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Footwear / Orthotics

Proper footwear is essential when exercising and even just walking throughout the day as you do your daily activities. Today many shoes are  made to look cool and flashy, but they are unfortunately making foot function worse. There are numerous shoes with anti-pronation devices, arch supports, ankle supports, and motion control devices & stabilizers. These are often causing problems in a lot of people, and they most likely don’t even know it. Take, for example, the hype behind the anti-[over]pronation shoes. Pronation is a necessary motion and function of the foot. It is supposed to happen — it is a major way you absorb shock when walking or running. However, many people are being told they overpronate or they think they overpronate so they wear these anti-pronation shoes and problems occur – foot, knee, hip, or back aches – all from the shoe they were advised to wear. Sure some people do overpronate, but it’s because of muscle imbalances in the lower leg and foot, not because they’re wearing the wrong shoe. Even worse, many people wear orthotics – casts of their feet that are supporting their gait dysfunction and imbalances which only support their problem and eventually cause other problems throughout the body. There’s a lot of hype behind orthotics. Many physicians, therapists, and salespersons who make and sell them think they’re the greatest thing since sliced bread. Well, I’m not a big fan of bread, I’m not a big fan of orthotics. (I’m kidding about the analogy part; I like bread a lot more and it tastes better anyway.) Orthotic supporters (no pun intended) claim that the inserts will fix every structural pain from your head to your toe. The majority of these people make what I’ll refer to as a  pathological orthotic, as they are making a cast (mold) of your foot in its current incorrect position. Since you wouldn’t want a broken arm put in a cast without setting the bone, you don’t want a cast of your foot made without making sure that the muscles are balanced and the bones are in the right place. Making a cast of your foot without addressing the issues of the foot isn’t fixing anything – it’s just going to support a problem you already have. Your pain may go away, but a new one will pop up later, perhaps somewhere else in your body. The goal is to figure out why the muscles and bones of the foot (as well as everything affecting the foot) are not functioning properly so the problem at hand (or is it foot?) can be resolved. Since you have to walk, an injured muscle may need to be supported as it heals temporarily…and this is where orthotics become very valuable for a slight few people – when they are used to help hold a correction in its place so function may be restored. However, as I write this, now into my 13th year in practice, I have never once needed to have a patient go and get an orthotic made to help stabilize or correct their foot. Maybe that will change tomorrow.Foot muscles and lower leg muscles which play a major part in the gait of an individual are very responsive to stress in the body. Abnormal stress from thick-heeled, over-supportive shoes, and those wearing orthotics, further weaken the foot and lead to problems. Dietary stress from a poor diet (refined carbs, processed fats), emotional stress, and physical stress from other injuries as well as excessive exercise also lead to lower leg and foot problems.I estimate that 90% of the time I need a patient to stop wearing their orthotics that were made for them by another physician because they are either causing a disturbance in their gait (the way you walk) or creating a foot dysfunction. About 10% of the time I’d say the orthotic is neither helping them nor hurting them. If you were told that there was very little chance of success with any treatment, you probably wouldn’t go and pay $250-$400 for it. Healthy People are Barefoot People!

  • Wear shoes that keep your feet close to the ground, are “low to zero-drop,” don’t have a lot of support, and aren’t too rigid (stiff).
  • Remember, your orthotic is most likely supporting dysfunction.

A whole lot more on orthotics over at my Sock Doc site – click here.

And still even more about proper/improper footwear here by Sock Doc – here.

Read more about proper footwear selection by Dr. Mark Cucuzzella here. The article is for both kids and adults. Also, Barefoot Science has some good information and research related to the dangers of orthotics and “shod” footwear. Click here.

44 Comments

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  1. Teresa Jeffries permalink

    My daughter is a new nurse working 12 hour shifts, on her feet the whole time. She already has a knee issue from gymnastics that will require 4 months of intense physical therapy..which she hasn’t been able to do due to being a full time nursing student and working. My question is what is the best shoe for her to wear for work. When she gets off now her legs, feet, back, knees everything is hurting! Thank you.

    • Nursing shifts are definitely tough on the body. If she’s already having knee issues then there is most likely a lot more that needs to be addressed than just footwear. I feel that no matter how long a person is standing on their feet, and no matter what the surface is (concrete, tile, carpet), one’s feet, knees, etc. should not hurt. She needs to definitely keep her feet strong, or strengthen them if they are not yet, and this can be somewhat accomplished by going barefoot (at home) and in minimalist type shoes as often as possible. If this hurts her now, she may have to transition to them. – so say a few hours in them a day and then more and more each week. The Nike Free and New Balance Minimus might be a good shoe for her to wear, if they work for her feet and the style is appropriate. Also check out Two Rivers Treads here – they may have other suggestions.

