If you have ever been given orthotics and never use them then listen up. If you have foot pain and are considering purchasing orthotics and want to avoid wasting money and having your newly purchased orthotics succumb to the same fate, then read on.
How did those orthotics find their way to your closet?
There are typically 2 ways that those orthotics end up in your closet. One comes from the shoe sales representative and the other is from foot specialists or professionals. In both cases it is the result of breakdowns in our understanding of what an orthotic is and why we might need one.
The shoe sales rep tells us what kind of shoe we need. Why wouldn’t they? They know the products and they look at feet all day. So surely they have the education to know when someone is in need of orthotics. Think again. Not all shoe sales representatives are equal. If you are lucky you might find one that has more education to arch function than others, which might be a short weekend course or limited self study. However most have none and and you will be hard pressed to find one that has a doctorate in the subject.
When we suffer from foot pain we reach out for help and it makes sense that we first ask the shoe sales rep what to do. They ‘assess’ your foot and up sale you to a $65 over the counter orthotic that is supposed to correct your pain. Or they use a cookie cutter assessment tool to quantify your foots needs by using some kind of foam box or electronic device that you step onto and then charge you $350 for a ‘custom’ orthotic. If you are lucky your purchase will pay off and your pain will go away. If you are like most of us, you were just duped. You suffered an upsell to a product that the sales rep was unqualified to ‘prescribe’ while they went home with more commission for the day’s work while the newly purchased uncomfortable orthotic makes it’s way to the back of your closet.
The other typical route to get an orthotic is through a more professional approach from a foot specialist, like a podiatrist. This route makes sense. They specialize in feet and are trained to treat foot problems. So when they prescribe a $450 orthotic that is not covered by your insurance, you follow doctors orders and pay up. For some this fixes the problem and you are happy campers. Congrats, you have found an experienced professional that knows orthotics and foot dysfunction and how to match the two. However, for others those expensive orthotics make their way to the closet to collect dust just like the others. What happened here? The brutal truth is there are a lot of working parts behind the scenes that lead to this poor outcome. But the elephant in the room is financial gain to the provider. The provider wants to minimize their time with the patient, push products that are not fully individually customized for rapid delivery, does not prescribe correlating corrective exercises, or pushes your care to the back of the line while they emphasize the larger ticket items in their practice (surgeries) to line their pockets for more money. This unfortunate scenario leads to poorly matched orthotics that don’t do what is intended, eventually leading to those costly orthotics getting thrown in the back of your closet.
Foot Mechanics 101
To better understand the orthotic collection problem you need a little background on foot function and what the arch does. The arch of the foot can be considered a spring or shock absorption mechanism when your foot hits the ground. When your heel contacts the ground you have an arch that is in a raised or rigid/locked position.
As your forefoot goes to the ground the arch collapses and lowers to the ground. This is the normal mechanics of the foot and is an essential feature to absorb the shock as your body hits the ground. It dissipates forces through the arch and takes pressure off of the knees, hips and low back.
Where we see most dysfunctions of the foot is the second phase of your gait as you step onto the forefoot and your heel raises off the ground. As your heel comes up in the air and your body weight is on the front of the foot, the arch should raise back up as you step onto the forefoot. This creates a rigid arch that is in a locked (or raised) position that we use to propel ourselves forward.
For many individuals this does not happen. The arch stays in a lowered unlocked position. In this position the middle of the foot is loose and leads to deficiencies in moving the body forward.
There can be many reasons for this including muscle and joint tightness, ligamentous laxity, muscle weakness, genetics, and/or learned dysfunction from poor subconscious movement patterning (to name a few). Walking in the second phase of gait with your arch in a lowered position leads to excessive stress across other structures that help hold the arch up. Overtime this pattern can cause tearing in the tendons of the foot (pain), ligamentous laxity of the foot (pain), degenerative changes in the joints of the foot (pain), and additionally lead to other painful problems up the chain at the lower leg, knee, hip and low back.
Orthotics 101
Orthotics are shoe inserts that go between your foot and the inside of your shoe. They typically are intended to help add support to the arch as we walk. This could be a good thing for those individuals that have a dynamic arch dysfunction as described above with or without pain.
Not all orthotics are created equal. There are countless possibilities that the clinician can include in an orthotic to correct the biomechanical problem found, including materials of different rigidity, angles for material buildup, types of material combinations, length of material used, etc. Too much info to go into for this top level understanding of orthotics. But the basic idea is total arch support needed equals the amount of arch dysfunction the individual has plus the orthotic used plus the internal support in the shoe worn. If the arch mechanics are good then so significant support is needed by an orthotic and the shoe does not need any additional support to assist the arch. If the arch mechanics are poor then any combination of choosing a shoe that controls the arch and/or using an orthotic in addition will get the individual moving correctly. A skilled clinician can run the art of this formula to get you an orthotic that is comfortable while addressing the problem to solve your pain and improve your mechanics.
arch support = arch mechanics + orthotic + shoe
Don’t Forget the Foot Mechanics
Some people have a flat arch upon standing, but when they walk the muscles kick in and the arch shows no movement dysfunction and looks normal. This is the result of good biomechanics and muscle function. The action of the arch muscles make up for the loss of ligamentous stability. Thus we see that the arch functions dynamically and is not a static thing.
When you go to the shoe salesman and they say you have flat feet does that mean you have arch dysfunction? The answer is no. This is just a static look at how your arch is in a resting position. People can have flat feet yet have excellent arch mechanics. You do not know this until you see them move dynamically with their gate, running, and jumping. Thus a dynamic gait assessment must be done. However the problem we can face when approaching a shoe salesman is that they might not have the education to do this assessment and then prescribe an orthotic based on the static presentation of your foot even though there might be good mechanics. They simply look at your static foot posture and recommend whether or not you need some kind of assistance or support in the foot.
The Missing Link
There is one more crucial piece of this puzzle that will lead to successful outcomes with an orthotic. That is addressing the root of the problem that started you on your painful foot problem to begin with, poor flexibility, weakness in the arch muscles, or poor movement patterning. After 20+ years of providing physical therapy, I have yet to see any shoe sales representative and have rarely seen a podiatrist concurrently prescribe exercises to correct the underlying problem along with the orthotic they sell. Simply put this is just putting a Band-Aid over your cut to help the healing, but if you don’t stop cutting yourself in the first place that Band-Aid will only go so far in helping you heal. A physical therapist that specializes in foot function and is trained in assessing the arch is one of your reliable sources to turn to for learning how to get to the root of the problem. Otherwise you can search Google and hope the exercises you find are specific to your needs. Throw mud at it and maybe it will stick, or maybe you will be left with a bunch of expensive orthotics hiding in your closet.
The Fix
You have to find someone that values your needs, has the background to assess the dynamic and static components of your foot function, and the skill and background to fabricate an individualized custom orthotic to fix your problem. With this information you could be on your path to getting rid of that foot pain or preventing a future foot problem that you have no idea is coming. The assessment can go a long way to save you money as well. Many problems can be corrected with one or two simple exercises and not even require orthotics. Others can be addressed with the combination of exercises and an over the counter orthotic. Some more involved cases would benefit from exercises and a custom orthotic made specific to your foot’s needs.
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www.PreventPT.com
PreventPT specializes in ‘The Fix’. Corrective exercises, gait training, and custom orthotics are some of the many valuable services we provide. If you have questions or are interested in a free virtual consult to see how we would go about helping you please click the link below and fill out our brief form to see how we can best help you.