7 things you may not know about foot orthoses
Foot orthoses ... How do they actually work?
Samuel Chidwick - Podiatrist
9/23/20264 min read
7 Things You May Not Know About Foot Orthoses
You may have been told:
“Your feet overpronate.”
“Your arches need more support.”
“Your foot needs correcting.”
“This orthotic will realign your leg.”
“You'll need to wear these for the rest of your life.”
But foot orthoses are actually much more interesting — and much more complicated — than that.
The way we think about orthoses has changed considerably over the years. Rather than simply trying to force every foot into an “ideal” position, we now have a much more individualised way of thinking about them.
So here are 7 things you might not know about foot orthoses.
1. Your feet don't have to look “normal” to be healthy
One of the biggest misconceptions about feet is that there is a single position or shape that everybody should have.
There isn't.
Some people have high arches.
Some have flatter feet.
Some feet pronate more than others.
Some are relatively stiff.
Others are extremely mobile.
And none of those things automatically means there is a problem.
You can have feet that look completely different from someone else's and be completely pain-free.
Equally, you can have feet that look relatively “normal” and still experience significant pain.
So seeing a flat foot, a high arch or a foot that pronates doesn't automatically tell us that something needs “fixing”.
The foot is only part of the story.
2. Orthoses don't necessarily “correct” your feet
This is probably one of the biggest misconceptions about orthoses.
An orthosis doesn't necessarily need to dramatically change the position or appearance of your foot to be useful.
Instead, think of it as changing the environment in which your foot is working.
Every time your foot contacts an orthosis, forces are generated between the two surfaces.
By changing the shape, stiffness, materials, friction and other characteristics of the device, we can influence how those forces are distributed through the foot.
That may alter how certain tissues are loaded.
But here's the important bit:
The goal isn't necessarily to make your foot look different.
The goal is to help the person.
Sometimes that might involve changing movement.
Sometimes it might involve changing pressure.
Sometimes it might simply make an activity more comfortable.
3. Pronation isn't automatically a problem
You've probably heard the phrase:
“You overpronate.”
But pronation itself isn't something that needs to be eliminated.
Pronation is a normal movement of the foot and forms part of how the foot adapts to the ground.
People naturally pronate by different amounts.
The fact that your foot pronates more than somebody else's doesn't automatically mean that you are going to develop an injury.
The more useful question is:
“Is the way this person's foot is functioning relevant to the problem they're experiencing?”
That's a very different question from:
“Does this foot look like it needs correcting?”
And that distinction matters.
4. Two people can have the same-looking feet but need completely different treatment
Imagine two people with almost identical-looking feet.
One runs 50 kilometres a week and has developed Achilles tendon pain.
The other spends most of their working day sitting at a desk and has absolutely no symptoms.
Would we give them exactly the same orthosis simply because their feet look similar?
Probably not.
We need to consider the whole person.
That includes:
Their symptoms
Their activity levels
Their footwear
Their injury history
The tissues involved
Their current capacity
Their training or occupational demands
Their goals
And, importantly, whether changing the way forces are distributed through the foot might actually help.
This is why assessment should come before prescribing an orthosis.
5. Custom-made doesn't automatically mean better
This is another common misconception.
“I've been told I need custom orthotics because they're better.”
Not necessarily.
A custom orthosis gives the clinician more control over the shape, stiffness and other design characteristics of the device.
That can be extremely useful when someone needs something specific.
But if a well-designed prefabricated orthosis achieves what we need, there isn't necessarily a reason to make it custom simply because custom sounds more sophisticated.
Think about it like this:
Custom is a method of making an orthosis. It isn't automatically a measure of how effective it will be.
The important question is:
“Is this device appropriate for this person and this problem?”
Not:
“How expensive or customised is it?”
6. You don't necessarily need to wear orthoses forever
Another common belief is that once you start wearing orthoses, you'll be dependent on them for life.
Again, it isn't that simple.
For some people, an orthosis might be particularly useful during rehabilitation while a painful or overloaded tissue settles down and gradually rebuilds its capacity.
For others, it may remain useful as part of their long-term management.
And some people may eventually find that they don't need one anymore.
There is no universal rule.
Treatment should be reviewed based on things such as:
Symptoms
Function
Activity
Goals
Rehabilitation progress
Response to the orthosis
If you improve and no longer need the device, that's useful information.
If you continue to benefit from it, that's useful information too.
7. Orthoses aren't a replacement for rehabilitation
You've probably also heard that orthotics will make your feet “weak” or “lazy”.
The reality is more complicated than that.
An orthosis changes the mechanical and sensory environment around your foot.
Whether that's helpful depends on why you're using it and what you're trying to achieve.
If someone has a problem with tissue capacity, for example, simply putting an orthosis in their shoe doesn't magically solve that problem.
We may still need to work on:
Strength
Load tolerance
Gradual exposure to activity
Training volume
Recovery
Footwear
Technique
Activity modification
An orthosis can be one part of the rehabilitation process.
It doesn't have to be the whole treatment.
So, do orthoses actually work?
Sometimes, yes.
But perhaps not for the reasons you might have been told.
They aren't magic inserts that “fix” your feet.
They don't have to completely change your foot position to be useful.
And they don't work in exactly the same way for everybody.
The important question isn't necessarily:
“Can we correct this foot?”
A better question is:
“Can we change the way this person's foot is being loaded in a way that helps them?”
That might mean reducing pain when walking.
It might make running more comfortable.
It might help someone tolerate their rehabilitation.
It might redistribute pressure away from a particularly sensitive area.
Or it might simply make their shoes more comfortable.
And sometimes, after assessing someone, the answer may actually be:
“You don't need an orthosis.”
That's important too.
The bottom line
Your feet don't necessarily need fixing just because they look different.
Pronation isn't automatically a problem.
Custom doesn't automatically mean better.
You don't automatically need orthoses for life.
And an orthosis shouldn't replace appropriate rehabilitation.
Foot orthoses are tools.
Used for the right person, for the right reason, they can be a useful way of modifying the forces acting through the foot and helping someone achieve their goals.
So rather than asking:
“Do I need an orthotic because my feet pronate?”
Perhaps the better question is:
“Could changing the way my foot is loaded help me do what I want to do?”
That's a much more useful place to start.
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