  2. Maria permalink

    Hello. Please do you have any advice on barefoot shoes for hiking and trail walking? I wear barefoot shoes for my daily pavement workout walks, but now that the weather is better I would like to go off road. I’ve just bought an horrendously expensive pair of hiking boots and although the manufacturers claim that one could jog in them, I’d be more inclined to try in a pair of diving boots.
    All the ramblers I know advocate sturdy soles and lots of ankle support, but I feel more ‘balanced’ on uneven terrain when I can sense the ground beneath my feet. I would be grateful to hear your opinion. Thank you :)

  3. James permalink

    HEY DOC. HOW ARE YOU.I HAVE BEEN A FIREMAN FOR 30YRS ALSO I,VE BEEN PLAYING GOLF FOR 7YRS AND I HAVE JUST STARTED WITH SYMPTOMS OF PLANTAR FASCIITIS.I,VE BEEN DOING YOUR RECOMMENDED EXERCISES THEY ARE VERY HELPFUL ANY ADVICE ON THE SHOES TO BUY FOR BOTH ACTIVITIES.THX KEEP UP THE GOOD WK YOU DO

    • Thanks James. Check out the Vivobarefoot shoe reviews I have at the Sock Doc site (sock-doc.com).

  4. Diane P permalink

    Hi Sock doc, I have plantar fasciitis I am what you would classify as obese. Is it okay for me to walk barefoot? Wouldn’t
    walking around barefoot be to much strain on my ankles and feet. Sorry doc just want to be sure. Thank you

  5. Joel Wright permalink

    SocDoc,
    I have listened to all your podcasts on TrailRunner Nation, and I am a huge fan of yours. I love to run the dirt trails behind my house, which have a lot of uphills and downhills. But I’ve had a lot of knee pain lately, and two different ortho’s have told me my I overpronate, and need to get either orthotics, or shoes that stop my overpronation, because the xray’s show my knees caving in, which is likely causing the pain. I’ve been running on the trails mostly in the Saucony Peregrine, or Altra Instinct, which both have very little pronation protection and a 4 mm drop or 0 mm drop, because I’m working on good running form. Should I change shoes to something with overpronation protection, or even some orthotics, or is there something else I can do? Thank you!

    • I would never recommend “overpronation protection” shoes (they really don’t do that anyway), or orthotics for this either. Check out the articles on SockDoc – there’s plenty there on knee pain, overpronation and a lot more on shoes/footwear.

  6. sam macri permalink

    Hi Doc
    I have aching feet and legs for over 4 years.
    I get relief by having a shower with warm/hot water.
    I have had all tests under the sun from ultrasounds to MRIs ,bone scans ,seen ortho surgeons,neurologists had bone scans etc.Nothing has been found all done on feet and lower back with no abnormalities.
    If I am on my feet for long periods my feet ache and will improve if I sit for a while.When I sleep my legs and feet may ache and will improve if I change positions,and when I wake in the morning I am stiff in my lower body and my feet hurt when I stand until I have a shower.
    I do have another condition and wondering if this is linked.The condition is bi lateral cutaneous nerve impingement to my thighs which comes and goes when I am walking or lying on my back in bed ,but not at every occasion.I don,t have plantar fasciitis so don’t know where from here.
    I am interested in your idea of trigger point therapy if the problem is to other parts of the body,any thoughts.

    • That’s really a tough one to say what’s going on. There are most likely trigger points in your legs but I’m sure they are there from muscle weaknesses in the lower legs/feet – that will give you the ache. Look for an applied kinesiologist or chiropractor in your area (AUS – right?) – who is familiar with soft tissue problems as well as metabolic problems. Typically something like this is systemic – ie: food allergy, nutrient imbalance, etc.

  7. Trudy permalink

    Socdoc,

    I have worn Nike Frees for several years. I was having some lower back/ hip issues. My chiropractor suggested I see a pedorthist. In January, I got custom orthotics and Mizuno shoes. I have flat feet and severe overpronation. My left foot has never felt good in the orthotic and my right foot in fine either way. I increased my running and was able to complete a half marathon with foot pain that I still deal with. I stopped wearing the orthotics in June. I now wear Nike Lunarglides and although they are great during short runs I am getting pains as my miles increase. My issues seems to be mainly pressure related in my 4th and 5th toes on my left foot. Do I need orthotics or is there a way to remedy this? I just want to run without pain.

