Do I Need Orthotics?

The Power of Understanding What You Feel Under Your Feet.

The picture you see above is an image taken from a foot pressure scan. You may have even seen something similar to this in a Dr. Scholl's commercial. It represents the pressure under your feet and uses color to tell you where there is a lot of pressure (red) and where there is very little (blue or white). If you were in a store or seeing a healthcare provider with the task of getting insoles or orthotics, they would likely use an image very similar to this to help find where cushion and arch support are needed.

While this all sounds pretty logical, let's dig a little deeper. Let's say you've learned to stand with more weight in one foot or with too much pressure under some parts of your feet while there is too little in others and problem in your foot doesn't stop at the foot. Your feet are the foundation your entire body stands on and if significant enough, these uneven pressures will eventually start causing pain somewhere in your body.

In the image above we can see that this person has high pressure under both heels and in the right forefoot. If we wanted to design orthotics for this person, the 3 red areas are where you would want cushion and the low pressure areas are where you might build up some support to match the shape of their foot. Also, with right foot having so much more weight on it, arch support would likely be recommended to prevent it from flattening. With these orthotics or insoles, it is very possible that they would have less pain and feel more supported in their current posture. I say "current posture" because wearing an insole is very rarely enough to teach your body a different posture or a better way to move.

So if someone is feeling muscle tightness, joint stiffness, or even pain, why give them something that allows them to continue to stand and move in the same way? It may feel like orthotics are helping because the provide pain relief. While there is value in pain relief, doing so without learning why the foot pressures look the way they do does not set someone up for long term success. Might relying on orthotics allow someone to side step and put off addressing the thing that actually caused their foot, knee, hip, or low back pain? What about overly relying on cushion under your feet to make you comfortable? Could things just end up getting worse because the real cause hasn't been dealt with?

My point is not to say that all insoles and orthotics are terrible, but rather to say that I see information about feet (including foot pressure scans) so often misunderstood. In the medical community, it is a common held belief that flat feet cause foot, knee, hip, and low back pain including but not limited to plantar fasciitis, Achilles tendinitis, runner's knee, iliotibial band (IT Band) syndrome, piriformis syndrome, or even a spinal disc diagnoses. This is the reason arch supports are so commonly recommended to people with these problems and the reason insoles and orthotics are now incredibly overused and often advised with a very limited understanding of their impact, or lack thereof, on the body. Each person has different foot pressure, a different posture, and a different history that has influenced how they stand and move today. All of these aspects need to be considered and putting a device under someone's foot without due diligence to understand the whole picture is short sighted and can cause further problems.

I use a foot scan in my practice to better understand what is happening in somebody's posture that causes them to feel pain, stiffness, or limited flexibility. The magic of a foot pressure scan happens when you can see something in your posture that is contributing to something you noticed in your foot pressures. The reverse can also be true and equally as powerful. If you understand more about where you tend to hold yourself, it will be easier to find a way out. As an example, the person in the image above was experiencing right calf and hip tightness. The weight in their right foot was causing increased strain and compression on the right side. We found the most success by performing exercises that focused on shifting weight OUT of the right leg and INTO the left. Orthotics, stretching, and foam rolling would have never been able to fix this problem on their own because none of them dealt with the problem of too much weight on the right. If you can understand what the foot and the body are doing in order to better understand why your body is feeling pain or stiffness, you are much more likely to be able to design a better plan of attack for any pain or stiffness you are feeling.

To answer the question of whether or not you need insoles, I would like to say the following. Even though orthotics seem like a quick, easy and therefore tempting solution, I believe that the vast majority of the population have a much better option. Your foot and body posture are changeable things if you understand how to work with them. Your posture and movement are the end results of everything you have experienced in your life and will continue to adapt, for better or for worse, as your life moves ahead. If you are in place where you are considering putting something under your foot to fix a problem, I would caution you to consider what you are setting yourself up for in the future. Understanding more about your body and what is causing problem will help you to make a much more informed decision about what is possible and set you up for living a pain free and active life well into the future.