Are Orthotics Really Ever Necessary?

The prescription and use of orthotics is a hot topic. Some physicians don’t appreciate that fact that I think orthotics are expensive pieces of carbon graphite, neoprene, and other material that most often serve as a disservice to the patient. My stance on orthotics is such due to how I evaluate, treat, and manage patients. It is a 100 percent holistic approach.  I see professional athletes – dancers, runners, hockey and soccer players – and professional people – CEOs, attorneys, medical doctors, accountants – and everybody in-between. These patients have injuries of all kinds – foot, hand, back, neck, etc. and ailments ranging from the common cold to infections such as Lyme disease, as well as hormonal problems, digestive disturbances, and sleep issues.  Using foot orthotics is not natural, so it is not part of my practice to prescribe such devices; I’m more interested in correcting a problem at its root source rather than only address the symptomatology.

Orthotics Help Relieve Symptoms In Unhealthy People

While I have had to refer patients for surgery or to their medical doctor for a necessary medication such as an antibiotic to overcome illness or perhaps save their life, I have never had to refer a patient to receive an orthotic, and yes, I have seen plenty of extreme cases of foot pain and gait imbalances. With no disrespect to those who treat their patients with orthotics and with no arrogance I feel confident saying that based off my education, experience, and understanding of the human body (not just the foot), that those who wear orthotics are suffering compromised health and those who prescribe them are not restoring their patient’s health to its fullest potential.

An orthotic is a support device meant to either control motion or change foot function, and therefore the function of other areas of the body. It’s not natural and unless all other means have been exhausted, (which they rarely have), then reconsidering orthotic use should be a priority. Orthotics may serve a very temporary purpose to help a person overcome acute pain and discomfort, but anything more than short term “emergency” use will only harm the wearer. Yes, they support some dysfunction somewhere – whether it is in the foot itself, the gait, or some other imbalance anywhere in the body.

A healthy person does not need an orthotic. Orthotics alter the somatosensory system in the body, which is how various stimuli is received and transmitted through the nervous system to the brain. This is major part of one’s proprioception (body position), along with one’s vision, inner ear mechanism, and other important reflexes. Actually, any footwear alters one’s proprioception to some degree, which is why going barefoot as much as possible is a great way to help balance, foot strength, and overall health.

Orthotics Will Weaken Your Feet and Dampen Your Senses

“Custom” orthotics, as well as other footwear devices such as heel lifts and arch supports negatively affect proprioception and foot health more than most footwear because they support muscles, tendons, and ligaments in such a way that they don’t have the need to function as they normally should. Essentially, the feet become weaker and weaker, and soon it spreads to other areas of the body including the nervous system. Then the orthotic user has to rely on other aspects of proprioception such as vision, because their feet are in such disarray. Put this common situation in an elderly individual who often already has poor vision and you’ve got an unstable person who will soon fall, break a hip, and die soon after. That’s a sad, common occurrence.

Are there exceptions outside the very temporary use? Yes, but they are rare. Orthotic use is a sensitive subject especially since many physicians rely heavily on them to treat patients as well as their own financial security. If orthotics are their major tool to help a patient deal with pain or walk properly then I completely understand that they are going to fight hard about their necessity. Currently the only patient who I treat who actually benefits from an orthotic suffers from post-polio syndrome. Her left leg is approximately three inches shorter than her right. So she walks with a lift throughout her entire (left side) footwear and this benefits her; she’s been wearing it for decades. I also treat another woman who suffered a different childhood disease which resulted in her left leg being approximately two inches shorter than her right. She came to me because of hip pain and fatigue when walking. The orthotic in her shorter leg not only helped her gait but also diminished her pain to about 50 percent for the many years she was using it. Eventually, over a period of four to five visits, her muscle imbalances were corrected by using various manual medicine techniques such as trigger point therapy, muscle reflex points, and nutritional therapies, so the orthotic only made things worse so she removed it entirely. Obviously this was a big step for her as she had worn it for over twenty years and because of the leg length discrepancy. Of course I was not able to make her leg lengths equal but by helping her muscles adapt to the way her body currently is, she was able to be pain free for the first time in her life and without an orthotic or supportive device of any type.

Orthotics Do Not Correct Muscle Imbalances

Dr. Phil Maffetone discusses and demonstrates proper muscle testing procedures in his book, Complementary Sports Medicine. Chiropractors, physical therapists, athletic trainers, and most medical doctors are taught some form of muscle testing during their education. Unfortunately, it is often not taught properly and when the therapist does learn to correctly test a muscle, (studies show accuracy greatly increases after five years), they often don’t know what to do with the information they receive from the test. I am in the position to say this as my office is in close proximity to both Duke and the University of North Carolina and I see physical therapists and athletic trainers who have graduated from these schools who quickly realize that their muscle testing education was not up to standard. After all, an inhibited muscle (one that is “weak”), cannot become facilitated (“strengthened”) by exercise, which is what most are taught. I discuss this a bit more in my “Stop Stretching!” post. Muscle imbalances occur due to nervous system dysfunction which can be the result of injury, pain, nutritional imbalances, organ dysfunctions, and other health issues, including general stress. Muscle imbalances in the foot will cause local foot imbalances and this leads to a physician often considering and using an orthotic to correct this imbalance. Orthotics can (when applied correctly) facilitate muscles; I see this in my office when evaluating a patient with many muscle imbalances and their orthotic was properly made – it helps. But the problem is that the continued use of the orthotic doesn’t allow the body to heal and correct those imbalances and the orthotic is not addressing why the imbalances are there in the first place. Remove the orthotic – the imbalance presents itself again. That is not healthy.

Take a common muscle dysfunction of the tibialis posterior muscle. This muscle supports the main arch of the foot and is responsible for proper pronation and overall foot stability. In one individual the tibialis posterior might be inhibited because of a local injury to the muscle, which itself can be a result of too much walking or running in improper footwear. When this muscle is injured, symptoms like plantar fasciitis and shin splints can be the result, leading one to perhaps resort to orthotics. As I show in my videos of the respective subjects, these injuries can often be treated very successfully in other, more natural, ways.

A gait disturbance is another very common reason for a person to have muscular imbalances and joint dysfunctions leading them to seek out help and orthotics. I recently saw a patient who was wearing orthotics because he had plantar fasciitis symptoms several months ago. Those symptoms were gone, (the orthotics helped him recover quicker), but now he had some shoulder pain when playing tennis. I had to correct several muscular imbalances in his injured shoulder using the manual medicine therapies which I utilize in my office but interestingly I had to correct even more in the foot that had the plantar fasciitis issue months ago. The foot problem still existed and was causing a gait disturbance, but the orthotics were essentially hiding this imbalance and causing further compensations elsewhere in his body. The patient removed the orthotics and both the shoulder injury and the foot dysfunction quickly improved.

In another person that tibialis posterior might be failing because they are under so much dietary stress, (eating too many refined carbohydrates, for example), and that it is causing inhibition of the muscle. Excess carbohydrates are known to cause inflammation throughout the body, and this inflammation can impact muscles of the foot too resulting in foot pain and diagnoses such as tendonitis, bursitis, or plantar fasciitis. This is another common occurrence I see in orthotic-wearers. Their diets are often horrendous. They are often consuming high levels of sugar and other refined foods, diet drinks (Splenda and Nutrasweet), trans fats, and too many vegetable fats from corn, soy, canola, sunflower,and safflower oils. They’re an inflammatory nightmare and their joints, muscles, and health are all suffering. So they need support, and one way is through orthotics. Once they clean up their diet, they can ditch the orthotics too.

Orthotics and “Arch Supports” Don’t Support Your Arch

Many people wear orthotics or various types of “arch supports” because they have either flat feet or pain in their arch. Flat feet are normal in a toddler; as they get older the tendons in the foot strengthen and tighten to form the medial longitudinal arch, often by the age of three. Some never fully develop this arch in the foot, often due to poor footwear. Many adults have what appears to be an arch when they are non-weight bearing but the arch flattens or fatigues when they stand due to muscle, tendon, and ligament weakness in the lower leg and foot.

The problem with orthotics and arch supports that are used to treat flat feet, fallen arches, and painful feet is that they don’t support the arch of the foot where it actually needs to be supported. To properly support any arch, such as a bridge over water or the arch of the foot, either end of the open space should be supported. In the case of the foot, the heel and the forefoot should be supported, not the space in-between the ends of the arch.

To truly strengthen the entire foot and all the arches, it’s important to position the foot correctly at all times. This means that the heel should be flat on the ground, as should the forefoot (think barefoot -“zero-drop”) and the toes should be allowed to naturally splay apart for proper support. Typical shoes with a heel higher than the forefoot and a toe box that is narrow will only further weaken the foot and arch, especially with the addition of an open-space arch support or orthotic. More at my DRG site: Flat Feet – Causes, Prevention, and Treatment.

Orthotics Support Dysfunction

One can see, whatever the case, an orthotic is not the ideal treatment – addressing the root cause is. Figuring out that root cause and working through it can sometimes take a very long time, an hour if not much longer, which is not something most physicians have the time, energy, or ability to do either physically or mentally. So many have to resort to orthotics. And for those who practice this way and get a person walking, moving, and out of pain then that is entirely fine. But again, it is treating the symptom, not the cause, and it is not addressing the patient’s overall health. The use of the orthotic will hopefully be temporary to truly benefit the patient.

Orthotics will always support a dysfunction. If they were supporting normal function then they would not be necessary because function would be restored in the first place. I don’t quite understand the term “functional orthotic.” There is nothing functional about controlling motion. If an imbalance “appears” to be restored with an orthotic, it is only that – an appearance. Yes, I know that’s not something any physician wants to hear and I got some slack for that statement after speaking to a several hundred chiropractors at a conference, but I can’t think of any exceptions. Feel free to kindly comment if you have an exception, (I’ve received some nasty ones from a couple docs whose livelihood is based off prescribing orthotics). But even in my one patient with post-polio syndrome, we both fully realize that we are supporting her dysfunction with the orthotic. For most all patients though, dysfunction can be restored, even if they have tremendous foot pain. It may take time as they wean out of their orthotics like they would transitioning from  a traditional shoe to a minimalist shoe, but as overall health is restored, so is foot health. Some other devices, like Ray McClanahan’s “Correct Toes” is a great product to use for feet that have suffered structural mis-alignments due to years of poor foot health and improper footwear, (not an orthotic).

Address Your Problem – Ditch Your Orthotics

So you can see there is not necessarily any specific exception for using an orthotic; it is all very individualized and even in what some might consider an extreme need for an orthotic, perhaps isn’t so. Treating an individual fully is a lost art. Sure, all physicians want to say that they treat everybody differently and every case is unique. But how many physicians evaluate the entire body every time? In other words, how many evaluate the state of an individual’s hormones, diet, exercise regime, and entire musculoskeletal system when investigating any major problem let alone a foot dysfunction? How many examine the integrity of all the joints in every limb and their relationship to the present foot ailment? I’d say very, very few. It takes a lot of time, a thorough understanding of the entire body, and proper evaluation skills – many of which require proper muscle testing and other challenge parameters, which is a skill acquired over years, and one that is not regularly taught in any school of medicine – conventional or “alternative.” The many “specialists” in the field of medicine typically fail to see the whole picture of a patient, including the ones who prescribe insurance-covered foot orthotics.  This is the concept of what I like to refer to as systems health care – the inter-relationship between everything in the body and how every organ, muscle, bone, movement, etc, is related to each other in some fashion. In other words, poor health results in poor foot health which results in the appearance to need orthotics. What comes to mind is that marijuana commercial from the 80s. This is your foot (egg). This is your foot in orthotics (egg on frying pan). Any questions?

* Check out the new article (April 2013): “A Case For Orthotics

Comments

  1. How about if your bones don’t go the way they should? I was told the bones from my ankles out to my toes are at an angle instead of straight out causing the bones in my feet to come together when I step down instead of moving apart. I’ve worn orthotics to keep that from happening. Or so I thought?

    • In some extreme cases, when there have been major bony mis-alignments due to poor biomechanics and muscle imbalances over many years, other interventions may be necessary. This is where a device like the Correct Toes can help, as I mention. Now perhaps, if you really have some significant bone-related problems in the foot, more drastic measures such as an orthotic may benefit you. But I have dealt with many people who say their bones aren’t lining up correctly or moving correctly and it’s because of muscle imbalances, ligament and tendon problems, and/or gait imbalances. So without seeing you, it’s impossible to say if you’re the person who really has developed some major osteo mis-alignments, or if you’ve just been told that because the physician treating you just sees what they have in front of them, and not why it is that way or how to properly correct it.

  2. I’ve been reading your articles about PF with a lot of interest. as of Aug 1st this year I ditched the shoes and have been running completely barefoot on grass and trail. My PF seems to be finally improving. I still get a bit of heel pain but nothing like before. On March 20th I ran my 3rd standard marathon (42.2km) and nearly ended up crippled. Yes I know wrong shoes and MEGA orthotics. My Orthotics consisted of soft heel cups in both shoes and a 13mm heel lift in my left shoe
    My left leg is 20mm shorter than my right. This is not due to a muscle imbalance but rather that the tibia and fibula are physically shorter. I’m finding that my left calf is now taking a bit of a hammering. This definitely beats the hip pain I used to get. I’m looking to move into shoes again so that I can get out on the tar. Probably Inov-8′s or something similar. What do I need to do in order to compensate for the LLD?

    • Hi Steve. Your left tibia and fibula are shorter due to some childhood illness or accident, I presume? A 20mm differential is pretty significant, and going from that to barefoot very quickly might not be the best idea. As I note in one of my case histories, if you had a doc go through and balance everything you may not even need a lift – or at least a lift so significant; it all depends. But if you had a 13mm lift in there and then you go to zero, that’s a bit of a shock to the system. Just as someone wearing the typical over-supportive running shoes should not go 100% to a zero-drop shoe or barefoot immediately (but transition), you may want to do the same with the lifts. Get in those Inov-8′s on similar that you’re comfortable in, and see how you feel in those with the 13mm lift. Then, go down from there – maybe getting different heights that can knock off 2mm each, which you change out every week or two, depending on how you feel. So you go from 13mm to 11mm to 9mm, etc… and see how low you can go where you are most comfortable – no hip pain or calf problems. Let’s hear back from you on how that works out for you. Remember, you’re not going to be “unsuccessful” if you can’t always be barefoot running. You’ve got to do what works for you. Your goal is to be as efficient as possible and that means pain-free.
      SD

      • Just a bit of an update. I got a pair of Inov-8 Road X 255′s to run on tar. Not totally minimalist or zero drop but very comfortable none the less. I tried slipping in my heel lift on a short runand promptly took it out again a few strides up the road. It just felt wrong! I am suffering with mild postmedial shin pain on that side. What to do? I have thought of using an old silicon heel cup as a heel lift in transition. This will give me about 10mm. ( Sorry I can’t think in inches)

        • Look for the trigger points in that area as I show in the Shin Splints Video. 10mm may help, that is 1/2 of your differential from what you mentioned before. Really just gotta see how you feel with it.

          • The silicone heel cup is working like a dream. it is just enough to take the strain off my hip and calf muscle. Shin splint is recovering nicely. I have to admit that running with proper form is so much less effort.

  3. I found this article really interesting but wonder how much of this applies to problems with bunions. I have seen 2 podiatrist re: my bunions and the pain they cause. Both said, even after surgery (which they both agree is inevitable) I would need orthotics to prevent the same problem from occurring. It is possible the p.t. could help with that?

    thanks so much for your information

    • Thanks Megan, for bunions check out the Correct Toes I mention in the article, they may be exactly what you need to straighten out that big toe and prevent future problems, and maybe even keep you out of surgery. Orthotics after the surgery if you go that route? I’d say no way if you correct the problem you’re having now which is causing the problems – whether that is weak foot & ankle muscles, improper footwear, etc…

  4. This is a good, very thoughtful look at foot orthotics. I recently reviewed a textbook written by one of the top biomechanic researchers in the world, and it reveals wide variability in orthotics and a lack of scientific evidence behind them. You may wish to read it – http://www.americaspodiatrist.com/2011/02/biomechanics-of-sport-shoes-the-disturbing-truth-about-running-shoes-inserts-and-foot-orthotics/

    Great website, overall! I love that you wear socks in the office!

  5. I am a 59-yaer-old runner, a beginner, with approximately two years experience. Thus far I have suffered through a neuroma in the left foot, a case of planter fasciitis in the right foot, and bursitis in the ball of each foot.

    I run in a neutral shoe, Nikki. I tried running in the over the counter orthotics provided by Gazelle Sports and then went to the ridgid orthotic prescirbed by a podiatrist long before I began running. My current podiatrist has made adjustments to these (as well as the over the counter) to accommodate the bursitis. With the ridgid orthotic I get relief from the bursitis but developed horrible blood blisters and “black toe” as a result of my foot moving around so much in the shoe. After running approximatelty 30 miles in the ridgid orthotics I went back to the over the counter without a re-break in period. I think that was a mistake because I developed knee pain so severe that it was difficult maneuvering up and down stairs. I have taken a couple of weeks off from running and am feeling pretty good at this time and ready to start up again.

    I hope you can give me so advice because the truth is after many years of fumbled attempts at sports (lots of motivation but no talent) I have finally found a sport that I am good at and that I thorougly enjoy, and I want to continue for as long as I am able.

    I have a moderately high arch, second toe bone longer than first, possibly a difference in leg length, and I am a mid-foot striker. Thank you very much!

    • Hi Lynn, this is a tough one to stay where to start other than to say you need to just about start over. You’ve only been running <2 years and have already suffered 3 significant injuries, and knee pain too (so 4 injuries?). Check out the “START” tab on this site if you haven’t already as those articles, which includes this one on orthotics are very important. If you want to run as long as you are able – which should be at least 20 more years – you need to completely resolve those injuries and I don’t see it possible with any supportive footwear. Aerobic training, a healthy diet, proper footwear – all good places to start and implement into your life. :) SD

  6. Jim Haselmaier says:

    Some people claim lax ligaments can prevent some people from getting away from supportive shoes and orthotics. Have you seen this happen? Is there such a thing? If so, can other muscle strengthening compensate? Thx.