  8. Aaron permalink

    Socdoc,

    I’ve been intrigued by your website, thanks for posting. I’ve been wearing orthitics for almost 20 years now and I’m getting a new pair soon. When I was recently being fitted the PT said the ligaments have stretched, etc and then I thought hey, why is that happening. Besides walking barefoot when I get home, are there other exercises to strengthen the lower legs and feet? Be great to get rid of the aches and pains. Also is there anyone you can recommend in the Baltimore Area.

    Thanks,

    Aaron

    • Balancing on one leg is a great exercise to develop “foot feel” and when you can successfully do this for 30 seconds or so, then close your eyes (it will make it more difficult), and further develop balance and foot sense. Running in your place on the balls of your feet (like jump roping) is also great. Do this for about a minute, never letting your heels touch down. Though some people have other exercises to add in to this routine, walking and running are ideal and it does take time to build up the strength of the foot and develop the skin to a certain extent as you get into running outside. Check out the other articles on Sock-Doc too.

  9. netbell44 permalink

    I have hammertoes, and also have had numbness in the balls of my feet for years now. I used to also have burning, but that has alleviated. Several years ago I was diagnosed with having Morton Neuromas in both feet (I thought it was odd that they were in both feet, but assumed the doctor knew what he was saying/doing) and was told to never, ever walk barefoot again! I started wearing metatarsal supports in my shoes and of course, they did do a set of orthotics (covered by my insurance), but after wearing them for a few days, I threw them out..they were NOT helpful at all..I felt like they were making matters worse (just like you say). Anyway, 4 years later, and the numbness has NOT gone away. It doesn’t bother me during the day (although sometimes if I only wear socks, the balls of my feet feel like I’m walking on bunched up socks and it is very uncomfortable) – it is mainly at night, particularly toward the early morning hours. When I stretch my feet, it literally feels like my toes and balls of feet are rubber bands and it’s difficult to stretch them out. (I do get cramps in my legs as well as my feet at night..probably at least a couple times/week.) I recently went back to a different foot doctor to see if I could get some relief – now I was told I do NOT have neuromas. He also performed a Nerve Conduction test and that was perfectly normal. He was obviously at a loss, but he thought it might have something to do with diabetic neuropathy (I was diagnosed with diabetes 2 years ago – A1c of 6.5, BUT I REVERSED this to a A1c of 6 and am no longer considered diabetic) and he gave me some METANX to try (which is basically Folic Acid & B vitamins, from what I understand.) I took it for about 2 1/2 weeks…with no improvement. I do still only wear flat and pretty expensive shoes (Naot, New Balance sneakers) and usually still wear the metatarsal supports (they do seem to help and are comfortable). Was just wondering if you have any thoughts on what else I could do? I would really appreciate it!!

  10. netbell44 permalink

    Thank you. I will try the TWT diet and see if there is any improvement.

  11. Sulaiman permalink

    Hi Dr. Gangemi

    I have a severe overpronation in my foot and i tried everything changed my shoes , used orthotics and tried walking barefoot around the house but still there is some pain. the pain subsides after a round of proper stretching but flares up again in 3 or 4 days. i was a active athlete but this stopped due to the pain. i had an MRI scan but doctors said that there is nothing wrong. your advice please

    thanks

  12. Eileen permalink

    Hi Doctor,
    I am so glad I found your site while I was looking for help for my foot problem. I don’t actually see anything wrong with my foot, but it feels like I am walking on something. I have no pain on the top of my foot or near my toes. It feels swollen, on the bottom, behind the 2nd, 3rd and 4th toe. Is there a name for this? Will walking barefoot help this? If I try to push the big toe down, I get pain between the big toe and the 2nd toe and under the ball of the big toe. I did wear orthotics for a few years for a lump under the ball of the foot of the big toe. They wore out and I never replaced them, and now I have this. I can only wear sneakers because of this problem. If I wear a heal the pain gets worse. Any help will be greatly appreciated. I did some of the excecises you showed with bare feet and now I have more pain. I have had this for years now and I would like my left foot to feel great like my right foot does. Thank you.

    • Best bet right now is to read the info on the Sock Doc site about going barefoot and the videos on Foot Pain.

  13. Chris permalink

    Sockdoc,
    Thanks so much for this information. I have been using minimalist shoe-wear ever since discovering your website and reading more about the barefoot/minimalist lifestyle. At first I found it hard to find casual shoes that achieve minimalism and proprioception. I just wanted to pass along info on some shoes I found that achieved both just in case anybody is interested. They are called Sanuk Standard Slip On’s and they run between $30 (kids)-$40 (adults). The trick I use is to remove the insole and then the shoe is actually more minimalist than even my New Balance Minimus’s! Thanks again for all the info on your site(s)! Such a great resource!

