How do foot orthoses actually work?
Foot orthoses ... Do they actually "correct" your feet?
Samuel Chidwick - Podiatrist
9/23/20265 min read
How do foot orthoses actually work?
Do They Really ‘Correct’ Your Feet?
Foot orthoses are often described as devices that “correct” the way your foot moves.
You may have heard phrases such as:
“Your feet overpronate.”
“Your arches need more support.”
“Your foot needs correcting.”
“This orthotic will realign your leg.”
“You need to wear these for the rest of your life.”
But the reality is considerably more interesting, and more complicated.
As a clinician, I am guilty of oversimplifying things at times and using terminology which is "colloquially" acceptable but not mechanically accurate. Partly because it is what some patients understand and want, and it helps to explain or visualise a treatment or an approach.
I wanted to write this blog post to offer some further thoughts for those patients and clients of mine who want a little more of a deep dive, because the way we think about foot orthoses has changed considerably over the years. Rather than simply trying to force every foot into an ideal position, a more useful approach is to consider what the individual person is experiencing, which tissues are being loaded, and whether an orthosis (orthotic/insole) can help make that loading more comfortable or manageable.
This is why I assess patients before ever considering an orthotic!
So the first "myth" to bust...
There isn't one ‘perfect’ foot position
One of the biggest problems with the traditional approach to orthoses is the assumption that there is a single position that every foot should occupy.
Human feet are different.
Some people have "high arches". Some have "flatter feet". Some feet pronate more than others. Some are relatively stiff, while others are extremely mobile.
And importantly, a particular foot posture does not automatically mean that something is wrong.
A foot can look unusual and be completely pain free.
Conversely, someone can have a foot that looks relatively “normal” and still develop significant pain.
This is why simply looking at someone's foot and deciding that it needs to be “corrected” can be an overly simplistic way of approaching orthotic therapy... but trust me, this is still something that I see being done a lot, from clinics to cruise ships, running shops to county shows...
So, what does an orthosis actually do?
An orthosis doesn't need to dramatically change the appearance or movement of your foot to be useful.
Instead, think about an orthosis as something that changes the environment in which your foot is working.
Every time your foot contacts an orthosis, forces are generated between the two surfaces.
Changing the shape, stiffness, materials or friction of the device can alter how those forces are distributed through the foot.
In turn, this can influence how different tissues are loaded.
That doesn't necessarily mean your foot will visibly move into a different position.
And that's an important distinction.
A change in foot position isn't necessarily the goal.
The goal should be to achieve a meaningful improvement for the individual.
It's about the person, not just the foot
Imagine two people with very similar-looking feet.
One runs 50 kilometres a week.
The other spends most of their day sitting at a desk.
One has Achilles tendon pain.
The other has no symptoms at all.
Would it make sense to give both people exactly the same orthosis simply because their feet look similar?
Probably not.
When considering an orthosis, we need to look at the whole picture:
What is the problem?
Which tissues are involved?
What activities aggravate it?
How much load is the tissue currently tolerating?
What are the person's goals?
Could changing the forces acting through the foot help?
This is a much more individualised approach than simply looking for something to “fix” a particular foot posture. We would love it if it was that easy, but it is not.
Orthoses don't work in exactly the same way for everyone
This is perhaps one of the most important things to understand.
Two people can wear the same orthosis and respond differently.
One person may experience a significant reduction in symptoms.
Another may notice very little difference.
Someone else may find that the device makes their symptoms worse.
This doesn't necessarily mean that one person has a “good” foot and another has a “bad” one.
It reflects the fact that our bodies respond differently to changes in mechanical and sensory input.
Custom made doesn't automatically mean better
Another common misconception is:
Custom orthoses = better treatment.
It's not quite that simple.
A custom device gives the clinician greater control over its shape, stiffness and other design characteristics. That can be useful when a particular individual needs something specific.
However, if a well designed prefabricated orthosis provides the changes required for a particular patient, there is no obvious reason why it must be custom made simply for the sake of being custom made.
Do you have to wear orthoses forever?
Again, there isn't a universal answer.
For some people, an orthosis may be particularly useful during a period of rehabilitation while a painful or overloaded tissue settles and gradually rebuilds its capacity.
For others, an orthosis may remain useful as part of their long term management.
And for some people, they may eventually find that they no longer need one.
This is why the idea that everyone who receives an orthosis must wear it permanently is misleading.
Treatment should be reviewed according to the person's symptoms, function, goals and response.
What about “weakening your feet”?
You may also have heard that wearing orthoses will make your feet or muscles “lazy”.
This is another area where we should be cautious about making blanket statements.
An orthosis is simply one way of changing the mechanical and sensory environment around the foot. Whether that is helpful, unnecessary or unhelpful depends on the individual and the reason it has been prescribed.
The presence of an orthosis shouldn't replace rehabilitation.
If someone has a capacity problem, for example, we still need to consider strengthening, gradual exposure to load, appropriate activity modification and the other factors relevant to their condition.
An orthosis can be one part of that process — not necessarily the entire treatment.
The most important question: does it help?
Perhaps the biggest change in thinking is moving away from:
“Can I make this foot look more normal?”
towards:
“Can I use this intervention to help this person achieve their goals?”
That might mean reducing pain during walking.
It might mean making running more comfortable.
It might mean allowing someone to tolerate rehabilitation more effectively.
It might mean redistributing pressure away from a particularly sensitive area.
Or it might simply mean that the person feels more comfortable in their shoes.
The appearance of the foot is only one small part of the picture.
A good orthotic assessment should be individual
There is no single orthosis that is right for everyone.
There is also no single foot posture that everyone needs to achieve.
A good assessment should consider the person's symptoms, activity levels, footwear, injury history, physical examination and goals before deciding whether an orthosis is appropriate.
And importantly, the response to the device should be monitored.
If it helps, that's useful information.
If it doesn't help, that's useful information too.
If it makes things worse, that is equally valuable information — and a reason to reassess the approach.
The bottom line
Foot orthoses aren't magic inserts that “fix” your feet.
Nor are they automatically unnecessary simply because they don't dramatically change the way your foot looks.
They are tools.
Used appropriately, they can alter the way forces are distributed through the foot and can form a useful part of a broader rehabilitation programme.
The key is not finding the “perfect” orthosis.
The key is understanding the person, the problem and the purpose of the device.
So rather than asking:
“Do I need an orthotic because my feet pronate?”
a better question might be:
“Could changing the way my foot is loaded help me achieve what I want to do?”
That is a much more useful place to start.
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