Foot Orthotics – The Truth

Foot OrthoticsThe science behind foot orthotics is relatively new and continually evolving. To date some of the evidence regarding the benefits foot orthotics for athletes etc. has been a little conflicting. Reasons for this may include 1. differences in the experience and training of prescribing practitioners; 2. differences between foot orthotics suppliers and materials used 3. the temptation of monetary gain from prescribing foot orthotics unnecessarily.

From my experience foot orthotics do work for certain conditions the majority of the time but I feel they are way overprescribed for monetary gain. They mainly seem to benefit conditions from the knee down to and including the foot.  I cannot  really see how they would prevent hip or back pain(unless maybe there is a leg length discrepancy),neck pain etc. as some suppliers suggest. A lot of people are under the illusion that foot orthotics are some kind of amazing item especially the more expensive ones. If you have a pair, take a good look at them. They are basically a very fancy supportive insole, not much more.

Foot Orthotics – How they work

Let’s look at how they work, i.e. in the case of a lower limb tendinopathy. This condition usually occurs when the tendon has been under strain for long periods. The idea is that you put in a strategically located lift in the orthotic to take the pressure off the tendon and thus give it a chance to heal. For example with an achilles tendinopathy, you put in a little heel lift thus taking the pressure off the tightened achilles tendon. You are trying to reduce the tension on the tendon or give it slack, hoping as a result it gets a chance to heal. Looking at it from a different angle though, maybe you just had tightened calves from wearing high heels or from overdoing it in training. By loosening out the calves with massage and stretching you can reduce the pull and strain on the achilles tendon to which they are attached….maybe there is no need for orthotics? However other tendinopathies like tibialis posterior or peroneal can be more difficult to treat and may benefit from foot orthotic.

Say you have medial knee pain from running, it may be due to flat feet causing an inward force on the knee. You put in a foot orthotic with an arch support, it corrects the fallen arch, lessening the inward stress on the knee and  taking the pressure of the medial knee. As you can see there is nothing amazing going on here and the theory is pretty good. You can even use different types of materials when manufacturing foot orthotics, some which give more spring in your step reducing the load on shins (shin splints) etc.

In the case of plantar fasciitis which can be due to torsion on the plantar fascia as a result of rotational movement between the heel and forefoot. Here a heel lock in the foot orthotic coupled with an arch support can stabilise the heel and forefoot, reducing torsion on the plantar fascia and allowing it to heal.

However, here are a few things I want you to consider. 1. If you have been running for several years injury free, why would you suddenly need orthotics, could you not just have an injury that needs rest or treatment. 2. You have a young child and somebody says they need foot orthotics because they have flat feet even though they are not in any discomfort. The child is growing and developing, do you want to alter and interfere with that natural process. sometimes even if there is mild pain, maybe it is just ”growing pains” . 3. if you have flat feet or high arches and are in no pain or discomfort, why let somebody convince you that you need foot orthotics. I know plenty of runners and athletes with one of those conditions(high arches or flat feet) that never wear foot orthotics and have no problems.  4. The ”one leg an inch shorter than the other trick” to sell you foot orthotics. I can easily make it appear like one of your legs is shorter than the other when measuring you. A tiny percentage of the population 1/1000, have leg length differences of greater than 20mm or 3/4 inch(Guichet et al.; Clin Orthop. Rel. Res. 1991, 272:235). It is at this level that leg length discrepancy becomes significant. Wearing orthotics to correct a difference when there is no difference could quiet possibly cause you problems down the line. However if there is a definite actual leg length discrepancy a little heel lift in an orthotic can correct this and provide considerable relief. I regularly see people told they have a one inch discrepancy in leg length and sold foot orthotics for several hundred euro. Upon testing them I frequently see little or no difference whatsoever in their leg lengths. Here is an interesting article on leg length discrepancies Also the only way to reliably determine anatomical leg length discrepancies is to take x-rays of the lower extremities and actually measure the length of the femur, tibia, talus and calcaneus, since these are the primary weight bearing bones.   5. Lower back pain is often either disc or muscular related. I cannot in any way see how orthotics could benefit these conditions. As for neck pain, not a hope.

As for gait analysis in running stores, this is my advice; If you have been using a specific runner and having no problems, stick with it, brand and all. So often I have seen people measured up for runners and told for example they are over-pronating.  Then they are  given a runner to correct for this. Next thing two months later they have a tendon injury because they have been used to running a certain way in specific running shoes and now this altered runner is changing that suddenly, with no chance for the body to adapt.  Stick with the footwear you are used to. Make sure it is comfortable, supportive and laced up well. Replace worn out foot wear.

Also for people new to running, give your body time to adapt. Take it slowly, this is the best way to prevent injury. In terms of price, you should be able to get a quality off the shelf foot orthotic for around 60 euro. These often do the trick for many conditions. They usually include little stick on attachments to correct for various conditions so your practitioner can customise them to the injury. Custom foot orthotics shouldn’t really set you back more than 300 euro. Paying more does not mean you have a better product. Many are way overpriced for what you are getting. What seems to be major factor in whether orthotics will work or not is how comfortable the feel when worn. If you have been overtraining resulting in a lower limb tendinopathy, don’t think you can just stick on a pair of foot orthotics and keep going. Often it is rest along with eccentric rehabilitation exercises that is needed, not foot orthotics as such. I hope the above article gives you a few things to think on.


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