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Sock Doc WorkshopsProper footwear is essential when exercising and even just walking as you do your daily activities. Today many shoes are made to look cool and flashy, but they are unfortunately making foot function worse. There are numerous shoes with anti-pronation devices, arch supports, ankle supports, and motion control devices & stabilizers. These are often causing problems in a lot of people, and they most likely don’t even know it. Take, for example, the hype behind the anti-[over]pronation shoes. Pronation is a necessary motion and function of the foot. It is supposed to happen — it is a major way you absorb shock when walking or running. However, many people are being told they overpronate or they think they overpronate so they wear these anti-pronation shoes and problems occur – foot, knee, hip, or back aches – all from the shoe they were advised to wear. Sure some people do overpronate, but it’s because of muscle imbalances in the lower leg and foot, not because they’re wearing the wrong shoe. Even worse, many people wear orthotics – casts of their feet that are supporting their gait dysfunction and imbalances which only support their problem and eventually cause other problems throughout the body.
There’s a lot of hype behind orthotics. Many physicians, therapists, and sales persons who make and sell them think they’re the greatest thing since sliced bread. Well, I’m not a big fan of bread, and I’m not a big fan of orthotics. Orthotic supporters (no pun intended) claim that the inserts will fix every structural pain from your head to your toe. The majority of these people make what I’ll refer to as a pathological orthotic, as they are making a cast (mold) of your foot in its current incorrect or imbalanced position. Since you wouldn’t want a broken arm put in a cast without setting the bone, you don’t want a cast of your foot made without making sure that the muscles are balanced and the bones are in the right place. Making a cast of your foot without addressing the issues of the foot isn’t fixing anything – it’s just going to support a problem you already have. Your pain may go away, but a new one will pop up later, perhaps somewhere else in your body. The goal is to figure out why the muscles and bones of the foot (as well as everything affecting the foot) are not functioning properly so the problem at hand (or is it foot?) can be resolved. Since you have to walk, a severely injured muscle may need to be supported as it heals temporarily – and this is where orthotics may be valuable for a slight few people – when they are used to help hold a correction in its place so function may be restored. However, as I write this, now into my 13th year in practice, I have never once needed to have a patient go and get an orthotic made to help stabilize or correct their foot. Maybe that will change tomorrow.
Foot muscles and lower leg muscles which play a major part in the gait of an individual are very responsive to stress in the body. Abnormal stress from thick-heeled, over-supportive shoes, and those wearing orthotics, further weaken the foot and lead to problems. Nutritional stress from a poor diet (refined carbs, processed fats), emotional stress, and physical stress from other injuries as well as excessive exercise also lead to lower leg and foot problems.
I estimate that 90% of the time I need a patient to stop wearing their orthotics that were made for them by another physician because they are either causing a disturbance in their gait (the way you walk) or creating a foot dysfunction. About 10% of the time I’d say the orthotic is not actually hurting them, but is no longer benefiting them, and they’d therefore be better removing the orthotic and allowing their foot work naturally as it is intended to do so – restoring proprioception and overall health.
Wear shoes that keep your feet close to the ground “low to zero-drop”, don’t have a lot of support, and aren’t too rigid (stiff).
Remember, your orthotic is supporting some dysfunction. Always.
Read a lot more about the Sock Doc take on orthotics – here.
* Check out the new article (April 2013): “A Case For Orthotics“
Dr. Stephen Gangemi "Sock Doc"
I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.
Coach Dion says
Hi there
Love what you wrote, my wife once had some injury, and the dr gave her orthotics, and her injury went, so I told her to take them out and only put them back in if the injury returned, it never did…
I run a couple of times a week in 5 fingers as a training tool, and I believe it works.
will have a look at that else you have to say.
thanks
Mark says
I wondered if you had any views on orthotics to correct leg length discrepancy? I’ve been running around 2 years and after initial problems with bad shin splints in cushioned shoes I took a ChiRunning class, worked on my form, and found a big improvement after also switching to more minimalist shoes (currently Nike Free/Saucony Kinvara/Merrell Trail Glove). I’ve also always spent a lot of my time barefoot since I was a kid.