    • Yes, there is such a thing as ligament laxity, where the ligaments can’t support a joint properly. Putting a person in orthotics obviously doesn’t correct the problem. Most often the laxity is due to hormonal imbalances, primarily the adrenal glands and their production of aldosterone, which regulates electrolytes (sodium, potassium).

      • For ligament laxity, which I have, my 8 yo girl and my 3yo daughter with Down syndrome definitely has, there are supplements to help ligaments! Specifically Vitamin C, Magnesium, Sulfur in the form of MSM, some people say Chondroitin and Glucosamine. Methyl Donors (methylcobalamin form B12 and Folinic Acid like MTH-5, Metafolin, and DMG or TMG aka Betaine) will also help muscle function and can help compensate for ligament laxity

  7. Not sure if this has already been mentioned as have just found your website… I haven’t tried these personally but have heard about the benefits of http://www.barefootscience.com/ insoles which work to strengthen the foot while wearing shoes. May be a good transition to barefoot running – first work on strenghten the foot and improve biomechanics, especially in those with actual foot problems.

    • I have had a few patients try them. Mixed results – either no change or has helped. They are probably the only insole I’d recommend, and one still needs to work towards barefoot. But they are a good transition device going from highly supportive shoes or orthotics (or an injury) to minimalist/barefoot.

  8. Andrew of Perth says:

    Orthotics should be banned for all but extreme cases of need. Foot strengthening exercises, i.e. barefoot walking should be used instead of these foot weakening “walking stick” devices.

    The fact that podiatrists “prescribe” orthotics is a huge misnomer, it’s seems to me it’s all based on guesswork.

    After wearing orthotics for 10 years the original problem has long gone and now I have five more problems that I never had before the orthotics. Think carefully folks if you have these foisted your way.

  9. Like your site.

    I had a bunion removed about a year and a half ago but no physical therapy after as I lost my health insurance & job. I have had regular pain since the operation and a burning big toe and though I can walk through the pain, and it gets a bit better during the day, I find myself becoming quite a bit less active. I would like to be able to run again, even just a bit.

    My foot looks more “correct”since the surgery but I think it is pronating (turning in?) a bit now. Recently removed my over the counter orthotic which I wore for about a year i and just put in some cushioning.

    Two months ago I banged the front/toes of my foot on a piece of metal sticking out of the sidewalk and My foot felt really out of whack for at least a month. I even visited the Dr who operated on me but he was mainly interested in the bones and did not see any problem though he noted the scar tissue.

    I wonder If I can afford at least one visit to some sort of PT to give me some directions. Or acupuncture? Or, since it may be cheaper, can foot massage be helpful esp for the scar tissue and if so, what sort? The ball of my foot is still quite solid (a bit stiff too since the operation) but the rest of the bottom of my foot feels weak and thin & sort of shifty.

    • This is a tough one to give advice on w/o seeing you. If right now the pain is not that bad when you walk, and as you say, gets better during the day, I’d focus on walking barefoot as much as you comfortably and safely can throughout the day. If you know a good massage therapist who knows the foot and lower leg muscles well that may help too. Otherwise, walking barefoot and balancing on one leg to develop foot and ankle strength is a great way to get started. And it’s free!

  10. David Kalal says:

    I am a 42 year-old runner who transitioned into BF/VFF running (also with Nike Free+ shoe) over the past 6 months, very slowly. I was eventually able to do moderate distance (4-5 mi on the road and 6-7mi trail) with no problems. Until bam – felt a pain last month, now have dx of 2nd metatarsal stress fracture and Posterior TT. I have a tibia length discrepancy from an accident in my early 20′s, but had read that a fore/mid foot strike shoud mitigate this to some degree. As such, I ditched my prescription othotics. Now I’m being told by my podietrist that the injuries (in my longer leg) are due to the legnth discrepancy. I’m at a loss about how to facilitate my recovery – back to my “wedge” shoes with orthotics, put the orthotics in a minimal shoe, or just start running slowly sans orthotics? Can a length discrepancy due to bone size differences be overcome in minimal shoes?

    • Hi David. That’s tough to say what should be done. Just because you got a stress fx doesn’t mean you should ditch your orthotic-free goal. You might have gotten the stress fracture from the Nike Free shoes or the VFF. I’ve seen gait imbalances in certain minimalist shoes (some work better for certain individuals than others) and I personally cannot wear VFF – after 30 minutes running in them I get sharp pain in my right 5th met – as if it’s going to break. They clearly don’t work for me. Also, as I note in the stress reaction/stress fracture post on this site, there are other factors than just the footwear. Unfortunately, it’s impossible for me to tell you if you should or should not use the wedge in the short side, the long side, an orthotic, or what type of footwear without seeing you as that’s a hands-on analysis because it’s so very individualized.

  11. I mostly agree that orthotics are crutches and that barefoot is best, but there are many different kinds of orthotics. The plaster cast kind that I think most podiatrists still use are from the stone age and absolutely useless. I absolutely agree that those shouldn’t be used. I suffer from severe (off the charts) over pronation and those kinds of orthotics never really helped much and in fact were quite painful. With them my choices were to stand in pain (wearing them) or cause knee pain when walking. Years after giving up on those I stumbled onto a good chiropractor and got my first set of “Foot Levelers.” They actually support all 4 arches of the foot and somehow also stimulate the muscles of the foot and calves to work better. I think “Good Feet” have a similar approach but its more of a system. What do you think of that type of orthotic? After a year or so in them I’ve noticed my feet look better, I have better splay in my toes and almost the beginnings of an arch shaping up. I’ve gone through spurts of going barefoot, but all it does is hurt my knees and worsen my back problems. I don’t understand what you would do with someone in my situation. I think with feet like mine the main issue is that my ligaments are all stretched not doing their jobs. Strength and coordination is great but when you’re just standing around its mostly your ligaments that keep your foot in shape and give you a nice base. I just kinda flop down.

    • Hi Matthew. I’m very familiar with Foot Levers as they’re very active in the chiropractic arena. I won’t say anything bad about them; no need to make enemies. Do I use them? No. No reason to. It’s great that they have helped you, perhaps you are the rare exception. But if you are, it’s still important to try and wean yourself off them, even if it’s a little at a time. You “support” arches by supporting the ends of the arches, not the middle (check out the free booklet we have at Natural Running Center) where the arch actually spans; that’s one major flaw of orthotics. And if they’re really helped with rehab (true correction) you should be able to do without them, even a little bit. That’s why they “never do their job” as you say.

      My approach is quite different than most. I test each muscle of the foot and lower leg, and typically the entire body, to see where there is over facilitation (muscles working too hard) and inhibition (weakness). I see people often who look at me like I’m crazy when they tell me they can’t walk without pain with their orthotics in their oversupportive shoes. Some take longer than others, but I’m proud to say that I can get them all barefoot w/o any pain. Some still have setbacks when they’re under too much stress and they need to put their shoes back on – but never their orthotics.

  12. Hi sock doc, love the site. I started using orthotics several years ago to prevent over pronation on the advice of a podiatrist. The main reason was fairly severe itb pain on running and some knee pain at rest. I am finding that I am now getting severe shin splints and neural tension in calves after soccer and even sometimes with walking. I assume this is due to further imbalance caused by the orthotics. I have started wearing vibram 5 finger shoes for short bursts (10 mins) and trying to self trigger point gastroc etc. However my knee pain returns promptly without the orthotics. Do you have any advice on how best to wean from my orthotics and help prevent over pronation?

    • Thanks Richard. I wouldn’t be going from wearing orthotics to VFFs so suddenly. Use a transitional shoe – Nike Free 3.0 or plus, NB Minimus, or one of the others that we have in the reviews at The Natural Running Center. The way to wean from the orthotics is to walk & stand barefoot as much as you possible can (w/o pain) at home and work. If your feet hurt, put them back in. Eventually you should need them less and less. Then with a transitional shoe you should be able to run w/o pain unless there is still a lot of neuromuscular work that needs to be dealt with. Only once you’re comfortably barefoot all the time and running pain-free in a minimal transition shoe should you then move further towards barefoot with the VFF or similar zero-drop shoe. No rush!
      Hope it works out for you.

  13. hey doc,
    i found your post because i’ve just been prescribed orthotics by a chiropractor and wanted to learn more about them. i’ve had two knee surgeries for torn medial meniscus. the last surgery was 5 years ago. i can walk okay but have never gotten back to running. i’ve tried the Vibram FF shoes but still have knee pain. my chiropractor says i’ll be out running pain free in about 3 months after i get used to my orthotics. according to this post i should stay away from orthotics. what is your background/specialty and how do i find someone that will take a holistic approach to my knee problem?

    • Hey Dale, I can’t personally advise you what to do (wear the orthotics or not), but you know my thoughts on them. They suck. Pain free in 3 months? First – that’s a very long time. Second – pain free maybe where you’re having problems now, but you’ll develop another injury, maybe a similar one as you have now. It’s almost a guarantee if you try to “correct” your problems with braces. You can read more about me in the About tab. I rarely refer since a lot of my techniques/therapies I have developed on my own and those I have learned from others, not a lot of docs use. When I see someone like you I treat – then have them run – and treat again to see what held or didn’t hold – until it’s right or the problem is known.

      • hey doc,
        well i’ve spent a little time reading through your website. i’ve got so many questions i don’t know where to begin. most of them pertain to my knee injury/surgeries and if i’ll ever be able to run without pain again. i’ve been mostly limited to indoor aerobic machines for about 7 years-elliptical machine, stair masters. i’ve read your post about stretching and that has set me back wondering how much damage i may have done. the stretching i do has been “learned” mostly through yoga classes. i wonder if my stretching has been “dynamic” enough to avoid weaking my muscles. so i guess my main question is how do i find a dr. like yourself who takes the whole body into account when precsribing treatment? where do i look? what questions do i ask? etc?

        thanks,
        dale

        • Hi Dale, not a lot of docs I refer to because they don’t spend the time with the patient (my initial appointment is 2+ hours long) and most docs don’t treat – they just look at you, feel around, then send you to someone to get worked on and that often isn’t too great. More info here.

  14. Joyce J says:

    Your advice sounds god to me. After years of orthotic use I am ditching mine, My last podiatrist had me stretching and using a splint. My plantar fascitis was so bad he wanted to perform surgery. Before doing so I asked my chiropractor and she adjusted my feet and ankles. As soon as I stood up I could tell it was gone! But I noticed that when I put the orthotics back on my feet quickly returned to their pain. I have realized that I can go longer between adjustments if I don’t use the orthotics. Thanks for getting out the word on how relying on them weakens ones feet.

  15. Christian Taylor says:

    Hi Doc,
    I am from montreal and I just discover your site from listening to the podcast last week.

    If you have a few minutes a would appreciate you reading this and please comment if you can.

    I am doing ultra trail running for about 4 years, never really had bad injuries’, but last september when I was running a 100 miles,

    at about miles 40 I started to feel a sharp pain under the heel, I finally at miles 45 DNF from the race because it was just getting worst, I have to say that a few months before I would

    feel some minor discomfort under the heel some time not all the time.

    My self last year started to go with the minimalist wave, got from a regular running to minimalist and five fingers shoes, I would go for some 3 to 5 miles runs at the time, I have to say

    I really enjoyed it when it rain it felt really good on the feet all the way to my brain.

    After the race the next few days wore ok but I would be sore true out the day mostly, so I decided to go for an ultrasound and they said that I most of have at some point a minor tear of the fascia

    because they could see the inflammation of about 12mm on a 5 mm length, the doc said don’t run for a few months, so I totally stop everything with made really depressing because I was in so good shape I was winning races and just felt great.

    after the diagnosis I went true physio for a few session but then decide to go for shock wave therapy, I would go for 3 treatments and it was very painful, and after a few weeks more pain, so I said to my self well cortisone shot twice now and they told me to be in a boot and crutches for 6 weeks witch I am almost over. now I will go see my podia trice and they will tell me again to get one mere pair of orthotics’. do here I am Doc and this thursday my doctor will tell that I can finally walk on my foot , what should I do i’ve been watching your video and ding the towel and the trigger point message, but what else and what would you suggest for a running shoe, I know I wont start running right away but I am planning to do that very soon.

    please help with some advice.

    thank you for taking the time to answer and all the work you do so we can be healthier runners.

    • Hi Christian – just to clarify – you are saying that you now have NO pain and this Thursday (in 4 days) your doc is planning on giving you the okay to walk again? My concern here is how is your foot healed? Shock wave therapy, cortisone shots, and stability boots merely take the pain away but don’t address the problem. I hope it is healed though and you are set to go.

      When you injured your foot at mile 40 of the 100 you were not in minimalist shoes, correct? But after the race you began to wear VFF? If that’s the case, and you did well in the VFF, that may be the best shoe for you for rehab.

  16. Having transitioned to barefoot over a good many months, I have ended up with 2nd metatarsal break. I used to have insoles with a pad to shift the pressure around the front of the foot because my 2nd metatarsal was a lot longer than the others

    This type of injury makes sense to me and I cannot see how using barefoot running/minimalist shoes can be helping me. I think I will be returning to my orthotics

    I also don’t get why running in zero drop shoes is OK when others are not. Do they not also alter the feedback thing that you are talking about

    Surely barefoot cannot be good for everyone

    • Correct barefoot is not for everyone, though is it good for everyone? Of course. How can barefoot be bad? I’m actually in the process of writing a post which will be up next week titled “healthy people = barefoot people” which discusses how an unhealthy person typically can never run barefoot or even in minimalist shoes. Unhealthy people, or those who have been in orthotics or modern shoes for so long have caused significant changes in their feet and lower legs – not just the muscles, tendons, and ligaments, but also their proprioception and kinesthetic sense. So they have to transition very slowly, and many can never be barefoot if an underlying health problem is not addressed.

  17. Dr. G.,

    I saw your article on orthotics. I’m a younger athlete, 33 years old, and in good health. After going in circles for 3 months, a CAM boot, and some serious 80 year old orthotics, they found I have a small layer of osteonecrosis on the top of the navicular with a tiny stress fracture. I assume they don’t expect the stress fracture to heal at this point. My question is about the orthotics. I wore them for about 5 weeks 1/2 a day & not really for cross training. They make my feet hurt & have hurt my knee. The left was made to give enhanced support for my navicular & is the same side as the knee problem. I can’t see even going back to running in those suckers. Are orthotics necessary to keep the condition from returning? My other alternative is surgery where they will remove the dead bone & put a strengthening screw in the navicular. I’m not by any means a professional athlete but I love the sport & i was getting up to a pretty good clip, trail running, & using more minimal shoes.
    I’m just curious on your take for this type of problem. I’m dedicated to using strength exercise to make my body strong & i wonder if I could do those for my foot.
    I have a doc here that does Graston/ART & it has seemed beneficial. I get frustrated though when no one knows how to make things strong again.
    Any advice?

    • Hey Kim, well as you know from reading this orthotics post that my feeling from what I see clinically is that you will only support your dysfunction and continue to have muscle, tendon, and ligament weakness the longer your wear those orthotics. Sometimes they’re okay if they take pressure off a bone while it heals, but they should then be removed as soon as possibly. But you’re feeling pain in your feet and knee with them – that’s not right. Sounds like they’re making things worse. Not sure why your stress fx is not healing. It should be if the mechanics and nutrition are there (see the Stress Fracture post on this site). Situations like this are always tough to give exact advice via on-line means because, and as you say, no one knows how to make things strong again. Well, not to sound too cocky or arrogant – but I do. Each individual muscle of your foot, lower leg, and pelvis needs to be tested to see what is working, and what is not. The gait needs to be analyzed too – how your left arm and right leg work in harmony and your right arm and left leg too. Though this can sometimes be done via a spiffy video gait analysis the downfall there is they’ll tell you what exercises to perform to “fix” your gait. But they can’t tell you where the problem is coming from – only where it is seen. So if your hamstring looks out of balance there is no way of them knowing if that is from an imbalance with the quads, the calves, something in the foot, or the opposite upper-body limb.

      Anyway, this response might now only give you more questions than answers and w/o seeing you I can’t comment on surgery; but obviously know that should be the last resort – once you screw a bone in it’s almost always permanent.

      • My stress fracture will not heal because its located in the portion of bone that’s already died. Dead bone isn’t going to regenerate nor repair itself.

        I believe your thinking is correct on imbalances. I went through 9 months of PT to correct severe low back pain only to never really have it resolve but it has lessened. PTs are good & are very good for cut & dry injuries, but an active person really needs someone that’s going to address the entire muskleoskeletal system & help to correct it.

        So, I don’t fly well with the normal medical community since I don’t like orthotics, NSAIDS, surgery, or really anything that isn’t natural.

        When I recover from this round of bills from doctors, tests, etc. maybe I’ll be enough ahead to afford to come get a clear diagnosis for recovery. Until then I’ll limp along & wish I was running & probably pay for some PT so I don’t feel guilty about trying to run again without proper rehabilitation. Thanks for your input.

        • Correct on the bone, but the entire navicular isn’t dead – you said “small layer”. I’m not sure to what extent that osteonecrosis contributes to the stress fx not healing; that’s out of my realm. 9 months of PT – more than a bit much. Good luck with everything.

  18. Jean Myers says:

    I’m 60 and developed a Morton’s neuroma on my left foot about a year ago. I’m using an orthotic with a pad that just raises the third metatarsal, leaving more space between the metatarsals to relieve the neuroma pain. I never wore high heels or tight shoes but I have had so-called flat feet all my life.

    The orthotic plus rocker sole shoes does relieve the pain and going without shoes exacerbates it. However while I can do all my regular daily activities, walking more than a mile is not comfortable. I ride a stationary bike, do water aerobics and Pilates for exercise but sure would like to walk and hike again. Any thoughts on how to relieve a neuroma? Thanks so much!

