In June we had the pleasure of attending a Strong Foundations Day at Achieve Podiatry in Newcastle, NSW. Podiatrist, Lecturer, and Educator Blake Withers gave an excellent talk on foot health.
Foot orthoses, otherwise referred to as foot orthotics are specially designed shoe inserts that help redistribute forces throughout the lower limb. Blake has provided some insight on what foot orthoses really are and has helped to bust common foot orthoses myths.
MYTH 1: Pronation is ‘bad’, and you need foot orthotics to fix it
The majority of the population pronate and need to for normal walking and running. Pronation is one of the pivotal movements of the foot. Pronation and injury risk is an age-old debate. More recent research, specifically by Nielsen et al. has demonstrated there isn’t a significant relationship between pronation and injury risk (1). However, like most things in sports medicine, there is always a grey area. We now understand that tissue resistance and tolerance are better measures to use, meaning regardless of what your ‘foot posture’ or running/hiking looks like, the body’s capacity to withstand the stress you put on is more important. Although there are cases where someone may be sensitive to this movement (pronation or supination), it would be beneficial to limit that movement for a period of time with the goal of returning to the previous function.
At Achieve, we will assess a range of different areas including movement patterns, strength, balance, and tissue capacity to assist in rehabilitation and performance.
MYTH 2: Orthotics are a lifetime sentence.
Foot orthoses are most commonly NOT a lifetime sentence. There may be some cases where they help and offer long-term support while rehab is being undertaken, such as in post-surgical cases or adult acquired flat foot.
A good analogy to think of is that orthotics are like a shoulder sling. You may only need them for a while to heal....
For example, if you were to hurt your shoulder, you may use a shoulder sling for the next 12 weeks to reduce the load and stress going through the shoulder. Once you have built some strength and desensitised the area, you will be free to come out and continue as you were.
Foot orthoses are much the same, once that area has desensitised and you can tolerate load through that area again, they may not be required. This is all happening in conjunction with adequate rehab, education, and guidance.
MYTH 3: Orthotics brace the feet and make the feet weaker
Your foot muscles still work to stabilise and control the foot when on the device. Currently, within the world of research, there are five studies looking directly at foot muscle strength with foot orthosis. The majority (90%) of the studies show no decrease in strength capacity or stability. So, what did the other study show? An increase in strength. Remember, we are not supporting the muscles, we are modifying the load and spreading the pressure out underneath the foot. The muscles and structures still and do work just as hard.
MYTH 4: Orthotics can only go in a neutral running shoe
We understand that the shoe does play a role in the effect of the orthoses (another reason why we will recommend a strong and supportive shoe) and as we know, we must have a shoe for the foot orthoses effect to be reached.
Can foot orthoses go into any shoe?
They can go into any shoe if they achieve the required effect. They can go into minimalist, maximalist, neutral or motion control shoes. Foot orthoses are like a drug and so are shoes, both have an effective dosage. What we are trying to do is find the right dosage for you so we can get the desired effect. If we can combine both the shoe and orthoses, we get a combined dosage of both. So, as long we achieve the right dosage, we achieve the effect.
Remember to always ask questions about your footwear such as what is the best shoe for your orthotics to go into? Timeframes of recovery? And so forth.
Do I need a custom orthosis?
There are a variety of foot orthoses, which reflects the fact that there are a variety of needs for foot orthoses. biomechanical factors, footwear factors, the level of support someone needs, the weight of an individual, and the structures or tissues we are looking to influence are a few common considerations in deciding what materials and type of foot orthoses are most suitable.
Always ask questions about your footwear such as what is the best shoe for your orthotics to go into? Timeframes of recovery? And so forth. And remember, orthotics are not the answer for everyone and are not a lifetime sentence, ask your podiatrist questions about what the purpose is, how long and if they are actually needed. There may be other
solutions to your foot problems!