Orthotics: Are They Worth It?

You should be skeptical of this, especially if someone is trying to charge you $700 plus for a pair. What I’d like to discuss in this post:

• Pronation vs supination?
• What are custom orthotics and how do they “fix” your “alignment?”
• 3/4 length vs full length……what gives?
• How are they made (traditionally)? And what is wrong with this model?
• What are their success rates?
• So Sam….what do I do about my feet that hurt?

‍

Now, you may also be thinking to yourself. “Well what do you know about orthotics, aren’t you just a physical therapist?” Excellent question. Let me give you a brief synopsis of my background. Prior to PT school I was a pedorthist. I had advanced training in orthotic fabrication techniques, shoe modification and shoe construction. I was the guy the podiatrist would send your casts off to, in order to have your expensive orthotics made. But not just me, they go through the hands of a multitude of people before you get the finished product. I also had the privilege of learning under some of the leading human biomechanics professors in the nation and have fabricated orthotics for professional athletes, weekend warriors as well as for people that have experienced amputations from diabetes or trauma. This was all prior to PT school. Couple rehab experience as a PT and it gives me an interesting vantage point about orthotics and the research behind them. Now…. let us get into the nitty-gritty. (I’d like to mention that everything from here on out is based on research, it is not my opinion. There are items here that are not 100% for everyone, there are always exceptions to these rules based on the individual person orthotics are made for.)

‍

PRONATION VS SUPINATION?

Pronation is simply a term describing a tri-planar motion in the foot. Supination is the opposite of that motion. Despite what people say….Pronation is NOT BAD!!!!!! It is essential for proper loading of your legs and hips so you can walk, run, jump, etc.

"I take my only exercise acting as a pallbearer at the funerals of my friends who exercise regularly." —Mark Twain

Without it, you’d be in rough shape. More important is how far you pronate, when you pronate, and if you can supinate out of your pronation. It is funny…..your forearms also pronate and supinate, but no one uses scare tactics up there when it comes to pain.

WHAT ARE CUSTOM ORTHOTICS AND HOW DO THEY “ALIGN” THINGS?

Well plainly put, custom orthotics are products that are molded from your feet in one way or another and are 100% custom to your individualized needs. More often than not they are made from durable polypropylene or polyethylene hard plastic material that will last approximately five lifetimes if it was tossed into a landfill. I’ve seen some offices mold pre-fabricated orthotics to individual’s feet and try to pass those off as custom. Those are NOT custom. These are customized over the counter inserts. I am by no means saying these are bad or wrong, just not true custom orthotics. It would be the same as if you took a “insert brand” insert and added a heel lift or a met pad. Customized, not custom. Orthotics do NOT align things. Maybe in a world where you strickly stand stationary, they can help align things but the second you start walking alignment gets thrown out the window. Now we need to focus on function and movement. If your clinician isn’t focused on movement the inserts probably aren’t going work as well as you’d like them to.