  19. I went and saw the chiropractor for pain in my heels. He said I had heel fat pad syndrome. He said only rest will heal it and that if it didn’t heal I could go see an orthodontist or something. He mentioned heel cups and taping them. Heel cups didn’t work but tapin them helped a bit. After about three months everything got better almost out of nowhere. I didn’t really rest it but it go better. After a month of it being pain free. My heel pain came back . Now I’m not sure if I should go see the chiropractor again since he didn’t do anything but diagnose the problem. But I’m wondering what else can be done

    • Even though it’s a different type of injury and diagnosis than plantar fasciitis, try the same therapy as I show in the plantar fasciitis video as the muscle imbalances that result in fat pad syndrome are similar to PF. Shoes are a big issue too and thick shoes will cause you to be a more heavier heel striker when walking and of course a heel striker when running.

  20. Hey Doc,

    Your site is tremendously intriguing – found it while seeking help for my adult son. He was born with club feet that were manipulated and casted for the few few years of his life – and a time or two in the interim. His feet now work somewhat normally, but with arches that completely collapse upon standing – he wears regular shoes, but does have foot and lower leg pain on a regular basis.

    He recently tried custom orthotics, can’t say they helped much either.

    My question is how would you treat a congenital issue such as this one? Are fully rehabilitated feet a possibility for him?

    I’d really appreciate any thoughts your can send our way on this. Thank you for your time.

    • Thanks Debora! This is a great question and one I actually touched upon in the recent post over at my other site – drgangemi.com. Check it out: http://www.drgangemi.com/2012/03/flat-feet/.
      Basically what it comes down to is the height of the arch (or lack of) pretty much has nothing to do with performance. If he’s not in pain and is performing well, then the best thing to do is naturally strengthen his feet with barefoot exercises. Orthotics won’t help as the studies show, and will probably just make things worse. When you say “fully rehabilitated” if you ask will he ever get his arch back then then answer is most likely ‘no’ – not now as an adult. But if you mean in regards to function there the answer is most likely ‘yes’ barring any other complications – health issues, as I mention in the Healthy People = Barefoot People post on this site. Enjoy!

  21. Chris Novelli says:

    Dr. G:
    I developed plantar fasciitis in my left foot a year and a half ago and have been wearing orthotics on both feet ever since. The pain is in the exact center of the bottom of the foot. It’s a sharp stabbing pain, which happens whenever the muscle tears. I’ve been through four sets of custom orthotics and two over-the-counter, and have never been able to find any that don’t make my feet hurt. In fact, I’ve started wondering if these orthotics cutting into the bottom of my feet were actually aggravating the problem because they press on the injured area. I discovered your website this past weekend and have started trying to ween myself off of the orthotics. However, I recently got the sharp pain in my left foot when I was walking and last night, for the first time, got the pain in my right foot when all I was doing was standing. And that was my GOOD foot. I understand my foot muscles are probably atrophied and can no longer support my 140 lbs of weight. I also have high arches. What should I do when I get these stabbing microtears? Retreat back to the orthotics? Ditch them completely and stop switching back and forth? Since, I’ve now torn my right foot, if I wear an orthotic, won’t it heal in that position and then just tear again the next time I try to walk without it? I feel like I’m trapped by my orthotics in a vicious circle of pain and dependency — like a heroin addict. I’m male, 44, and not a runner or athlete. I’ve seen an orthopedic doctor and a podiatrist, and they treat with orthotics. Before all this happened, I used to like walking around the house barefoot.
    Thanks,
    Chris

    • Hi Chris – 6 sets of orthotics and insoles in 2 years – that could be a record. You can’t keep doing what you’re doing, right? That would just be silly – it already is. I really doubt you’re “tearing” the fascia as you say when your feet hurt. Yes, wearing the orthotics over the year or so has probably caused problems with your “good” foot and now it’s also a problem. Look at the plantar fasciitis video to see how I address that problem. Also read “Healthy People = Barefoot People” to read more about why your feet hurt and how to properly wean off the orthotics and typical supporting footwear. Report back here!

  22. Marjolein says:

    Hi Doc,

    Your website is very interesting. I can’t stop reading.

    I have had knee problems for the last three months and a half. My right knee started after I twisted my ankle during a run in the woods. At least I think that’s what triggered the pain. I have had arthroscopic surgery to remove part of my meniscus 20 years ago, so once in a while that knee is hurting me. So I didn’t think much of it, and kept on doing what I normally do including playing ice-hockey. After a week I went to physio, because by then my left knee had started hurting me as well (because I tried to avoid my right knee). The physiotherapist discovered a swelling in my right knee and imbalance of the major upper leg muscles, so she gave me a lot of exercises. She also recommended minimalist running shoes to transition to forefoot running instead of the very bad heel striking that I did. The swelling should go away by itself.

    When the pain was gone, I injured my left knee while snowboarding. My knee rotated and was stuck in that position. However, I didn’t know that until a week later. My physio corrected it, and I had to do more strengthening exercises. Of course the pain in my right knee was back, because this time I was avoiding my left.

    Because the left knee was not getting better (and therefore also not the right knee), the physio discovered that the arch on my left foot caves in each time I make a step. She prescribed orthotics and foot exercises to strengthen it.

    I have had x-rays and MRI’s done and they showed that I have a meniscal tear and a cyst, related to the meniscal tear, in both knees. The x-rays showed no arthritis. Both cysts can’t be seen from the outside, but are fairly big (left: 5 by 3.5 by 3.5 cm and right: 3.5 by 0.9 by 0.9 cm). The idea is that the cysts are what is causing the pain, which is consistent with the coming and going of the pain and the changing of the pain spot the last 2 months.

    I have not been able to do any impact exercises like running or even jumping, but I do bike my kids to school and I swim.

    Apart from changing my diet to more Paleo type diet and 1-2 Tbs vinegar per day, what else do you recommend? Would you recommend removing the meniscal tears? And what should be done about the cysts?

    I have lax ligaments as well. Can you test the hormonal imbalances? And what can you do to get it back in balance?
    Will the laxitiy be gone then?

    Thank you very much for your time,

    Marjolein

    • Hi Marjolein, check out the Knee Video if you haven’t already. I can’t personally advise you on whether you should have surgery or not, since you’re not a patient of mine. Tears can heal on their own depending on the severity of them. Cysts can also resolve on their own too, or at least the pain from the can be removed if the muscles are all working in the area.

      In my office I test hormonal imbalances via patterns of muscle imbalances and challenge tests to the nervous system that occur when either the adrenals, thyroid, reproductive organs, or pituitary are out of balance. Lab tests can sometimes be beneficial too. Ligament laxity is most common an adrenal symptom and usually due to electrolyte imbalances from hormonal insufficieny.

  23. Hey Sock Doc,

    I was diagnosed with Plantar Fasciitis last year and decided to stop exercising in order not to aggravate the condition. I was also doing calf stretches as many people seem to believe that this reduces the P.F. pain. I must admit that strethcing does feel good, but has not proven to be curative in my case. Now, a year later, even though I´ve not been doing vigorous exercises, my foot pain seems to be getting worse. My arches, heel, and my ankles are sore. The bottom of my feet feel tired and kind of like they´re on fire or something. I recently bought a pair of Vivo Barefoot shoes thinking that maybe they would alleviate the symptoms but I have not noticed any improvement whatever.

    Today I visited a Podiatrist and she examined my walk and stature with a machine, and visually. She claims that a high arch is the cause of the problems. Guess what she recommended, orthotics. I bought them cause I´m want to do what´s best for my feet. Then I found your video on P.F. and you suggest that shoes and stretching and orthotics are no good. I suppose I will try the calf massage to see if that alleviates the condition.

    Any other thoughts or suggestions would be greatly appreciated.

    Additional Info: I walk a lot during the day (on hard surfaces, like pavement) and I am often on standing for fairly long periods.

    I look forward to hearing from you.

    Thanks in advance,

    JD

  24. Mr. Sock Doc,
    I just got back from a visit to a podiatrist – flew from Costa Rica to Los Angeles special for the visit. I’ve had problems with my feet for the last 4 years and it’s gotten to the point of pain medication daily. It has all the symptoms of a neuroma but it seemed to be in the unusual location of between the 1st and 2nd metatarsals, and both feet at the same time. After getting here and doing a proper MRI, nothing is there – no neuroma and nothing that would seem to be an issue. He said nothing is wrong with the bones and structure but it is obviously something with the nerves. The doc was a bit surprised and wasn’t sure of what to do next (pod for 41 yrs, highly recommended). The only option he has at this moment is possibly orthotics as the next step and did some special taping to mimic the effect as a test. It seemed to be helping some or it might be the drugs kicking in – not sure. I searched the internet for the dreaded question – do I have to wear these things forever. Most sites pretty much said yes till I ran across your site.
    It was interesting to say the least. As a layman I understand what you are saying that orthotics are seeking to address the symptom and not the problem – and can actually cause other problems. I could tell from my conversation with the pod that he doesn’t know what the problem is to address, he’s totally unsure. I saw your instruction to the guy with a neuroma to watch the PF video. I did and it was pretty wild, in a painful sort of way, that pretty much all the way down my legs I had knots and pain. Some long, some short, but both legs. I’ve begun to follow your instructions for working on them.
    After working on them for an hour they are tender but still there – not sure if they are less but it seems to be helping my feet. Again, it might be the drugs kicking in.

    How many times a day should I work on the knots – 2-3 times a day, every hour, etc.? And for how long on each leg per session – 20 minutes, 45 minutes, etc.? Any idea about how long it will take to begin to work them out – couple days, week, longer? Finally, if it is related to the feet pain and cramping I have, will that pain lesson as the kinks get worked out if it’s related (which will give me encouragement to continue)?

    Thanks for taking the time with this post.
    doug

    • That’s a long trip to make to get orthotics. The answer to your questions can be found here on the Trigger Point post & video: http://sock-doc.com/2012/04/trigger-point-therapy/

      • I actually came to LA with the expectation of surgery, orthotics was what was offered as a possible once surgery was ruled out. I’ve been working on the sore spots for a few days and sometimes it seems like progress, sometimes not.

        During the process I’ve also found what seems to be trigger points on the top of the ball of my feet near my toes, or at least pain points. I had watched most of your videos but watched again to be sure. If you could help me understand a few things: There are so many over so large of an area, should I work on all of them at the same time or just a few? Does it matter if I work up the leg or down the leg? In the video, you mention 15 sec or so to notice a change, release, etc. but you don’t elaborate about no change in pain. Should I go to something else and come back to it in a few minutes or wait till another session? How many times a day should I work on the points (been doing 2-4 with some in the middle of the night when the pain awakens me)? Should I push as long and as hard as I’m willing to tolerate the pain or does it become counterproductive at some point?

        I’ve stopped stretching to get relief and am only using the trigger points (and some meds when it becomes an issue). Of course I’d like the pain to stop now, but if you could give me an idea of a realistic time frame as a guide for some encouraging results it would give me a goal to look to and hope for.

        And please, If I’m not asking the right questions, let me know the questions and answers that would be helpful. I’m new to this but I’m studious and don’t delay application. Coming to see you would be awesome but the 4-6 month wait is too long unless you are considering Costa Rica for some vacation time in the near future. Thank you in advance…

        • Remember it really depends on WHY you have the trigger points – which is what you read in the trigger point post. You want to press hard enough so there is some discomfort, but you don’t want to just beat the hell out of the muscle or tissue and not be walking the next day. Sometimes you need longer than 15 secs. Maybe up to 60 max. And yes you work out every area you find, no specific “pattern.”

          That’s really the best I can tell you. Yeah, it’s a long wait to see me but you might want to consider getting on my wait-list. If you’re well in 6 months, and I hope you are, then you don’t schedule. It’s free to be on the list. But if you’re still in pain in 6 months and want to see me you get to wait another 6. :)

          • Thanks for sharing your thoughts. I sent an email to sign up for your wait list, but hoping things will be better by then. I’ve been re-reviewing the why part of the trigger points as you suggested and I think I have a pretty good idea of why they started and what may be helping to perpetuate them so I’ve started on those.

            Is there a book on trigger point technique that you could recommend or a website that might go into more detail on specifics for the novice/learner? The sites I’ve viewed on the web seem to range a bit in technique.

            It seems from what I read on your site that you aren’t the type of doctor that seeks to create perpetual patients, but instead help people get healthy and teach them to take care of themselves – it’d be nice if there were more docs in your field with that approach but I’m guessing sometimes people just aren’t interested in the work and want the quick fix by the doc instead. For cases that are on the worse end, how many consultations do you usually take to get them far along the road to health (as long as they listen to your advice, of course)?

          • Here’s the trigger point article in case you didn’t see it: http://sock-doc.com/2012/04/trigger-point-therapy/.

            I don’t recommend a specific book; yes there are many.

            The time it takes me to get someone well depends on what is going on with them. Typically, for a chronic injury, it’s an average of 3 visits – if the diet is good. If the diet is poor and overtraining is involved then it’s a bit longer depending on compliance.

          • Dang it – I did read that before. I’ve read so many other things in my research it’s kind of blending in at the moment so thanks for reminding me. I was hoping for a book referral with pics so I could try to decipher what’s a trigger vs. tender spot location wise but I understand about recommending one that would have stuff you probably don’t recommend as well.

            And dang it on the 3 visits – meaning I must be doing it wrong since I’ve done it way more than three times. I’ll keep at it. I do feel I’m improving overall it’s just the pain in the feet that mimics the neuroma symptoms (stinging tingling sensation, odd numbness, cramping toes in my sleep, funky and painful spot when I walk, etc.) has not as much improvement but I’m sure I’m just being too expectant for learning to self administer the points.
            thank you again for your time your responses. perhaps in your ‘free time’ you’ll put together a book that you’ll be able to recommend. let me know if you decide on a trip to Costa Rica :)

  25. My 9 year old son was seen by a podiatrist today for the first time. Has had heel pain in bottoms of both his feet since basketball (before Christmas). I finally broke down and took him to the podiatrist. He said had some long hard to pronounce word for Severs Disease (which is what I suspected he had after researching). He said we need to use ice and get orthotics. I’m not thrilled about jumping right into orthotics and now after stumbling across this am even more concerned. I’ve not heard one good thing from anyone who had orthotics. My son plays football, basketball and baseball. He played most of the basketball season w/ pain and is now playing baseball even though the pain persists. It flares up when he’s active or if he’s been standing on his feet for a few hours. Was wondering what your take is on this and if orthotics are necessary in his case? Everything I’ve researched has stated Severs Disease is a condition the child will eventually outgrow and the podiatrist agreed that he will at somepoint outgrow but orthotics are necessary to help minimize the pain. He has a high arch and rolls feet inward some. Thanks for any advise you can give. I will research more.

    • Since Severs involves the growth plate of the heel you want to take the stress off that area as much as possible and that means you address the Achilles tendon. So check out the video for Achilles Tendonitis as well as Plantar Fasciitis (since that is the connective tissue at the bottom of the foot attaching to the front part of the calcaneus). Basically if my kid had Severs (and for the couple kids I’ve seen with this) I have them walk barefoot as much as they comfortably can and use a lot of trigger point work in those calf and foot muscles as I show in the video.

      • I will check out the suggested videos. I haven’t had much time yet to investigate further, but I’m curious since you believe in going “barefoot”, if you would think it’s ok for my son who has severs disease to play basketball outside barefooted? He also plays in his room w/ his pro mini hoop and jumps up and down on the hard wood floors without his shoes on….I’ve told him he absolutely can’t play basketball outside or jump on the hard wood floors unless he has shoes on……trying to logically think, I thought being barefooted would flare up his heel pain.

        I also have a friend who’s a physical therapist who said if he has a high arch she would go the orthotics route. She’s noticed how he’s been running in baseball (almost a side to side hobble because of the pain in his heel)….she mentioned he’s now starting a habbit that will be hard to break probably creating a problem elsewhere. It’s so confusing when I get so many different takes on how to treat or what to do. I also have an absolute great chiro dr and am thinking of taking my son to the chiro. I know of a boy who had similar issues as my son and all it took was a treatment or two from the chiro…it turned out he was out of align. Do you think that is a possibility?

        • It really depends on how strong his feet are and how well balanced the muscles are. I’d most likely have him walking, running, and jumping in bare feet – basketball might be too much for him (stopping/cutting).

          High arches = orthotics? No way? Read this: http://www.drgangemi.com/2012/03/flat-feet/. The arch height has NOTHING to do with it. If you want to make his arches weaker, then use orthotics; they’re very effective in that case.

          Sure I’m all for a good chiropractor just as I am for any other good doc or therapist. Really depends how they were trained, their philosophy, and their knowledge.

          • So what do you recommend for feet that roll inward? I know you are against orthotics so what should we do to correct that problem? A physical therapist told us my son’s feet rolling in was causing the stress on his foot muscles which is causing his heel pain. Football practice starts next week…I’ve gotten so many opinions and different takes on his feet I’m totally lost. Therapist told us to do stretches, which I know you’re against.

          • The only general advice I can give is what you see on this site – walk barefoot, run barefoot, wear the proper shoes, clean up the diet, etc. There may be specific muscle imbalances that need to be corrected but I wouldn’t know what those are or how to correct them w/o seeing him. You might look for a whole-body type doc: chiropractor, PT, rolfer, massage therapist.

  26. Hi Sock Doc,
    I know this is an old thread, but just stumbled on it! I’m 32, badly broke my ankle at age 12 playing soccer. Surgeon put two screws in it, I rehabbed with no problems, and went back to competitive athletics pain free through high school and into my 20s. In my mid 20s I wasn’t quite as active on it, but still ran occasionally and the ankle never bothered me. Late 20s started to play some pick-up basketball and BAM, semi-chronic pain that essentially eliminated all activities except walking and cycling. I had the ankle scoped, no change in pain. One year later had the screws removed, no change. A second opinion surgeon basically told me I have osteoarthritis as a result of the original break and that I need to accept my ankle as-is and stop hoping for recovery. He said goal at this point should be to keep it from getting worse. Also told me to get some orthotics and/or rocker shoes, that both would help with pain and continued wear and tear. Truth is, I am so desperate for a little pain relief (even walking is off-an-on painful) that I’m ready to try pretty anything. But still hard to let go of the possibility that I might be able to get it *better*, or at least to a place where I can run and jump on it a bit.

