Do Orthotics Work? Real Answers for Foot, Ankle & Knee Pain Relief

Orthotic insoles, also known as ‘orthotic innersoles’, ‘orthosis’ and just simply ‘orthotics’ are incredible devices that sit comfortably under your feet to change loading.

Many shoes come with a foam innersole; designed as a one-size-fits-all comfortable platform to walk on. Custom orthotics differ in that they are designed to fit your individual biomechanical profile. The foot orthotic sits inside your shoes and addresses your specific risk factors and injury history.

They are most often used to take our injured areas out of their “overload zone” and bring them back into their “comfort zones”.

An example of this in action is a person who has a sore ankle that’s giving them trouble when they walk or run. Orthotics can be used to alter the loading around that ankle so that instead of having the structures around the ankle working too hard by pulling at the foot, the orthotic can provide a push force to balance things out. The end result for that sore ankle is it’s not sore or less sore. Then our walker or runner can continue on happy and healthy.

Do Orthotics Really Help Flat Feet?

Orthotics are not arch supports for flat feet. Now, this might be a little controversial for some people but there are years and years of research done in this area, and we can confidently say, that is not correct. To understand this, we need to go back into the history of terms like flat feet and what people actually mean.

Every day in our clinics in Melbourne, we have multiple people present to us reporting they have “flat feet”. There is this cultural norm that having a flat foot is bad and if you have any problems with your feet (likely the reason to present to an expert Podiatrist) it must, therefore, be true that you have a flat foot and this is the cause of your problems. A big fat false myth.

When asked what a client means by their flat foot self-diagnosis, you get all sorts of answers.

• “I have a low arch” – usually accompanied by this person sitting cross-legged and pointing to their arch without any semblance of normal weight bearing.
• “The shoe shop told me I have a flat foot” Facepalm – a post for another time.
• “My husband told me I have a flat foot and walk funny” – yes, men are often very forthcoming with their diagnosis.
• “I dunno, it’s sore so it must be flat”
• “Look I wear out the outside of my heels on my shoes” – normal!

The simplest explanation around flat feet we can give is just like height, hair colour and body shapes – our feet are all really different!

When we look at thousands of feet, we do start to see patterns emerge; and these patterns fit a normal distribution or bell curve. On one end of the spectrum, we have really low arched, flexible feet which, historically, are what most people would term a ‘flat foot’. On the other end, you have the stiffer, more rigid, cavoid or higher arched feet. In the middle is where most of the population live; some a little more flexible and lower arched; some a little stiffer and higher arched.

As in life, nothing is black or white whether things are better on one end of the scale or the other. Down the lower arched side, you have more movement available which leads to greater demands on muscles to control this increase in motion. This is why when tested people with “flat feet” have stronger and larger muscles than those with higher arches.

On the higher arched side of things – where the feet trend stiffer with less movement available – you get efficiency benefits as there doesn’t need to be as much strength in muscles as there is less movement to control. Sounds great but with less overall strength demands, these muscles don’t tolerate great changes in load as well and things can go wrong.

So, what this means for orthotics for our feet – whether they trend flatter or higher in the arch, or the more modern way of thinking, ‘more flexible’ or ‘more rigid’ – is that there is no one solution that fits all. The days of an arch support being shoved under your foot and told to slowly “break them in” are long gone.

We can now say with confidence that a Melbourne orthotics are going to help you achieve your goals by reducing the load on your… (whatever is overloaded and injured, or at risk of injury). Great result!

What Are Orthotics Good For?

Orthotics are not just good but great for a myriad of lower limb conditions. As we discussed at the top, they alter the loads around our legs by pushing up on our feet at different times, under different loads and different areas of our feet.

This load altering is super important for our overuse injuries in our lower limbs. Ask anyone who has ever had a foot, ankle or leg injury, and you will hear how life draining the constant pain or disruption to daily life actually is. For most of us, the idea of walking, running or being on our feet LESS than usual, to reduce loading, is just impossible. We have our sporting careers to think of. We have our children and family to care for. We have that fun run coming up with a PB so close! We have to get to work and spend 10 hours on our feet every single day.

