PRIDE Physiotherapy – Does this person need ‘orthotics’ (correctly called ‘in-shoe orthoses’)?

Neil - Doctor of PhysiotherapyOrthoses, Pain0 Comments

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Does this person need ‘orthotics’ (correctly called ‘in-shoe orthoses’)?

Is it even the same foot!.

It’s fairly safe to say that the top foot is as ‘flat’ as a pancake with very little ‘arch’. A Physio once asked the owner of this plumb-line masquerading as a foot, which rock he’d crawled out from under.

Surely these Neanderthal appendages cause problems!?

Aren’t flat feet supposed to cause ‘over-pronation’, knees that roll in (causing pain), internally rotated hips (more pain), back pain and all manner of compensating and secondary problems from apparently having not evolved?

And if the two feet are in fact attached to the same limb, how come there’s an arch in the second picture?

Oh my goodness. So many questions and such a vast trap for the unwitting paddle-footed earth-dweller walking into a Physiotherapy practice for help to fall foul of.

“Oh dear, young man, your ailments are clearly a result of those horrible under-developed flappy paddles down there. You must start wearing these custom-made orthotics immediately to stop yourself from any further damage. You will need two pairs, but rest assured, that’s more cost effective. How would you like to pay for those today”

I’m happy making these smart-arsed remarks because these bookends are in fact *my* feet and I love them dearly. They’ve served me and the rest of my body very well for 4 decades.

We need to stop the ‘orthotics’ nonsense right now.

Although I’ve worked in a gait laboratory and understand feet well enough to see the scam a mile off, I’m not an ‘expert’. Sports Podiatrist Ian Griffiths is though…
The rather blunt statements below are my summary of the hour long conversation from the podcast link. The conversation is intended for clinicians, but if this post makes you feel all prickly because you love your orthotics like a comfort blanket, you may wish to listen to it for yourself (don’t shoot the messenger):

Over-pronation isn’t valid (“it isn’t a thing” – we all pronate just as much as we supinate), how Physios are taught to test your feet in a clinic room simply isn’t reliable, and “orthotics” don’t (can’t) *correct* anything to do with your alignment – in your feet or anywhere further up your leg.

Those images you see of a seemingly bent ankle ‘before’ followed by a perfectly straight ankle ‘after’ are nothing but a sales scam.

For almost everyone (there are always exceptions) experiencing pain in the foot or lower limb, management is simply a matter of load management. An orthoses alters the way in which your foot reacts with the ground i.e. It changes the forces through your foot without altering the position of your foot. I’ll repeat: orthoses don’t (can’t) correct alignment or support arches. An orthosis is useful and can help improve symptom because it can alter the forces through your foot and leg. Crutches enable us to unload an injured leg too, but we don’t continue to use crutches indefinitely.

For the vast majority of people currently wearing orthotics, it is very very likely that they aren’t getting any benefit from them and possibly didn’t need them in the first place. If an orthosis improves symptoms – fantastic! It probably didn’t do it the way you thought, but that doesn’t matter. The goal should be to return to not using them and most definitely not feeling that you ‘need’ them.

The sense of structural fragility that these devices create, and dependence upon an external aid for normal function possibly does more harm than good.

Love your feet, even if they look like mine.


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