    I’ve seen an osteopath, a somatic body worker, an acupuncturist, etc. All to pretty much no avail.

    Interested in any thoughts or ideas you (or anyone) might have. Thanks!

    • Interesting as I am seeing a woman in her late 40s who hurt her foot when she was 8 years old and it’s never been the same since. X-Rays show that several bones in her foot (tarsals) are fused together. She couldn’t walk more than 10 minutes or so comfortably even with her orthotics in. Now, without her orthotics she is almost 100% pain-free while walking and standing. I had to do a lot of structural work on her and I’m sure I didn’t un-fuse any of those ankle bones. Point is, the pain is/was coming from muscle imbalances from chronic gait imbalances and compensations – for her, the last 40 years – for you, the past 20 years.

      Rocker shoes – terrible advice; worse than orthotics. Since when does a human need to “rock” when they walk or run? In your case if you can’t get to see me for whatever reason then you try to find a doc or therapist who looks at the entire body and knows how to reverse compensatory patterns that have developed over the years. Don’t go to someone who only looks at your foot. But you need to be treated to have this sorted out.

  27. I Had a Gunshot Wound to my Foot, 44 magnum, the Surgeons did what they could…, but I think they sorta botched the final surgery a little bit…, at least I still have a big toe, it went through that but inside the foot not the toe…, Now My big toe is shorter than the one next to it, & Facing Downward, I can walk, I could run, jump whatever…, CAN, but it’s not pleasant, I could use some pain killers, I’m noticing arthritis setting in & I’m not even 30 yet…, I’ve got a metal plate & a couple screws through the thing…, Can’t afford follow up surgery…..

    Wouldn’t Orthotics be something that would be helpful to me…, I have never tried them but recently I’ve been thinking about it because I’d like to be able to walk, Run, Jump, practice my martial arts, Without so much discomfort…, plus I figure that the older I get the worse it will be…, So I gotta do something…

    • Yeah you gotta do something and although I’ve don’t have any experience to date with a gunshot wound to the foot I’ve seen plenty with botched surgeries. Sure everybody is different but if you get into orthotics and all they do is address your dysfunction and compensations then realize you can get worse than where you’re at now. I can’t personally advise you to get orthotics or not, but it would be good for you to find a more holistic doctor (podiatrist, chiropractor, or a doc who looks at the entire body), to get a thorough evaluation.

  28. Thank you for this website and for the courage to take a non-traditional stand. (Sorry about the pun.) I’ve worn orthotics for 31 years. About a month ago, I ditched them and started going barefoot, pretty much all the time. NO PAIN! I still can’t quite believe it. I don’t ever want to wear conventional shoes again.

    But it’s summer now, and I’m not quite sure how to proceed when Fall and Winter come around. What do I wear to the office or to class (I’m a professor)? What do I do about my ski boots come ski season? And how do I keep from getting frostbite in a Minnesota winter.

  29. I developed major calf pain and then PF pain last November. I was told that I just had severely tight calves and PF.

    Before that, I had been running on and off for about 2 years (in Asics – Gel Cumulus 13). I had also started doing yoga for about 6 months (1 time a week).

    Now if I walk in flat shoes or barefoot, my PF acts up. And, every morning, even though I stretch daily, my calves are still really tight. My doc has me in custom orthotics and they help my foot pain but, my calf tightness persists.

    What do you think?

    • What do I think? – you know that from reading the article I hope! You’re supporting your feet with the orthotics just like you did when you wore the Asics. So now when you walk barefoot you have foot pain because your feet and lower legs are so weak they can’t support you. PF is not a foot problem – (see the video) – it’s a calf problem. And we NEVER, EVER stretch on SockDoc!

      • Thanks for the reply. I posted again because I didnt see my original post. I’ll check out the video. I’m ready for this to be over!!

  30. I was prescribed orthotics after having calf pain (both legs) for about 4 months. We did the usual PT….stretching and more stretching. So now I have them and they feel “ok”. When I stand barefoot for a few minutes I can feel the tightness moving into my calves. This ordeal has been 7 months so far. It’s incredibly annoying.

    My doc also said I have fallen arches. Is this why it is uncomfortable to stand barefoot?

    • Well all I can say you hopefully will learn a lot on this site. Fallen arches = orthotics = bullshit.
      Read this: http://www.drgangemi.com/2012/03/flat-feet/

      • So I went to a new physical therapist who said, just like you had, let’s throw away those orthotics. BUT, while they were measuring my legs and seeing where my hips present themselves, they noticed my hips and ankles are out of alignment.

        They did some myofascial release around my hips and calves (along with some back stretches) and got my hips closer to one another but couldn’t get my ankles to line up.

        Do you have a recommendation for that?
        One more thing…

        When I stood barefoot, they all could see that my hips were out of alignment (my right side lower than my left). I misspoke in the previous message. I was information overload at the PT office today.
        Thanks again for your help and advice throughout your website.

        • I’d say it’s very common for PTs to always say that the patient has one hip rotated in just as chiropractors say the hip is higher (shorter leg). Nobody is perfectly symmetrical and it’s only when the asymmetry causes dysfunction is there a problem. Sure you don’t want one hip drastically higher than the other, but the goal should not be for perfect alignment but perfect function. Miss-alignment can be so many things it’s impossible to say what could be causing yours. A hip issue could be from the hips themselves, the feet, knees, back, shoulders, diet, footwear, sitting posture, etc…

  31. Hello,
    I just came across this article and am intrigued. I recently got orthotics because I have very high arches, but my problem is that I can’t get them to sit properly in any of the shoes for which I need them– they feel good under my arches, but then they pinch or push my foot somewhere else. Here are my questions for you;

    1. Do you recommend that people only wear the most minimal of shoes, or are there things that one can do to wear more stylish shoes comfortably? I’m not talking about 5″ stilettos– just a normal pair of pumps with a 2″ or 3″ heel. Unfortunately we live in a world where a woman is not taken seriously as a professional if she doesn’t wear the universal “uniform,” of which heels are a part.

    2. Is it bad to have any kind of support directly under your arch? I recently discovered the shoe brand Earthies, and they have terrific arch support, but would that be as bad as orthotics in your book?

    3. I once got a stress fracture after walking around for half an hour in a pair of ballet flats that were absolutely flat. When I feel pain from shoes, it really does feel like it’s in my arch. How can it be that all you need is the ends of the foot supported? To me it feels like lying across a gap with your head and shoulders supported and your feet supported, but nothing to hold up your midsection. That’s how it hurts in my foot! How can my own sense of pain be so misguided?

    Thanks, and I look forward to your responses! I’ve been having foot problems for so long and it’s very frustrating. I’m always seeking new information on the subject.

    Emily

  32. thierry says:

    Hey Doc,

    First I like your website ! thanks for all the shared information.

    I saw your June 9 answer from where I understand that working on some muscle imbalance , people with serve foot trauma can still hope to run with no pain?

    I have severe subtalar joint damage since 6 years now. I’ve been trough a lot including transitioning to flat shoes walk and run on VFF, physio, PRP and stem cell injection, balanced diet etc…

    The pain is much lower than before but still present every day of my life.
    I feel i’ve tried everything and was just able to improve things but not solve the problem…

    How can I check what’s wrong ?

    • Yes that’s correct. If your progression is going no further then you should look for a doc or therapist who looks at the entire body to help you out.

  33. Georgina says:

    I have flat feet, was a collegiate runner, sprained it in college, 10-15years later… I now have 4 kids, just gave birth 8 months ago. I have been wearing orthodics for over 10 years now and my foot have been progressively been getting worse. Can barely walk and keep up with my toddlers, up at night with pain and worry. Wating for new orthodics but taking too long,now I see your article, what can I do??? please help hurts to exercise..see a PT? nutritionist?

  34. Dear Soc Doc,

    As far as I can see, there’s not a single reference to a research paper in any of the articles on your website. Anecdotal statements such as “. . . I feel confident saying that based off my education, experience, and understanding of the human body (not just the foot), that those who wear orthotics are suffering compromised health and those who prescribe them are not restoring their patient’s health to its fullest potential,” are all well and good — experience counts — but what does the published research tell us about foot orthotic devices?

    One other thing: Spectacles for myopia are an orthotic device. Would you say people who wear spectacles are “. . .suffering compromised health and those who prescribe them are not restoring their patient’s health to its fullest potential”?

    • Actually Ray I do have references on some of the articles on this site and I discuss the eye spectacle “comparison” elsewhere too in other comments. It’s a really poor comparison and I’m sure you can find research on vision therapies to dig deeper in your quest to understand eyesight deterioration. You can find some orthotic studies on my DRG site in relationship to flat feet though but overall I don’t have the time to look for studies to support what I’m saying especially since there will always be studies to go against it, so you might want to stick with a more “evidence based research site”. http://www.drgangemi.com/2012/03/flat-feet/ In my practice if I went off studies then I’d be in the same boat as conventional medicine – treating symptoms, healing patients slowly or not at all, and not exploring new ideas and therapies.

  35. I have seen two podiatrists within the last 3 weeks. I am 25 years old and have Morton’s Feet. The first doctor gave me hard inserts and met. pads which did not work, in fact, it made things worse. The second doctor removed the pads and put in support more under the arches. He told me to go back to the first doctor and get custom-made orthotics. Is that the answer? Should I do that? Because I haven’t worked out in 2 weeks and the second and third toes on both feet hurt all of the time. Thanks for listening!

    • Do you really think you’ll be the first person who all of a sudden I’m going to say, “Yes! Orthotics are your answer to end your foot pain!” Come on now. I’m kindly giving you a hard time by the way. I can’t tell you what to do or what not to do but I think if you’re asking me this and understand what orthotics do (and don’t do) you know what you should do.
      Also check out the foot video here: http://sock-doc.com/2012/05/foot-injuries/

      • What do you do for people with Morton’s Feet?

      • Reading this over a period of time, I feel that this is certainly a constructive conversation but that framing the issue in absolute terms may not be helpful when we all have such different foot problems. No orthotics or support ever? I think that changing my shoes to one offering a little more support has been a positive thing for me. Of course, my slow healing from a bunion removal could have been faster had I read this blog before, to guide my initial recovery. But I do think that the slightly more supportive, but elastic, soles, perhaps together with the Glucosamine, may have helped in the past 4 months. That, and bringing down the swelling with Ipobufren in the winter …usually I tend not to take pills at all and it seemed to me that getting my foot out of the pattern of being inflamed was good. This is my guess, I know.

        I am wondering if diet has helped folks heal foot problems, whether through weight loss or less sugar in the bloodstream. I was not really overweight but had added some inches to my stomach which are now pretty much gone. The dieting coincided with my improving foot, so that’s why I wonder.

  36. Well it turns out that i was mis-diagnosed with pf a few weeks ago and that i have actually “strained” my tib post and possibly the flexor hallucis as well – as much as i don’t want to use orthotics or any kind of support if i can avoid it, is has been explained to me that the tib post is under strain every time i walk (and i am on my feet for 8 hours a day at work) and that short term, it needs help to heal as this area (below the inner ankle where the tendon wraps under the foot) is known for not healing that well due to it not getting great blood flow.
    Putting weight on it for long periods (even short) is not going to help recovery at all – what would you suggest for some short term support for this? – or is there anything else i can do apart from the trigger points as even though they will help, they can’t take the weight off the foot. thanks.

  37. I am about to receive some orthotics so obviously reading your article with great interest. I have been told that the pain in my knees is due to my left leg being significantly longer than the right ( born this way – I can’t see it though) and that my big toes lock when I walk causing two lumps to appear on my big toes (not bunions). I was told by the physio that no amount of physio is going to correct this and was referred to a podiatrist. The podiatrist told me that my femur is pushing down onto my knee and that I will get arthritis earlier than normal but with orthotics we can prolong my the period before the arthritis kicks in.

    • I really can’t tell you what to do or not to do since I’m not your doc. But I can tell you I hear all kinds of crazy stories about “why you NEED orthotics” and I’d say 99.999% of them are bull. Maybe you’re that 0.001% – maybe get a second opinion.

      BTW – the only way to truly know if one leg is shorter due to a growth problem or congenital (born that way) is via X-Ray – unless it’s just so obvious; and in your case it doesn’t sound like it is. And even when there is a difference, orthotics, as I note in the article, are still not “necessary.”

  38. My 20 year old son just saw his podiatrist. He recommended custom orthotics. My son has low arches and overpronates a bit. The outside of his shoes heels get a bit worn down (same with my husband). He also walks with his feet pointed out in a V, like my dad. Are there exercises he can do that will strengthen his arches and help his feet turn inward? He plays football and has gained 45 lbs over the last 2 years. He lifts and trains religiously. He’s solid. He’s had shin splint troubles this summer.
    I see that you do not recommend orthotics. If you find the right exercises and wear the proper footwear, is it possible to permanently alter the outcome so that your feet are facing forward and they do not overpronate as an adult? (We are always barefoot indoors, but never outdoors.)

    • If he truly overpronates then that is a problem but low arches are not. More on that in these two articles:
      http://www.drgangemi.com/2012/03/flat-feet/
      http://sock-doc.com/2011/05/overpronation/

      The feet pointed outward could be more of a knee or hip issue; would really need to be evaluated to see where it’s coming from. Personally, I grew up with my right foot flared outward (coming from my hip) and since it was never corrected that is still my “natural” position. It does not create a problem at all for me. As long as there is no weakness or pain then it’s a non-issue. Now that he’s 20 it very well may be permanent but again, nothing to be concerned about if the biomechanics are intact. (And it sounds like something is off since he has shin splints – but that doesn’t mean it’s because of the ‘V’.)

  39. Dear Soc Doc,

    I very much enjoyed reading your website and I have found very informative advice. Pertaining to my situation, I was diagnosed with Plantar fasciitis about 10 years ago and I began wearing custom-made orthotics. 6 months ago I underwent surgery and had bunions on both feet removed. I am now beginning to exercise again (haven’t done so in a very long time) and I am receiving shin splints on both legs. Perhaps they are not actual splits/fractures on the bones but more strain on the muscles (anterior tibialis, I believe).

    I am beginning to see light regarding the orthotics weakening my muscles in my legs/ankles/feet. What would be the safest method to begin running again without injuring my PF, bunions or flat feel and most of all, myself? Thank you so much for your time and attention to this matter.

    Sincerely,
    LBH

    • You’ve got to slowly ease back into it and I’d recommend walking barefoot as much as you can and then move to a minimalist-type shoe once you’re ready to start running. See this post: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

      And the Sock Doc Training Principles will teach you how to build your aerobic base so you prevent injury from a physiological standpoint. http://sock-doc.com/2012/01/sock-doc-training-principles/

      • Dear sock doc,

        Thank you so much for your prompt reply. Per your suggestion, I have started working barefoot. I have also ditched the orthotics in my neutral tennis shoes. My feet are beginning to ache and I’m afraid my pf will flare up again. I am also afraid my bunions will reappear. If I go some days with orthotics and some days without will I end up slowing the progress of my barefoot goal? Further, I walked barefoot on concrete for a few steps the other day and discovered that I am a heel striker. I am now looking to bange my gait to a mid foot. And I have considered the vibram five finger shoes to help me ease into barefoot walking? (no running yet.) what are your thoughts about these shoes and would you recommend them to me now? Again, thank you so much for your time.

        Respectfully,
        Lbh

        • Per the post you read, if you need to wean out of the orthotics then that’s fine. Remember there’s a lot more to your feet than the feet themselves – so don’t think that if your feet and PF aren’t healing up it is simply because of a local foot problem. You might try Correct Toes for the bunions too. And Vibrams are fine if they work for you – there’s plenty of minimalist type and barefoot type shoes out there to try.

  40. Hello

    I came across your blog while doing some research into a new pair of NIKE’s i want. I wear a pegasus which is a neutral shoe but I also wear asics kayanos which are a structured shoe. the nike structure is a arch supported shoe – in fact their MOST supported shoe. I used to wear orthotics I got from the australian institute of sport to suppot my knees which twist in a little.

    Now keep in mind this isnt for running it is actually for standing up in retail all day – i work in a sporting wear shop so luckily we get to wear sports shoes but we are very active and im in my shoes for 8-9 hours a day, 5 days a week. My Kayanos are great and when I switch to my neutral nikes I get aching on the outside area of my foot in both feet. Could this be from too much support in the kayanos or not enough in the nikes?

    Any help would be great, thanks!!!

    • Hard to say if it’s the shoes themselves or your feet. The way to tell is to wear the most minimalist shoe you can and see how your feet feel. They shouldn’t hurt AT ALL even if you’re on concrete. I am barefoot (of course) all day in my office – up to 8 hours. I’d say 5 of those could be standing and moving around. I have no pain. You shouldn’t either. If you do – find the most minimalist shoe you can wear and go from there as I discuss here: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

  41. Sock Doc, I just ran across your website and have a few questions. I’ve been training to go into the military for a little over a year now. When I began training I noticed a lot of foot pain along the bottoms of my feet while running and even while sitting. Now my feet ache whenever I put them into shoes. Even while I’m sitting they will hurt if I’m in shoes. I went to go see a Podiatrist in May and he informed me that I have pes planus and my feet pronate. He suggested that I get motion control shoes and OTC orthotics. Needless to say and it didn’t work so I went to go see him again (which was this morning). Today he told me that I have developed plantar fasciitis in my left foot. He prescribes orthotics and told me that I would have to wear them all the time. But when I told him that I don’t want to be stuck in shoes because my feet ache while I’m in them he told me that the orthotics would cure it and that I would need to wear them all the time. I found this interesting that my feet NEEDED to be corrected with orthotics to work. So I guess my question is, have you had any clients that get foot pain even while sitting in shoes? Like I said earlier I want to go into the military but they don’t except anyone with symptomatic flat feet. I’m currently 22 years of age, 5’9″ in height and 150 Ibs in weight. Thanks

    P.S.
    I’ve been doing some stretching and foot strengthening exercise for a couple of months with some relief but my feet still hurt after about 10 minutes of standing in shoes. I’ve also tried some barefoot running and it feels great. Whenever I run barefoot I have zero pain but sometimes I feel it aggravates my plantar fasciitis so I haven’t ran barefoot for a couple of weeks now.

