to avoid them, you’ll need to put in the work to make your foot both strong and/or flexible.Perhaps you’ve been labeled an “over-pronator” and you rushed out to buy the “Born to Run” book along with a pair of the Vibram 5-Toed minimalist shoes with the intention of gaining strength. Well, the disclaimer that must be included is this: it doesn’t happen overnight, and you have to be very diligent with your strengthening as well as with your foot recovery techniques to regain an arch, and get rid of pain.On the other hand, if you’re one of those rigid-foot-supinators that needs mobility, you’ll have to commit time to regaining flexibility in the ankle, toes, and hips. Increased motion at these joints allows for the foot and arch to collapse in a manner necessary for absorbing shock in the ankle and leg muscles, without stressing bones.So, if you’re willing to put in the effort, you might be able to save yourself some money, though, I’ve seen most people struggle to do so, and end up purchasing a pair after a few months of non-compliance. Rest assured, I don’t blame them. After all, I’m in the same situation, not making the time to change my feet.
5. What are your job, or daily life demands?
If you have poor foot structure, but work at a desk and don’t find yourself walking or spending long amounts of time on your feet, then you might not require custom orthotics. Perhaps you only walk casually, and on fairly stable surfaces. People that have this style of living often just require supportive shoes for their daily walks that have more rigid lasts built into the sole of the shoe to decrease shock. There’s even a maximalist movement by shoe companies now to thicken the soft cushioning in a shoe (although keeping the material extremely light) in an effort to create decreased impact forces in the leg, and a larger sweet spot with landings.However, if you have poor feet and a job that demands a lot of standing, or hobbies with high amounts of impact, you might find a custom orthotic to be your saving grace. In my experience, it’s not a matter of if pain will eventually creep into your legs, but when it will force you to be sidelined in some manner.I’ve seen the arthritic build-up in knees, hips, and spines developed from years of overdoing on poor foot structure. These patients show up in the clinic with back pain resulting from years of bad mechanics that could’ve been prevented. While I don’t prescribe them orthotics on the first day, I do have a conversation with them about the compensations their body has undergone to adapt to the stresses that ultimately begin in their feet. These stresses, when discovered at a younger age, can ultimately be reduced, allowing for less degeneration, but early identification is the key. Most of these people will end up in some form of custom orthotics once pain has set in, which will hopefully prevent surgical repair to worn out areas!
The most important thing to consider when deciding on orthotics is: what type is necessary? There are a myriad of choices out there ranging from $25-50 on the cheap side to $200-800 on the expensive side. While the cheaper orthotics can serve as a nice temporary support for your foot, they use weaker materials and base their design off a common posting angle that may not benefit your particular foot mechanical problem. On the other hand, the custom-molded, more expensive orthotic may not be the right choice for you either. The actual making of the custom orthotic relies heavily on having the correct expert assess your foot both statically and dynamically under different loads, or ground reaction forces. Without an expert that understands how to assess your foot under different stressful situations, it’s nearly impossible to get the correct orthotic prescribed.
In the end, a custom orthotic is a big investment and shouldn’t be taken lightly by the practitioner responsible for getting you properly fit. I’ve seen way too many patients limp into my clinic carrying a bag of orthotics they have been “prescribed” through weight bearing scans, crush boxes, and treadmill video recordings. You can imagine the disgust they feel when I show them the reasons their $1000+ investment in foot care is really just a scam that has been played over and over to them by some of the best sales teams in the industry. I’m forced to try to use foam padding and tape to post and position their foot better with the orthotic they bring in, but this never serves as a long-term solution. They’re just a number to these sales teams, and no attention has been paid to their individual foot needs based off of their hobbies and work demands.