It is common for many in the medical community to recommend an orthotic for those dealing with foot pain under the assumption that they need to support the foot. Unfortunately, this approach does not address the root cause of the problem. More often than not, it is the shoe that is at fault.
But for a moment, let’s discuss the idea behind arch support. Podiatrist Dr. Ray McClanahan explains that the misconception stems from our poor understanding of how arches truly function.
Ask yourself this question, “What is the weakest point of a bridge?”
The answer depends on the architecture or design. For example, if the bridge you envisioned was an elevated flat road between two pieces of land, the middle portion that is unsupported would be the weakest. An arched bridge on the other hand uses a curved structure to distribute the weight from the center outwards towards either end. Rather than have a single weak point, the entire structure works together to hold itself up. For this reason, the arch bridge is far stronger than the traditional “beam” or straight bridge and why your feet are designed with an arch of their own! This ingenious design allows our body to efficiently support a ton of load (whether we’re carrying a backpack, pushing a sled, or trying to squat 800 pounds).
An engineer will tell you that the strength of an arch depends on the support structures on either end of the curve. So, if you want an arch to remain in place (whether that arch is supporting a bridge, the historical roman aqueducts or the famous St. Louis Gateway Arch) you focus on the ends. Simple physics.
If we apply this same logic to our feet, it would make sense to support the ends of our arch (the heel and forefoot joints) in order to strengthen and enhance its capacity/function. However, this is not at all what traditional orthotics are designed to do. Rather they attempt to prop up our arch by lifting from the middle.
Now this isn’t to say that current “arch supports” (like the Dr. Scholl’s inserts you can find at most drug stores) aren’t helpful at all. There are some that do get a small amount of pain relief from their use. However, we must understand they should only be a temporary intervention.
Think about it like this, you wouldn’t wear a cast for a broken bone in your hand forever. Of course not! After a short time of wearing it, the muscles of the arm would begin to atrophy. The same goes for how orthotics affect your foot. Long term use of these “supports” do nothing to treat the cause of many foot problems. Doing so will only lead your foot muscles to atrophy and lose strength over time.1
If traditional “arch supports” are not a real solution for most foot issues, let’s talk about what is. The idea of reinforcing the ends of the arch to increase its overall strength is based on the assumption that the ends of the curve are on even terrain. However, most current footwear do not hold the foot in this manner (the heel and toes are often both elevated from the ground). Therefore, the only way to establish true “arch support” is to ditch modern shoes and return the foot to its natural position with the heel and toes completely flat on the ground (this means wearing a shoe with a heel-toe drop of zero). In doing so the heel and “ball of the foot” along with the toes will be in a position to provide authentic support for the arch as they were designed.
Now some of you reading this will be wondering, “But my doctor said I need orthotics because my arch is too high (or too low)!”
While there is a very small percentage of people who have foot anatomy that requires orthotics, arch height (or lack thereof) is not a determining factor in foot health for a large majority of people.2
It’s all about how the arch functions, not its appearance!
Having “low arches” does not automatically lead to foot problems. Having low arches that are weak however can. Therefore, many who believe they have “flat feet” generally just have very mobile/weak feet.
Having “high arches” does not automatically lead to foot problems either. Having high arches that are stiff however can. Those with high arches generally tend to have more rigid feet and would therefore benefit from being barefoot more often to allow their feet to move and function as they were designed.
You have to understand that for most of human history we have survived just fine without shoes (or with very thin shoes shaped like feet) without anything supporting the arches of our feet. This is why those who live in cultures around the world today who do not regularly wear shoes have significantly healthier feet than those of us in industrialized countries that constantly wear “modern” footwear. 3-16
Maintaining a healthy and pain-free foot is in large part determined by how your arches function and move, not in how they look. While orthotics can work for a small minority of people, the overwhelming majority of us don’t need them! Most people are better off addressing the root cause rather than stuffing an orthotic into their shoe hoping for the best.
For most of you reading this, we need to take a different approach to orthotics. After modifying your footwear, I highly recommend using a toe spacer (also called a toe wedge, bunion splint, or foot-toe orthotic). While there are a few different options available today, the “Correct Toes” toe spacer developed by Dr. Ray McClanahan is my favorite (this is actually the pair I wear everyday). The thing that sets this product apart from others is that it’s designed to be worn when weightbearing (walking, running, etc.) rather than at rest.