However, since starting running I’ve had persistent left hip pain as well as pain around the side of the shin, and recently saw a physio (athletics-specific, working with some big names). They thought I had longer left leg, but also identified weak soleus, and tight right abductors. Six weeks of strengthening and stretching and this is much improved. The hip pain has reduced, but still stops me running more than ~7 miles.
So I saw the podiatrist they recommended. They identified high arches, some rotation of lower legs, and “over-pronation”. But also, that my left leg is 1cm long than my right (I’m ~190cm tall). When I was videoed at the ChiRunning class it was clear that my left hip was bouncing up and down, and I am quite convinced this is due to the leg length discrepancy, and main source of the hip problem.
So reluctantly I’m having some orthotics made (not based on casts though)… What do you think? Is leg length discrepancy a big issue, and is there any alternative to orthotics? I’m unwilling to give up my “minimalist path” since it has been helpful so far, but can legs of different length really be overcome by something other than an orthotic? I’ve heard orthotics likened to a neck brace – for temporary use only as you mention – but then I’ve also worn spectacles since the age of ten – and don’t believe that any amount of eyeball-rolling exercises would “fix” my eyes now…
Sock Doc says
Hi Mark. Thanks for the comment. You bring up a great, (and very common) issue. So let’s address it. Leg length discrepancy is very common. Actually most people aren’t perfectly symmetrical. 1cm is not much, and I’d say from a lot of experience with leg length discrepancies, it is most likely not the reason you have the hip pain. I see plenty of people who have such a leg length issue and have no pain, or I’m able to get them out of pain, and they still aren’t perfectly balanced. Rather, I’d say your leg being shorter on one side (or longer on the other) is most often due to muscle imbalances in the pelvis, thigh, or lower back, and that causes the leg length difference. So your hip pain, although it is better, is not corrected, and that’s why it still bothers you after 7 miles. Most likely your leg length difference becomes more than 1cm after that 7mi run as more and more hip problems occur and you create more muscles imbalances from the run.
Yes, orthotics support dysfunction. I wouldn’t liken them to wearing glasses though. I’ve never not been able to get someone out of orthotics. Also remember the short leg is on the high pelvis side. So while some would make the orthotic thicker (a heel lift) on the short leg side, that would not balance the pelvis, it would just make up the difference the foot is to the ground. But placing the heel lift on the long leg side would raise that side of the pelvis and create balance in that area, though I still don’t agree with it. I just want you to see how people have their own thoughts on which side should be corrected. Now if someone has a congenital (from birth) short leg or say perhaps from a disease like polio, the heel lift can be very beneficial. I have such a patient and a lift in the short side helps her tremendously. These are rare exceptions.
Finally, I’ll say – and this is the touchy part – that strengthening “weak” muscles with exercises or weights does not turn them on or “facilitate” them from a neurological perspective. And as you know, I am against stretching because that does relax or “inhibit” muscles that are working too hard. The Sock Doc stretching article will be up in a few days. But the reason you’re still having problems is because although you’re stronger, the problem is not fixed.
Mark says
Thanks for your reply, something to think about, especially about “turning on” the strengthened muscles – is there something I should read about that?
It’s true that my physio originally was not sure whether the leg length discrepancy was “functional” due to muscle imbalance, but I understood that the leg measurements taken by the podiatrist were to reference points such that they would not be affected by this? As a young child I remember having some hip issues (examined a lot but not explicitly treated) which I think may have been Perthes’ disease, so I think it is possible there is a physical difference in the leg length. I have been prescribed orthotics with a heel lift for the short leg.
