When Custom Orthotics Do More Harm Than Good

If you recognize that you need to learn about custom orthotics and are looking to fill the gaps, I wrote this for you.

If you found your way to this post because your new custom-made orthoses are hurting your feet, I also wrote this for you.

Do you have a friend or family member who doesn’t know custom orthotics increase compensation and fragility?  If you do, please share this post with them.

As you might imagine, not long after this post was originally written, the experts who regularly sell custom foot orthoses were not happy about it.

After discussing my post in their online meeting place called Podiatry Arena, I have had many painful interactions with the practitioners who regularly sell custom orthotics.

Painful because none of the orthotics enthusiasts were willing to engage in a conversation that included the principles of human function or the science of biomechanics.

“Biomechanics is an exact science, it’s our powers of understanding the science that’s limited.”

— Tom Purvis, Physical Therapist and Owner of the Resistance Training Specialist Program

Since writing this post in 2016, the common thread throughout my interactions with custom orthotics enthusiasts was their claim that their version of orthoses was superior to the rest.
Then they would substantiate their claims with the time-tested and forever flawed years of experience argument.

Bruce’s tweet is an example of first-layer knowledge. The truth is most running shoes are overly supportive and guide your foot without custom orthotics (hint, hint).

Nonetheless, whether you are running or walking on planet Earth, the stance phase of your gait cycle occurs right after your entire foot makes contact with the ground. Therefore, when custom orthotics are underfoot, your foot has nowhere to go except out (supination).

As for Bruce’s notion that foot orthotics can be “prescribed correctly,” that is not possible.

And whether you have pain or you don’t, your feet are weaker for all of it. 

3 / Custom orthotics force compensation and add undue stress to your muscles, ligaments, and joints.

The man in the above image had bowed legs, to begin with. Then, a chiropractor sold him custom orthotics.

Because he had back pain, the chiropractor thought the foot orthotics would align his feet. And the alignment of his feet would help to keep the rest of his body in alignment.

Orthotics enthusiasts need to think again.
Twenty-five percent of the muscles in your entire body are located throughout your feet. Circling back to how pronation is defined, the last thing you want is for all of those muscles throughout your feet to not be able to take advantage of the different directions of motion that occur simultaneously.
To say the same thing differently, the last thing you want is for the muscles located throughout your feet to not be able to control the simultaneous motion that naturally occurs when the ground punches your feet from below.
The first image is proof that his right leg could not be more misaligned.
Unfortunately, the decision to choose “alignment” over motion came from a combination of first-layer knowledge and a cognitive bias.
[Sidebar: when a person has bowed legs without custom orthoses underneath their feet, a trained professional should recognize the patient has a lower extremity that is starting from a position of supination (a.k.a., turned out). By adding custom orthotics to a lower extremity that is already supinating, there’s only one direction for this man’s lower extremity to move, which is to turn out further.

 It took twelve sessions of hands-on therapy to achieve what’s shown in the second image.] 

Not knowing what he didn’t know, he used those pebbles for ten years. The first image was taken on the day he stopped wearing custom orthotics. The second image was made possible when his brain recognized that muscles were capable of providing stability.

To achieve the outcome shown in the above image, I recommended a flat, flexible athletic shoe that allowed his feet to control his shoes.  In other words, rather than walking with athletic shoes that controlled his feet, his feet were in an environment that allowed his feet to control his shoes.
Science has shown that our brains are, in fact, plastic. And with the right inputs, our brains can undergo significant change at any age. That’s right, even after nine back surgeries and using custom orthotics for over ten years, our brains can recognize stability.

Has a practitioner told you that you are compensating? The truth is compensation is cumulative.
Most practitioners spend their days addressing symptoms. Because of that, the reality is you are compensating for every injury you have ever had (hint, hint).
For example, if you sprained your ankle at some point, it’s doubtful you worked with a practitioner with second-layer knowledge. Of course, it’s possible you felt better and stronger. Nonetheless, in most cases, the experts do not think about restoring the function of your muscles prior to performing the one-size-fits-all exercises and stretches. And yet, you were released from rehab.

Custom orthotics stack compensation upon compensation.

To get more second-layer knowledge as it relates to running shoes, listen to my interview with Jenn Schwartz, the host of Think Fit. Be Fit.  Podcast.

Are you a pronator? You could be an overpronator. Or maybe, you are a supinator or underpronator?

