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?
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.
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.
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…
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!
Thanks a lot for that comment; means a lot coming from you!
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
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).
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.
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.
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!
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.
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.
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.
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.
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.
Thanks for sharing Joyce! Orthotics + Stretching = a recipe for disaster!
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.
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.
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.
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!
Hi Jean, check out the Plantar Fasciitis video since a lot of the issues with that injury are similar to the ones that develop into Morton’s neuroma. Also – info on Flat Feet is here. http://www.drgangemi.com/2012/03/flat-feet/
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.
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!
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!
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.
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
You’re a baby Sock Doc follower right now – when you read more of my philosophy and methods and watch the videos you will understand (I hope) why stretching and orthotics will only make you worse; And you may not be ready for Vivobarefoot shoes just yet. Read: http://sock-doc.com/2012/03/healthy-people-barefoot-people/
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/