How to know if you need a shoe orthotic or insert

Orthotics and Foot, ankle, or knee pain

The popularity of orthotics, or running shoe inserts, is on the rise. Video analysis of running and walking on a treadmill is standard practice in most athletic shoe stores. In fact, the rapidly growing market for orthotics is expected to top $50 billion dollars by 2024. Because runners subject their feet to prolonged stress, it is critical that the foot functions correctly. Video analysis often identifies “over-pronation” of the foot when it hits the ground. Some degree of pronation is needed for the foot to function properly, however if an athlete is excessively pronating their joints and muscles can be at risk for injury. Over-pronation can stem from a number of imbalances throughout the body. It is also important to note that not all mechanics that look like pronation are true pronation. We will discuss this topic in another article about the ankle anatomy and function.

determine if an orthotic is right for you

Orthotics may help relive pain or improve performance. They can also create more problems very quickly if poorly prescribed. I will start by saying that I do not advocate correcting movement impairments with orthotics or any other equipment if a person is not experiencing pain.

For patients who have excessive laxity or instability at the ankle which manifests as a collapsed arch or rotation inward of the tibia (shin bone), orthotics can be a useful tool to relieve foot, ankle, knee, hip, and even back pain.

How to determine if orthotics might be right for you:

1. I have pain in my foot, ankle, or knee with activity

2. When I squat, my foot collapses

3. My knees cave in when I squat or lunge onto 1 leg

4. Can’t lift big toe off the ground when standing or in lunge

5. I sometimes get back pain or hip pain with increased activity

6. My friends say I walk funny

Orthotics they may not be right choice for you if the wrong type is used or the root cause of the discomfort is unknown - factors that are based on your anatomy, strength, flexibility, and activity. Inserts intentionally create a change in foot posture, which could result in unexpected mis-alignment elsewhere in the body. Alternatively, if the root cause of your injury doesn’t originate in the foot, it could create more problems. If an issue in the lower back, hips or knees impairs balance and running movement, then re-aligning the foot without addressing the underlying disorder can aggravate the condition and prevent any sort of recovery.    

Identifying the cause of pain or dysfunction

Physical Therapists are uniquely prepared to identify and correct these biomechanical issues by performing a comprehensive assessment. This includes a postural screen, movement assessment, strength and flexibility assessment, and often a video analysis of your activity. Since the ligaments of the foot cannot be “tightened” with strength training, an orthotic may be the necessary step to correcting any issues that have an impact up the leg. Through gait analysis, movement symmetry and range of motion tests, your PT will evaluate how you move as a whole. A customized treatment plan should be designed with significant consideration for your lifestyle and athletic goals. It may include therapeutic techniques and strengthening exercises in addition to, or perhaps even in place of an orthotic device.

Assessing the need for orthotics

Here are just some of the factors that a physical therapist will consider before recommending an orthotic device:     

·      Does the ankle have enough flexibility to allow the orthotic to work properly?

·      Based on shin bone orientation, will an orthotic place extra torque on the knee?   

·      Are the hips strong enough to allow a full and normal stride while walking and running?  

·      Is there damage from a repetitive stress injury that needs to be addressed as well?

Hit your pace

Consulting with a physical therapist or other medical expert before investing in an orthotic insert sold at athletic stores is always a wise choice.  At One Nine Sports Physical Therapy we can assess your joint flexibility and strength in order to determine the best plan for your needs. Happy running!

Guest post written by Corey Rovzar, DPT - check her out @cor_ophyll