When you don’t know what you don’t know, it is extremely difficult to recognize the pseudoscience that goes along with overly supportive running shoes and custom orthotics. Again, pronation is normal. As it turns out, supination is also normal.  (Pun definitely intended.)

[ Sidebar: the person leading in the above image is walking with broken-down shoes that force his left foot to overpronate. So, in this case, it’s more about the condition of his footwear than it is about his foot overpronating.

As for the guy who is trailing behind, his foot is also overpronating. The difference is his foot is adjusting to the angle of the ground. And that is what the human feet are designed to do. For that to happen, your feet have to control the shoe (not the other way around). ]  

When it comes to understanding what your body is taking on with custom orthotics, it’s helpful to understand the complexity of pronation and supination.

There is a shorter explanation. The short version is pronation involves motions that allow your feet to go with gravity.

For example, if you actively flatten your arch, your foot is going with gravity. Now, imagine what that would look like when your feet collide with the ground on every step.

When your arch is right up against an orthosis, how much space does your foot have to travel then?

Answer: Your feet have nowhere to go but out. Supination is the term used to describe what is occurring when your feet roll out. Supinated feet are going against gravity. Like pronation, supination involves three directions of motion that occur simultaneously.  

When you use orthotics, your feet end up going against gravity. In other words, your feet supinate at a time when they should be initiating shock and going with gravity. All because the orthoses enthusiast’s thought process is to drive your feet away from the pain.

The truth is you are better off not making it through the “break-in” period.

Now, let’s pretend you have some air space between your arches and the ground. Because orthotics enthusiasts sell what they sell, they choose to bring the ground up to meet your arches. This, without knowing what any of the hundred muscles below your knees are capable of providing.

How much room will your feet have to travel then?

Answer: Your feet have nowhere to go but out.  

Now, let’s pretend you’ve been told that you overpronate. But, your navicular dropped on one side, and you’re experiencing pain in that foot.

Of course, it’s customary to sell custom foot orthotics in pairs.

So that begs the question, how far does your foot with no pain have to travel?

Answer: The foot that was not painful before custom orthotics has nowhere to go but out.

Before recommending custom orthotics, practitioners regularly recommend the same old calf stretches.

Coming straight out of surface-layer knowledge, those same calf stretches have been shown to reduce the strength of your posterior calf muscles (a.k.a., your plantar flexors).

Stretching your calf muscles makes your feet less responsive to the ground. So no matter how therapeutic stretching feels at the time, your posterior calf muscles are weaker for having done it.

Whether you realize it or you don’t, calf stretches also put more stress on your plantar fascia.

Calf stretches encourage more sales of custom orthotics.

Most practitioners are ignoring muscles. Given enough time and frustration, you can feel like you have tried all there is to try.

The truth is plantar fasciitis is less about pronation and overpronation.

Instead, plantar fasciitis is caused by the muscles’ inability to overcome gravity at the right time, i.e., supination.

Stretching, Cortisone injections (aka., steroid injections), and custom orthotics all have one thing in common—they increase fragility.

Whereas when your trunk and spinal muscles’ ability to contract is on point, your weight will be distributed differently across your feet. In a good way! So without touching your feet, there will be a noticeable improvement in how your feet feel.

And if they still have lingering pain or muscle tightness, I can address muscles throughout their lower leg and foot.

4 / Pain science tells us pain is an output of our brains. So when you are dealing with plantar fasciitis or orthopedic conditions not requiring surgery, where you feel the pain is not a green light to address the local area.

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The Loudest Voice In The Orthoses Enthusiasts Forum Had This to Say About My Article on Custom Orthotics

1 / “He has no evidence to support his claims (if you are going to make such claims, then the onus is on you to come up with the evidence)” 

If you read the six reasons to avoid custom foot orthoses, you have all the evidence you need.

2 / “The actual evidence contradicts the claims (which he obviously has not even read!; yet still writes on the topic!”

If you don’t sell custom orthotics, the first reason on the list is enough.   

3 / “He just makes stuff up and wishes it was true (wishful thinking fallacy)”

“For every action, there is an equal and opposite reaction.” – Sir Isaac Newton

Unfortunately, critical thinking is not encouraged at any level of education. Not only that, it’s human nature to keep one’s best interests first.

For those reasons, you are better off not putting the practitioner who regularly sells custom orthoses on a pedestal.

Instead, recognize that the practitioner who wants to sell you custom orthoses is human too.

Can’t get to Dallas?  Get details on how you can work with me from home.

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