There are a number of reasons why it make sense to consider using custom orthotics as a tool for managing foot pain, plantar fasciitis, heel pain, ankle pain, knee pain, hip pain, and even back pain. There are reasons several reasons why it makes sense to consider the extra cost of custom orthotics over shop bought insoles. There are also deeper reasons why the topic is even worth talking about in the first place.
The terms orthotics, insoles, arch supports and shoe inserts are all terms that are used interchangeably, all refer to supportive devices that go in a person’s shoe.
Custom orthotics are professionally made devices that support the feet of the specific person they were made for. The terms insoles & inserts refer to generic, non specific arch supports. The common aim of custom orthotics / insoles / shoe inserts is to provide some form of protection or support to the foot.
Custom orthotics / insoles / shoe inserts provide support and protection not only to your foot, but your entire skeleton, including your spine. Insoles and shoes inserts all have the potential to improve your alignment during weight bearing activities and reduce strain in the joints and soft tissues.
‘Custom Orthotics’ are usually pretty easy to distinguish from off the shelf insoles and shoe inserts. At a glance it is usually possible to tell that a custom orthotic is quite a different product. Custom Orthotics have an arch height and general design specifics tailored to your individual foot. Custom Orthotics also have heel control specific to your foot, and there are further modifications to custom orthotics that assist with individual needs for shock absorption and support of the bones in the forefoot.
While there are aspects of their manufacture that utilise machinery, orthotics are essentially a hand made product. Most times when you see custom orthotics it is kind of obvious that this is the case.
Insoles / Shoe Inserts
Insoles or shoe Inserts that are usually purchased in a shop ( we sell high quality ones at our clinic fyi ) tend to look more like a ‘product’. They often come in a box or a package and have a more colourful and generic appearance. In most cases the primary benefit of insoles and shoe Inserts is that they provide some shock absorption as opposed to full structural support of the arch. There are however some Insoles and shoe inserts that provide more support, and those are generally the stiffer ones.
Custom Or Not Custom?
As is the case with most things in life that matter. There is some debate over whether it’s better to spend the extra money and purchase custom orthotics or not. On the one hand, there are those who maintain that you can get sufficient support from a cheap shop bought insole. And on the other hand, there are those who maintain that their experience has been that custom orthotics are more effective at reducing pain and improving alignment.
In a strong sense this custom orthotics vs insoles debate is a bit of a red herring. The reason for this is that it implies there are only 2 options to be weighed up. The actual reality of the debate however, is that there’s a broad spectrum of potential different styles and materials involved with custom orthotics, and also with insoles. It’s like debating a preference for Italian food vs Indian food, all the while pretending that all Italian food is pizza and all Indians food is naan bread…. there is a bit more to that debate than pizza vs naan.
Our experience has been that badly made generic insoles offer nearly no support, and no benefits in terms of pain relief. A high quality generic insole that has a bit of strength to it, can however be quite helpful with reducing pain and improving alignment.
On the other hand we have found that poorly made custom orthotics will tend to be much too large, too stiff and ‘over corrective’. This frequently leads to it being uncomfortable for the patient to wear in their shoes. These kind of custom orthotics frequently end up in the back of a drawer.
In contrast to the options outlined above. A well made, custom orthotic prescribed to fit with the movement of the persons foot, that’s not too stiff, not too flexible, is made of the right materials, and has the right modifications in the right places; will often be completely life changing for a patient with stubborn pains.
Well made custom orthotics do outperform well made generic insoles, badly made custom orthotics on the other hand frequently do not outperform quality generic insoles. That’s been our experience over the past 2 decade anyway.
History & Environment
It is an inescapable fact that humans did not evolve to walk on hard flat surfaces. If you spend time out in nature away from ‘man made’ surfaces including tracks and the like, the ground is almost never hard and almost never flat. Your hunter gathering distant grandparents lived in the big outdoors with their feet in the mud, that lifestyle accounts for 99% of human history.
When your human heel strikes sand, soil, grass or leaf litter it sinks into the ground, when your human foot presses flat onto the ground in preparation to push off the ground hugs your foot throughout their entire process. On the other hand, when you walk on industrially fabricated surfaces like concrete and paving slabs there is no shock absorption whatsoever, and certainly no arch support. This is a big part of why we are so dependant on shoes in the modern world, shoes provide some protection from the ground hardness of our cities..
Consider jumping a few metres down from a seawall onto sand in bare feet.. it can be kinda fun. Now consider jumping from the same height down onto a pavement in bare feet.. not so much fun. These observations are glimpses of how different our urban surfaces are from nature. To fully grasp their significance though we need to acknowledge that we take between 3 & 6 million steps on these hard surfaces every year of our lives.
We have gone from walking on natural surfaces, to walking almost exclusively on hard, flat urban environment in about 3 generations. This change in our environment opened up the door for chronic repetitive strain in our feet, legs and lower spine in a seriously big way.