This is where an orthotic really comes into its own. Whatever area is overworked or overloaded can be given a helping hand with a gentle nudge from our orthotics in Melbourne.

A couple of examples are:

• Painful plantar fascia – previously known as ‘plantar fasciitis’ and now, ‘plantar fasciopathy’ – being overworked by too much tensile or pulling load. An orthotic can reduce this by limiting the lengthening of the plantar fascia.
• A painful plantar fascia being overworked by too much compression. This happens when the heel twists whilst the ball of the foot is on the ground. An orthotic can reduce this compression by reducing the twisting movement.
• Knee pain – whether it be PFJ (patello-femoral joint) pain or meniscal injuries, an orthotic can reduce the compression by changing the loading around the knee.
• Ankle pain or ankle sprains can be assisted with an orthotic by balancing the movement and load around the ankle, whether that be the inside or the outside ankle.
• Bone injuries to the feet, such as stress fractures, stress reactions or “hot spots” can be unloaded or ‘load-optimised’ by an orthotic.

Will Orthotic Insoles Help Reduce the Pain in My Feet and Legs?

At Pride Podiatry, we use the latest technology and evidence-based practice to prescribe orthotic insoles, if required, to meet your goals. We work with you every step of the way to ensure you are comfortable and happy with your results.

We consider your lifestyle, your needs, and your biomechanics to create solutions for your pain.

There is a growing body of evidence that orthotic insoles when prescribed by podiatry experts in lower limb biomechanics, can reduce pain in the following conditions:

• Plantar Fasciitis or Heel Pain
• Stress Fractures in the lower extremities
• Knee pain
• Bunions
• Tendonitis
• Neuroma’s
• Shin Splints
• Sever’s Disease or children’s growth plate problems
• Arthritis
• Corns and calluses
• Lower back pain and Hip pain

Foot Orthotics help these conditions by altering loading on affected or at risk structures, and improving your body’s ability to be efficient at walking, running, specific sports and more.

If you suffer from pain in your feet, legs or lower back and want real results, call Pride Podiatry now and speak to our staff about custom orthotic insoles.

What Kind of Custom Orthotics Will I Need?

The orthotic family tree can initially be broken down into Functional and Accommodative orthotics.

• An accommodative orthotic is designed to offload specific pressure lesions on the skin’s surface. For example a callous, corn or diabetic foot ulcer.
• A functional orthotic is designed to alter the loading patterns on tissues within the body to reduce pain, improve efficiency and reduce the risk of reinjury. For example, adjusting the load on the plantar fascia for heel pain, or reducing the compressive forces within joints with arthritis.

It makes no sense wasting money on a generic insert for shoes when every foot is different. But having custom orthotic insoles designed by a podiatrist for you personally can have an enormous impact on your quality of life, and relieve chronic foot pain and aching in your legs and lower back.

The style of foot orthotics prescribed will depend on your circumstance:

• What kind of correction your foot requires
• Does your job require you to stand for long periods
• Are the orthotics for sport and if so, which sport
• What kind of shoe the insert is for

Are Orthotics Alone, Enough To Help Me?

Maybe. But it is unlikely this will be the best result you can achieve. If we think of orthotics as a way to optimise the load on our bodies tissues, then it’s easy to see how we can go from being sore to not being sore. The thing is though, our tissues are not static structures like a building or a car part, they are adaptable, pliable, trainable!

A thorough plan that your Pride Podiatrist in Melbourne will develop with you, will take into account your goals, your history, your injury profile and so much more. If there is a need for orthotic therapy in your plan to achieve your goals, there is most likely a need for some tissue-based changes as well. To get these changes, your podiatrist will prescribe your personalised exercises to target the risk/at-risk areas and take them from being able to do 10 arbitrary units of work, to 1000 arbitrary units of work.

