Orthotics: Do I need them?

Do I need orthotics?

That is one of our most commonly asked question! Patients often come in with foot pain, together with this very query on orthotics.

And our answer? No.
No, you do not need orthotics - at least for now.

The question about orthotics is often, but not always, backed by a misunderstanding that gait correction can be easily solved by a quick fix. This misunderstanding is also the reason why orthotics backfire, and proving injurious to the user instead. To give an example, an arch support is often recommended by people who overpronates. However, this same group of overpronators who overpronates during midstance often also excessively inverts their feet during pushoff. As such, these arch supports actually worsens the amount of inversion during push off, resulting in increased instability of the ankle, increasing the risk of ankle sprains among other issues.

Before addressing the need for orthotics, we need to start work on aspects that are not addressed and that needs work. Before you think about bringing in something external to support your body, we need to first work on aspects of your feet and your body's mechanisms to optimise the way you load.

Orthotics do not give you the strength you need. They do not erase any poor movement patterns of your foot. They do not correct the slouch from your head down - from the way you hold up your pelvis to the way you hold up your shoulders.

Let's work on improving the way you move and the way your body handles load and impact, before we think about bringing in orthotics - if there is even any need for one.

For foot conditions such as those with bunions or severe structural changes, there are still aspects of strength and mobility that require work upon. However for these conditions, treatment outcomes often improve with the complementary support provided by orthotics. In these cases, we do advise our patients to consult an orthotics or podiatrist for simultaneous assistance while continuing their physiotherapy rehabilitation work.

The way we make changes upon the running and walking gait is primarily via muscle activation and strengthening. Orthotics can be recommended on a case by case basis, but it's often unnecessary as with strengthening, the arch, the foot and the body's mechanics can change to improve the way the body loads the ground, removing the need for any supplemental orthotics. Even with the recommendation of orthotics, there is a need for regular revisions and replacement of orthotics as the foot structure can change with the strengthening work incorporated. As such, the reliance and usage of orthotics should not be prioritised over corrective strengthening work.