A toe spacer orthotic spreads the toes and help realigns the foot back into its “natural position.”17,18 Think of these spacers like braces many wear on their teeth but for your toes (they teach your body how to adapt to a different and more optimal orientation). This kind of orthotic therefore is not designed to support the foot but rather allow the muscles, tendons and bones of the foot to function in a more optimal manner. Wearing toe spacers while you move throughout the day allows you to enhance the capacity of your foot muscles with minimal need for any isolated strength work. In fact, research has shown their use to help enhance balance in as little as four weeks!19 I personally have worn “Correct Toes” since 2019 and have seen a massive change in the shape and function of my feet.
That’s it for today’s blog article! Next time we’ll discuss whether or not a cortisone shot is a good idea for dealing with plantar fasciitis!
Until next time,
Dr. Aaron Horschig, PT, DPT, CSCS, USAW
Dr. Kevin Sonthana, PT, DPT, CSCS
- Protopapas K, Perry SD. The effect of a 12-week custom foot orthotic intervention on muscle size and muscle activity of the intrinsic foot muscle of young adults during gait termination. Clin Biomech (Bristol, Avon). 2020 Aug;78:105063.
- Hegedus EJ, Cook C, Fiander C, Wright A. Measures of arch height and their relationship to pain and dysfunction in people with lower limb impairments. Physiother Res Int. 2010 Sep;15(3):160-6.
- Sim-Fook L, Hodgson AR. A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. J Bone Joint Surg Am. 1958 Oct;40-A(5):1058-62.
- Hoffmann P. Conclusions drawn from a comparative study of the feet of barefooted and shoe-wearing peoples. The American Journal of Orthopedic Surgery. 1905;s2-3(2):105-136.
- James CS. Footprints and feet of natives of the Solomon Islands. The Lancet. 1939;234:1390-1394.
- Shine IB. Incidence of hallux valgus in partially shoe-wearing community. Br Med J. 1965;1(5451):1648-50.
- Shulman SB. Survey in China and India of feet that have never worn shoes. The Journal of the National Association of Chiropodists. 1949;49:26-30.
- Mafart B. Hallux valgus in a historical French population: paleopathological study of 605 first metatarsal bones. Joint Bone Spine. 2007 Mar;74(2):166-70.
- Mays SA. Paleopathological study of hallux valgus. Am J Phys Anthropol. 2005 Feb;126(2):139-49.
- Swallow A. The history of shoes. Baillieres Clin Rheumatol. 1987 Aug;1(2):413-29.
- D’AoÛt, K., Pataky, T. C., Clercq, D. D., Aerts, P. 2009. The effects of habitual footwear use: foot shape and function in native barefoot walkers. Footwear Science, 1(2):81–94.
- Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br. 1995 Mar;77(2):254-7.
- BARNETT CH. The normal orientation of the human hallux and the effect of footwear. J Anat. 1962;96(Pt 4):489-494.
- Kato T, Watanabe S. The etiology of hallux valgus in Japan. Clin Orthop Relat Res. 1981 Jun;(157):78-81.
- Hollander K, de Villiers JE, Sehner S, Wegscheider K, Braumann KM, Venter R, Zech A. Growing-up (habitually) barefoot influences the development of foot and arch morphology in children and adolescents. Sci Rep. 2017 Aug 14;7(1):8079.
- Thomas B, Singh YL, Mullerpatan RP. Comparison of foot structure between urban and rural Indian school children. Physiother – J Indian Assoc Physiother. 2019;13:38-42.
- Tang SF, Chen CP, Pan JL, Chen JL, Leong CP, Chu NK. The effects of a new foot-toe orthosis in treating painful hallux valgus. Arch Phys Med Rehabil. 2002 Dec;83(12):1792-5.
- Kwan MY, Yick KL, Yip J, Tse CY. Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysis. BMJ Open. 2021 Aug 18;11(8):e047273.
- Kelly A, Stanek J. The Impact of a Foot-Toe Orthosis on Dynamic Balance: An Exploratory Randomized Control Trial. J Sport Rehabil. 2020 Sep 1;29(7):871-878.