Do you need to rely on orthotics long term after injury or even if you have flat feet? There’s a good chance that you don’t, but only if you are up to the task of foot strengthening
Orthotics are widely used as the go-to treatment for foot, ankle and knee pain, but should they be relied on long term? Let’s look at the alternatives and how they stack up! As a Physio, I find orthotics hugely useful in helping with lower limb over-load injuries such as:
- Achilles tendinopathy
- Plantar fasciopathy (plantar fasciitis)
- Runner’s knee
BUT the majority of the time as with anything external such as a brace, strapping and more, they should not be a long term fix. They do help guide movement and they do help ease pain which is brilliant short term, but they don’t create lasting change to your tissue.
So, what is the alternative?
The big one is to focus on improving your foots function, strength and resilience so that extra support isn’t needed in the long term. Think of it like improving your bodies ability to control motion rather than relying on something external to do it, in the long term.
Progressively load your foot and it can adapt and improve to be able to handle more and more – as long as that loading is smartly progressed, and good recovery time given. Foot strengthening isn't a quick fix, but it certainly is a bit part of the long term fix for foot pain, injuries and reliance on supports.
But does the research back this up?
Can you work towards ditching your orthotics, or even reliance on bulky stabilizing shoes?
A study was done that compared the effect of foot strengthening exercises with orthotics and how that changes the weight bearing arch height. They measure this with the navicular drop test which measure how much your medial arch drops lower when standing compared to sitting.
They found that that there was a significant improvement in the group that did the foot strengthening exercises for 6 weeks compared to no difference in those that just used insoles. As a huge bonus the group in the study that did the foot exercises also improved their balance scores by over 10%. Keep in mind that even though they found a significant difference, it wasn’t a large study size so take it with a grain of salt.
To back that up, HERE is a larger study that showed orthotics have no benefit over exercise rehab in the treatment of anterior knee pain (runners knee).
Yet another study, this time a systematic review, found a similar result in that the outcome for those with knee pain in this case when comparing orthotics to strengthening (of the hip as this partly controls the leg rotating and hence foot pronation) that there was no difference between the two.
So all in all, there is a lot of research on the effect of orthotic use but not a lot on the effect of exercises to improve arch control and resilience. The studies that are available though show either a similar effect between the two treatments or more improvements with exercises.
That gives us a good idea of what we can do to get the same if not better effect as orthotics and it’s a great long-term option!
What if I have flat feet?
Firstly, there isn’t a lot of strong evidence that having a lower arch (flat feet) is a big issue as it doesn’t have a strong correlation with injury across the research. Most research has shown that there is a relationship between both high and low arch height and lower limb injuries but the relationship is fairly weak
In terms of pain associated with flat feet, then there is some really cool research on this. One is a good sized meta analysis (Hoang et.al. 2021) done this year and to sum it up, it showed:
Exercise alone OR combined with orthotics has better effects on pain that orthotics alone. They showed clearly that active intervention (strengthening) had better result that passive treatment options. They also showed that neither treatment changes foot alignment or foot posture but this isn’t often needed as it’s not about having the perfect foot posture but having the capacity of your soft tissues to control motion and absorb and release energy/shock.
Orthotics don’t improve your intrinsic tissue capacity to handle load and actually are a risk factor for injury in runners. They are definitely useful but best when used as a stepping stone while you work on improving your foot and legs mobility, strength and overall resilience – which takes time and patience. The same goes for if you have flat feet, you can improve your capacity to handle and control load and therefore you will have less reliance on passive supports and you can gradually free your feet!
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Disclaimer: This is not medical advice and If you have orthotics – don’t go throw them out and go cold turkey. If you do want to ease away from relying on them you need to work on building strength, control and mobility first and then progressing away from them, ideally under the guidance of a Physio.