    • Sure I see some people whose feet hurt all the time, even when they sleep. It all depends on what’s causing the problem. Of course lack of orthotics is not your problem – but lack of foot and lower leg strength is. Read this: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

      They don’t accept anyone with flat feet? You mean Flexible Flat Feet? That’s nuts – I discuss it here: http://www.drgangemi.com/2012/03/flat-feet/

      Of course I am 100% against stretching and it sounds like the walking/running barefoot is helping. You just need to find the balance between doing that and it helping, but not hindering, your PF. Maybe try some different shoes. I typically have my patients start with a Nike Free 3.0 or a NB Min MT10 Trail shoe (transitional shoes) and then into the new NB Min Zero Road or Trail shoe or a Vivobarefoot shoe. Check out their boots too (pricey but nice!): http://www.vivobarefoot.com/us/mens/off-road-hi-mens-6.html

      • the military will except you if your flat feet don’t cause any pain but right now my feet start hurting after about 10 minutes standing in shoes.

        Thank you for your advice. I will read the articles that you have suggested.

        The shoes that I’m currently wearing are the reebok yourflex. I thought they would be a good transition to minimalists. am I wrong?
        http://shop.reebok.com/us/product/men-yourflex-run-shoes/EF414

        • Funny because that makes no sense (not you but the military) since there is little, if any, correlation to flat feet/arch height, and pain.

          I’m not sure on the drop or stack height on the Yourflex but from the photos they don’t look good. You’re going to lose a lot of “foot sense” with those and they’re not going to help your feet heal up. I like the NB Minimus Trail (MT10) which is 15mm-11mm > a 4mm drop. The Nike Free 3.0 will give you more cushion (21mm-17mm) – same 4mm drop. Or the Free + will give you a 23-15 – more stack height and an 8mm drop. So I have many patients go from the Free + to the Free 3.0 to the NB Min Trail.

          But ultimately it’s what works best for you.

          • Sock Doc, I would just like to say before I ask my question that my plantar fasciitis is practically gone after getting my feet out of the motion control shoes and stopped the calf stretching and started your suggestions from your video. I have a follow up question to our conversation last month. I went out and bought the NB minimus trail as one of the shoes suggested. The shoes definitely feel better than any other shoe that I’ve worn but my feet still hurt after about an hour in the shoes. I guess the question I’m trying to ask is, how long does it usually take to rehabilitate weak feet and to feel a difference in the ache in the bottoms of your feet?

            Thanks,
            Matt

          • That’s a tough one to say Matt because without seeing you, I/we don’t know what is causing your feet to be weak, or feel weak. There is a strong relationship between the feet & lower legs with the adrenal gland hormones so one question to ask you – is the ache after one hour during aerobic runs as well as harder, anaerobic runs. If only during anaerobic, then you’re dealing with an intensity/conditioning problem. If the same with both then it may be dietary or stress related. Most likely it’s not a footwear issue anymore.

  42. I just went to the foot doctor was was given arch supports for my shoes because of a pain in my left arch which he said was Plantar fasciitis and my right foot where I had a stress fracture a year ago October and its still healing. I do not like the arch supports but they do seem to help with the pain. What else can I do to heal my two feet?

    Thanks,

  43. Should I not wear the arch supports and go and see a different doctor? I wish I could come and see you but that can’t happen. I live in Nebraska? What do you suggest?

  44. I have capsulitis of the second toe and just got new orthotics. They are so high and painful on the arch of both feet. I haven’t been able to “break them in” yet. I realize you can’t give specific advice, but any information you may have in general about dealing with capsulitis would be appreciated.

  45. rachel Gillespie says:

    Hi – I am a woman of 37 and have weakness in both tibula tendon in foot. This is causing my feet to roll in and I am consious of this when walking. I have been given Orthotics but to date they have caused me hip pain. What would you advise I do?

  46. Hello. Three weeks ago while incline walking, my left big toe started to hurt very badly and of course, I just pushed through the pain thinking that my foot just needed to pop. I was in immense pain and could not go up onto my tip-toes or walk properly. I saw a podiatrist two days later who took radiographs and told me that my big toe is simply too long in length. He made me a pad and told me that I would need custom inserts. He did say that if the pad didn’t help relieve my pain, that I would have to get my big toe injected with steroids. The last resort would be surgery to shave off some of the bone (this is not an option for me). Do you believe that custom inserts would be warranted in my case?
    Thank you so much for your time!

  47. Dear Soc Doc,

    I found your website very interesting and informative. I’m a 22 year old man who has always suffered from pain in my feet, bad posture (to the extent it caused me a disc herniation 2 years ago) and short hamstrings and tons of muscle imbalances. I’ve been using orthotics for over 5-6 years now and they have removed my horrible pain in my feet, aligned my posture (slightly) and overall made me feel better. However, when I take then off for say two weeks my feet hurt again, my posture is all messed up and I get very painful muscle spasms on the muscles of my arch. I don’t know what to do and I would really like to get rid off the orthotics but I feel they’re really needed for my normal functioning. My brother has flat feet like me but he doesn’t wear his orthotics and hasn’t been wearing his for a long time. But, in your opinion, where can I start? I’m a young guy but I fear that if these problems go untreated when I get old I’ll have a very bad time.

    Kind Regards,

    Ferdinando

  48. What do you think of minimalist shoes with a little bit of support such as the brooks purecadence? I agree with the whole minimalist approach and that the shoe should not influence the foot too much. I’ve been wearing the NB MT20v1 minimus trails for several months, but have recently been recommended trying a stability shoe after getting a gait analysis. What do you think? Could wearing a shoe with a bit more support intermittently be counterproductive?

    • If a gait analysis showed instability, you don’t correct that by wearing a stability shoe. All that will do is support the problem. I personally don’t think that Brooks shoe is a good one at all – too much support and too thick.

  49. Hi Sock Doc,
    I really enjoy your website! Quick question for you…I have never used an insole (think Superfeet), yet I’ve noticed a big push recently at running stores. I overheard one of the salespeople saying that 90% of their customers who purchase shoes also leave with inserts? When I asked another salesperson about this, she proceeded to tell me that the insoles/inserts that come with the shoes are “junk” and should be replaced with “Superfeet” insoles. Okay Doc, what’s the real story here?

    Thanks for all the great information!
    Susan

    • That salesperson is both right and wrong. The insoles are for the most part useless but Superfeet are even more useless. They don’t make your feet super. I bought into this theory with cycling shoes in the past (guy fitting me saying that my shoes needed to be more snug – which they did, but I really just needed a smaller shoe, not insoles).

      • So Doc,
        Again, I’ve never purchased insoles, but almost everyone I know seems to have them…strange.
        Would you recommend leaving the shoes “as is” and not replacing the insoles that come with the shoes?
        Thanks again for your help!
        Susan

        • I pretty much ditch the insoles unless it’s cold outside and I want a bit more warmth. Any thick insole, especially with a heel cup, you should definitely remove.

  50. I am 42 and have had severe foot pain since I was in my early 20′s. I was an avid soccer player and runner and today I can barley walk yet alone run. I have been diagnosed with plantar fasciitis and gone thru so many treatments including injections, wraps, physical therapy, orthotics, casts, expensive shoes etc. I have worn orthotics since my 20′s and they helped for about 10 years and now nothing seems to help. I am tired of the pain, tired of trying to find someone to help, every doctor I see wants to try the same treatments that have not worked for 20 years. I want to walk, run and live life again. Can you point me in the right direction?

  51. Hey Sock Dock,

    I was fitted with orthotics when I was 13, now 28. I never had any pain at all with my feet, legs, etc… The original reason for them was I was getting a painful pinch under my left arch when I would walk. It was instantly cured when I got the orthotics made all those years ago. The reason for my post is that recently I started walking around 2-3 miles everyday and I developed left ankle pain that has now gone to my hip/lower back. I do have a slight disc bulge there. I decided to find the most reputable pod doc in the area. He said my current orthotics are not doing the job, that I can pronate right over them. He spent 45min’s explaining bio mechanics to me. He told me my left leg was slight shorter has well. He took a new mold by wrapping my foot in cloths etc.. and had some ideas for work shoes (dr. comfort) because i had asked. Then I hit the net and now I feel lost. Should I ditch them all together? I never wear shoes in my house and have worn flip flops all summer. I probably am only in the regular shoes a couple hours a day if that at this point. Of course the days can vary if im out on sales calls but i do a lot of work from home. I started noticing this pain 2 months ago when I was out walking around in work shoes. When I took the shoes off there wasn’t any pain. Also when I wore the new balance shoes w/orthotics I didn’t have any pain. Now it doesn’t matter if which shoe… If I do ditch them I’m afraid I will reverse what they have done all these years…

    • Hi Dan. I can’t specifically advise you to wear orthotics or not wear them. But what I can tell you is that they never “cured” anything over those 15 years – that’s impossible. Orthotics don’t cure anything. What they do (and did) is create compensatory imbalances which eventually result in other problems while supporting the problem/injury they are prescribed for. And you can see this now. So there is really no way you will “reverse” anything beneficial by getting rid of them. Though of course not everybody can just removed their orthotics and be pain-free because problems may still exist and their body may have compensated to a great degree. So you may need the help of a doc or therapist who is going to look beyond your feet. Also read this: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

  52. I am not sure if I get the full meaning of this article. About a year ago, I started having this really bad hip pain. After two cortisone shots and lots of medicine, it stil hurts. I struggle with running. Also, recently my podiatrist said my 2nd and 3rd toe bone is longer than my 1st toe and prescribed me orthotics. It hurts so bad to walk on my feet period. The ball of ny feet hurts, the heel and the area where my big toe hurts also. Can you please give me some advice. How can I contact you for a possible office visit?

  53. I am 61 and had a bunion operation July of 2011. I was told to keep the boot on for too long after the operation (about 11 weeks) and my muscles got weekend. My ankle had been achy & sore since. I’ve had physical therapy for almost a year now and I’m wearing an orthodic for a few months. My ankle pain is still there and it seems like my other leg feels weaker when I walk for awhile. Could the orthodic be throwing my whole body off now?
    The ankle pain in the foot that was operated on never went away and I’m more comfortable when I’m barefoot. The therapists say my gait is wrong and I need to correct it by training my brain with excercises to change things having to do with my hips and walking.
    I feel like it’s going against nature and I’m not improving. How does this sound to you?
    By the way the part where the bunion was looks great. I traded a bunion for a screwed up foot.

    • As you know from reading the article, orthotics always support dysfunction and “throw off” your gait. And if your gait is wrong as the therapists state then you’ll never properly retrain your brain, or those affected muscles, wearing orthotics; it’s impossible.

  54. Hi I’m a squash player who recently ruptured my plantar fascia, it came out all bruised etc and I had to stop about 8 weeks aqo. I had physio etc and tapped it, the bruise went after a week, but it is not healing and now my other foot has plantar fasciitis symptoms. I stand on my feet all day at work, morning pain is not bad but after an hour or so at work my feet are in all sorts of pain in my arches. I’ve tried barefoot and minimal shoes but its not getting better, I’m having an mri on both feet to see whats going on in there, but i’m sure ill get referred to a podiatrist who will suggest orthotics. I don’t want to have to rely on these forever, short term would be ok if it works and doesn’t come back. Any other suggestions, in lots of pain.

  55. I had surgery for Morton’s neuroma 43 years ago on my right foot. I had surgery one year ago on my left foot for same thing. The ball of my right foot hurts severly when I walk, along with my second toe joint. The ortho prescribed orthotics, which do nothing, and suggested “toe-shortening” surgery as the next option. With 3-6 mo recovery, I am not opting for that. I started acupuncture with no good results as of this time. I have an appointment to have Prolotherapy in about 3 weeks. I got on the treadmill today and only lasted 15 mintues with excrutiating pain. Going barefoot is very painful. Should I cut my foot off. I am 74 years old, have always been a walker, and cannot walk for exercise at all. I walk into work and sometimes that is a chore. What do I do now?

    • Check out the Foot Pain Video where I discuss Morton’s Neuroma. Your toe all of a sudden didn’t just grow one day, you’ve been that way your whole life. So cutting a toe short doesn’t address the problem. See if the video helps and if not, or not enough, then look for a doc or therapist who doesn’t just focus on the actual area of pain but the whole body as a dynamic unit.

  56. Hey Dr. Gangemi!

    Would someone with a leg discrepancy and wearing orthotics, with a built-in lift still be advised to go barefoot, or at least without the lift? I have discrepancy of about three quarters of an inch. (broken femur when I was three) This has caused a pelvic tilt, and some abnormal curving of my spine.

    I would love to get away from my orthotics and go barefoot as much as possible, but would need to weigh the possibility of doing more damage by not wearing my lift.

    Any thoughts would be great!

    Thanks!

    • Tough to say, you could very well be an exception, though you’ve developed with this imbalance. It is really a case-by-case situation as I note in the article. Either way, I doubt you’d want or need to meet the exact 3/4″ if you need something at certain times.

  57. Maria Leary says:

    I’d like to know what your thoughts are on children with neurological problems who are proscribed orthotics because of low or high tone. Is there a better solution than orthotics?

    • Even more important for kids with those issues NOT to wear orthotics. If their feet are “over or under sensitive” then the other factors need to be addressed (diet, nutrients, external stimulation (TV, computer)) rather than dampen or alter the foot and its nerve endings.

      • Maria Leary says:

        I don’t mean kids with sensory issues, I’m talking about genetic disorders or severe cognitive issues… children who have physical issues because they have a neurological defect.

  58. Soc Doc, if you are so against orthopedics and heel cups to manage heel spurs, how can i ‘naturally’ relieve the spurs without consulting a podiatrist or having to have orthopedics in my shoes? Im a 35 yr old male, i lift weights, and i developed heel spurs, painful ones, in both my feet due to heavy lifting over the years and improper footwear, i am now paying the price. I can only barely walk without pain with nike running shoes with heel cups, not appropriate for the office. Im not going back to the podiatrist b/c all they want to do is inject cortisone shots in my foot or recommend $400 inserts, i am at my last draw, please let me know what im NOT doing! By the way, i stretch my plantar faciitis about 3-4 times a day with my hands, which relives the pain temporarily. I would appreciate if you can reply to my email address directly, for some reason im not able to view my responses on this website,

    Thank you,
    Joseph

    • That would all depend on what is causing your heel spurs. Stretching definitely won’t help, and may very well be hindering healing. Check out the videos on Plantar Fasciitis and Achiilles Tendonitis (usually a problem with heel spurs).

  59. Hello Doctor,
    I was just prescribed by my podiatrist orthotic shoes and inserts because I keep getting calluses on the balls of both feet and my heel. My doctor said its due to the fact that I over pronate when I walk and she said I also have dropped metatarsal heads which are causing my calluses. So she prescribed me orthotics but they really hurt my feet , more than before I started to wear them. Should I be wearing them or is there another solution ?

  60. WOW!!! I have been wearing orthotics for years because I haven’t been unable to get the surgery needed to correct the problem for MANY reasons. I shattered both my heels in a car accident, and without my orthodics, and other treatments, I can hardly walk. I understand their are plenty of people who probably don’t need them, but to read your article, you do sound very arrogant. Not all of us are filthy rich or have fabulous health insurance so we can quit working for 3 months to have our feet fused! Not to mention, that is not even a guarantee to help with the pain!!! Thank God for secondary options!

  61. Sara MacMillan says:

    Hi Soc Doc,

    I’ve read many of your posts and love your approach. Thank you!
    I weaned off my orthotics 5 months ago, at first to Vibram 5 fingers, then to Vivobarefoot shoes, so as not to stand out so much! I love walking “barefoot”, and it makes total sense to me, but my feet never really stopped hurting, especially in the mornings as I get out of bed. Massage and cold water plunges help but are temporary solutions.

    What can I do?

    Thanks,

    Sara

  62. Zach Hulce says:

    Hi sock doc

    I live in Charlotte NC I was wondering what is your profession and is there someone like you out here with a more holistic approach. I have flat feet plantar fasciitis, hip joint pain, chronic back pain, and knee pain and I’ve tried several orthotics. I played football for West Virginia and tore my acl in 2008. I was getting ready to buy exepensive orthotics ($399) then I stumbled on this article. I have a flexible ligament In my foot it’s hereditary I’m told and that I need an orthotic to correct it. But I feel like if god made us to walk without shoes why do I need an orthotic? I watched your video and I’m going to apply your techniques (trigger point) but if you can give me some advice on where I can find a guy like you out here or help me out in any way I would appreciate it!

    Zach

    • Hi Zach, really not making referrals right now unless I really know the doc. Sorry. You’re only a couple hours away from me, come on up to CH. At least get on the wait-list, you can always cancel then.

  63. Zach Hulce says:

    I’m really considering coming to see you doc! I have one more question, I have a very wide foot and when I went to a podiatrist out here she tapped on m shin bone (which is was painful) and she watched my gait. She told me my foot was like a tripod and that it was only operating on two when I walk ( the front inside where the big toe is,and my heel) and that every time I land it was trying to create the third so that’s why I had pain in my ankle, all the way up my shin. And thats why im having all my problems. basically every time i land my foot doesnt have stability. i can’t find anything on your website about this so I was hoping you could elaborate on it. And how I can take a holistic approach to fixing it. If possible

    Thanks,

    Zach

    • Sure that’s just one gait variation of instability. Most likely there’s an imbalance in the muscles on the inside and outside of the foot – I discuss some of this in the Foot Pain Video.

