Recently, there’s been an influx of people asking about orthotics. Of course that comes into the territory of talking about flat feet. Often I hear patients complain about “OH, so-and-so [insert doctor, physiotherapist, massage therapist, friend, family, co-worker, etc] says that I have terribly poor flat feet and I absolutely need orthotics!”
My response to them is this, “What makes them think you have flat feet and has the orthotic helped your flat feet?” Most of the time, people will respond with “I’m not sure.” or “The orthotics have kind of sustained me for [insert amount of time]” or lastly, “I can’t walk without wearing my orthotics. I have to wear them all the time!”.
Often times, when I see patients come in for flat feet… They actually don’t have flat feet at all. Some of them they have high arches. Recently, I’ve seen a patient who has relatively high arches, but her previous practitioner prescribed her orthotics that continue to make her arches higher. The practitioner unfortunately, did a disservice to this patient by perpetuating the problem… which is high arches and that actually caused her another problem - bunions and ultimately a surgery (prior to seeing me at the clinic). Also by believing that she has gotten really flat feet (when she didn’t), she bought shoes that also had high arches and it never really addressed her foot issues.
A common misconception that many people have is that flat feet is bad. We as patients and sometimes even practitioners get stuck on that fact that flat feet is bad. That unfortunately is incorrect. Normal walking gait requires having a flattened foot and also having an arch as well. This is required in normal gait and also provides proper joint movement and muscle activation. Another common misconception is that orthotics will permanently fix a foot problem. That is also incorrect. It is possible for orthotics to help change the biomechanics of the foot, but it is not a permanent solution for the patient. It does not allow for the foot, joints, and muscles to adapt to challenges.
Normal walking gait requires pronation (flat feet) and supination (high arch). Individuals are sometimes flat footed or sometimes high arched. So my approach is to let’s see if we can change the mechanics of the foot before we jump into something like orthotics. Teaching the foot how to move properly between supination and pronation provides so many benefits to the body. It can help prevent bunions, provide proper alignment of the ankle, knee and hip during gait. Also importantly, allows for the proper muscles in the foot, lower leg, thigh, and hips to fire at the appropriate time. The orthotic is like a semi-permanent correction in foot problems. Individuals rely on it too much and it doesn’t allow the foot or the body to adapt to different types of terrain while walking.
In the above patient that I mentioned, we put her on a course of corrective exercises for her feet and she has not needed orthotics since. She has been able to walk barefoot on hardwood floors. She’s had decrease numbness in her big toe (post surgerical bunion) and also less discomfort on the ball of her big toe. She has been able walk with a relatively normal gait and has no issues since we started this course of treatment.
So having said all this stuff, I hope that clearing up some misconceptions about flat feet and orthotics helped! Again, not all foot problems are a candidate for orthotics, but most of foot problems are candidates for corrective exercises that can help in a multitude of ways!