  14. Chuck permalink

    Hi,
    I was wondering if you could help me. I suffer shin pain on my inside shin just above the ankle and I believe this is from over pronation.

    The thing is that I am one of those people who have a smaller big toe than usual (i.e. my second toe is quite a lot longer) and therefore I tend to land on the heel not to push off the ball of the foot correctly. That was the analysis I got years ago from sports med person anyway.

    For years I had this under control using shoes with good stability, stretching out the lower leg carefully after running and making an effort to push off the ball of the foot.

    The question is whether I should try barefoot or minimalist running shoes or whether they would actually exacerbate the problem?

  15. Carly permalink

    I have a 12yr old son who pronates and has what they call “flexible” flat feet. He has always had orthodic inserts. as he grows his ankles look much better (since going barefoot and walking on the beach over the summer) I am wondering what would be a good PE sneaker for him. He would wear for an hour a day during the school year. Thank you

  16. Tanya permalink

    Hi doctor I’m 12 and I’m planning to buy nike free runs. Is this a good idea because I wear orthotics and I’m not sure nikes will be good.

  17. Jacqueline chow permalink

    Asians go barefoot all the time when they are home. I have been barefoot at home since a kid. I also am flatfoot and has bunion. I have osteoarthritis on both knees. Besides that I have sociolosis with spinal stenosis. What should i do? Running gives me pain. Swimming is painful when my muscles are tight. I take dance classes twice a week.

    • I’d have to see you to help you out with those issues. Or look for a naturally-minded therapist or physician who can help you with those problems.

  18. Jenn permalink

    My son is now , five 11 and 180#. At the age of 11, he had his left tibia and fibia surgically broken to correct a 50 degree out toe (tibial torsion), and a year later they did the right one for the same reason. He also has no arch at all, and pronates insanely bad. Surgically cannot fix this.

    What you are saying here really confuses me as he went WITHOUT inserts for YEARS and could barely run or walk without knee pain. His barefoot walk was stilted and painful.

    Upon insertion of proper/doc prescribed inserts, he is running several miles with NO PAIN.

    His doc is the head of the top pediatric orthopedic hospital. No quack.

    So are there situations like this one where the insert is actually beneficial?

    • If you read the several more comprehensive orthotic articles over on the sock-doc site where you will see that there are sometimes exceptions. You do what works for you, and obviously your son’s condition is far from typical.

  19. Tony permalink

    Hi Doc,

    I was diagnosed with plantar fascitis a couple of years ago and was told i needed orthotics. The pain went away after about 6 mos with the orthotics but now i have numbness and tingling in the balls of my feet and toes all the time. i work behind a desk most of the day and i am not diabetic. Do you have any idea what could be going on?

  20. Hi Doc
    I was prescribed orthotics to deal with Mortons Neuroma. They worked for the neuroma but were never comfortable and in particular I used to get extremely sore calves in them after walking only a few hundred yards and a sensation of slipping off the aggressive arch support onto the more tender outside part of my foot and toes. Eventually I gave up and threw them away and almost had to learn how to walk properly again. It went well at first but now I have intense pains on the bottom of my foot mostly by the toes but also the heel. In particular driving long distances seems to aggravate the pain as it is exactly where the accelerator presses on my right foot. I also find that sitting at a desk is very painful due to the constant pressure of the soles of my feet on the floor. I’ve tried a couple of orthopaedic surgeons and had 2 MRIs but they never ‘found anything to operate on’. Any ideas.

  21. Robby Fast permalink

    My 15 year old daughter has bunionettes. She has had daily pain for more than two years – both barefoot and in shoes. Two different podiatrists have told me that she needs surgery to correct the bone in her foot that is growing down and causing the problems and the pain. Insurance would not pay for surgery so I took her to Shriners to see if there were other options. The Orthopedic surgeon said that surgery was not an option but he wanted her to have orthotics and wide shoes. Since the orthotics (6 weeks) her pain is minimal while in shoes but has become VERY painful when in bare feet. The doctors don’t agree and the orthotics are making her feet worse; I am so confused. I am not a fan of surgery or othotics BUT i want my kid OUT of daily pain. I would appreciate your thoughts… barefoot hasn’t solved it (she was barefoot 80% of the time for about 4 months).

    • Check out the several articles on barefoot and orthotics over on my Sock Doc site. Start there and then let me know what questions you may have after reading those. Ideally you need a doc to properly assess & treat her (and not just say wear these – but actually go through all the muscles to see what is going on).

  22. rick permalink

    I’m wondering about my orthotic. It was made to get a little more arch as the foot had flattened some, and to avoid morton’s neuroma.

    Is this similar to concerns you have seen with others using orthotics in the similar circumstances.

    Thank you

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