      But what it comes down to (as I discuss in the gait articles) is that anything can cause gait problems – footwear, structural problems ANYWHERE in the body, and diet.

  64. I recently posted a question your your forum which I removed as this article answered my question. A leg length discrepancy of a 1/4 inch does not need to be evened out with an insert. Thanks for the article!

  65. Hi Sock Doc, I know you have lots of patients to take care of and lots of other questions on your site to answer, but could you please help me when you can?? I’m a 15 year old girl (xc and track for 1 year) and am aiming to run my first half marathon in January. It’s almost December… I started training in July by starting at a base of 4 miles and increasing one mile a week (I know, NOT a smart idea and I got a lot of heat about this from my coach) until I reached 10 miles in August. This is when my pain started; in the last mile of this run, I started feeling sharp pain in my left hip and ended up almost limping the last half mile. Being naive, I ignored the pain and continued with my intense daily workouts consisting of plenty of hills and speedwork. I didn’t feel any pain until the next week, when I attempted my 11 miler. PAIN the entire time in the left hip and started limping around mile 5 or 6, kept going and was forced to stop at mile 10.5. Missed my cross country season and spent it on the bike instead…when I stopped limping and all hip pain disappeared, I started training again (slower and smarter this time) and ended up in my PT’s office AGAIN, but now with shin splints and plantar fasciitis in my right leg/foot. I know my right foot is a little pronated, both my feet aren’t significantly flat and I naturally run more on my heels than midfoot, so I got orthotics to fix the pain. The pain in my shin and foot went away with the orthotics while walking for a while, but not with running… In fact, I can barely run 5 minutes without pain shooting up and down my shin and foot with or without orthotics. I’m also involuntarily putting more pressure and kinda leaning on my left side while I run. In the last two weeks (I’ve been wearing the orthotics for a month now), the orthotics have been giving my right foot a new pain, so I took them out and now they feel fine when I walk only… My coach suggested that the orthotics aren’t really doing anything for me and they’re just fixing a problem that wasn’t there in the first place. Is this true? She suggested I might have a muscle imbalance and see a muscle activation therapist. Will going to this therapist help? What should I do about my plantar fasciitis and how can I get rid of it for good without using orthotics? I’m thinking that rebuilding my form from the ground up and switching to mid-foot striking might solve both the shin splints and plantar fasciitis, but I don’t have that much time to do that if I still want to run the half in January. Skipping the half in January to work on form is alright with me as long as I can run during track season and don’t have painful injuries again. I need your advice!! What do you suggest I should do?! Sorry this question is SO loaded, but I’m so frustrated and desperate to run, I hate hearing about all my friends’ amazing runs and races while I’m still sidelined… Could you answer my question whenever you’re available? Thanks!!

    • Hey Hallie – great to hear from a young runner. Now you ask for my advice and we will see if you take it. I’ll be direct as always. DO NOT RUN THE HALF MARATHON IN JANUARY. That ship has sailed, it’s too late because not only are you behind in your training schedule but you’re injured. If you keep this up not only will you get worse, you can pretty much kiss your track season good-bye. You’re training too much out of emotion since your friends are running great. You can’t play catch-up. Right now you need to find a good doc or therapist to get you fixed up so you’re 100% pain-free and then start training for track.

  66. Sally-Ann Bird says:

    I had a foot operation 16 years ago to remove a bunion this reduced my big toe’s size and it is now smaller than my second toes This past 9 months I have he increased pain in my 2nd toe and it is very painful. I have tried orthotic,s for my flat shoes and they work for around 3 hrs then the pain starts again.

    My main problem is that I am a sales rep and need higher heeled shoes are there any solutions for this.

    I am not convinced that orthotics are the solution any other devise please

    Thanks

    • I discuss bunions and pain the toes in the Foot Pain Video (http://sock-doc.com/2012/05/foot-injuries/). Most likely you have a some fascial adhesions that need to be worked out in the bottom of the foot – so look for those around the arch area and in-between the fist and second toe. You may have a prontation/ supination problem too, which I discuss in the video. Don’t necessarily think that you’re having the pain because of the past surgery – that was 16 years ago.

  67. Jane Hart says:

    Dear Mr Sock doc,

    I have been wearing various orthotics for a while (originally for shin splints). I was getting a sore L toe and felt the most recent orthotics made it worse.

    Recently I have stopped wearing orthotics and been walking around in Vivo barefoot shoes and correct toes. This had been going well and my feet felt good (my podiatrist said I have sesamoiditis but orthotics and padding didn’t make it better). I have been doing a bit of running in them too (15 – 20 mins). Today after a short run yesterday I have pain under the bones of my left toe (it has a bunion too) and under (and a bit at the side of) the left toe joint. Could this be caused by the minimalist shoes?

    As I said this joint has a bunion and the toe is slightly rotated medially. I am not sure if I am doing the right thing with the correct toes and vivo barefoots. If I see a podiatrist they will probably recommend orthotics again.

    Best wishes,

    Jane Hart

    Edinburgh

    • You may be transitioning out of your orthotics into barefoot shoes too quickly, and that’s why you’re getting the pain. Perhaps try a transitional-type shoe; I like the Nike Free 3.0 but there are many others with a 4-5mm drop and some cushion. Read this for more, especially the end where I discuss proper transitioning out of traditional footwear.
      http://sock-doc.com/2012/03/healthy-people-barefoot-people/

      • Jane Hart says:

        Dear Sock doc,

        Thanks for your reply. Perhaps you are right and I should try transitioning more slowly. I was told that I needed to wear “barefoot” type shoes to properly master barefoot running technique.

        As mentioned, I have a bunion on my left foot. Would the Correct Toes be able to improve this? I am concerned that if I wear minimalist shoes without the Correct Toes then my foot will be unstable as the big toe won’t be in the right position but is this right?

        Also the left big toe is rotated slightly medially so the outer edge seems to perhaps contact the ground before the inner edge. Is this common in a bunion? I would see a podiatrist but they would try to make me wear orthotics again.

        Best wishes,

        Jane

        • Correct Toes are designed to help with bunions and I recommend the for my patients. You’ll want to wear the CTs barefoot as much as you can and in shoes too (need the wide enough to fit).

          Your toe can have different deviations due to how it is stressed, and that in turn can result in a bunion.

  68. Hi,

    I found this article very interesting for me because I’ve been suffering from prolonged foot pain and I’m not convinced my orthotics are fully working for me.

    Around 8 months ago I suffered an injury to my heel while playing ball hockey. I had basically done an aggressive foot plant and felt a tear on the bottom of my foot. After hospital, pills, then physio, I finally resorted to getting orthotics. In truth, the orthotics have done well to take away the heel pain but I have a lingering injury in the front of my foot. It seems similar to Metatarsalgia but I would the pain is slightly more to the outside of the foot.

    Personally, I don’t see how I could possibly walk without my orthotics due to the pain in my feet when I attempt to do so but I also feel like the orthotics may be causing my other foot pain.

    Fortunately, my injuries seem localized to my feet and I don’t have problems elsewhere in my body.
    How does one deal with the pain of moving away from orthotics and how does one treat pain on the metatarsal area when it is a bi-product of orthotics?

    Thanks.

  69. Hello,
    I’m a 59-year-old female. Thought never diagnosed, I believe I have Morton’s Neuroma… or something similar. I have had foot pain since I was about 11 years old. My feet are very wide across the toe, with very high arch and very high instep. I almost literally have never had a pair of shoes feel good on my feet for more than 10 minutes or so. Most shoes aren’t wide enough in toebox for me. When young, I wore boys shoes, but now I’d wear a men’s 6.5, and no one carries that size.

    I’ve been an athlete through the my young life, and suffered the pain simply because I adored doing sports. But as of about age 45 or 50, I couldn’t take the foot pain any longer. Stopped most physical activity—skiing, biking, hiking—they are all excruciating and have found no footwear for those sports that don’t cause agony. But I do force myself to do treadmill at the gym. Have to do SOMEthing to stay in shape, but I’m sooooo tired of the pain. I’ve gotten into yoga, and thankfully, that activity doesn’t require shoes! But I’d really like to just be able to walk 3-6 miles and not be in agony… or go shopping and not be in agony.

    I’ve just gotten my first pair of orthotics from New Balance. Have worn NB shoes built on SL-2 last for a number of years. Yes, my feet are fairly comfortable just hanging out, but if I walk more than about 15 minutes or stand that long, the 3 middle toes go to sleep, then start burning and pins/needles, then the entire bottom/ball of my foot goes on fire with pins/needles, too. Agony!

    The NB people thought an arch orthotic with the Neuroma pad would help. And I’ve been told that from others as well. But it feels like someone is jamming my arch with their fist. And the shoes are even MORE uncomfortable with the orthotic than without it. And without it, same burning as with other shoes upon doing activity. Though at first blush the new NB 840s seem very cushy. 20 minutes on the treadmill had me suffering.

    You don’t seem to like orthotics. What would you suggest for me to do? Other than the extreme toe width and burning middle toes I don’t have other foot pain. Arches have never hurt. And my feet never hurt when barefoot. And I am barefoot at home most all of the time because it’s the only way to avoid foot pain. But eventually, we have to go out and work and shop and play. I can’t go hiking barefoot, nor can I do treadmill at the gym barefoot. What do you think of those barefoot shoes? Could that be a real solution for me?

    Hope you can help. I have lived too long hurting.

  70. Scott Emhoff says:

    What should you do about TARSEL TUNNEL SYNDROME

  71. Paul Morgan says:

    Can you take a moment to advise me? please and thank you.

    OK, I’m 51. Male. I think my problem is that my home has all ceramic tile. I suffer from Plantar Fasciitis. Tendon along arch hurts, heel hurts, and the bone that runs on outside of bottom of foot hurts. I don’t have a lot of natural padding on bottom of my feet. I believe that my arches fall when I put weight on them. I don’t exercise daily. I tried MBT shoes. They push up and hit the outside of the arch to much and hurt. I want a good walking shoe. Everything I put on feels like there is zero arch support. I’m sort of thinking that the real problem is lack of daily exercise. That would strengthen the muscles and solve the problem. So, I think you will tell me that I am right…that the problem is a lack of exercise and that there are plenty of shoes that will do the job. Should I put carpet in my home? Have a good day.

  72. Im a 26 year old male, very active currently training for my application into the royal marines,
    background – slight bow legs and feet naturally curve inward and hence i overpronate.
    some medial foot pain below ankle. prescribed custom orthotics, used them for the last 8 months or so.
    recently some knee discomfort MILD pain has been creeping in mainly through walking, no pain when running.
    An Osteopath has advised me i should have no problems getting into the military but i should ditch the orthotics as they are too hard with not enough give and this could be inpacting my knee.
    so now im trying to figure out what to do. my potential career rests on my body working.
    this article is interesting and seems to be promoting barefoot, but obviously in the military i would need boots, so what would you advise ?

    • I don’t promote barefoot as much as I promote minimalist. Check out this article: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

      • Hi! thanks for the reply, i read the article and it sounds good. I have no problem being barefoot and will check out some more minimal shoes, but because i have bowed legs and over pronate, when i land forefoot first, my feet seem to rolling in at an angle when they land, is that going to cause problems?
        And if i do more minimalist running, then if i get into the military with boots, wont that undo all of this?
        should I wear a overpronation insole to help support the foot?

        • It’s really hard to say w/o seeing you but I’ve seen plenty of people strengthen and correct these imbalances even though they still may have the structural abnormalities (like your bowed legs). Hopefully if you wear a relatively rather flat boot and only when necessary then you won’t unravel. As you know from reading this site I don’t use any insoles to alter foot function. You only want to support after an injury or if that is the last alternative, which it very rarely is. So if you are in pain and can’t perform your military duties yet an insole helps, sure that is better than the discomfort.

  73. HI, I’m 59 with recent tenderness in L arch and major pain and loss of ROM in R hip. Resisting orthotics, voiding stretching, and doing water exercise with ROM never approaching pain threshold. One question: What do you think of taping the arch? My PT used Kineseo tape as well as Luco tape. I find it comfortable, it seems to stabilize my gait without acting like a “crutch” , for lack of a better word. It seems to me the taping will allow me to build strength until I won’t need it in the future.

    My goal is to avoid a hip replacement and to return to some favored activities. My methods will include gentle exercise, weight loss (I could use to drop 20 lbs), better eating (fewer carbs, more protein and health fat, more vitaminC, adequate hydration and electrolytes), and a day built on varying my activity among sitting (not too much!), standing, and walking. As it is, while I can’t walk around the block pain free, I can bicycle 20 miles every other day without incident.

    I will be back to this site frequiently!

    • If taping helps you get over pain so you can move and your body heals up then that’s fine. But obviously if you always need the tape then that’s a problem.

  74. Amazed to have found you – pls help. I’m 40, born with a hip ante version , fell down stairs aged 12 injured tailbone which didn’t heal well ; left foot has always dragged and turns in when I walk and there is curvature of lower spine with significant “crease” in my back on left side. I have significant episodes of lower back and left knee pain. Been wearing heel lift in left shoe and orthotic inserts for 3 years . I don’t like how they make my foot slip out of left shoe, how ” tilted” I feel when bArefoot, how uncomfortable I feel even in my special shoes that mimic being barefoot with the lifts in. Now puppy has eaten my insole, so went without – out of action with back pain for 3 weeks now. Now using cheapie pair bought off amazon. Desperate to know – can I get free of these orthotics and feel balanced again? Please don’t tell me to go see specialist – NHS doesn’t work like that, lol. Please advise, thank you soooo much.

    • Well I don’t see how a special shoe with a lift in can mimic being barefoot. (??)

      It’s not that you need to see a “specialist” because typically those docs specialize in a symptom-based treatment system, but you need to find a doc or therapist who can treat the whole body and knows how to properly rehabilitate the feet too so you can get out of orthotics. Those docs who think all their patients need orthotics don’t understand how to treat the entire body and re-train and strengthen the foot and lower leg muscles. It’s much easier to stick someone in orthotics, relieve some pain, and get a person happy quicker even though they’re masking the problem and most often setting them up for another problem in the future.

      • Paul Morgan says:

        Far to many doctors just don’t care. They are out to make the money. These are intelligent people who probably believe that the world is doomed and therefore get yours now, enjoy, and don’t worry about how it impacts the rest of the world. And that is not a whole body response. It is a whole world response. You either desire to be part of a solution or you desire to make as much money as possible. The only way I can see someone following that path is if they truly believe in get theirs and who cares about the rest. To many people today like that. Hey, you look at the big picture and you think, we are going to destroy humanity. To many people just don’t care. Your next step is to think, hey get mine take care of me and my family. Get as much as possible, build my families strength to be as powerful as possible and just maybe we will survive. Or you embrace completely a willingness to be part of a grand solution and just maybe if enough of us do this, we can save the human race.

      • Sorry I meant I have a pair of Skechers MBT shoes, but I use the lift in those too. I don’t really know what to do – those kinds of drs aren’t found on NHS and I can’t afford to go private. (I’m American so I understand this us a much easier issue to address over there ). I gues I was just looking for some assurance that I could slowly wean myself off the orthotics. But thank you for replying.

  75. I’ve been wearing orthotics for a while because i have aleays had flat feet that pronate. There were a few months when I went without any arch support in my shoes and after coming home from standing all day at work my feet and especially the inner tendons in my ankles would hurt so bad that it would bring me to tears. As soon as I got new orthotic shoes the pain immediately went away when I wore them. I began wearing orthotics due to pain. If wearing orthotics is not actually helping my feet, then I was wondering how I can alleviate pain and address my over pronation without them? Thank you.

    • Start by reading this, and then the links/video in the article. http://sock-doc.com/2012/03/healthy-people-barefoot-people/

    • Shannon,

      That was me too — it started with bunion pain over 30 years ago. My podiatrist then prescribed orthotics and they made the pain stop. I even ran two marathons with them. But over time, my feet slowly got worse. I developed heel spurs and finally a hammertoe. But I always wore my orthotics, even in the house. My feet ached terribly if I didn’t.

      And then 9 months ago I started going barefoot. At first, I just wanted to work up to running barefoot, but my feet felt so much better when I used them actively without shoes that I pretty much stopped wearing shoes altogether. The only time I have pain now is when I do wear shoes. I don’t think I’ll ever go back.

      Good luck!

  76. Sock-Doc: I have a case of classic metatarsal phalangeal joint (MPJs) pain (ball of foot) in both of my feet due to overuse. I am age 65 and play full court basketball once/week and tennis twice/week. In my case it is more a nuisance tenderness with no debilitating piercing pain. If I rest for 3 days symptoms generally disappear. I have never had any serious foot or ankle injuries in my life. Besides retiring from playing basketball, what do you recommend besides perhaps beginning to ice down after playing these sports which involve lots of intense footwork? I know you are anti-orthotics so I suspect you will warn me to avoid trying off-the-shelf or custom orthotics designed to help with this issue. I own high quality New Balance basketball shoes, Asics tennis shoes as well as Altra (Lone Peak model) zero drop casual shoes. Any particular flex or strengthening exercises you recommend?

  77. Hey Sock Doc, I have read all of your articles about healthy people being barefoot and stretching can actually cause injury. I had plantar fasciitis when I was about 14 the cause being I was very overweight (215lbs) and had just had a massive growth spurt (about 5-6 inches in 3 months.) It was treated with a few months of PT and just over the counter athletic orthotics (http://www.aetrex.com/products/Lynco-Sports-400-Series-%252d-L405.html).

    I am now 18 and am in the best shape of my life, I am about 25-30lbs lighter than I was. However I’ve been wearing the orthotics for the past 4 years and I’ve had no issues until recently when I decided to try working out in my new Nike Lunar Fly 3 without the orthotics, I was feeling fine and was able to easily run farther without them. However I slowly started to get mild shooting pains through the arch of my left foot and now I believe that my fasciitis has returned. It is not terribly bad yet, however I would like to stop it before it returns full force. How can I get to a point where I don’t have to wear orthotics?

