Well, it’s 2020 and we are slowly emerging from a global pandemic shutdown. This is by far the longest vacation I have ever taken. As a result, I’m completing tasks that have been on my”to-do” list for quite some time. As a disclaimer, I’m a chiropractor not a writer, but I would like to answer common questions people have about custom made orthotics. Yes, it is true some people still see chiropractors as just “low back” doctors. The fact is, that as doctors of chiropractic we have a wide range of skills including adjustments of the whole body, acupuncture and custom orthotics to name a few. Hopefully, those of you who already have some knowledge about orthotics will read this and take the opportunity to try a pair earlier than you would have otherwise. For those of you that were unaware of the benefits of orthotics, my hope is that this information will lead you down a path to less pain.
What Are Custom Orthotics?
For those of you who don’t know what custom orthotics are, they are custom medical devices that chiropractors and other health care providers prescribe to help with foot, ankle, knee and low back pain. Orthotics are most commonly prescribed for medical conditions such as plantar fasciitis or flat feet. They are heel or shoe inserts that look like insoles, but are custom made from imprints of your feet. Orthotics are worn in your shoes and are designed to correct foot imbalances.
The History of Custom Orthotics
Foot problems are nothing new to the human race. People have been modifying their footwear for thousands of years, but it wasn’t until the 70’s and 80’s that custom orthotics started gaining recognition as the medical device we know today. There are numerous reasons why custom orthotics gained popularity at this time. One reason was the popularity of exercise and by association athletic shoes. As people started to exercise more they started to develop more foot troubles. Another large contributor to the popularity of custom orthotics was the acceptance of the medical community and by extension the insurance companies. With this acceptance came standards as to what is and is not a custom pair of orthotics. As this became more defined over time, practitioners such as chiropractors started to incorporate the prescription of custom orthotics into their practices. Foot imbalances have a large impact on the low back and since we are considered low back specialists we needed to incorporate treatment of the feet into our practices. Historically, we knew that changing what was under our feet, helped with foot pain. However, we didn’t know why. Today, due to a lot of research, we know that custom orthotics work by stimulating the large number of ligaments, joints and muscles of the feet.
When I look at a diagram of the feet what I see is how strong they are with a lot of robust ligaments and muscles supporting a large number of joints. The feet are designed like this to support the tremendous amount of pressure going through those ligaments, joints and muscles with each step we take over our lifetimes. As a result, anyone can develop major foot pain whether you have healthy feet or not. Foot pain can happen early in life as seen in people with joint issues like flat feet. It can also occur from traumas, age or lifestyle factors such as nurses walking on concrete hospital floors for 12 hour shifts for years. Fun Fact: Some women who have had children grow a full foot size or more as a result of the hormonal changes during pregnancy that prepare the body for delivery. As a result of these temporary hormonal changes, the ligaments of the arches relax and flatten out elongating the feet. Pretty cool, eh!
How Orthotics Helped Reduce My Foot Pain
As a former athlete, I was fortunate enough to be able to play hockey until I was 26 years old. For those of you that have put on skates enough times you know as well as I do, that they can do a number on your feet. As a result, I damaged my “transverse arch” or the ligaments that give stability to the knuckles at the balls of our feet. Over the years I had developed a bunion on my left foot that could become quite sore with exercise. When going through Chiropractic college I was discussing this with one of my professors and he suggested orthotics. About 4 months after I received and started to “wear in” my orthotics the pain in my left foot was dramatically better. Not 100% resolved but at least 50% better after exercise. So, to say that I was sold on custom orthotics was an understatement. When I graduated as a Chiropractor in 2008, orthotics became an important area of my practice because I had first-hand knowledge on how they benefited me. Our patients have had really good outcomes with orthotics as well.
How Orthotics Work
Orthotics stimulate the bottom of the feet with every step. When you walk over your orthotics, the custom modifications on the devices put pressure on various areas of your feet changing how all those ligaments, joints and muscles move and function. Some of the modifications are for support, such as support for the arch, in fact most people call orthotics “arch supports”. But the arches aren’t the only structures of the feet we can help with. Some modifications are to target a change in a particular set of joints of the feet that may be causing issues. The end result is partial or complete resolution of a person’s troubles.
