The prescription and use of orthotics is a hot topic. Some physicians don’t appreciate the fact that I think orthotics are expensive pieces of carbon graphite, neoprene, and other materials that most often serve as a disservice to the patient. My stance on orthotics is based on how I evaluate, treat, and manage patients. It is a 100% holistic approach. I see professional athletes (dancers, runners, hockey and soccer players), 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 rather than addressing only 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 on my education, experience, and understanding of the human body (not just the foot), 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 is rare), 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 in the body.
A healthy person does not need an orthotic. Orthotics alter the somatosensory system in the body, which is how various stimuli are received and transmitted through the nervous system to the brain. This is a 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 like 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 need to function as they normally should. Essentially, the feet become weaker and weaker, and soon that weakness 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 of 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 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 from 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% for the many years she used it. Eventually, over a period of four to five visits, her muscle imbalances were corrected using various manual medicine techniques such as trigger point therapy, muscle reflex points, and nutritional therapies, so the orthotic only made things worse, and she removed it entirely. This was a big step for her—she had worn the orthotic for over 20 years because of the leg length discrepancy. Of course, I could not make her leg lengths equal, but by helping her muscles adapt to the way her body 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 close 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 a physician to often consider and use 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, and 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, 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. The symptoms were gone (the orthotics helped him recover faster), 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 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 is causing inhibition of the muscle. Excess carbohydrates are known to cause inflammation throughout the body, and this inflammation can impact the foot’s muscles 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 (with 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.
Orthotics and “Arch Supports” Don’t Support Your Arch
Many people wear orthotics or various types of “arch supports” because they have 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, both ends 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 narrow toe box will only further weaken the foot and arch, especially with the addition of an open-space arch support or orthotic. See more at my DRG site: Flat Feet: Causes, Prevention, and Treatment.
Orthotics Support Dysfunction
One can see, whatever the case, that 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 the 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 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 of docs whose livelihood is based on 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 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,” are great products to use for feet that have suffered structural misalignments due to years of poor foot health and improper footwear (not orthotics).
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 it 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, whether 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 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 of needing orthotics. What comes to mind is that marijuana commercial from the 1980s: This is your foot (egg). This is your foot in orthotics (egg in frying pan). Any questions?