  78. Hi, Sock Doc,

    Thanks so much for putting this site together. I am struggling with nagging injuries, and I started the transition to more minimalist/barefoot running in the fall, only to develop achilles problems in the Newton shoes I was trying. I returned the shoes.

    Having been in orthotics for the past 10 years, the last 3 in Foot Levelers (the best ones yet, but apparently still throwing me off enough for me to develop ITBS), I am looking to transition to minimalist footwear, but not so quickly that I hurt something else.

    Do you have any suggestions on a good shoe for transition? I tried on a pair of Saucony Kinvara and they felt pretty good (way less drop than “normal” but not quite zero), but after my disaster with the Newtons I am afraid I will pick the wrong thing.

    I’ve heard of so many people developing stress fractures as well (and I know this is also influenced by diet and overall health too, so I am working to cut refined carbs. I never use hydrogenated anything, and I am also already gluten and dairy free. Corn is next to go.).

    After my achilles problem I went to a pedorthic and he’s all about the orthotics. I’m just not feeling right with them and I want to try again with the minimalist route. I saw a couple of youtube videos by you, and I started to address the calf and the achilles is doing better. I will continue to read the articles here and see if I can make it work this time. Any counsel about shoes is appreciated.

    Thanks again.

    • Please read “Healthy People = Barefoot People” and that will answer your questions. Yeah, I don’t have much success with Newtons either. Plenty of other options. Orthotics are great to put under an uneven table leg.

  79. Hi Sock Doc,

    So glad I found your site. I was diagnosed with foot drop in both feet due to neuropathy 3yrs ago, and just as you’ve stated previously, I was quickly prescribed custom made orthotics’. I had complained often to my Neuro Doc that my feet felt worse whenever I wasn’t wearing the ortho’s. Long story short, I now have chronic knee swelling with fluid on my knees, numbness and chronic knee pain. Before the ortho’s, I never had knee problems. I just really want to thank you Dr. because from researching this issue, I know beyond a shadow of a doubt that ALL my subsequent issues were a direct result of wearing ortho’s.

  80. I found the article very interesting and helpful. I have an occasional shin pain and decided to get orthotics. I wore them for 1 hour today and now have a very bad lower back pain and it’s getting worse. Looks like the insoles put my body out of balance and I overworked some lower back muscles. Don’t even going to contact the shop where I bought my custom made insoles, as I won’t ever wear them again!! I agree with the Sock Doc’s opinion. And just have to deal with my shin pain with heat pack and massage and proper footwear. I hope my back recovers soon..Ouch! : ( Thanks you, Sock Doc!!

  81. Hi Sock Doc

    Mri result showed I hv soft tissue injury (calcaneal fat pad inflammation) and heel bruise for almost 2 months now. It has been disabling and I am miserably on wheelchair since then. I am 27 years female 52 kg. Orthopedist has suggest no steroid injection as it will thin the fat pad, no weight bearing allowed, hv tried heel cups, nsaids, dry needling, acupuncture but nothing works. I am in a horror to see my leg musle n bone going atrophy. Will the fat pad ever recover/regenerate and how long does it takes for the inflammation to subside? It has been 2months non weight bearing and the pain is still disabling. I dont want to be on wheelchair. Please help, thanks

    • Check out the Achilles Tendonitis Video and the Sock Doc First Aid Series. Other than that you should perhaps consider a second opinion from a doc who looks at the entire body, not just where your pain is.

  82. i have herniated disc due to that my alignment of the body is disturbed .i feel more pressure on left leg and right knee in pain as well causing me to limp significantly .back pain is constant but bearable.muscle spasm is significant but varies with the degree of movement on daily basis.
    any help or suggestion will be really appreciated.
    Thanks

  83. I had sudden onset pain in feet , knees, SI joints and chronic muscle pain below the waist for over a year and hit my 60th birthday feeling like I was 90. Saw every specialist and got a cortisone shot in my SI joint. Podiatrist made me inserts and in spite of the tweaking the pain in my feet got so bad I could hardly walk. Finally sought help from a trigger point massage therapist thinking at least I’d get help with the pain. But the first thing he did was to look at my feet and diagnose me with Mortons foot and gave me some inserts called Prokinetics. . 2 weeks later I have ZERO pain in my feet and the muscle pains in my legs are dissipating. I’m hopeful that correction of my anatomically bad Mortons feet will also help with the SI joint dysfunction. I’d be interested to know how barefoot running could help with my Mortons feet but for now these thin little inserts have been miraculous.

  84. I have osteoarthritis in my right hip and am told I need an orthotic in keep my right foot from rotating in when I walk. If the gait be the cause of my hip pain how do I correct the gait without orthotics

  85. Hi Steve,
    I read your article with interest this morning. I have been in orthotics for about 8 years as I had problems with back pains (neck, mid thoracic and lower), as well as shin splints and pain in my arches and big toes. My right foot seems to be worse than my left. I see a chiropractor regularly but only for my back and just symptom relief. The orthotics have been getting more and more extreme and while they seem to help with my symptoms I am concerned I will have no where to go. I am only middle aged and ?what will happen when I am even older. My father has similar problems to me but he is now 70. I am running alot in the orthotics and love it but it creates pain in my big toe and still in my shins. I am also doing some cross and strength training. How do I get out of the orthotics without too much pain? I can only walk barefoot for about an hour or two before it is too much. What exercises would you recommend? Are there any checks I should get done and from whom? Hope you can help out in some way as all health professionals in my area want to get rid of you in 5 mins, put a bandaid on it!

  86. shubham rai says:

    sir, ihad a problem in my foot i had a pain in my heal ankel,and knee also.I had too much problem in my heal that i even cann,t able to stand some times there is a swelling on my ankel …………………………………… so please tell me that what has happened to me and how i overcome with that .pleaseplease…………….. and sir i am suffering from this disease from last 5 month …………………….reply must sir ….

  87. Hi – I am 33 year old male and I have been diagnosed with Bursitis in my left hip over 2 years ago. X-rays show that the muscles in my left hip are holding my pelvis higher than my right. I was treated for bandy legs with leg brace’s as a kid which may have contributed to this. I cannot run or do any high rate repetitive leg movement with out pain 24hrs later. I have tried 2 physiotherapist, hours of sports massage and 2 cortisone injections with no real results. It is surprising how little is known about how to effectively treat this condition among the professional medical community. Every one suggest things to treat the pain but not the initial cause to the problem. I then proceeded with my own research and started with a personal trainer with whom I have lost weight and focused on building up my core strength. He suggested I see a podiatrist in which I now have orthotics.I have felt some benefit but I had a big relapse recently where I Boogied on the dance floor a little too hard.I have only had the orthotics for a couple of months but reading your article I am not so sure of it’s benefit’s. I am getting really frustrated and I am willing to try anything because I cannot do the physical activities I love any more. Any suggestions? Thanks – Adam.

  88. Thank-you for all of the information on healthy living! I appreciate your honesty and knowledgable insight into the human body and how things are supposed to work to feel your best. I have read most of the articles posted and have found a lot of answers to personal health issues. However, I still have a few questions.

    Within the past three years I have been experiencing a lot of severe muscle aches and pains all over my body especially in the legs and back. Fatigue, even after a good nights sleep is common and never seems to go away. I grind my teeth at night and have nearly split the device made for me by the dentist within less than a year. I used to be an active person enjoying skiing, hiking and doing lots of walking. But fatigue and pain keep me from enjoying any activities and exersize and walking make the pain and fatigue even worse. Though I have visited countless doctors and nutritionists, physical therapists and spents thousands of dollars on supplemental and nutritional regimes I have not been able to find relief from the pain or fatigue until I came to your site.

    Ten years ago I was given orthotics by the chiroprator I was visiting due to a mild back strain I had obtained from work. He stated that the orthotics would help me with “balance” since he notice that one leg was slightly longer than the other. I have been wearing them ever since. I haven’t been able to walk barefoot in years or go without shoes with these orthotics as it is too painful. This changed when I read the info on this site and stopped wearing the orthotics for 2 days just to give it a try. Initially it was uncomfortable and felt like I had “sea legs”. But after a full day or two of wearing sneakers without the orthotics, I felt like I regained balance like I hadn’t had in years! I have been going without the orthotics now for a week and found relief from calf and ankle pain and pain in the arches. I even go barefoot for a short time during the day. I am excited to have relief from some of the pain but I am concerned that there is no transition time like you suggested in adjusting to going without orthotics. I don’t want to injure myself further but everytime I try the orthotics now they cause reoccuring pain and fatigue.

    I also took your advice and did the carb free test. After only one week my muscles began to relax and I could sleep with my legs stretched out instead of falling into the contracted fetal position that I have adopted due to the fatigue and pain in my legs at the end of the day. As soon as I went back to adding carbs to the diet the pain came back. I know you can’t live carb free forever. But it is tempting just because it takes the pain away. I am having trouble finding that threshold of carb tolerance. Any suggestions?

    I would like to see continued improvement in my muscle strength and possibly be able to give up the dental appliance as well. I just need some help with the carb situation. I don’t know what to reintroduce and how much at a time. Perhaps you can help. I am open to any suggestions for improvement.

    Thanks again for your site!

  89. Jay malhotra says:

    hi, I love the sport of basketball and was a swimmer but over the let few years my knees have been more than painful. I noticed that even kicking in the water created a good deal of pain after a while. Whle playing basketball, I cannot bend too low or make jabbing motions. one day the pain was so much from rebounding it hurt to stretch it out. I went to the podiatrist and he told me he could have custom orthotics made but now I’m skeptical. I later saw a pediatrician who told me i have patellar tendonitis and crepitus, which i know i do from the crunching my knees make when i bend them. How can i be certain that these orthotics won’t work, and what do u recommend doing to fix my condition. I know i pronate but I don’t know what to do to get rid of the problem. I have noticed pain also in my lower back. please let me know what to do

  90. hi, thanks for a great site! I am a 47years old woman. I like walking and have a flat left foot. More than a year ago, I developed a swelling around my ankle, particularly below my left outer ankle bone, as if there was something soft there. It hurts when i put the foot on the ground especially when i first place it on the ground. Pain reduces after walking a bit and then increases. Wondering if it is necessary for me to wear shoes (Nike for flat footed, stable support). I hate wearing support shoes even to work and they look funny with women’s clothes, so do you think it necessary for me to do so or can I wear normal footwear? My father who is in his seventies has a similar problem and his foot has gone really bad- swollen and painful and the arch has collapsed. He is having to cut down on walking in a major way.He advises me to start wearing insoles to avoid being in the same position as him. He has been advised orthotics. Pls advise. Currently i am wearing the nike stable support shoes. What can i do to ease the pain in the foot? Thanks again for a great site. Though i feel very comfortable when i wear the shoes i am doubtful if they are a good long term solution.

  91. G’day. I live in New Zealand and I have been reading your site with great interest as what you are writing and showing us makes a lot of sense to me. I am writing to you in the hope you can help. I used to run in top-end asics gel runners which I always found comfortable. I have competed in lots of running and triathlon races at reasonable national level. However, over the years I developed a chronic calf muscle injury (in both legs). Some time into my run (could be 5mins or 25 mins) I can feel my calf muscles tighten. If I keep running it quickly develops in a stabbing pain forcing me to stop. It feels very different from cramp. I have to limp home and limp for the next few days. I can try running again after two weeks once it has settled down. I’ve tried all sorts of treatment including orthotics, compartment syndrome testing, strengthening, stretching, sciatica testing and after developing plantar fasciatis even a whole year no running. However, as soon as I started running again both the calf muscle injury and pf came back. I subsequently discovered natural running and replaced my running shoes with Activ8 shoes and my day to day shoes now have an almost zero drop as well. After a couple of months my pf has disappeared! I am not doing much running these days. Only say 25mins of gentle running 2 or 3 times per week. However, my calf muscle injury persists. I have had x-rays to check for bone fractures, I have had ultrasound to check for muscle tears. Both are negative. My PT calls it hyper-neural activity. I am undergoing dry-needling treatment, deep tissue massage and started calf strengthening exercises again. Still to no avail. I am at wits end so if you can help I will be forever grateful.

    • Well it sounds like you’re trying the right things. Note that the calf muscles are closely related to your adrenal glands which means they’re associated with stress levels. So if you’re under some other type of stress (physical – past injuries, emotional, or nutritional), then that can actually cause or contribute to your calf pain. Wearing orthotics and Asics for a period of time can create some compensations that may be hindering your progress too. Also, you might want to try some different footwear. Don’t think that all zero-drop or even a low 4mm drop are all the same.

      • Thanks so much Doc for taking the time to reply to my message. I don’t know why I mentioned Activ8 shoes. Must have been a blonde moment! :) I meant I am now running on Innov8 model Road X 255. I am considering purchasing a pair of the NB Minimus 10 or Zero.

        Interesting you should mention that calf muscles are related to adrenal glands. Like most people I am exposed to different types of stress, be it at work, traffic, managing my 3 rental properties for a 10 years, injuries that won’t go away etc! I’d like to think my nutrition is pretty good, though I might drink 2 or 3 cups of espresso coffee each day and some red wine in the weekends. Other than that I always eat fresh. Just wondering though if eating meat is a problem? Could lactose be a contributor to my calf pain? What about mercury potentially leeching out from dental fillings?

        Another point I wanted to make about my calf pain is that it occurs somewhere in the belly of the muscle, not sure if it is the soleus or gastrocnemius or both. I have also had it twice now that I felt a sudden stab of pain whilst walking out of the office, though the night before I stopped running because I felt it tightening up. So seems sort of late reaction.

        Thanks, Dan

        • I promote a Paleo Diet most often, as you can read about on this site. Sure food intolerances and heavy metal poisoning can contribute. Impossible for me to say on-line.

  92. Gregory Michael says:

    Thanks for the great information. Recently my back problems have worsen. I believe it all started when I was a young teenager. Why I was hanging from a doorway thinking I Michael Jordan slamming a basketball I don’t know but I slipped and fell straight onto the back. I have had problems ever since then and it’s progressively getting worse. Many many back spasms in the past fifteen years. One of them occuring last year that floored my butt and kept me on the floor for a while. After the spasms cleared up I started noticiing pain down the right side buttucks and hamstring. Occasionally making it to the calf. Still waiting on an MRI to prove it is a damaged disc pintching a nerve but ciroprator found my hips misaligned and place a 6MM wedge in the left foot and also prescribed a custom orthotics from Hersco in New York. Doctors didn’t tell me much at all about the custom orthotics that’s being made for me other then just wear them forever. I’ve always beleive natural is the way to go so after reading many articles on your website I have decided not to wear them but am very confused with what I should do now. Any suggestions? I like to try a minimus shoe but don’t know if i should include the wedge with it or not. So lost at the moment but need help fast! I consider myself still very active and in good shape but see things going downhill fast. I see your office is not to far from me and would love to come vistit but in the mean time any suggests to get things started in a different direction from these custom orthodics? thank you.

  93. David Ellison says:

    Hi, Soc Doc.

    Thrilled I found this website having come back from visiting a new podiatrist (2nd one!) and being offered new insoles *sigh.

    I have left knee soreness, popping left hip and also a weird strain a year ago (raising my upper leg was very painful had to stop running). I also keep getting blisters on the ball of my right toes after heavy walking.
    All this started when I got Orthotics from my 1st podiatrist which did fix an intense pain on the outer instep of my right foot but seems to have wrecked the mechanics of my legs.

    I saw a physio about the knee issue who told me I had weak muscles in my glutes and outer quads which was giving me the knee issues and gave me stretches and exercises to do like squats one legged squats, clams, etc.

    They then sent me to the lastest podiatrist who showed me video of me walking; I was pronating a bit on left foot but a lot on my right which he said was knocking my knees out of alignment, my right achilles wasn’t quite straight but he did say my feet were quite flexible but I had tight upper calves. Also my big toe sort of reaches out sideways a little to steady myself as I walk.

    First from the symptoms I have described am I better going to a Chiro than a Podiatrist?
    I want to ditch these hellish insoles which have turned one issue into many in my estimation.

    Can you please advise me on what steps to take next, I am still doing the exercises prescribed by the chiro as I am going on a weeks hiking in three weeks and me knees are still a little sore.

    Do I stop the stretches the physio showed me and the strengthening exercises?
    Should I ditch the orthotics and get Nike Free 3.0′s? (If I do will the instep pain return?)
    Should I do any exercises?
    Would correct toes help me?
    Am I right seeing a Chiro next (I’m in the UK, scotland, can you suggest anyone? If not what do I look for in a Chiro/doctor that’s a sign of a skilled one with treatments like your own?)

    Sorry for the barrage of questions and many thanks for you taking the time and giving your advice away for free! You’re a godsend.

  94. I read your article and it resonates because I have started to turn towards dr.’s who think outside of the box because of exactly what write about. We live in a society that wants that quick pill to fix the symptom instead of fixing the root problem. But I have to admit, until I read this article, I never considered the same possibilities in regard to our foot problem. I am confused about how organ issues and other various issues can affect your foot. Here is my daughters current issue that I am trying to wrap my brain around to discover if I am doing the right things. My mother, myself, and my 13 year old have had plantar fasciitis. My mom and I have relied on custom orthotics when we need them. My daughter plays soccer probably way too much, so that is problem #1. She was born with tracheal-esophageal atresia, tracheal-esophageal fistula- surgically repaired when born; grade 5 kidney reflux on left kidney; grade one on right- repaired by bilateral re-implantation into the bladder at age 3; severe Gerd because of EATEF-repaired with Nissen fundoplication at 9 mos.; over the past 2-3 years she has complained of cold and numb hands and her forearms are like ice when she exercises-she was misdiagnosed by her pediatrician who ran no tests with Raynauds syndrome. I recently had her checked out by a chiropractor who did x-rays and found 3 fused cervical vertebra and a slipped disk in her neck and a couple of very slight curvatures in her spine (scoliosis), but told not to worry about it at this point. She has cervical ribs on both sides that I knew about when she was born and told or read about thoracic outlet syndrome, but because she didn’t have symptoms then, I forgot about the information. Now she is seeing a neurologist who did an MRI and we see tomorrow for his thoughts on what to do. I know she should have more tests done to see which type of TOS she has and then do physical therapy and then possible surgery if symptoms don’t get better. But in the mean time for the past 5 weeks, I have had her seeing the chiropractor for adjustments for her pain all over her body, but specifically her neck/shoulder/foot pain. He adjusts her, but also is doing Active Release Therapy on her for very tight hips, pain in the knees, and thus pain in the foot. She was recently injured by a couple of soccer teams hacking her foot so bad in a couple of games that the orthopedic and chiro said she had contusions on the bones and ligaments in her foot. BUt one area that was taking longer to heal was tibialis posterior tendonitis. She is supposed to start physical therapy on top of everything else I am doing and it has been suggested we get her orthotics. She is a good eater and loves her veggies, but she’s 13 and loves her carbs and bad food as well. I know this is a lot of information. BUT, my confusion with your article is how it would apply to a child born with many birth defects that have been surgically repaired and the rest that I am currently trying to get treatment for while knowing that there are some things that just can’t be fixed, but part of this course of treatment includes orthotics. Should we do the orthotics for short term relief while we address her other major health concerns that will not be quick fixes. She is a soccer athlete and know that we might get to a point where they say it is not safe for her to play, but for now, she wants to play and needs to find some relief and help with aligning her posture. Thanks for reading!!