Orthotics & The Kinetic Chain
Custom orthotics change how your joints move, how your ligaments hold the joints together and how your muscles fire by the millisecond. A lot of the muscles that are affected are actually part of the calf muscles. These calf muscles attach down into the structures of the feet adding support to the arch and other structures. By changing how the feet move we have an impact on the whole body because everything is connected. This process is called the “Kinetic Chain” or movement chain. Foot problems don’t only impact your feet but also your ankles, knees, low back and even all the way up your spine. In fact, I prescribe custom orthotics to a significant percentage of patients who don’t even have foot pain! I often use the following analogy with patients at the clinic. Consider your feet like the foundation of your home. If you have problems with the foundation of your house, you will likely see those problems manifest upstairs before you see problems in the foundation. You can fix the cracks in the drywall and make other cosmetic repairs but until you identify the problem in the foundation and fix it, you will continue to have reoccurring issues. These problems will continue to get worse until you fix the root cause of pain. In most cases the combination of custom orthotics and prescribed exercises are the fix to the foundation
Custom Orthotics for Runners
During chiropractic assessments people often tell me that they only want orthotics for their running shoes because they only feel pain while they are running. The pain experienced while running demonstrates a bigger issue in the feet that needs to be addressed on a daily basis and not only when running. If someone were to only wear orthotics when they run a few hours a week it could cause more issues because of the enormous pressure that goes through the feet when running. The orthotics are built to put pressure on different areas of the feet to decrease your pain. In the beginning, the pressure points can aggravate the areas creating soreness. This will go away with repeated use, but those targeted areas need time to get used to the changes before they can give you pain relief. The best way to get used to the orthotics is to wear them casually and slowly incorporate exercise when your feet are no longer sore. There is no specific timeline for this, everyone’s feet are different. Fun Fact: Running can exert pressures ranging from 3-7 times your body weight with each step. For a person of 150 lbs that is between 450-1050 lbs of pressure per step through the arch of your foot! That’s a lot of pressure!
“Breaking In” Your New Orthotics
After making the decision to purchase orthotics, the next big step is wearing them in properly. It can take a while to adjust to new orthotics. In my experience, it took roughly 4 months to “break-in” my orthotics before I could work out intensely and get the full benefit. Once you have “worn in” your custom orthotics they will fit like a glove and you will wonder why you went so long without them!
General Orthotics Wear-in Guidelines
- Wear them in casually to start. Start by wearing them for 1 hour on day 1 and increase wear by 1 extra hour each day. By day 7 you should be wearing them for 7 hours.
- If after 3-4 days you are having difficulty due to discomfort, wear them in slower. Try 1 hour for 2 days, 2 hours for 2 days, 3 hours for 2 days etc. If the pain persists, take them out of your shoes until the pain is gone and start over with the slow version.
- Don’t start wearing your orthotics for exercise until you can go a full week wearing them all day without pain. This may take up to a month for some people. Start slow and work your way up in intensity of exercise carefully.
- If at 6 weeks you are still having trouble wearing them in casually, call the office and I will get back to you as quickly as possible. We may need to make adjustments to the orthotics. Please wait until the 6 week period before making the call. Most, if not all, initial problems disappear following the instructions above.
- A new pair of quality supportive shoes is recommended but not a necessity.
- Please don’t make adjustments to the orthotics yourself.
There is no strict time frame for how long it takes to “wear-in” orthotics as everybody responds differently. However, on average it takes about 2 weeks of gradually wearing your orthotics to break them in. After about 2 weeks a person can start to wear their orthotics on more vigorous walks and finally while running if your feet tolerate them well. The best course of action is to pay attention to how our feet feel as they become accustomed to wearing orthotics. As children, our feet are soft and malleable, but as we age our feet are less tolerant of changes so it is important to listen to our body. I think it is important to note that some people exercise no problems at all during the wear-in period. They just slide the orthotics in their shoes and skip through the wear-in period quickly, experiencing only the benefits.
Are Orthotics Good for Everybody?
From my experience, roughly 35% of people experience a complete resolution of issues with orthotics. About 60% of people that use orthotics will experience a partial resolution of signs and symptoms, similar to what I experienced. Only about 5% of my patients have not experienced relief with orthotics. There is no particular reason why some people don’t respond well to them and unfortunately, there is no screening tool to help determine if you will like them or not. That said, after about 6 weeks (with proper wear in), 95% of people feel better with orthotics. We hope this has answered some of the questions you have about custom orthotics. If you have specific questions or would like an assessment, please contact the office and we would be happy to help.
All the best in health,