Proper footwear is essential when exercising and even just walking as you do your daily activities. Today many shoes are made to look cool and flashy, but they are unfortunately making foot function worse. There are numerous shoes with anti-pronation devices, arch supports, ankle supports, and motion control devices & stabilizers. These are often causing problems in a lot of people, and they most likely don’t even know it. Take, for example, the hype behind the anti-[over]pronation shoes. Pronation is a necessary motion and function of the foot. It is supposed to happen — it is a major way you absorb shock when walking or running. However, many people are being told they overpronate or they think they overpronate so they wear these anti-pronation shoes and problems occur – foot, knee, hip, or back aches – all from the shoe they were advised to wear. Sure some people do overpronate, but it’s because of muscle imbalances in the lower leg and foot, not because they’re wearing the wrong shoe. Even worse, many people wear orthotics – casts of their feet that are supporting their gait dysfunction and imbalances which only support their problem and eventually cause other problems throughout the body.
There’s a lot of hype behind orthotics. Many physicians, therapists, and sales persons who make and sell them think they’re the greatest thing since sliced bread. Well, I’m not a big fan of bread, and I’m not a big fan of orthotics. Orthotic supporters (no pun intended) claim that the inserts will fix every structural pain from your head to your toe. The majority of these people make what I’ll refer to as a pathological orthotic, as they are making a cast (mold) of your foot in its current incorrect or imbalanced position. Since you wouldn’t want a broken arm put in a cast without setting the bone, you don’t want a cast of your foot made without making sure that the muscles are balanced and the bones are in the right place. Making a cast of your foot without addressing the issues of the foot isn’t fixing anything – it’s just going to support a problem you already have. Your pain may go away, but a new one will pop up later, perhaps somewhere else in your body. The goal is to figure out why the muscles and bones of the foot (as well as everything affecting the foot) are not functioning properly so the problem at hand (or is it foot?) can be resolved. Since you have to walk, a severely injured muscle may need to be supported as it heals temporarily – and this is where orthotics may be valuable for a slight few people – when they are used to help hold a correction in its place so function may be restored. However, as I write this, now into my 13th year in practice, I have never once needed to have a patient go and get an orthotic made to help stabilize or correct their foot. Maybe that will change tomorrow.
Foot muscles and lower leg muscles which play a major part in the gait of an individual are very responsive to stress in the body. Abnormal stress from thick-heeled, over-supportive shoes, and those wearing orthotics, further weaken the foot and lead to problems. Nutritional stress from a poor diet (refined carbs, processed fats), emotional stress, and physical stress from other injuries as well as excessive exercise also lead to lower leg and foot problems.
I estimate that 90% of the time I need a patient to stop wearing their orthotics that were made for them by another physician because they are either causing a disturbance in their gait (the way you walk) or creating a foot dysfunction. About 10% of the time I’d say the orthotic is not actually hurting them, but is no longer benefiting them, and they’d therefore be better removing the orthotic and allowing their foot work naturally as it is intended to do so – restoring proprioception and overall health.
Wear shoes that keep your feet close to the ground “low to zero-drop”, don’t have a lot of support, and aren’t too rigid (stiff).
Remember, your orthotic is supporting some dysfunction. Always.
Read a lot more about the Sock Doc take on orthotics – here.
Hi there
Love what you wrote, my wife once had some injury, and the dr gave her orthotics, and her injury went, so I told her to take them out and only put them back in if the injury returned, it never did…
I run a couple of times a week in 5 fingers as a training tool, and I believe it works.
will have a look at that else you have to say.
thanks
I wondered if you had any views on orthotics to correct leg length discrepancy? I’ve been running around 2 years and after initial problems with bad shin splints in cushioned shoes I took a ChiRunning class, worked on my form, and found a big improvement after also switching to more minimalist shoes (currently Nike Free/Saucony Kinvara/Merrell Trail Glove). I’ve also always spent a lot of my time barefoot since I was a kid.
However, since starting running I’ve had persistent left hip pain as well as pain around the side of the shin, and recently saw a physio (athletics-specific, working with some big names). They thought I had longer left leg, but also identified weak soleus, and tight right abductors. Six weeks of strengthening and stretching and this is much improved. The hip pain has reduced, but still stops me running more than ~7 miles.
So I saw the podiatrist they recommended. They identified high arches, some rotation of lower legs, and “over-pronation”. But also, that my left leg is 1cm long than my right (I’m ~190cm tall). When I was videoed at the ChiRunning class it was clear that my left hip was bouncing up and down, and I am quite convinced this is due to the leg length discrepancy, and main source of the hip problem.
