Orthotics: Temporary Or Long Term Solution?

(You can read here the article launching and describing the current project.)

Every now and again someone I’m working with (Doctor, Physical Therapist, etc.) says something that really sticks with me; and I end up pondering it for a good long time.  My Podiatrist made one of those “Things that make you go ‘Hmmmmmmmm’.” statements a number of months back.  “An orthotic is a splint.” 

That’s an interesting thing to say.  Why would he say that?  Why choose that word “splint”?  I kicked it around in my brain in the context of other things we’d discussed.  I had a pretty decent understanding of his treatment philosophies in general and I wanted to understand why he’d say that.  He is a strong believer in the philosophy that the foot was meant to move.  He appears to suggest orthotics very reluctantly.  Even when he does feel they’re necessary he prescribes flexible orthotics so the feet can move.  And he believes that, ultimately, one should try to get out of the orthotic.  To be honest, I was having trouble understanding why one would suggest an orthotic if the goal was to get out of it.

That word “splint” kept bouncing around – and then it kind of all came together.  I’m an analogy kind of guy.  Things become clearer when I can map what I’m thinking through to other situations or models I’m more familiar with.

When we break an arm typically a cast is used to keep it immobilized so it can heal.  A sling can also be used to help the healing process.  The reasons seems pretty clear:  The limb needs some help, support and protection in order to heal effectively.  While I’ve never broken my arm I know plenty of people who have.   Casts and slings obviously work pretty well.  We’ve all seen enough broken arms in our lives to know it’s virtually intuitive to us that treating it this way is the right thing to do. 

I now understand my podiatrist prescribed orthotics when my Plantar Fasciitis (PF) was raging because my foot was “broken”.  It wasn’t broken in the bone sense, but in the sense that there were tissues that were damaged and needed to heal.  In order for that healing to occur the foot needed help and support (a splint) so I didn’t re-injure the foot with each step.  (Just as the cast prevents us from re-breaking the arm every time it is moved.)

When the bone in the arm is healed the cast is removed and the arm is free to move again.  At this stage the arm isn’t really in a particularly good state.  Especially if it has been in a sling it’s likely weak and stiff and somewhat difficult to move.  We might and hopefully do go to Physical Therapy to get help in gaining back the range of motion and usefulness the arm had prior to breaking it.  Have you ever seen anyone leave their healed arm in a sling permanently?  That seems preposterous.  We don’t want our arm in a sling the rest of our lives.  We need to use it!  It’s too important to what we do in our daily lives.  That is precisely why we go through the rehabilitation process:  So we can have a useful, functioning arm again. 

In many cases the feet are no different.  Unfortunately there is a very common perception that if a foot needs an orthotic there is something fundamentally and structurally wrong with it and, consequently, the orthotic is needed permanently.  Flat feet very much seem to be in this “deformity” category.  I’ve seen people write “I’ve been diagnosed with flat feet.” as if it were a disease.  To me the term “flat foot” is more akin to describing some fact about any other part of our body; such as weak arms.  “I’ve been diagnosed with weak biceps.  Get me that sling – I now need to wear it the rest of my life because I have weak arms.  Nope.  There is nothing I can do about these weak arms.  I was born with them.  What a shame about me.”  A better diagnosis for someone reacting this way might be “Nuts.”

In reading the various running forums I like to frequent people also sometimes conclude orthotics are necessary because they tried to stop using them but failed.  They don’t seem to think about the method they used to get out of the orthotics.  One recent poster commented “I know for a fact I cannot run without my orthotics.  I tried going without them for a week.  I ran 22 miles and I got a stress fracture.  That proves it.”  Sorry – that doesn’t prove it.  The only thing it proves is that this person got a stress fracture when she did what she did.  That’s a far cry from proving that orthotics are essential to her ability to run.  I wonder how different the result would have been had the runner spread that effort to get out of the orthotic over a 4, 8 or even 12 week period.  We don’t go bench press 250 lbs right after we’ve removed the arm from the sling.  We build up to it slowly and over time.  We give the weak arm time to adjust, adapt, and get strong.

While the orthotic can help encourage the right healing environment, don’t forget we control the other aspects of that healing environment.  An arm, while casted, probably shouldn’t be used to do push-ups, for example.  The orthotic may be necessary, but not sufficient, to get the tissues healed.  The long and frustrating trial-and-error process I went through for my PF is a good example.  I got the (planned temporary) flexible orthotics, however I continued to try a small amount of running while the PF healed.  The only problem was – it wasn’t healing.  It’s easy for people to conclude that the orthotics aren’t working if they remain injured after getting the devices.  I had to do other things (such as not running at all, wearing highly supportive shoes virtually every waking moment, stretching, etc.) to not undo the positive things the orthotics were doing to help my feet get better.

So how does one get out of the splint (orthotic) once the acute injury is healed?  Well, just like the healed arm, very slowly and carefully.  Sure, there are stories about people taking them out one day and never having any problems.  I think those are the exception.  Most of us have to wean ourselves off of them in a controlled way.  In my case I started with 15-30 minutes each day.  As the feet handled a given level of no-orthotic time well I’d increase it – very slowly.  Occasionally I’d notice some issues.  If so I’d either hold where I was or even back off a little, just to get things solid again.  As my no-orthotic/no-motion-control shoe time got up to the 3-4 hour range I started formally studying and incorporating Pose Method techniques into my daily walking.  At this point my feet’s desire to be free just exploded.  An experiment one day to see how long past the four hour mark my feet could handle turned into the first day I’ve gone without orthotics in 10 years.  And I haven’t had them in since.

Does it really matter if our feet are in orthotics long term?  Well, in my opinion, no, as long as you’re pain and injury free.  At the end of the day that is the real goal.  “If it ain’t broke don’t fix it.” as they say.  But if you do have injuries, and you’re struggling to get over them, getting out of orthotics (as well as avoiding heel striking and adopting a less impactful form of movement such as The Pose Method, Chi Running, Evolution Running, etc.) may be an answer.  What we view as a necessary solution to our injuries may, ironicially, actually be contributing to them.  By letting the foot move, function and adapt as it should we’re creating a healthier system that will be less injury prone.  That certainly appears to be the case for me. 

Jim