A client asked me, why has one Podiatrist told me I need orthotics and another Podiatrist told me that I don’t. Do I really need orthotics? I loved this question she asked me, it meant I could help clear a debate about whether we should wear orthotics or not. Orthotics were first introduced in the 18th century, they were originally used for complex medical conditions. Eventually they were developed to provide support and realignment of our full body through use on the feet. Nowadays they are used predominantly in sports activities or when our arches collapse. But should we be using them when our feet are painful? Should we be using them when our knees and back are painful? When should we be using Orthotics?
So the idea is that Orthotics are worn when we have flat feet. Flat feet allows for a domino effect on the rest of the joints of ankle, legs, hips and lower back. Does everyone remember the bone song? Well, they are all connected.
Flat feet are bound to have an effect. But what does having flat feet actually do to these others joints. This I will cover in a future blog. My focus is Orthotics. The evidence in clinical efficacy of Orthotics to reduce pain and enhance functional activities is in debate. However, one quote I take from the ‘Journal of Foot and Ankle Research’ by an author named Murley and his colleagues (in 2016) is that the activation to the foot from the orthoses occurs during the midstance and propulsion phase of gait; and orthotics are only effective in the contact phase of gait. Am I getting too technical? In other words, where the orthotic sits on the foot it does not start to effect the foot alignment until the foot has already moved off the ground. Therefore, alignment may either not take place or may occur in the incorrect part of your foot. Food for thought?!
So why do Podiatrist prescribe and issue Orthotics. Without them misalignments of our legs and body occurs. Could we treat these misalignments with other forms of therapy such as Osteopathy, physiotherapy and certain forms of strengthening / stretching exercises. Yes we could. However, muscle architecture and physiological ability of muscles and tendons can only realign to an extent. Isaac Newton developed the scientific notion of gravity and center of mass. Our body works with and against this. Various forces in our environment can affect our center of mass. This is where the Orthotic plays its role. It is there to adjust and accommodate for the compensatory mechanism during our walking from either internal factors (our bodies ability) or external factors (surfaces or forces which effect our movement). So yes Orthotics are important.
How about their role in foot pain? Orthotics come in various forms, including ‘over the counter’ (i.e. bought in store), custom made (prescribed by a Podiatrist) or semi-custom made (manufactured in mass by expert orthotics company). They also are made using different materials; soft cushioning material or made from polypropylene (a form of plastic). If my feet were painful, the last thing I want is to be walking on anything made of plastic. At the same time, walking on something soft may allow for the misalignment to contribute to the foot pain.
Confused on whether Orthotics should be worn with foot pain? Don’t worry it is always a clinical debate within ourselves as medical practitioners. Don’t allow yourself the headache. Orthotics plays a role. When, where and how, is what we should be answering. I hope to bring answers to these questions about orthotics in my future blogs. Stayed tuned.