Anyway I guess I’ll keep an open mind for now and maybe find someone to take a look and give me a second opinion 🙂 Enjoying your site – I found the piece about MAF training particularly interesting as I hadn’t come across this before, and a lot about it rang very true to me (I’ve without a doubt been training way too much in anaerobic region). I’m also coincidentally 37, so the numbers worked out nice and easy for me too 🙂
Sock Doc says
Getting weak/inhibited muscles to work is a neurological phenomenon. This is why if someone used proper manual muscle testing procedures to test your adductor, you could then do certain adductor exercises and see absolutely no change in the muscle function when it is tested again post-exercise. The examiner will say this is because it takes time for the muscle to respond, but this is untrue. Any muscle, unless it has completely atrophied or lost nerve root innervation, can be turned on (facilitated) immediately through various means, specific for the individual and the muscle itself. Conventional medicine still does not accept this fact; hence they only use muscle testing to evaluate disc and nerve lesions, as well as local muscle injury, and treat with tedious rehab exercises. Though these exercises are beneficial, they are only after the muscle has become facilitated through other means. Read here.
If your leg measurements were taken at the exact same bony prominences from a specific point on the pelvis to a specific point on the foot on ankle, then yes, perhaps they were accurate and you really do have a short leg. Some physicians will take X-Rays to verify this because if the measurement is off just a bit here and there, (and also consider if one leg is rotated a bit and the other isn’t), getting one only 1cm longer than the other is not hard to do.
BTW – I was thinking after my last post about other patients. I do see this one woman who had hip pain and wore a heel lift on one side as her leg was a few inches short due to an issue as a child – so the leg really was shorter. She came to see me because of the pain on that short leg; 30 years later. Eventually she removed the heel lift based off advice, findings, and treatment because once the entire body was balanced, the heel lift made things worse. Essentially she grew that way and her muscles had accommodated correctly, but the lift supported the muscle imbalances. So even in true leg length discrepancy, the lifts are not always needed.
Mark says
Thanks again for your reply – I appreciate the time you are putting in! I read your article about stretching and some of that rang true with me – especially the concept of “balance” between the muscle groups. I should perhaps mention that I had a disc injury ~2 years ago which led to a huge lifestyle change from very sedentary to very active. This injury being apparent on my right side I wonder if there is some more significant asymmetry than I was aware of which is compensating for this and causing the left hip problems.
On the leg length discrepancy I also read many people commenting on running forums that they have been told they have a discrepancy and it does not in itself cause problems with their running, so I am now thinking that this was more an “observation” by my podiatrist than a “diagnosis”!
I found a chiropractor here who looks like they may be able to take a “broader view” of my problem – I’m in the UK and over here it does seem that physio -> podiatrist -> orthotics is the standard path which is a bit hard to avoid. Wish me luck!
barbara says
I am a person who had foot surgery a number of years ago and the surgeon referred me to a person who made orthotics, so I went. I did not know that orthotics could do such damage! The muscles in my legs and feet became very, very weak and it has taken me some time to gain the strength back. My feet are not the best, but I can tell you that the orthotics made them much worse. I threw the orthotics out and have learned how to strengthen the muscles with different exercises and my foot is no longer flatter than a pancake and I have muscle tone in the legs. My suggestion to people: STAY CLEAR OF THE ORTHOTICS. They are nothing but a money maker for some of these people. The amount of money one very well respected podiatrist charged me for one set of orthotics was outlandish and I consider him a crook. At the time, I could not walk and after having his inserts in for a short time, he did more damage to my feet. I took them back to him and all he did was put a piece under one of them, which made my walk worse. I am now walking much better since throwing orthotics out!
psych says
I’m 28 and I’ve had flat feet for all my life. It is completely flat, no arch. Started getting pain at different parts of my left foot from age 24. It would be on and off. Was advised by my podiatrist to wear a custom orthotic now – after 4 yrs of having these problems, that costed me $300. After wearing it my arches ache; but other parts of my feet dont ache anymore. I’m beginning to think these dont go a good job. But when I get the pain its so bad, I had to give these orthotics a go.
Sock Doc says
Check out this post: http://www.drgangemi.com/2012/03/flat-feet/
Jane says
Have you ever had a patient with congenital forefoot varus – the actual boney defomity not the forefoot supinatus that mimicks it?
Sock Doc says
I have not. I could see some support needed in a case like this, though it’s important to address the muscle balance of the foot so you’re just not using a brace to force the foot into a more favorable position.
