Foot pain can be relatively common (see below). People with foot pain, flat feet, or other foot issues often end up with orthotics to support their feet.
There is often some benefit in seeing a podiatrist, or another foot experience therapist, for orthotics. However this may not always be your best OR only option.
Orthotics will likely support your feet, but may not necessarily change your pain or how the muscles in your feet function. They mostly affect your foot alignment when your feet are flat on the ground during standing, or at the middle of the stepping phase (see the midstance picture below).
Orthotics isn’t likely to make a huge difference to your foot’s ability to absorb shock during the ground strike of walking/running/hopping. They also don’t make a large difference to force generation during foot push off.
- Walking 2. Running
The muscles in and around the foot play a big role in the way the foot and ankle function, and are important to consider when someone has foot pain. In most cases using orthotics does little to return muscle function, but may help with pain and alignment.
A general example of why orthotics may not be the only or best option, is if we consider someone who has a knee control problem that’s causing excess twisting and pain. If this person is given crutches and doesn’t use their knee, then most likely their knee won’t hurt.
However, this doesn’t correct the control problem that’s causing their knee to twist. And it probably doesn’t help them if they don’t use their crutches (or similarly don’t wear shoes with their orthotics in, or shoes at all).
In the knee example strengthening the muscles in and around the knee is crucial to return the knee back to better function (see real life example later in this article) and not simply using crutches, as may be the case with some foot conditions and “just getting orthotics”.
The foot and ankle complex is made up of many muscles. These muscles influence both foot posture, and the ability of the foot to generate the force needed for standing/walking based activity.
The muscles are located both in the foot (see image below), and outside in the leg/calf with tendons running into the foot. All these influence how we move, and can be targets for treatments other than orthoses.
- Bottom of foot 2. Inside (arch) of foot
As with orthotics, improving foot muscle function with exercises can also change how other pain sources in the foot are irritated, such as in the case of nerve irritation in tarsal tunnel syndrome (image below) OR a repeated ligament strain injury.
As suggested above, orthotics could be combined with a range of exercises to improve foot control and strength, and modulate pain (reduce). Other additional treatments could include hands on treatment, foot/ankle taping to perform a similar role as orthotics and provide alignment support, or any mixture of these.
As with all physiotherapy interventions, foot rehabilitation should be a joint management effort between therapist and the person with the foot problem, with clear goals/targets of each exercise. Rehabilitation needs to be tailored to suit both the clinicians skill set, as well as address the person’s impairments and expectations for best success.
In some cases a progressive exercise program for foot strength and control may be the only treatment required. This is particularly so in an appropriately willing person, as actually understanding and doing the exercises is important…
The added bonus of this approach is that your muscles and control are transferable to any shoes, and might even be effective when not wearing shoes.
Foot and ankle exercises, along with orthotic interventions, have also been shown to have a role in improving some knee pain conditions by helping change knee alignment and function.
Below is a current Physiotas patient with a knee ligament injury and contributing foot control impairment. It isn’t clear if her foot tended to roll into pronation before her injury, or if it was a response to her knee injury, BUT addressing it has helped us regain knee alignment control and reduced symptoms.
Physiotas patient completing her foot/ankle alignment control exercises in a lunge hold position.
To summarise this article:
- Orthotics is not the only viable treatment for foot pain. Although many people pursue this option, it may not be the best option for some people and their foot or knee problem.
- Unfortunately people often don’t realise that Physiotherapists and Exercise Physiologists treat foot conditions, or that exercises for your foot exist. We do and they do!!!
- A comprehensive foot pain assessment and diagnosis is important to plan treatment, as is foot/ankle assessment with knee conditions where the foot/ankle can useful in improving control.
So, if you have a foot problem (or knee) and are unsure whether physiotherapy with exercises, education, and hands on treatment or heat moulded orthotics may help, come and see one of our physiotherapists interested in foot/ankle conditions.
They can help assess your problem and explore options for treatment beyond “just orthotics”, and design an exercise program and intervention targeted at your problem.
About the Author:
Jacob graduated from Griffith University before starting at Physiotas. He has recently completed a Graduate Certificate in Musculoskeletal Physiotherapy and is currently undertaking his Musculoskeletal Masters at La Trobe University. His main areas of clinical interest include spinal disorders, shoulder, hip and groin pain.
His interests outside clinical work include music, watching sports, and continuing to play soccer or surf – both less often than desired!