If you’re already working on your tissues but still in pain or suffering from regular injuries, then this is where an orthotic can be a really useful clinical tool to take the demand on said tissue down from say 50 arbitrary units of work to 25 arbitrary units of work. You can still work on the capacity building but now, instead, from a safer and less painful or at risk base.

Can I Run With Orthotics?

If you have been prescribed an orthotic for running and your injury profile, load optimisation and more are taken into account – absolutely!

Now, if you have been prescribed an orthotic for cycling and your podiatrist has said to only use this for cycling in your cleats – absolutely not!

A really common reason for clients to present to a podiatrist is they have suffered a running-related injury, which often stems from a training error. It’s only human to go out and start running, then run more, and more, and more. Not many of us who enjoy running ever engage the services of a running coach or spend the time investigating the loading principles of training. Honestly, when most of us run, we grab our shoes, step out our front gate, turn right (it’s always right!) and run. We do the same run over and over again.

Orthotics are really useful for runners who have made a simple training error and are now too injured to optimise their loading and continue to run. When prescribed by expert podiatrists, like the Pride Podiatry team in Melbourne, there will almost always be aspects of capacity building in the management plan, as well as training advice and/or a referral to an appropriate running coach or EP (Exercise Physiologist).

Now, one of the key considerations regarding running, footwear and orthotics is weight. The simple maths is that the heavier the things we carry, the harder we have to work. This is a great segue into the materials that orthotics are made out of.

How Long Does It Take To Adjust To Orthotics?

Everyone is different. Some of us take a couple of days, while most of us take a couple of hours.

That’s right. Hours up to days is usually all it takes to get used to orthotics. Now historically it was said that orthotics took weeks and months to “adjust to”. This is due to outdated theories underpinning orthotic therapy, which basically sought to change what a foot looked like or how it “aligned”. Be honest, we’ve all seen the images of a person standing with and without an orthotic, and the curves or arrows drawn down the back of the leg. Well, it turns out that while this theory worked for some people some of the time, it didn’t work for most people most of the time. It’s bunk.

We now understand so much more – with much more to come from leading researchers like Pride Podiatry’s own Jade Tan. With a modern orthotic prescription, we are taking into consideration loading and how to optimise for reduced pain, injury and improve performance. For this, it usually only takes hours to a couple of days to get used to this altered loading and orthotic wear-in or adaption periods are incredibly short.

Will I Have To Wear Orthotics Forever?

Definitely not, particularly if you don’t want to! Orthotics are prescribed for you, your injury profile and your goals. If your goal is to wear orthotics forever then this can be taken into consideration by your podiatrist. In all honesty, we have yet to have this goal ever brought to us at Pride Podiatry!

In reality, your ongoing use of orthotics will really be dictated by what you’re doing with your life. Certainly, as we age, our bodies’ tolerance or capacity to tolerate loading decreases over time. We can reduce this via training and load optimisation but it still happens.

An old myth related to orthotics is that they “change my feet”, and that you cannot then walk or run without them. Orthotics can do a lot but remember, they are ultimately a loading tool. When used well, they optimise load; when used incorrectly, they can exacerbate load. You can also alter load by changing strength, footwear, cadence, volume and more. Your decision and long-term needs will be considered and outlined in your overall management plan with your podiatrist.

What Shoes Can Be Used With Orthotics?

Lots and lots of different style shoes can be used with orthotics; and due to recent advances in orthotic manufacturing and materials, this list has grown significantly.

As modern orthotics are lighter and thinner than previously, they can fit in shoes much easier than in the past.

General rules are that shoes need to have enough room to fit your foot in to start with – not these super tight shoes which some of us are guilty of buying too small. A removable liner inside the shoe makes things much easier but is not always necessary. A back on the shoe, known as a ‘heel counter’, is also ideal so that your orthotics don’t slide out under your feet. Some sandals without a heel counter can be worn as they have a high midsole ridge which can accommodate an orthotic.

