Orthotics the big debate
I have seen and heard a lot of physiotherapists debate over the years whether orthotics are appropriate or not. Some with the view that all non “ideal” mechanics should be improved upon and others that see it as sacrilege to place an solid object under a persons foot.
I lie in the middle ground on this debate, this is not just me sitting on the fence, you just have to take it on a case by case basis.
This debate depends on looking at both the static and dynamic foot type of the individual, i.e. The foots positioning while standing still and how the foot reacts when the person is moving.
Someone people have a naturally flat arch, this is seen quite commonly in many populations especially in the south pacific. I would think along the lines that an individual with naturally flat but strong feet may not benefit from orthotics. The orthotics could actually alter their biomechanics, taking the foot from it’s strong natural position into a possibly more “ideal” but weaker position. The person may not be able to control the impact from the ground as much in this new position leading to overload of other structures. That brings you back to the old saying if it isn’t broken don’t fix it. You could cause more damage than good as you don’t realise what carry on effect this will have on other structures.
In the case of individuals with a normal arch when standing still that collapses when moving it is a slightly different story when it comes to orthotics. There have been a lot of evidence showing the association between lower limb overuse injuries and biomechanics. Not all biomechanical lower limb injuries are linked to the foot, some are coming from higher up the chain, such as hip and pelvic control. However people with injuries and pain associated with biomechanical foot issues tend to experience a large range of motion between their neutral foot position and their foot position when moving. T
his can be from forces while jumping and landing or moving from heal strike into toe off when running or even walking. It is not just the range of movement but the rate of collapse that needs to be looked at. A high rate of collapse and the inability to control the movement is what puts stress on the supporting structures. Poor foot control can lead to foot pain, Achilles tendinopathy, shin splints, compartment syndrome and possibly overload issues around the knee as well.
Therefore it all depends not on whether someone is flat footed (over-pronated) but whether they have the ability to control the movement of their foot. In appropriate cases footwear and orthotics can be used as an adjunctive therapy along with strengthening and practicing of correct movement patterns. They may allow the person to get pain free quicker and start to develop strength through a smaller more controlled range of motion.
Catherine Simpson MISCP
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