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Cropped photo of the lower legs of a person wearing athletic shoes and walking outdoors
Cropped photo of the lower legs of a person wearing athletic shoes and walking outdoors
Cropped photo of the lower legs of a person wearing athletic shoes and walking outdoors

by Adam Brown
updated July 16, 2020

Foot orthotics are a very common way for people to address a variety of painful issues. They can be effective when matched with the right patient and made by an experienced and skilled clinician. Many people ask: How do orthotics really work to relieve pain? While there is plenty of debate on the subject, here is our view of how an orthotic works.

1) Amping up the feedback

Imagine walking barefoot through a field of grass when the arch of your foot comes in contact with a smooth rock on the ground. Because this is a sensitive area, your foot’s immediate response is to activate the muscles in your foot and lower leg to avoid any extra pressure on your arch. A well-made orthotic takes advantage of this mechanism by contacting the arch of your foot (in a comfortable way) that can change the muscle activity of your foot and lower leg. This change in muscle activity then changes the movement pattern of your foot and lower leg, which, in turn, reduces stress on injured tissues.

2) Posting

Posting refers to the ways that a technician changes the angle of the heel and forefoot portion of the orthotic. By making the inner side of the orthotic thicker, it can help to prevent the foot from pronating (rolling in). The goal is to post the orthotic enough for the subtalar joint to bear weight in a relatively neutral position rather than spending most of its time fully pronated, which places increased stress on soft tissue structures and often becomes painful.

3) Additions/Modifications

These refer to all of the things that we can add or take away from an orthotic to address a patient’s specific problem. For example, we often add a metatarsal dome, which is a gel-like bump. These are usually placed under the forefoot to spread out the metatarsal bones and help to create room for the nerves that run between them. This addition may be used to treat symptoms of a Morton’s neuroma. Aside from metatarsal domes, there are endless additions and modifications that can be made to an orthotic. A skilled clinician can choose which are appropriate to address the problem that the orthotic is meant to help solve.

This post may generate a healthy debate among the various types of clinicians who make orthotics. The reality is that the research is not yet complete. The points outlined above are what we at Cornerstone feel are the ways that an orthotic can help a painful condition. We do not advocate using orthotics in the absence of a painful problem for “prevention”. We feel the body comes in many shapes and size, and if it’s not broken…well you know the rest.

Adam Brown

Adam Brown        MClScPT
Registered Physiotherapist

Adam has been practicing as a physiotherapist since 2002 and has helped countless patients with their foot and lower extremity issues, through fitting and dispensing orthotics to educating and teaching rehabilitation exercises. He regularly mentors other physiotherapists on the proper application of orthotic devices.


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