Orthotics: Drugs for the feet?

Lots of folks ask me about the use of orthotics to correct structural dysfunctions.  My response is this: there are certain conditions for which orthotics can be a useful solution. A person with actual (as opposed to postural) leg length differences can benefit from using orthotics, as can someone with extremely flat feet, caused by a weakening of the supporting ligaments on the inside of the foot.

Doesn't that look awesome!

Doesn’t that look awesome!

However, apart from these cases I typically discourage the long-term use of orthotics to correct structural discrepancies. It’s sort of like taking a sleeping pill to cure insomnia. It may help in the short term; but it fails to address the underlying issue.

Being in the health and healing field, I’ve seen a remarkable push back against the pharmaceutical drug culture of “fix me now” mentality. Outstanding health insurance companies like CDPHP are putting a focus on health and wellness on the consumer side, possibly seeing that it’s cheaper to keep people healthy than fix them when they are sick. Certainly the clients at Bodywork Professionals, and our friends at Pilates Principle and the Hot Yoga Spot  understand this well. The idea of being empowered to keep healthy is alive and well in strong, independent people.

What we’ve seen in the past is a “fix me now” mentality sets us up to relinquish real healing in favor of more temporary “bandaid” solutions.  I am certainly not implying that orthotics have the same lethal potential as  many widely prescribed pain management medications, I still classify them as another “pill,” –  a “prescription” for your feet that only offers a “bandaid” fix.

Structural dysfunction can and often does show up in the feet. By treating this dysfunction with the use of orthotics, I would argue that it only serves to make the problem worse. Rather than correcting the structural issue, the orthotics actually reinforce it.  Think of what happens when a person is put on a regimen of pain medication. At first, she feels relief and can go about her daily business, free of pain. Over time, however, she finds that she needs more medication to achieve the same result. Eventually, she may become entirely dependent upon that medication.

This is what happens with the foot. By surrounding it with an artificial barrier it was never meant to have, it is prevented from moving naturally on the ground in the way it is supposed to, and, eventually, the foot becomes dependent upon that barrier and cannot function without it.

Another issue with orthotics are the way in which they are made. One common mechanism for creating an orthotic is the “foam box” approach. The client stands in a box of foam, which molds itself to the feet. Now, unless you plan to just stand all the time I don’t see how this particular type of orthotic can do much good.

Orthotics simply cannot be made for every physical situation or activity. And, one set of orthotics is never going to fit exactly the same way in every pair of shoes you wear. Unless orthotics are made specifically for the shoes they are being worn in, even mild wear inside or outside of a shoe will dramatically effect the way the orthotic works.

Rather than getting orthotics as a drug for your feet, I would argue that what is needed is to focus on having healthy feet in the first place. How do we get to healthy feet? It’s simple. Go barefoot! Forget the inserts, forget the orthotics and walk around barefoot. Harvard has a wonderful site with some science and facts about running and walking barefoot.

There is something empowering and freeing about being barefoot. It’s exciting and stimulating to walk about on the grass or at a beach. Sure, pavement is no fun, but there are a wide variety of simple shoes and sandals that will keep you protected (It really is too bad those finger toe shoes are so horribly ugly or they’d be great.).

Going barefoot says, “I choose my path, and I can go anywhere.” It’s the hard road, its more difficult and it may not always be easy. But your feet will grow stronger and more stable, your ankles will become more dynamic and capable of handling change, knees and hips will know to trust what is below them. Sometimes the best path in life is the long cut, with delightful vistas and challenges.

It is my belief that DYNAMIC feet, feet that can roll with the punches and change according to the demands placed on them, are the most healthy. Feet need something to trust, something solid but always changing. We simply aren’t made to be stuffed into shoes all day. Our feet are built to interact with a dynamic ground.

I’m not saying we’ve should all discard our shoes for life. I am saying the more we allow our feet to act like feet, getting them as close to the ground as possible, the healthier they will become.

If you have a structural aberration that causes you to to stand in a way that requires correction, the real “fix” is to correct the structure itself. Therapies such as deep muscle and tissue massage, Structural Integration, and other forms of treatment encourage muscles and fascia go back to working the way they intended to. By re-positioning the structural framework of the body, we can truly promote healing and an elimination of the pain that came as a result of the body’s mechanical dysfunction.

Feet are extraordinary objects, meant to listen to the changing sands of the ground and support your body. Give them a chance.

AUTHORS NOTE:

After publishing this article I received feedback from some orthotic users who have been successful in avoiding surgery for many years with the use of orthotics and found them very helpful. It has also been pointed out to me that use of othotics in the elderly can be very beneficial.

If something as non-invasive as orthotics can help avoid surgery or improve quality of life for the user I am whole heatedly in favor of it.

The ideas expressed in this articles are opinions I’ve formulated from 20 years of working in the massage and bodywork field and are simply the view from here. I encourage the reader to do research and make up decisions that best suited to their situation.