Foot orthotics, movement training or both; What works, what doesn’t, and how to choose the right approach for you?

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A recent Medscape article which is written for healthcare providers asks the question "Do foot orthotics for foot injuries really work"? Foot orthotics are a brace that helps keep the foot in a mechanically neutral position to redistribute the forces from the ground up.   While the opinions on what they do or how they work vary, the purpose of a foot orthotic is quite simple; to level out the hips and improve the effectiveness of the way we move. The baby boomer generation is helping to fuel the growth of the foot orthotics industry.  The market for foot orthotics reached $4.7 billion in 2015[1]and will continue to grow rapidly at least through 2021, market analysts say.[2] "The crucial driving factors accelerating the market are rapid increase in aging population; high incidence of chronic diseases and disabilities and rise in sports injuries," according to a report by IndustryARC.[2]   The truth is that the only way to get a consistent product is to manufacture one, and the market for off the shelf and custom orthotics is growing and many products are also entering the market place pre-manufactured which you can buy either in-store or online, with a growing number of products designed for more corrective professional use that either has more correction than a store purchased device or a device your doctor can modify in their office to give you a custom fit. Figuring out which one to purchase can be as easy as just trying one of the many brands available (they are not all created equal), or for people with marked asymmetry, a customized in the office device may be a better choice for a better effect. posture helixThe bottom line is, does the orthotic level out your hips, and prevent your body from looking like this DNA strand?  If not, the device is either worn out or just not right for you, and we are all different biomechanically.  As a rule, if you tend to require a new device every three months, a custom orthotic which is cast may be a better more cost effective choice, since they will last longer, cost less, and be more durable, even though the upfront cost is higher.   The quality of the cast is most important, and the device should allow good movement of the foot, and fit the shoes you wear, and work with your lifestyle. In general, the obese patient will do best with a custom orthotic, since they are most likely to fatigue the material in the device more quickly.

Is a foot orthotic enough to treat plantar fasciitis, shin splints, ankle, knee, or other problems?

The orthotic is a device that is a brace under the bottom of your foot, however, if your intrinsic foot muscles are weak and deconditioned (It is theorized that shoes decondition the internal foot muscles), this will affect your legs, your glutes, and your core, resulting in conditions such as plantar fasciitis, weak ankles, knee, hip and back pain. Strengthening the intrinsic muscles can be as easy as doing foot drills daily for two months.  Our patients report their feet and legs feel much better and plantar fasciitis and shin splints improve from doing these exercises. Gait or movement training is important as well.   If your gait (the way you walk or run) is asymmetrical and very compensated, doing more of it aerobically will eventually cause pain because of the inefficient way we use the core muscles and eventually, we lose the spring in our step.   When this occurs, you will be sore and in pain, as you attempt to exercise like this so retraining and improving efficiencies in the gait cycle is important.  After training, the brain uses neuroplasticity to remember what we showed it, and your gait habits can change over a period of a few months. While any change will affect how you hit the ground, some will state that orthotics make some people worse.   The problem is that one size does not fit all and that orthotics should be fitted for the individual, even in off the shelf applications because we are all different and one size fits all solutions, while sometimes helpful is clearly hit or miss.  The same goes for training, core stability, etc. Gait is not necessarily a stable activity, so relying on just core stability training is not the whole answer, and neither is just wearing an orthotic.  It requires an understanding of your unique biomechanical needs and recommending the right shoes, orthotics and exercises to help you feel and function more efficiently, which ideally translates into less pain and hopefully fewer problems. To truly change ones gait, it can require months of exercises and activity modification, something most people forget when the pain is gone.   Treating the foot, and doing surgeries often makes problems worse, as this alters gait, and rarely offers the long term solution most people desire, plus it is quite risky. From the chiropractor's perspective, it is not enough to do exercises and modify movement because the fascial system and the joints also are part of this accommodation and adaptation to our unique body mechanics.  Chiropractors perform manipulation of the extremities and in combination with myofascial release, can offer a much better outcome, since the movement of the bones of the foot is important to the way we walk as well.  A comprehensive approach of chiropractic manipulation, exercises, gait retraining and myofascial release positions patients who suffer from plantar fasciitis, shin pain, knee pain, and even back and hip problems.  
  1. Papuga MO, Cambron J. Foot orthotics for low back pain: the state of our understanding and recommendations for future research. Foot (Edinb). 2016;26:53-57. Abstract
  2. Orthotic devices market analysis: by type (knee braces & supports, ankle braces & supports upper extremity braces & supports and others), by application (injuries, chronic diseases, disabilities, pediatrics)"”with forecast (2015-2020). IndustryARC. July 15, 2015. Accessed May 23, 2016.