Foot pain is not normal and should not be ignored. It can lead to complex problems that can affect the functioning of other parts of the body, including the hips, knees, and back. Foot-related problems are often treated very successfully with functional orthotic shoe inserts.



Orthotics are prescribed to:

1) Reduce pain

2) Provide support

3) Prevent or slow down the development of a foot deformity

4) Provide better positioning of the foot, knee and hips

5) Improve the overall biomechanical function of the body

Functional orthotics allows the muscles, tendons and bones of the feet and lower legs to function at their highest potential. When appropriately fabricated, orthotics can decrease pain, not only in the foot, but in other parts of the body such as the knee, hip and lower back. By eliminating the need for one's muscles to compensate for imbalances, orthotics can reduce fatigue and promote efficient muscle function to enhance performance.

They can also increase stability in an unstable joint and prevent an early foot deformity from developing additional problems.

What you should know about orthotics

The use of functional orthotics adds a new dimension in the treatment and prevention of overuse injuries of not only the lower extremity but also of the hip and back. However, there is still confusion as to what orthotics are, what they can and cannot do, along with who really needs them.

What is a functional orthotic?

The Greek work ortho literally means straight, upright and correct. An orthotic is a biodynamic device that fits into running shoes to accomplish two things:

(1) To ensure that the foot moves correctly through the various phases of running which includes heel contact, whole foot contact and toe off, the orthotic functions like a rudder to help the foot function efficiently biomechanically.

(2) To support the foot, the orthotic assists the foot and enables it to communicate and align with the rest of the body. The body is then balanced above the foot in midstride as well as when the foot is on the ground.

A true functional foot orthotic is a custom-made device prescribed by a podiatrist or pedorthist. What it is not is an off-the-shelf device that is essentially just a nice arch support. While these devices are often helpful, they are not a true custom functional orthotic!

The science of biomechanics has provided much of the framework from which functional foot orthotics have evolved. Lower extremity biomechanics is the study of human motion primarily concerning gait, foot stability, propulsion and muscle action.

BIOMECHANICAL BASICS

To fully appreciate why some runners need orthotics and others do not, an insight into basic biomechanics will go a long way towards explaining the need for orthotics.

Our feet go through a very complex series of movements to help propel us forward. One of the most important functions of the foot is to help the body absorb shock when it hits the ground. In running, every time we strike the ground, our lower extremities experience a force between one and a half and three times our body weight.

Pronation

The foot normally strikes the ground on the outside (lateral) part of the heel. As soon as this occurs, the heel should roll in. This motion, called pronation, which absorbs shock, gives the appearance that the arch is flattening out. This mechanism of pronation helps prevent impact related injuries such as stress fractures by reducing forces to the ankle, knee, hip and back.

Once this 'pronation phase' is complete, the foot begins to roll-out or supinate slightly, creating a more stable foot position and allowing the lower extremity to achieve maximum efficiency when pushing off.

Pronation then, is a normal, necessary biomechanical motion in foot function. However, if the foot pronates too much or for too long it will remain unstable, making the lower extremity less supportive of body weight. This can result in a multitude of overuse injuries from heel or arch pain, stress fractures, knee, hip and back pain and injuries.

Pronation, therefore, is a problem only when it becomes excessive. Excessive pronation can result from several causes. Hereditary congenital bone structure refers to our foot type, which to a great extent, is genetically predetermined. The position of the joints can cause the foot to assume a pronated position.

Excessive pronation can also result from biomechanical abnormalities. If a certain part of the foot or leg is unable to go through the motion necessary in normal walking and running, another nearby joint may be required to make up or compensate for this lack of motion. For example, one of the most common biomechanical problems causing the foot to over pronate is a tight calf muscle also known as an equinus. The foot needs to bend (dorsiflex) upwards five to ten degrees at the ankle for normal lower extremity motion to occur.

If this motion is unavailable, the foot will overpronate to make up for the limitation. By stretching the calf muscle properly, these forces acting on the foot can be reduced and can help to prevent lower extremity injuries.

Finally, improper shoe gear is another cause of overpronation. Running shoes that have a curved last or shape will tend to increase the amount of pronation that occurs in the foot. Many shoes are categorized as 'motion control shoes', usually made from a straight last, have more supportive materials on the inner (medial) side of the shoe to limit the amount of inward roll (pronation). They are not included to stop pronation but to let this motion occur in normal limits.

Many runners almost literally run their shoes into the ground and discard them only when they have the shoes reduced to little more than a pulp. Shoes are meant to only last 6 months or 500 miles; whichever come first. Remember that if the shoe is worn-out or broken down it cannot function in the way it was designed.

Supination

Is the opposite motion of pronation. It occurs normally right after heel strike to help the foot become a 'rigid lever' to propel toe-off. Over-supination is very rare no matter what the resident "shoe guy" at the runner store touts! What is more common is under pronation which can occur with a rigid high arched foot.

A foot that underpronates can be prone to stress fractures because it is not able to absorb ground shock very well. A foot that underpronates needs a shock absorbing shoe. Motion control is usually not important in this type of foot; however, in some cases foot orthotics can help in supporting and redistributing pressure in the foot when a neutral cushioned shoe is just not enough.

How do you know if you need orthotics?

Between 70 and 85 percent of all people have biomechanical imperfections, yet not all these people require orthotic control.

Most serious runners who have biomechanical imperfections end up with orthotics out of necessity. The runner who runs fewer than 20 miles per week will not likely need orthotics unless they have a serious biomechanical weakness, but for the serious runner any biomechanical weakness will be magnified ten-fold, with the result being injury.

When a runner gets a series of nagging injuries one after the other, they are probably caused by a biomechanical flaw and can be corrected by orthotics. Runners who chronically suffer from knee pain, arch pain, plantar fasciitis, heel spurs, hip and lower back pain and certain types of muscular fatigue very often benefit from orthotics.

Will orthotics improve performance?

This is the ten million dollar question! Performance enhancement with the use of functional orthotic devices is an area that requires more research. In theory an orthotic which improves the biomechanical function of running should have a positive effect on running. Although there is no proof that orthotics can make you run faster, by allowing your foot and leg to function more efficiently and by reducing the chance of injury, they may indeed have a positive effect on running performance.

It is important to remember that while orthotic devices are dispensed to achieve optimal biomechanical control they must be part of a total treatment plan and they are not a substitute for regular stretching and strengthening exercises.