Greetings, dear readers! I'm here today to argue that orthotics, or stability in general, are not the evil entity they are made out to be.
First, some background and a few disclaimers. Many years ago I worked as a Physical Therapy Aide in an outpatient orthopedic PT Clinic associated with a local hospital. While I was there, I had the opportunity to be a part of the process of custom orthotic fabrication. Orthotics can be made in a few different ways. There are "cookie cutter" orthoses, which are created based on what people's feet generally look like, and can be bought at your local convenience store or sports store. There are what I call "static custom orthotics," where a doctor or PT (usually a podiatrist) has you stand in a material that molds to the shape of your foot, and the orthotic is created out of this mold. Finally, there are "dynamic custom orthotics," where a more comprehensive examination is carried out and includes leg length measurements, postural assessment and gait analysis, as well as a casting of the foot done by hand. I assisted with dynamic custom orthotic fabrication, from sitting in on assessments to performing the foot casting. Once this was complete, the Physical Therapist who performed the assessment would write up a comprehensive report, and would design an orthotic based on her findings.
Orthotics and stability shoes have been cast aside by the "progressive" athletic community in recent years. The thinking goes that external stability provided by shoes and orthotics ensures that the body won't have to do the work itself, creating further intrinsic weakness in the foot, particularly in the arch of the foot. Therefore, anytime the person is without this stability (say, in a different pair of shoes), they are unable to be this way for very long without risk of pain or injury. They become, in essence, dependent on an external mechanism for stability their body should be able to provide.
The counterargument is that some people just naturally have flat feet or high arches, and this can lead to problems over time if not corrected. Indeed, this can be true. Those with high arches tend to carry their weight on the outsides of their feet, leading to knee pain and the potential for chronic ankle sprains. True over-pronators also tend to experience anterior knee pain with activity. Any time you have movement at the foot, it affects what happens at the joints further up the chain, so it's sensible to think that extremes in either direction (flat arch or high arch) could have a detrimental effect on the knees, hips and spine.
Again, though, shouldn't people be able to correct this on their own? Like tightness and weakness, can't a little training work correct these issues - by strengthening the intrinsic muscles of the foot to support the arch in those with flat feet, for instance?
In most people, sure - but not in everybody. The truth is, there are always going to be people on the extremes. In the case of orthotics, some people are just not able to create the kind of support from their own body that you would like them to have, perhaps because they are overweight and their foot can't support the load, or because they have a previous injury, or because of the aging process. For these people, an external form of support could be beneficial, and perhaps help them on the road toward a healthier life by allowing them to do things they otherwise wouldn't be able to do.
Orthotics and posted shoes get such a bad rap because those who don't really need them started to seek them out. For example, say you are a runner. Your hamstrings and calves are pretty tight, and you keep getting this pain in your hip. You read up on hip pain, see that you have arches like the "pronator" picture, decide that you're over-pronating during your stride, and you seek out orthotics. The podiatrist sees that you do in fact have flatter-than-normal arches, casts you in the standing position, and fabricates orthotics for your sneakers. Meanwhile, he or she also prescribes a stability shoe with a good amount of heel cushioning to reduce impact forces. Anywhere from $200 - $600 later, you're on your merry way.
Well, $25 could have gotten you a foam roller and 10 minutes a day could have gotten you some increased length in the muscles and tissues in your legs. This person is the one who will spend hundreds of dollars on dietary supplements and performance enhancers (like protein shakes or glucosamine), but won't take the 15-20 minutes before a workout to correctly warm-up in a way that will prepare them for increased performance and decrease the chance of injury. For this person, orthotics are a band-aid - or, worse, may even increase the chance of injury.
Both healthcare professionals and the patrons who seek their services are complicit in this overprescription of stability products. It takes work to overcome bodily dysfunction, whether it be tightness, weakness or actual injury. Many people want the "quick fix," and are willing to pay for it. Unfortunately, it is not a cure-all. Orthotics may be right for some people, but like anything, they certainly aren't right for everybody, and are possibly not right for most people.
Next post, I make an argument for why "minimalism" (which I will specifically define later) may be the right choice for most people. Until then, go do some activities!! :-)