An old myth relating to running shoes and orthotics was that orthotics had to be placed inside neutral classed shoes. As with most myths and stereotypes, there’s just enough truth there for it to be believable. Different running shoes in different categories will influence your feet and your orthotics differently. Your expert podiatrist will take this into consideration when planning and prescribing your orthotics. It might lead you to wear your orthotics inside a neutral class of shoe or it might not.

What Is The Process Of Getting Orthotics

The process for getting orthotics starts with your history and assessment. Our podiatrists in Melbourne will sit with you and assess everything from current capacity, current loading, joint axis and movement ranges, strength, footwear, and so much more.

From here, the assessment transitions towards the dynamic where walking, running and other tests are conducted relevant to your needs.

Finally, when the treatment plan is agreed upon and if orthotics are identified as a key part, the prescription process can begin.

First – a 3D scan of your feet is taken to capture every wrinkle, lump and bump on your feet which make us so unique.

Second – your podiatrist will advise on the materials and options relating to colour and comfort preferences.

Third – your foot scan and your orthotic prescription are sent to our partner orthotic laboratory in Melbourne where our colleagues (fellow podiatrists) either 3D print or mill your orthotic exactly as your prescription specifies.

A week later, your custom made orthotic is ready to go, you place it in your shoes, you learn a little about how it alters loading and commence the next phase of your treatment plan.

Common Myths About Orthotics

Myth 1: Orthotics are only for people with flat feet.

Orthotics provide support, stability, efficiency and neuro-feedback to the wearer. People with flat feet often need some extra support under the arch however that is not just what an orthotic can do. High arched people are much more likely to suffer from ankle sprains as the sub-talar-joint axis laterally deviates in these cases. This means it’s much easier for the foot to roll out rather than roll in. An orthotic for a high arch can provide this extra lateral support too.

At Pride Podiatry, we are confident in our orthotic prescription, assessment and management planning that you will be more than satisfied with your orthotics.

Myth 2: Orthotics are rigid and will give you foot pain.

The wrong orthotic can give you foot pain. The right orthotic for you for the wrong activity can give you foot pain. We’d never recommend walking or running with a cycling orthotic. An orthotic that is too stiff in areas that your foot does not appreciate stiffness can give you foot pain. But an orthotic that is prescribed for you and your needs, and used accordingly will not give you foot pain. We guarantee it.

Myth 3: Orthotics make your feet weak and you become dependent on them.

This myth has been debunked by science many times over yet still keeps popping up. It’s one of those things that we think intuitively must be true… An orthotic provides support therefore if I use it my muscles don’t work and they get weak. After all, we all know that if we don’t use them we lose them.

This is wrong. Orthotics cannot take the work a muscle does to zero. They can be used to increase or decrease work, but not make it disappear (as that would be breaking the laws of physics). If a muscle is overworked it becomes weak and injured. So if you’re prescribing an orthotic to take the overload from that muscle, and bring the load back into the muscles ideal loading zone you’ll actually build strength from that muscle.

Ask any muscle-bound gym rat what are the important principals of building and maintaining muscles strength and they’ll tell you. Work out, refuel and recover.

An orthotic helps our muscles recover as they are no longer overworking. The workout part still needs to be completed by you and refuelling is all about dietary intake.

Myth 4: If you are wearing orthotics, you don’t have to wear good shoes

An orthotic pushes on your foot, but needs to push back against something else to actually help you out. This is the sole of your shoe and how it interacts with the ground.

If you have a very flexible soled shoe and you need to be able to push back on your foot the shoe will bend away, and the orthotic won’t be doing what it could and needs to do.

Good shoes come first, great orthotics come second.

Myth 5: Over the counter orthotics work the same as custom orthotics

They don’t work the same but they can have the same results in very specific circumstances. Your podiatrist will be able to tell you if this is the case for you.

This could be that both a custom foot orthotic and an over the counter orthotic will reduce your heel pain to zero. One might do it for 3 months, the other for 3 years. Or one might be able to do it very comfortably in all shoes whereas the other only in certain runners.

At Pride Podiatry, we are confident in our orthotic prescription, assessment and management planning that you will be more than satisfied with your orthotics.