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Tuesday, September 5, 2017

Can I wean off my full time use of Orthotics?

Hi, Dr. Blake!

I've been reading your book and need your advice. 

Long story short, I have been wearing orthotics pretty much all the time (even stay In my shoes at home) for about a year and a half.  I went to see a PT for bilateral knee pain and he told me my feet were causing a dysfunctional gate cycle leading to overall tightness and knee pain.  He took a mold of my foot and sent them to a sports podiatrist he works within Iowa that made me some orthotics.  He also said that there was really no workaround for me with regard to improving foot function on my own and I pretty much-needed orthotics 24/7 for me to move correctly.  They do make a drastic difference with regard to the knee pain and tightness but I still have some issues and am questioning some things, specifically that my foot is structurally so messed up like he said it was.

I have attached the sheet rationale for the PRI orthotics that I received if you have interested in reading it.  The PT said the human foot was not made to function on flat ground like concrete and functions better on undulating terrain which the orthotics provide and also keep me from overpronating by stabilizing my left heel when I walk which allows me to push off my toe instead of pronating.  He said when my foot over-pronates when I walk (mainly the left one) it anteriorly tips my pelvis and basically throws me out of alignment and puts me in a bad position for when I start lifting or try to work out or lift weights. 

I've been active my whole life and never had knee pain until I started dental school where I was sitting the majority of the day and was forced to wear dress shoes.  This is in contrast to my previous 7 years as a personal trainer walking around all day in athletic shoes. I always had insoles that my podiatrist made because I would get pressure calcifications I would have to go have picked out but I never had any biomechanical issues like what started a few years ago.  Obviously, I don’t want to have to keep wearing my shoes all the time for the rest of my life, as that doesn't seem like a fix IMO.  I’m not sure if my left foot overpronating is due to a handedness pattern type thing or if I really have developed an alignment issue, maybe an x-ray would help this or show if I had an alignment issue?

What direction should I take from here to fix my feet?


Dr. Blake's comment: I have found that moderation with the use of anything is normally best. Some use of orthotics when you need them for activities, some walking without orthotics, and some barefoot is normally a great recipe. You could take some photos of your feet standing, especially looking from the front, looking towards the back of the heel, and then the arch from the side. Best to have another take these so you can normal with your feet firmly on the ground.
     One of the keys to great feet is strong feet. My blog is filled with information on strengthening the intrinsics with met doming, the Achilles with 2 positional heel raises, and the arch with single leg balancing and theraband work for the posterior tibial tendon and the peroneus longus. You will find as your feet get stronger there is less need for orthotics and the most stable shoes. I said less need, not no need!
     Various types of orthotics give different support. Various types of shoes give different support. Various types of activities need different support. So, this is a lifelong challenge of all of us wanted to stay upright and exercise. What do I need to protect my feet and still participate at a high level? Many use pain as their guide, many have such a high pain threshold that they have to use educated guesses.
     Besides strengthening, the tightness you mentioned may play a major role in symptoms. Almost everyone should be on a daily regimen of Achilles, quadriceps, hamstring, iliopsoas, and low back stretches. These should take 5-10 minutes to do before and after your workout, never with pain, and done at least once on your rest days. If you find tightness, stretch 3 times a day until it resolves. If you find you are tight on one side of your body more than another, stretch that tight side 50% more than the looser side. 
     I hope this gives you my general philosophy. Next time you see the physical therapist ask for a lower extremity tightness and weakness evaluation so you can know the pattern in your body and can work to fix it. Good luck. Rich
     

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.