If your feet hurt, it may seem a simple solution to purchase an over-the-counter orthotic device—the shoe inserts that come in various shapes and sizes and promise to relieve your aching feet. But the orthotics displayed in your local drugstore may not help and may even cause more problems, say local podiatrists.
Opinions vary about the potential harm an over-the-counter orthotic shoe insert can cause, but experts agree that you’re better off to seek professional advice about the underlying cause of foot pain.
“It should be noted that the machine that is available in some stores to help people evaluate which insert maybe best for them without the guidance of a professionally trained individual can be misleading and result in being matched with an inadequate insert,” says Dr. Alissa Duncan, a podiatrist with Foot Healers. “Guidance for choosing the proper OTC orthotic devices should be done with the assistance of a trained professional, such as a podiatrist, who can help determine the foot type and which device should be purchased.”
Although Duncan does not believe using an inappropriate orthotic will cause lasting damage, Dr. Michael Horwitz, a podiatrist with Feet for Life Podiatry Centers, disagrees by saying, “Orthotics weaken feet 100 percent of the time,” he says. "This is the trade off. Do you want weaker feet?” he asks. “Read the book, Born to Run, by Christopher McDougall. Or just go online and visit the minimalist shoe websites. Once you learn the truth about orthotics, you may want to get a few more opinions from professionals who understand the reasons why they can cause so much harm.”
Horwitz considers orthotics ‘convalescent devices.’ “Advanced arthritis and severe dysfunction of the posterior tibial tendon are good reasons to have orthotics. Older people that are sedentary do fine with them. But a younger person with a normal arch can be made much worse with orthotics use,” he says.
Not everyone is a candidate for orthotics, agrees Dr. Steven Frank, a podiatrist on staff at Missouri Baptist Medical Center. “But many people can benefit from them,” he notes. “If you are having pain, aching or fatigue in your feet; if you have pre-existing or developing foot or toe deformities; are significantly overweight, are diabetic, or have other certain skin lesions, you might benefit from orthotics.”
Frank also agrees that professional assessment is the best route for determining if orthotics are needed and choosing the best type. “Improperly fitting or sized orthotics can make some conditions worse, or even cause sores or blisters that could lead to infections,” he says. “We base orthotic prescriptions on the given conditions, age and weight of patient, type of shoe-gear utilized, and various co-morbidities, such as diabetes, neuropathy or poor circulation. For instance, diabetics will typically need a softer, accommodative orthotic to offload pressure or callus points and prevent sores on the feet. Younger patients may need a more rigid device to help correct alignment or deformities.”
Duncan notes that like shoes, orthotics must be broken-in slowly. “Your body needs time at first to get use to this new ‘foot posture.’ ” she says. Orthotics should only be worn no more than two hours the first day, with wear time slowly increasing over a couple of weeks. “If an individual overuses the orthotics during this break-in period, they may develop discomfort, blisters, or back, hip, knee or ankle pain,” she adds.
So pause before you carelessly slip any old orthotic into your shoes. Duncan sums up: “By seeing a properly trained individual before purchasing custom-molded or OTC orthotics, an individual will be able to make a more informed decision so that they can continue their daily activities without any discomfort.”