Joseph Morris says
Sock Doc, I know that my main problem is my weight, as well as type 2 diabetes. I am working on this, I would like to start a good walking regiment along with my diet and exercising. Are there any recommendations as to a good walking shoe. My Wt. is 360lb Ht 5’11” shoe size is 11.5 3-4E. Need help tired of being over weight and of sore knees and heels. I am 51 years old, and just want enjoy my Grand Babies…
Sincerely, Joseph Morris
Sock Doc says
I put most patients in Nike Free + for an initial shoe. After that you can move to the Nike Free 3.0. It’s a good minimalist shoe to start in. Stay barefoot in the house as much as you can.
inmatoor says
Hi Sock Doc,
I got orthotics around 6 months ago to treat pes cavus/clawfoot. They have done a great job at getting rid of the pain around the ball of my feet, yet the heel pain I experience hasn’t changed or subsided. I was told that I then had plantar fasciitis and needed “to wait it out” with frequent icing, stretching and ball rolling under my arches. Nothing seems to have changed since and I now find that my ankles, shins, calves and knees all experience some sort of pain if I am on my feet for a long time. Have the orthotics thrown my body motion out? Or is Plantar Fasciitis something I need to be patient with… Or do you have any preferred treatments that seem to work better than others?
Sock Doc says
That’s what orthotics do – they have supported your injury so the pain goes away, but created problems in other areas. It’s so common.
https://sock-doc.com/2011/09/unnecessary-orthotics/
Donna Russford says
I was told that if you take a shoe press down on the toe box and the arch collapse do not buy. Is this correct?
Sock Doc says
No. I want my shoe to collapse and I want a shoe to not even have an arch in the first place. That’s a medical view – wrong website. 🙂
Jeffry Howard says
I went to the good feet store and got an Orthotic to releive my Mortons Nueroma, it worked for that but now my feet burn and it feels like pins are sticking in my toes and the bottom of my feet. Have you seen Orthotics causeing nerve damage?
Sock Doc says
I haven’t personally but I’ve seen plenty of other problems.
Gail says
I had surgery by a podiatrist in 2005 on the big toe of my left foot. The podiatrist actually shortened the toe by sawing out a section of bone and reattaching the remaining sections. The result was a big toe shorter than my second toe. The big toe no longer touches the floor, but points upward at about 10 degrees. The second toe moved over to bear my weight and it started to curl under so much that I kept hitting it if I walked barefoot. There was a lot of pain. The podiatrist gave me cortisone shots, then, when I had a reaction to the cortisone, she stopped treating me. I muddled on until I fractured my second toe exercising. My new podiatrist prescribed custom orthotics and told me not to use walking as my major form of exercise. I now have frequent severe leg cramps, which I think may be related to the orthotics. I think I need something to prevent my fracturing the second toe again, but are the custom orthotics necessary?
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Ken says
Hi,
makes sense, but what about leg length discrepancies? I broke my ankle, tibia, fibula, across growth plate. Wouldn’t you need to fix the structural imbalance before strengthening the leg muscles in the right directions? Are there such things as custom sock orthotics? like something i could get custom fit and molded to my foot so i can go barefoot. something i can use so i do not have to use an insole orthotic? basically it acts like a new foot which i ware all the time and can fit into my shoes with?
thanks
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
David says
Hi,
I’m very interested in what you are saying here. I found your website because I am someone who has been wearing orthotics for over 15 years now. I think I have a combination of FFF and RFF (if that’s possible). My feet are vey over pronated – I have looked at a number of youtube videos showing examples of flat, over pronating feet and my feet look worse to me (a pediatrist once told me that they are a 6 on a scale of 1-10). I have also been told that my Sub Talus joint did not develop properly as a child? I think I developed problems early on because looking back at photos of myself when I was a teenager, I can see that the problems were there but not as bad as they are now.