The sudden change from soft uneven ground to hard flat ground. is the single biggest reason that so many people need custom orthotics. Custom orthotics hug the arch and support the heel in the same way nature once did. There are those who believe that this benefit can go as far as slowing or even preventing arthritis
It has been estimated that we are on average we are only engaging in about 20% of the amount of physical activity that our grandparents did. It may be that we only do 10% of what those hunter gatherer grandparent did. The human body is a vessel that was designed to hunt its own food, make its own shelter and avoid real life dangers with teeth. The tasks involved with human survival would have often meant many hours of vigorous physical activity each day.
There is a price to be paid for muscle weakness and muscle wasting that goes beyond a lack of athletic performance. Skeletal muscle tissue is obviously involved in movement, it is every bit as much involved in maintaining posture and preventing damage to our joints and connective tissues.
It could be argued that it’s our lower bodies that pay the greatest price for all this muscle weakness because they bear the weight of the upper body when we are moving. Being weight bearing structures, the joints in the lower half of the body are more exposed to the extra strain associated with muscle weakness.
A clue to the amount of strain your lower body sustains compared to your upper body is the size of your knee when compared to your elbow. Despite being the equivalent to a ‘leg elbow’ the knee is many times larger, because of the crazy amount of weight bearing it does. This is a clue to how much more scope for strain there is in the leg, if and when our muscles aren’t strong enough.
Custom orthotics assist with sedentary type muscle weakness in the lower half of the body in 2 ways….
The 1st way custom orthotics can help you with muscle weakness you may have in your legs is by stimulating special nerve activity called ‘proprioception’ in your foot. Flexible custom orthotics hug the arch of the foot & act as a natural stimulus to the nerve cells in the arch of the foot. Proprioceptive nerve receptors within the arch help to activate the bodies postural muscles, not only in the leg but the spine too. This is often clearly visible, in the form of immediate improvements in balance while standing on one leg with orthotics in.
The 2nd way custom orthotics help us with sedentary muscle weakness is by providing extra postural support to the foot. Remembering that our feet evolved to interact with flexible surfaces, it only makes sense for our feet to have that kind of support. The need for this support is greater if the ‘postural’ muscles in your legs are weakened by spending a large part your life in an office.
Their ability to stimulate nerve activity in the foot and their ability to provide natural support, are the reasons behind so many people find orthotics reduce their foot pain, plantar fasciitis, ankle pain, knee pain, hip pain & back pain. Improvements in mechanical function leading to reductions in pain.
As we have been recalling your hunter gathering grandparents lead very different lives to you. They didn’t live in warm dry houses, they didn’t have address to modern healthcare and they did have to contend with far more unpredictable environments. The combined risks of starvation, sickness, dismemberment and massive injury meant that they didn’t live anything like as long as you and I.
It has been estimated that the average life expectancy for much of human history was 40 years or even less. We have done such an excellent job of ‘engineering’ so many of the variables out of our existence that we live almost twice as long. Living for twice as long means we need our joints to last for twice as long.
If you need anything to last a long time it makes sense to look after it as best you can, sometimes that means cleaning it regularly or replacing parts, if it is something that cannot be cleaned or replaced ( like a knee joint ) it makes sense to minimise its exposure to stress. Custom orthotics minimise exposure to stress in the joints of the lower body, this is part of how you play the long game when it comes to mobility and pain. Ideally in combination with carefully chosen, long term exercise prescription.
The Biggest Why Of All
As you can hopefully see, there are many reasons why it makes sense to consider custom orthotics as a tool for managing issues like foot pain, back pain and knee pain. The real ‘Why’ behind the consideration we give tools like custom orthotics is something far deeper that forms a part of our inner & outer world for each of us…freedom.
Freedom is one of the core concepts that guides our sense of happiness and our quality of life. So many of our greatest fears revolve around the loss of freedom. Being really sick is a loss of physical freedom… scary! Being buried alive is a loss of the freedom to move and breathe… scary! Our ultimate punishments are imprisonments and death.. both pretty major losses of freedom I think we could say… scary!
A few steps removed but nonetheless fundamentally identical to these more obvious threats to your freedom, are the losses of freedom that come with pain & loss of joint mobility.
Not being able to engage in the activities you love is a loss of freedom. Not being able to connect with others the way you would like to because you have pain is a loss of freedom. Not being able to walk or run as far as you would like to is a loss of freedom. Even being able to sit comfortably and sleep comfortably are basic forms of freedom that we hold dear, often without realising until they are lost.
Any tool that millions claim to have used successfully in supporting these forms of freedom is worth your consideration.. why? Simply because being able to move without pain is so important to you. Custom orthotics have the additional bonus’s of being supported by a good deal of scientific data, being safe; being non-invasive and being hugely cost effective in bigger scheme of healthcare costs.
Custom orthotics do not guarantee the maintenance of your pain free physical freedom, far from it. There is a lot more to managing knee pain, back pain, plantar fasciitis etc than simple putting orthotics into your shoes and sprinting off into the sunset. Custom orthotics are however a key tool in the completion of that job for many of us, to the point where they have often been mistaken for a magic bullet, due to the huge relief from pain that they can bring.