So reluctantly I’m having some orthotics made (not based on casts though)… What do you think? Is leg length discrepancy a big issue, and is there any alternative to orthotics? I’m unwilling to give up my “minimalist path” since it has been helpful so far, but can legs of different length really be overcome by something other than an orthotic? I’ve heard orthotics likened to a neck brace – for temporary use only as you mention – but then I’ve also worn spectacles since the age of ten – and don’t believe that any amount of eyeball-rolling exercises would “fix” my eyes now…
Hi Mark. Thanks for the comment. You bring up a great, (and very common) issue. So let’s address it. Leg length discrepancy is very common. Actually most people aren’t perfectly symmetrical. 1cm is not much, and I’d say from a lot of experience with leg length discrepancies, it is most likely not the reason you have the hip pain. I see plenty of people who have such a leg length issue and have no pain, or I’m able to get them out of pain, and they still aren’t perfectly balanced. Rather, I’d say your leg being shorter on one side (or longer on the other) is most often due to muscle imbalances in the pelvis, thigh, or lower back, and that causes the leg length difference. So your hip pain, although it is better, is not corrected, and that’s why it still bothers you after 7 miles. Most likely your leg length difference becomes more than 1cm after that 7mi run as more and more hip problems occur and you create more muscles imbalances from the run.
Yes, orthotics support dysfunction. I wouldn’t liken them to wearing glasses though. I’ve never not been able to get someone out of orthotics. Also remember the short leg is on the high pelvis side. So while some would make the orthotic thicker (a heel lift) on the short leg side, that would not balance the pelvis, it would just make up the difference the foot is to the ground. But placing the heel lift on the long leg side would raise that side of the pelvis and create balance in that area, though I still don’t agree with it. I just want you to see how people have their own thoughts on which side should be corrected. Now if someone has a congenital (from birth) short leg or say perhaps from a disease like polio, the heel lift can be very beneficial. I have such a patient and a lift in the short side helps her tremendously. These are rare exceptions.
Finally, I’ll say – and this is the touchy part – that strengthening “weak” muscles with exercises or weights does not turn them on or “facilitate” them from a neurological perspective. And as you know, I am against stretching because that does relax or “inhibit” muscles that are working too hard. The Sock Doc stretching article will be up in a few days. But the reason you’re still having problems is because although you’re stronger, the problem is not fixed.
Thanks for your reply, something to think about, especially about “turning on” the strengthened muscles – is there something I should read about that?
It’s true that my physio originally was not sure whether the leg length discrepancy was “functional” due to muscle imbalance, but I understood that the leg measurements taken by the podiatrist were to reference points such that they would not be affected by this? As a young child I remember having some hip issues (examined a lot but not explicitly treated) which I think may have been Perthes’ disease, so I think it is possible there is a physical difference in the leg length. I have been prescribed orthotics with a heel lift for the short leg.
Anyway I guess I’ll keep an open mind for now and maybe find someone to take a look and give me a second opinion
Enjoying your site – I found the piece about MAF training particularly interesting as I hadn’t come across this before, and a lot about it rang very true to me (I’ve without a doubt been training way too much in anaerobic region). I’m also coincidentally 37, so the numbers worked out nice and easy for me too 
Getting weak/inhibited muscles to work is a neurological phenomenon. This is why if someone used proper manual muscle testing procedures to test your adductor, you could then do certain adductor exercises and see absolutely no change in the muscle function when it is tested again post-exercise. The examiner will say this is because it takes time for the muscle to respond, but this is untrue. Any muscle, unless it has completely atrophied or lost nerve root innervation, can be turned on (facilitated) immediately through various means, specific for the individual and the muscle itself. Conventional medicine still does not accept this fact; hence they only use muscle testing to evaluate disc and nerve lesions, as well as local muscle injury, and treat with tedious rehab exercises. Though these exercises are beneficial, they are only after the muscle has become facilitated through other means. Read here.
If your leg measurements were taken at the exact same bony prominences from a specific point on the pelvis to a specific point on the foot on ankle, then yes, perhaps they were accurate and you really do have a short leg. Some physicians will take X-Rays to verify this because if the measurement is off just a bit here and there, (and also consider if one leg is rotated a bit and the other isn’t), getting one only 1cm longer than the other is not hard to do.
BTW – I was thinking after my last post about other patients. I do see this one woman who had hip pain and wore a heel lift on one side as her leg was a few inches short due to an issue as a child – so the leg really was shorter. She came to see me because of the pain on that short leg; 30 years later. Eventually she removed the heel lift based off advice, findings, and treatment because once the entire body was balanced, the heel lift made things worse. Essentially she grew that way and her muscles had accommodated correctly, but the lift supported the muscle imbalances. So even in true leg length discrepancy, the lifts are not always needed.
Thanks again for your reply – I appreciate the time you are putting in! I read your article about stretching and some of that rang true with me – especially the concept of “balance” between the muscle groups. I should perhaps mention that I had a disc injury ~2 years ago which led to a huge lifestyle change from very sedentary to very active. This injury being apparent on my right side I wonder if there is some more significant asymmetry than I was aware of which is compensating for this and causing the left hip problems.
On the leg length discrepancy I also read many people commenting on running forums that they have been told they have a discrepancy and it does not in itself cause problems with their running, so I am now thinking that this was more an “observation” by my podiatrist than a “diagnosis”!
I found a chiropractor here who looks like they may be able to take a “broader view” of my problem – I’m in the UK and over here it does seem that physio -> podiatrist -> orthotics is the standard path which is a bit hard to avoid. Wish me luck!