My experience has been that having had orthotics prescribed for shoulder pain, which was presumed to be related to my feet, I have been on a steady course of increasing prescriptions. The design of orthotics have also changed and most recently (about a year ago) I was prescribed a pair of hard foam orthotics which were moulded to the shape of my feet in a supposed good position. I was told to wear these orthotics all of the time, both in the house and out. The orthotics seemed to improve matters for a period of time, however, progressively I started to get pain in my right knee and hip to a point where I was having difficulty walking. The feeling was like having shin splints going up my leg and as though I was walking on cobble stones. I found this very disturbing as I’m only 38 and very healthy in other respects and used to be active and able to run well etc. I went to see my podiatrist who basically said that my feet couldn’t be getting worse as a result of the orthotics and said that I should have my hip x-rayed. I didn’t accept this as I strongly felt that the problems were coming from the foot up my leg and not the other way around.
I decided to stop using the new orthotics and moved back to the old ones I had used for the previous 10 years. My concern is that in the year that I have been using the new foam orthotics, it seems as though the over pronation, in my right foot in particular, has really increased. Going back to using my old orthotics has helped somewhat but I am starting to get knee pain again and my right foot feels really collapsed. I was wondering if there is any way back to a stronger foot at this point. My right foot feels so collapsed when weight is placed on it that I don’t know how to begin to strengthen it.
Thanks in advance for any advice you can give.
Kind regards,
David
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Tim Mac says
I had some achilles problems and a few eeks back was recommended heelp lifts or raises as they might be known which has stopped the problem and also means I dont get cramp anymore – however my left ankle which was a little sore is now very sore (it has 5mmheel lift but physio said put in 3mm heel raises) I’m tempted to bin them all and go back to neutral shoes a
Beatriz says
I have been wearing arch support orthotics (for pantar fasciitis) for 6 months. I do cardio exercise 7 days a week (running, step, zumba and kickbox) and sometimes I do it for two hours. I started feeling ankle pain and pain on my left ankle and the achilles tendon. I took the orthotics out and in two days almost all of the pain went away and I was able to exercise fine. The only problem is that I am afraid of getting fasciitis again… Any advice you can give me?
Sock Doc says
Check out all the foot strengthening exercises on this site. The stronger your feet and lower leg, the chance of you developing PF or any other injury.
Dawn says
Hello,
I am a 52 year old female who over 3 years ago developed plantar fasciitis in my left foot after a course of prednisone made it impossible to wear most of my shoes, leaving me walking around in a pair of flip-flops for a few weeks. After the prednisone was halted the PF developed. Podiatrist #1 saw me, asked my problem, and then without even observing my arch, my gait or the position of my feet when I stood declared that I overpronate and her first question was “Does your insurance cover custom orthotics?” I have numerous friends and acquaintances who all told me not to go that route. One friend has a dresser drawer full of custom orthotics. Thousands of dollars worth from various podiatrists. I agreed to go into a brand that she sold in her office (won’t divulge the brand name here). Pain got worse, was told to push forward with them and then after a couple of months I started to develop lateral foot pain not just on the foot with the PF but on my “good” foot. After 18 months of suffering, a personal trainer told me to pull those things out of my shoes and just go with the stock footbeds that came with the shoes. Within 3 weeks (3 weeks!) my PF was gone and the lateral foot pain in the PF foot was also gone. The “good foot” saw a decrease in lateral pain by about 50% but didn’t recover any more than that. Enter Podiatrist #2 who proclaimed a slight leg length discrepancy and informed me that the longer leg overpronated at the ankle. After 4 weeks of physical therapy for peroneal tendonitis I was basically pain free. Podiatrist #2 recommended arch support orthotics due to my previous “pathology”. Peroneal tendonitis returned immediately.
My concern is this: is the overpronation of my right foot at the ankle (the arch doesn’t seem to collapse and my wet footprint and scanned footprints show a normal to high arch) serious enough that I need to wear some form of arch support that only seems to make my lateral foot pain flare? I was a very active person, but since all this garbage began I have gained 20 pounds and spend a lot of time near tears. I haven’t taken a hiking trip in 3 years.
