Do I Need Orthotics?

This is a loaded question, and I have my biases, but here’s the breakdown.

On one hand, this is similar to when people ask me if Icy hot will help their shoulder pain. Maybe, but if you’re asking what else I, as a physical therapist, can do for your shoulder pain, that’s an entirely different question.

So, here’s the line of questioning to get a specific answer for you, personally:

1: Why do you think you need orthotics? Often it is for general back pain or plantar fasciitis. If that is the case, my general answer is to first see if we can change some biomechanical adaptations in both your foot & your whole body first, then see if you need them.

If the patient’s answer is, “because I have flat feet,” or “because I have high arches,” then I go into my spiel about how perfectly functional feet have a wide range of arches- the height in and of itself is no reason to get orthotics. Let’s take a look at how it functions. Can you splay your toes? Scrunch your foot? Do you have mobility in your little tarsal bones?

We can do a lot with manual therapy. Often times, I will see a line of tissue tension from the inner arch to the inner knee or even the pelvis. After treatment, the patient is better able to balance, or have better mobility.

2. Are you already wearing them? If yes. Are they effective? If you already have them & like them, I will probably not tell you to get rid of them. What was your initial goal with them?  Are they custom or off the shelf? If they are custom- did you just stand on a platform? My beef with this method is that your footprint may look different when you are standing on 2 feet vs 1 vs 1 foot moving dynamically. So, if your problem is that your feet hurt when you stand in place for a long time, then the method of measuring matches your symptoms. If you have pain with running, there’s probably more to your story than how your feet look standing, and you might not get as much effect.

If you have already been through some good PT, are a runner, and are set on orthotics, you may benefit from getting a pair that is made from a mold casted to your foot while your ankle is held in a specific position.

3. Do you have a “true” leg length discrepancy? Sometimes it can look as though one leg is shorter, but when you get therapy to your ankle, pelvis, back, etc, the length changes. That is what we call an “apparent” leg length difference, and is not the size of your actual bone. If you do have a true length discrepancy (gold standard verified via radiographs), custom orthotics may help. If you are in the apparent length group, (again with my professional bias) opt to treat the body. Be warned: if you do go down the road of custom orthotics, you may be sensitive to not having them. Say goodbye to flip flops or being barefoot.

4. What else can I do?

Preliminary taping video. This is a basic arch support taping. You can use athletic tape, leukotape, or in this video (mainly for color contrast) Kinesiotape. Sometimes we have an acute bout of pain. Consider this to be both diagnostic (if it works, orthotics may be good for you), and short-term (you wouldn’t wear an ankle brace forever just because you had one sprain).

Naboso insoles. These are great, I’ve been wearing them over a year. If we back up, I would say as a teen & into my 20’s I had “weak ankles.” A few sprains here & there, nothing big. The first time I went paddle boarding, my arches were killing me. Then I lived in Hawai’i for a year, wore super minimal footwear, hiked in chunky lava fields, ran on the sand, etc. The next time I paddle boarded, my feet were not an issue. In fact, I could do a lot of performance-based activities better- like jumping. Fast-forward, It had been years since my Hawai’i adventure, and I went back to having “Midwest feet.” More fast forwarding (I don’t think I was that old), I tried out some Naboso insoles. My Hawai’i feet were back. It’s subtle for me, and I don’t know if I would have recognized it without previously having that feeling. I can do my little toe dexterity motions better, and my feet don’t get sore in ice skates anymore. I educate often in my PT sessions about body awareness, and brain function, and Naboso insoles just fit my whole treatment approach of giving a little nudge to the weakest link. They do not have an arch support, but have a nubby little texture that stimulates the nerves in your feet. (Coupon Code OCONPT).

I’ll end with a joke: “Dr. Scholls? I don’t think it takes a doctor to tell you that standing on a cushion is more comfortable.” – Mitch Hedburg.

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