Winnipeg Free Press - PRINT EDITION

Get back on the right foot

Long-term goal should be to phase out reliance on orthotics

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Close your eyes. Take off your shoes and socks. Spread your toes and feel the world beneath your feet, the hardwood flooring, the shag carpet, or maybe, if you're lucky, the warm sand between your toes.

Our feet are incredibly tactile and I would argue that, even ahead of our hands, our feet are our main interface with the world around us. They can be beautiful and rugged, graceful yet powerful, resilient yet fragile, oh-so ticklish and at the same time numb to the duress they are put through everyday. While the interaction between our feet and the ground has forever been intimate and immediate, these days more and more practitioners are insisting the insertion of cushioned shoes and custom-made orthotics is necessary treatment for the ever-growing amount of foot pain in the developed world.

The ultimate question is this: do we have more foot pain because we live in a 'concrete' world and stress our feet more now than decades past, or is it because our sedentary lifestyles have softened us to the point where the slightest overload results in pain? The divide and debate on this question and the effectiveness of these interventions will never end, but if you understand the why and the how, you can make more informed decisions rather than being led (astray) by a practitioner.

By definition, an orthotic is actually any device that modifies any part of the musculoskeletal system, but colloquially an orthotic is referred to as an insole or partial insert, custom made or off the shelf, designed to fit into many types of footwear and intended to support the structures in your foot and take pressure off high-pressure areas. They can range from $14 to $450 and come in many different shapes and designs. Some time ago, it was common practice to pad, cushion, and protect a chronic injury, and it seemed as though practitioners had crunched some numbers and realized over-prescription of these devices could result in significant revenue for themselves. Today, proactive therapists are realizing these chronic issues require an individual to train their body to withstand forces and endure the rigours of life rather than just soften the blow.

A therapist's ultimate goal is to return you to optimal function without the use of supports or aids -- no matter what the injury. If you have torn ligaments in your knee, we are assisting you toward returning back to work, sport or life without the use of your knee brace. It should be used as an aid for a short period of time while you are vulnerable and to support structures as they heal and remodel into healthy, strong tissue. If, for the next five or 10 years you require your brace to play soccer, we have failed as therapists.

Why do we approach feet any differently? Why do patients and therapists alike feel as though foot pain means a lifelong relegation to insoles and bulky shoes? Our bodies were created to withstand brutal forces, and our feet are no different. As a society, we have become soft, granted -- but relying on an orthotic to lessen the impact only makes us softer.

Improper use:

You are diagnosed with some type of foot pain, and are told long-term use of orthotics is the best way to correct your problem. Come back every few years for an updated pair. The reality is orthotics don't correct much -- they provide a secondary shock absorber rather than drastically change our biomechanics, and if used for a prolonged period they weaken our intrinsic shock absorbers. While your pain may be reduced while wearing your orthotics, there will invariably come a time when you don't want to wear them, and your deconditioned body will be unable to withstand the stresses placed on it.

Proper use:

You are diagnosed with some type of foot pain, and use orthotics along with other therapeutic interventions to reduce acute inflammation. Once that subsides, you stop using them and begin a progressive strengthening program. The majority of foot pain is the result of mechanical overload creating irritation. As mentioned previously, it means your body just can't handle the forces being placed on it, and using an orthotic to reduce this stress is useful. But as your pain lessens, so should your orthotic usage while your strengthening program increases. If your body can't withstand a stress, you train it to be able to handle it.

Custom Made vs.

Over the Counter (OTC):

It's understandable many people would shy away from custom-made orthotics because of the price. If you agree with the stance orthotics should be used only in the short term, then shouldn't the $15 Dr. Scholl's from Shoppers Drug Mart suffice? The difference in price is observed in the resiliency and knowledge you get with a custom-made insole from a respected professional -- because there are different insoles for different uses.

Paying the higher amount means if used only intermittently, your orthotics should last you for a very long time, whereas an OTC insert will break down almost immediately. It also means there should be a knowledgable professional backing that product who is willing to alter it as needed and is able to provide you with other types of therapies to overcome the issue. You need support in the form of information more than you need support under your foot.

In the end, orthotic usage is a very passive way of reducing foot pain, which is unfortunately a good route for a patient unwilling to put the time and effort into a proper rehabilitation program. Its long-term effectiveness is also questionable. Just like nobody desires being dependant on a drug, we should strive to be able to live life without an orthotic addiction. If you want to be able to stroll down to the beach in your flip-flops, take them off and trudge through the sand, rethink the way you use your orthotics and take the time to improve your own shock-absorbers. Next time we will discuss the other side of the coin -- barefoot/minimalist running -- and whether or not it's right for you.

 

We welcome your questions. Email tim@mordenphysiotherapy.ca and you could be featured in a future article. Tim Shantz is a certified athletic therapist and trainer.

Republished from the Winnipeg Free Press print edition March 29, 2014 D16

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