  95. Very interesting! Thank you so much Doc!

  96. What about for bunions? I’ve been told that I need to support the heel and arch. They’re so bad now, I have to have surgery to remove them.
    One other question regarding bunions – do the shoes that are like a flip flop but separate each toe really stretch out the feet in a good way?
    Thanks

  97. Helen Moorwood says:

    Hi

    I have run the gamut with my foot problem. In a nutshell, in Nov 2010 I woke up with left foot pain mainly in the ball of my foot but extending into the big toe, and for no reason. 3 weeks later when the pain hadn’t gone by itself, I went to my local GP and he sent me firstly for an X-Ray (no conclusion) and then for a bone scan where they said “possible microfracture”. I was put into an air boot for 9 weeks and was still in the same amount of pain when I came out. The Dr said that there was nothing else that he could do and sent me on my way. I went to my regular Physiotherapist who said it may be ‘turf toe’ and showed me how to strap myself up for this, which I did for the next 3 months (again, with no success). I then proceeded to bounce around from Podiatrist (who just wanted to put me in a pair of expensive shoes that he happened to sell), acupuncture etc, until my new Dr sent me on a 2nd bone scan and referred me to an Orthopaedic surgeon. After another set of X-Rays and an MRI, he decided that my outer sesamoid seemed to protrude a little too much and I had it shaved in surgery.

    All went well, and 4 months after surgery I felt great so I put a small heeled strappy sandle on to attend a work Christmas party in Dec 2011. By the end of the night, my foot had swollen up like a football and the pain had returned. I went back to the surgeon and he suggested cortisone injections (I’d rather give birth) and 3 weeks later, I was feeling great. My surgeon said that the cortisone wouldn’t last and the fact that it worked meant that I had an issue with the medial nerve and removing it would take the pain away….so I had a second surgery. The outer sesamoid was shaved again, and the medial nerve was cut at the point where the big toe joins the foot and removed up to the arch where it was buried in muscle.

    This was 12 months ago. I am in more pain than ever as now I still have the original pain, in conjunction with scar tissue that has to be massaged daily by myself and weekly by a deep tissue masseuse just so that I can walk. I also have the de-sensitivity that resulted from the nerve removal. I have also had another course of cortisone which didn’t work.

    I then went to a ‘big’ surgeon in one of the ‘big’ hospitals in Sydney who said that it may be a muscle problem and showed me some stretching exercises.

    My last resort, since the surgeon told me that there was nothing else that he could do, and my Dr said that another surgery would just create more problems, is to see yet another podiatrist. I showed her the results of all my tests along with X-Rays taken after my last surgery and I walked for 2 minutes on a treadmill where she evaluated my gait. End result….my left arch is too high and my right arch is too low. Solution: $400 custom orthotics and another pair of $200 ugly shoes.

    I am very interested in hearing what you think about my problem and although I live in Australia (Wollongong), was wondering if there was anyone out here that you know of that follows your line of thinking who could help me (that is if you can’t directly).

    I am at my wits end. I find that the pain is at it’s most when my leg is elevated. I’m not too bad through the day and have the occasional annoyance but mostly a 5 out of 10 on the pain scale. I can sleep ok most nights but the trouble comes when I lay on my bed to watch TV. It then hits about a 7-8 and I have a fairly high pain threshold. Since the 2nd surgery, I cannot wear anything on my feet except crocs, which I know have no support but they are soft rubber so the ball of my foot is protected and they have a large box toe (I have developed an ingrown toenail since the surgery and the tip of my toe is extremely tender).

    Please help me if you can.

  98. Hannah Powell says:

    Hi Sock Doc!
    I have been reading through your website and have found your work extremely interesting.
    Last year I ended up in A&E with severe pain in my right foot, eventually after another visit to A&E they told me it was Ganglia – which my Doctor then laughed at when I told him. I ended up being referred to a physio who evaluated my foot/leg etc and told me that my right leg is shorter than my left leg and this is causing pain in my foot/ankle/leg and hip. I was referred to orthotics who gave me a heel wedge. This seemed to be helping but a year later my hip is hurting and is affecting my running and fitness, also my trainers are ripped to shreds. When on holiday in the summer I didn’t wear shoes for 3 weeks and I didn’t feel any pain! I go to the gym or run 5-6 days a week and I am looking for some guidance as to whether I should even be wearing the orthotic or not! Without it I can feel an unbalance but now I am worried that it is because I am used to having it in my shoes? I am concerned that it is now affecting my back and shoulders which appear to be at different heights. Please help if you can!!
    Thanks you and regards,
    Hannah

  99. Hi I had a lisfranc fracture (2nd 3rd and 4th metatarsals) and dislocation of 4.7mm in my left foot a year ago. My surgeon prescribed me custom orthotics and they have been amazing support, and I do feel the difference if I don’t wear them. As I’ve gotten more confident with my foot now I sometimes don’t wear them, but surgeon didn’t make it clear when/if to stop. Is it just a matter of just trying without them and if i experience any pain? I stand up all day so I wear them to work especially and when I exercise. Thanks

  100. Stephanie says:

    This article was very interesting! I suffer from hip and back pain on my left side and I suspect it is because my left leg is a bit shorter, but I’m not sure.

    Anyway for a while I was wearing Crocs and the pain in my hip and back went away, but recently the podiatrist I saw recommended I go back to regular shores because crocs allow your feet to slide around and can cause ingrown toenails (the problem I went in for). After a week in normal shoes with no inserts in the sole (just the regular straight kind that comes with the shoe) the pain is back again.

    My question is what is the best type of shoe for good foot health so that one does not need orthodics in this case? Are crocs a good choice, or all hype? I am a cook who is often on my feet, so foot health is important to me!

  101. This is really interesting. To see another side of the story is refreshing as I am starting to give up. I was told from my physiotherapist that I need orthotics and was given stretching exercise for PF. On the same foot I have tendonitis from the metatarsal bone to the toes. I am a 39 year old female that a 1 1/2 ago was starting to have problems in my right foot heel. After about a year I went to my doctor and his only solution was to lose weight and see physio. Physio referred me to a podiatrist who made me orthotics. That was 6 months ago. Since then have gone back for many many adjustments as my heels still hurts. Now they want to make me a whole new set saying that maybe the mold was wrong. Now I told her that I dont like hard shoes…never did so she made them with a softer material but still the same result. So I am wondering if I try your method will it help. I have a special trip planned next year where I will need to be able to work and stand for 8 hours a day for a week…and at this point I cannot even walk a block without my feet hurting so bad at the end of the day that I want to cry from the pain in my heel. I have a sit down job everyday and I don’t understand why my feet hurt so bad. If there is anything else you can recommend it would be most helpful.

  102. Phoebe du Preez says:

    I have been wearing orthotics for about 8 hours per day for 3 months for a collapsed arch and aching feet when I walk. However, at night my feet start to ache and by morning I can barely move my feet. The pain at the ball of my feet and my toes is excruciating, they feel stiff and are swollen. I have to take pain killers virtually every day. The only way I am able to walk during the day with minimal pain is with the orthotics. I have been diagnosed with a collapsed arch and tendinitis. Please let me know what you would recommend.

    Many thanks
    Phoebe

  103. Gerimaya Whyte says:

    SockDoc, I’ve become increasingly suspicious of my custom made orthodics which I’ve been wearing for a year now. I originally got them when I was suffering from a lot of chronic back pain. Desperate for some relief I conceded to have some made for me when I was getting my toe looked at for an ingrown nail. The promise of curing my back pain was too much to pass up on given my insurance covered a good portion of the cost. Some pain seemed to disappear but only with assistance of a really good CMT in addition to my inserts. Recently my back pain flared up again and I decided to start using my vibram five fingers. After about three days of walking, light jogging, and some yoga my back pain disappeared. When I started using my inserts ie at work my legs felt uncomfortable and my right knee started hurting. I have no history problems and can only attribute this to my inserts since it is the only time it happens… Should I just stop wearing my inserts since my body seems intolerant to it now?

  104. I’ve suffered with PF for 4+ years. Two years ago I finally went to the Dr for it and he promptly gave me a shot of cortisone and a sleeping boot. I had already been wearing store bought orthotics but he recommended custom fit. After several more shots and a walking book and finally and permanent cast for 6 weeks. Over a year and a half and NOTHING worked!!! Six shots of cortisone and I was just bound to have PF forever. I finally decided to try Acupuncture and went for 24 treatments and she used a light amount of electricity on the foot to decrease the inflammation, I’m not sure if the pulses of electricity worked or just the acupuncture but the PF seemed to be gone for 6+months and then one day it started to come back. (All this time I have been using my custom fit orthotic). So yesterday at a gathering I was talking to a friend who believed she was getting it, self diagnosed, and she did a search for PF and came upon your website. She liked what you said and she found relief. So I am perplexed. Seems you literally go against almost everything I have been trained to do for the last two years. I am however going to try it, anything to get this to go away for good!

  105. mike lowe says:

    I don’t think barefoot is a good idea for everybody. I have been wearing the correct orthotics for my feet for years and my quality of life is totally improved. some orthotics did not help but the correct orthotics helped a great deal. I was looking for info on orthotics for my sister and I came across this opinion. If you walk on sand barefoot is good but on asphalt. everybody has something to sell

  106. Caroline says:

    Hi there Doctor
    I found this article and I am not doubting my doctor, and that is not a good thing.
    I have been diagnosed with anteriomedial impingement and a medial meniscus tear horizontal.
    I saw one sports Dr and he only diagnosed the tear and recommended surgery. I had a problem with that because 3 radiologists missed the tear on my MRI.
    I went to see Dr #2 and he diagnosed the impingement and his explanation are making sense to me.
    His plan is to first try PT : working on strength …glutes, quads, balance, core.
    Went to see the PT who is supposedly the best in the area where I live and he made me a program to work on my weak areas AND ordered orthotics to correct the impingement.

    How do you correct impingement without using orthotics….
    Thank you for your time

  107. Susanne says:

    Hi Doc, I have just read your article. I had an implant (one sided) put in my right large toe because all the cartilege was worn off and running was becoming impossible. Within a year after surgery, my 2nd and 3rd toes were beginning to lean toward the big toe (which no longer quite touches the floor when I’m standing naturally). An X-ray basically shows the toes are starting to go “off the rails.” My doc gave me orthotics but I came across your website. I have started wearing Correct-Toes spacers and an going around all day long in Altra running shoes with the insoles removed. Do you think this will fix the problem over time?

    Also, my left foot is not starting to develop a bunion, apparently because the cartilege is also worn off and I have some bone spurs. Will the Correct-Toes slowly correct that a bit as well? By the way, I can run some, and hike a lot, without much pain since wearing the spacers and Altra shoes.

  108. natalya Van steen says:

    Hi

    I was wonderinf if you can please offer me some advice on how to wean myself off my orthotics. They are custom made and very hard and high. I regret having them done as recent physios have told me I have slight pronation inwards and flat feet but dont really need the orthotics. When walking long disatances the orthotics hurt my feet and make them feel stiff.
    I have started walking in the house without them but when i walk properly for up to ten minutes I experince so much pain in my legs and get achey knees that its almost impossible to keep walking without them. However, I know they arent doing me any good so do you have any suggestions as to what I should do?
    Also when I pout the orthotics back into my shoes after walking barefoot they really hurt my feet and knees….so im in a bit of a catch 22 with them.
    Thanks

  109. Hi Doc

    I was suffering with PF for almost a year and was was given custom made orthotics by the podiatrist. Whilst they do help with the pain in my foot i now have constant pain and tightness in my tibialis anterior and around my ankles. I am at a loss and have spent a small fortune on physio and different styles of running trainers. I’m tempted to get rid of them but i’m unsure. Can you just remove them straight away?

  110. Hi,

    About five years I broke my right femur and some other bone in my back. During the healing process my left arch fell and my right didn’t. I’ve tried orthotics for both feet and even just one for the left foot. I’ve also been without them, but it seems like I have pain regardless. The point is I’m off balance. I’m only 30 and want to be active. I don’t have medical insurance, but I ‘am a veteran so I have medical care. What is your opinion on just wearing one orthotic for the fallen arch. Should I ditch them. Could it be a bigger problem due my broken femur, that doesn’t seem like it healed properly. I did have a metal pin but I had it removed. This has set me back and I know with the right proper medical care I can regain my health. Thank You

  111. I just found orthotics to be uncomfortable, expensive (like $300 WITH insurance), and they wear out really fast. And then they just give you another pair. It’s like giving someone with a broken leg a cane, it’s something you just end up relying on but it doesn’t cure you and yes I’ve suspected it could make things worse. So my point is I have SEVERELY flat feet that make me just dog tired (I work so I have to wear at least a low heel to remain professional, which as you said above only makes things worse), so what’s the answer? How do I strengthen those muscles? I am at my wits end, the foot pain has been so bad I’ve literally thought I had mono again or chronic fatigue or something, it’s practically beyond exhaustion. At this point I’d try anything, I’ve even considered surgery, radical as that is as an adult.

  112. I agree! I was told I had a 1 cm difference in the length of my legs along with other problems with my feet requiring me to get orthotics. I even got a second opinion who confirmed the same. At that point in my life I was inactive and sat a lot due to my work at the time. The orthotics worked great for 1-2 weeks then all my symptoms came back. I was hesitant to believe I had the prescribed problems from the get go because it seemed to be a sudden display of symptoms where I would have thought they would have been more gradual.

    Despite the cost, I decided to throw them away and get active again, while stretching extensively after each run. I wholeheartedly bellieved that I did not need them. My symptoms went away within a few weeks FOR GOOD! Now I am just more aware of my posture.

    Just for fun I wen to one of the health professionals who had previously confirmed the 1 cm difference in my leg length and asked him to measure and there was no difference (he had forgotten he had previously told me there was). I told him of the previous diagnosis, thanked him and left.

  113. Jeff Andrews says:

    I have high arches. I have experiences a lot of metatarsal pain in the past year from running. I went to the podiatrist and he told me that I over supinate and I need orthotics. I have worn them at work for about a week. I have only worn them a couple of times to run so far, but they are uncomfortable and I am afraid that they are doing more harm than good. I am a forefoot runner and the orhtotics raise my heel up, making me put more stress on the calves and shins to not land on my heels. Plus I have noticed my knee that I had ACL surgery on 2 years ago hurting me more since wearing them. I don’t understand how arch support can be the fix for both flat feet and high arches. My feet do feel better when I walk barefoot around the house. Will a minimalist shoe also help with high arches?

  114. I have had really bad pain in my right foot. Sharp pain between my second and third toe and the ball of my foot between those toes. I went to a foot doctor today and he took xrays. Said I have heel spurs on the bottom and on the plantar fachia(sp) he taped both my feet and told me to wear as long as possible to see if orthodics would help. So far both arches on both feet are killing me! He said something about the”knuckle” around the toe joints being inflamed. Talked about injections or shots. Do you think this sounds helpful or should I try something else. I have chronic illness. Fibro and degenerative disc disease. Thanks for your time.

  115. Jennifer says:

    Hello, I am not a runner but do a lot of gardening and got PF probably from squatting on left foot too much. I was diagnosed, referred to a Podiatrist, and got orthotics on June 19th. A couple of weeks getting used to those, and then all was fine, although I still have pain in the very back of my heel. Today I suddenly have pain in my butt and all down the back of my leg, and am thinking it is sciatica, and resulting from the orthotics. I was born with rearfoot varus in left foot and have pronation in both feet. My left foot corrected itself when I was young. I also had a rotational deformity and remember sitting in a W for many years. But if there was also something askew with my back when I was born, maybe the orthotic is messing that up now. What do you think?

    • As you know from reading this and the other few orthotic articles I think they’re for the most part garbage and cause other problems in people either immediately or over time.

  116. Hi Steve,

    As I see you’re an accomplished triathlete, I wondered what your take was on orthotics or moulded foot beds in cycling shoes?

    As cycling with clip in pedals isn’t a natural movement and I assume there’s no gait cycle to move through, are these an exception to your article? Following a recent bike fit with video analysis I was given some insoles with arch support to make my knees track in a straight line through the pedal stroke, and I’ve also been told that having something fitted to the shape of your foot increases power put down through the pedal, which seems to make sense to me.

    So, basically, are your shoes for that fancy Cervelo flat inside or do they have insoles in :)

    Cheers,

    Adam

    • I was told similar when I once put the footbeds in my Sidis. I don’t buy it, unless your foot is super imbalanced, and then you’re back to the ‘orthotics supporting dysfunction and mechanoreceptor problems’ scenario again. So I have taken mine out and just use the little sock liner they come with – I want my foot to move as it’s intended – though I think cycling shoes should be more snug than running shoes.

Trackbacks

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