Sentenced to a life in orthotics?
One of the most common, and frustrating narratives I hear in the clinic from patients, is that they’ve been wearing the same orthotics in their everyday or athletic footwear for up to 10-20 years. Often they’ve been resurfaced or even completely re-made, without having an un-biased healthcare professional thoroughly re-assess their need for orthotics and discuss modifications in wear-time, as well as, their short and long term (positive and negative) effects.
Does this sound like you? Have you ever questioned what you’re orthotics are doing for you today? Was the teenage version of you, initially prescribed orthotics for foot pain, ever educated on HOW or WHAT your orthotics are doing for you, or for how long they would be required? Sure, we often don’t pay attention to these boring details, so it’s partially our fault, but I urge you to question whether or not you still have the same need for orthotics as you did 10-20 years ago. Consider, not only how much our knowledge as professionals recommending and prescribing orthotics has evolved, but also how much you have evolved!
The second most common and frustrating narrative that I hear from patients in the clinic is that, somewhere along the line, they’ve been given the devastating diagnosis of congenital “flat feet” or “absent arches”. Most of these patients have, again, somewhere along the line, been informally sentenced to a life in orthotics to correct their tragic condition. All sarcasm aside, in a nutshell, your flat feet are not the problem. I am more inclined to blame the “flat feet” pandemic on our shoe dependency- full time structural supports that weaken the muscles of our feet over time. Our shoes can’t take all the blame though, how about the fact that while we know that strength and conditioning is important to prevent injuries, why are our feet exempt from this idea? Have you ever taken your shoes off and trained your feet, or even simply performed your typical exercise routine, garden work or daily walk without shoes on? Many of you who have been sentenced to a life in orthotics often even avoid walking barefoot at home, for fear of pain or just a lack of clarity as to what you should be doing for your feet.
Your feet should be treated no differently than any other part of your body when it comes to injury prevention and management. Perhaps they should be given more attention, since they are our front line workers- they are the first to absorb impact and they carry us around all day.
I am not saying there is no place for orthotics. Corrective orthotics can
play a huge role in decreasing pain and improving quality of life in many cases including, significant leg discrepancies, congenital or post-traumatic structural abnormalities (this does not include flat feet) and neurological conditions, to name a few. Further, prescription of short-term custom or non-custom orthotics can help to settle down an acute inflammatory condition or flare up by providing an external support- like a crutch would offload your painful limb. Unfortunately, while none of us would assume crutches are necessary for life to prevent the recurrence of pain, with respect to orthotics, many people either make this assumption due to a lack of education, or are misinformed that this is the case.
While healthcare practitioners have an obligation to better educate patients around orthotics, I would also encourage patients to ask more questions about your new or existing orthotics. Here are the questions we should be asking before endeavoring into the world of orthotics:
WHY do I need orthotics?
HOW are they going to help with my pain/injury?
Is there anything else I could be doing to resolve my problem instead of or in addition to orthotics. If the answer to this question is no, please seek a second opinion!
Think of your prescribed orthotics as you would a medication. You’d probably want to know the following regarding DOSE:
For how long do you anticipate I will need to wear them for?
How frequently should I be wearing them? This answer should change over time!
When should I be re-assessed?
With respect to the third question, all passive treatment modalities (orthotics, splints, braces, manual therapy, needles, tape etc.) should be accompanied by corrective exercises. Generally speaking, in the context of repetitive strain injuries for which orthotics are prescribed, pain typically arises from one or more of the following:
A muscular imbalance or asymmetry
A destructive compensatory pattern from an old injury
Weakness/learned non-use- think “flat feet” in shoes
Too much of anything, too soon (without adequate build up), without adequate recovery
While passive modalities, including orthotics, can help in the short term to help calm things down, and create an optimal healing window, if we don’t subsequently USE that healing window to replace passive interventions with corrective exercises, or simply allow you to gradually return to activities without fear of re-injury- we, as therapists, are not providing you with a long term resolution.
I hope that by drawing your attention to the “flat feet” pandemic, I have highlighted a broader theme, that is, orthotics should not be considered as a solitary treatment for ANY condition. I hope that I have inspired you to be inquisitive during your next follow-up and play an active role in your recovery. Don’t settle for short term relief, and certainly don’t settle for long term dependency (on any treatment), before first seeking guidance on active interventions, whether it be strengthening your arches for flat-feet related pain, or strengthening your core for back pain.
**Please do not wean from your orthotics without first consulting with your physiotherapist, asking the questions I’ve suggested above and coming up with a plan!**