Christine says
Well my problems started five years ago. Went to a podiatrist who told me I needed orthotics, they were very hard under my feet. Anyway went to Bali fir a holiday soon after and overdid the walking, I couldn’t even walk to the plane at the end of holiday, my right foot was in shocking pain. I ended up going to a different podiatrist who made me new orthotics, softer ones BUT that was four years ago and my feet constantly hurt, I can’t seem to walk without the orthotic either. I have terrible pain in my right foot, I’ve had X-ray and MRI scan which shows nothing wrong, I feel I have nerve damage. I am becoming very desperate to find someone to help me, podiatrist has no idea. Any ideas on who I should see about it! I am at my wits end, spend hundreds of dollars on proper shoes etc.?
Susan says
Hi, I know your article was from a few years ago but I’m looking for advice.
So 2 years ago I was diagnosed with hypermobility in my ankles – after debilitating ankle pain and weakness. Every podiatrist I saw (3) agreed and said I needed orthotics to run. Recently I’ve had debilitating calf pain (last few months) and a friend suggested running without orthotics as they raise the ankle too high. Tried it today = no calf pain.
I’m not sure what to do now. I don’t want my ankle pain to return, but I do want to run. I’m going back to the podiatrist next week to see what they say. I was just wondering what your thoughts were – especially as the hypermobility means I have a very real condition that won’t ever go away?
Dr. Stephen Gangemi "Sock Doc" says
I think you need to listen to your body. Most all podiatrists are going to want to support you with braces. If you ran with no orthotics and no pain, perhaps that is telling you something.
Jody says
I have been wearing orthotics for years for my spine issues. I have degenerative disc disease, osteoarthritis, and minor scoliosis. I am ready to throw out my orthotics too! I am beginning to think they are causing me more pain than helping. I’m glad my mom forwarded this article to me. I am going to give this a try. No orthotics for a while.
Claire Ireland says
Hello doc,
5 years ago I tore my outside quad on my left knee and after an mri was told I had 2 flat knee caps. I put over the counter arch supports in my shoes (my custom made ones took ages to come to me) and seemed to do good for a few years so didn’t use the custom ones. Unfortunately my right knee started to get a painful gripping on the outside of the knee and knee felt as though it was falling in towards my left one and pain in my inside ankle and so the orthotics I had made 5 years ago I put them in my shoes and bought comfy velcro trainers. I have had them in for 6 months now. My ankle pain has eased and my gripping pain has eased. Unfortunately I now have very painful it band and it’s getting worse. Not sure what to do. Any helpful advice would be very much appreciated thank you.
Dr. Stephen Gangemi "Sock Doc" says
Check out the knee video on this site and also the dietary posts regarding inflammation and ways you can improve your diet to help with that.
Ann says
I went to a podiatrist due to a problem on the posterior side of my right foot. She told me I would benefit from orthotics, but after wearing them for about 3 weeks I started having pain on the arch/heal of my left foot that radiated to my toes. It got better after she adjusted the orthotics, but the nerve pain never completely went away. Another doctor told me it could have created scar tissue on my left foot. I continued to wear them for about a year and then started having iliolumbar problems. A chiropractor that I started seeing told me that he didn’t think I needed the orthotics, especially since I have a high arch. I am completely out of orthotics now and feeling much stronger. The orthotics didn’t even provide relief from my original problem, which was a ganglion cyst in the tarsal tunnel that required surgical removal. I don’t understand why many doctors think putting hard plastic in shoes is a good idea. Thank you for this post.
Luke says
Hello! I am a 27 year old male and have moderate bunions on both of my feet as well as hammer toe on one of them. They have been that was since I was very young and I am told that it is genetic. I have been able to do everything a normal person would do throughout my life except that I have more instabiltiy than others on my feet due to over-pronation. I also had a removal of 20% of my meniscus in my left knee because of an injury (I trail run) Over-pronation shoes or orthotics are the the only thing I can wear without causing my knee to have pain. I am interested in zero drop shoes but I believe that because they don’t stop my bunion induced over-pronation they’ll just cause them to get worse and that is what I want to avoid over anything else. What do you think? Thank you for your time!
Dr. Stephen Gangemi "Sock Doc" says
Hi Luke – Check out this article as you’re going to want to get your feet moving well again before you just hop into too minimalist of shoes. https://sock-doc.com/barefoot-minimalist-walking-shoes/