Who Needs Custom Orthotics Continued

According to a recent study the global foot orthotic insoles market registered revenues of around $2.5 billion in 2014 and is estimated to grow at a CAGR of 5.8% to reach $3.5 billion by 2020. The biggest contributor is the North America region with a market share of around 45%. From this we can deduce that there are a heap of people out there wearing orthotics to assist with managing pain. Life being what it is there will be a percentage of them who have a great experience with their orthotics, and some who don’t have a good outcome at all from their prescription. So if this is true and it no doubts is, it poses the question ‘who needs orthotics.. custom or otherwise. 

Most of us live in urbanised areas and have to contend with extremely hard, flat industrialised surfaces year in and year out. Many of us stand and walk on concrete in our workplaces and often in our homes, then at the end of the day we put on our trainers and go for a run on tarmac. This type of chronic exposure to hard ground poses a threat to all of us in varying degrees, in the same way, we are all somewhat susceptible to issues if we have excessive amounts of sugar in our diet. Those of us who most need to at least investigate whether we need orthotics are those who suffer from some pain or injuries in our lower bodies. 

Back Pain

Your spine is in many ways an extremely delicate piece of equipment, hence our shared understanding of the importance of ‘core work’. Most if not all of us know that the spine is a sufficiently delicate structure that it needs the support of the large trunk muscles. What is it that the spine needs protection from though? 

An obvious need for protection of the delicate spinal column comes when we are bending and lifting, especially heavier objects. A less obvious need for protection of the spine comes along during times of prolonged loading. If you sit at a desk all day or go on a long car drive there is a lot of compression and stress on the spine.. that’s why those times so often hurt a bad back right!?

One major source of stress and strain on the lower back that’s often overlooked is the act of weight bearing through the leg and foot while running and walking. 

When our heels strike the ground a shock wave far more forceful than you realise travels through your leg bones, up into your pelvis and spine. Believe it or not the bone shock at heel strike has been measured at 200mph when we walk on concrete. Following your heel strike, there is further opportunity for strain in the spinal tissues if the arch collapses into an over-pronated position. Over time this can be a recipe for stubborn lower back pain that frequently goes undiagnosed. 

Hip Pain

The first thing people think of when you mention hip pain is osteoarthritis, the truth is however that there is way more to hip pain than that. Hips are big strong weight bearing joints that sustain your body weight thousands of times per day, part of their secret in achieving this feat is the strength of the soft tissues around the hip. It is these soft tissues that generate most of the pain that shows up in the hip area. 

If you have had stubborn or intermittent niggling hip pains, which include the very base of the lower back, you may be having issues with foot and leg alignment. These kinds of issues can make the soft tissues around the hip extremely irritable over time. 

A major part of the reason the soft tissues of the hip get into trouble is the amount of work they do in maintaining alignment of your leg when you are weight bearing. Part of the reason your glutes and hip muscles are so big is that they are involved with the support of the ankle and foot. If they are asked to do too much though,  eventually they start to suffer the consequences in the form of microtrauma and pain.

If you live in a city on very hard surfaces with the combined strain of an awkward heel strike and arches that collapse when you walk ( one of many possible patterns ) the extra strain on your hip’s soft tissues is immense. Over time these kinds of patterns can do a great deal of harm to both that hip joint and the soft tissues around the hip. Wearing prescription orthotics is a major way of reducing these kinds of issues and the pains that go with them.

Knee Pain

A huge number of knee issues in the world can be attributed to the alignment of the bones in the feet and legs, especially during walking and running. If you have persistent misalignments playing out in your lower limb it inevitably puts long term strain on the soft tissues in the knee. Chronic strain can undermine the strength of muscles that support the knee and even major stabilising structures like th meniscus and ACL. 

If you have had weak or sore knees for some time it is highly likely that you have some persistent misalignment issues in your legs and feet; this should be pretty unsurprising. It should also be unsurprising that orthotics are a likely part of the solution. What is often a little harder to grasp is that severe knee injuries often have the same root cause. More often than not it is the individuals with alignment issues who suffer the ACL or meniscus tear, these structures having been slowly weakened over time. 

In the fossil record of our species, we can see the exact moment when we started standing upright because our knee joints doubled in size to cope with the strain. This is how hard the knees work to sustain the work of being a large mammal who walks upright. Knowing this perhaps it’s no surprise that our knees are so susceptible to pain and injuries. Joints that work this hard often need a bit of a helping hand, like custom orthotics that assist with alignment and shock absorption in a life spent on concrete, paving slabs and tarmac. 

Ankle Pain & Ankle Sprains

The human ankle is a somewhat miraculous joint, it bears the weight of your body somewhere between 3-6 million times per year on hard surfaces that it wasn’t designed for. The ankle does all this with minimal stabilising muscle,  unlike other weight bearing joints like the knee, hip and lower spine. Many of us get away with this feat surprisingly well, others do not. The ankle sprain is the most common sports injury by far, in fact, it virtually outnumbers all the other sports injuries put together. 

The fundamental instability of the ankle is why it is so predisposed to sprains, and also the stubborn pain and weakness that so often rides in the wake of ankle sprains. 

The research into the prevalence of longer term issues following ankle sprains is eye opening, to say the least. Part of the problem that the ankle has, over and above its lack of stabilising muscle is the fact that it is very very hard to rest it. We may do a couple of weeks on crutches after a big sprain, but the deeper levels of tissue healing continue for months…. months in which you take thousands of steps every day. Part of the legacy of this abuse during the healing process is often scar tissue, scar tissue that is a major cause of stubborn ankle pain. 

Custom orthotics don’t give sprained ankles rest, they don’t strengthen the muscles around the ankle and they may or may not help to prevent ankle sprains. Custom orthotics do however assist with the natural alignment of the ankle as it sustains your body weight millions of times per year. By maintaining alignment orthotics reduce the amount of strain that occurs in your ankle over extended periods of time.. for people with stubborn ankle issues this can be quite a life-changing. 

Arch Pain & Heel Pain

The arch and heel of your foot are 2 other structures that sustain a massive amount of stress and strain in the course of a day. The soft tissues on the underside of your foot are designed for shock absorption, and it’s those shocks that do damage to them. 

In the modern world, the underside of your foot leads to a weird existence sandwiched mostly between paving slabs, bone, and some plastic foam. Before we had streets, offices, and sneaker factories the sole of the human foot lived naked in the mud and dirt for its entire life, a starkly different reality in more ways than we could probably do justice with words. 

Despite the weirdness of the reality your heel and arch find themselves in,  they can still get by quite nicely if your foot alignment is on point. If however you come down on the inside of your heel bone when you walk as many people do it is very easy to develop heel pain. If you pronate excessively as many people do it is very easy to develop arch pain. These are exactly the types of things prescription orthotics can help with and when they do so the benefits play out over 10’s millions of steps.. and this can mean a dramatically different quality of life. 

Plantar Fasciitis

Plantar fasciitis is pain caused by repetitive strain in the sole of the foot, repetitive strain so bad that it has in most cases lead to significant degeneration of cartilage fibers and a significant build-up of scar tissue. Plantar fasciitis almost certainly takes years of gradually increasing strain in order to manifest as pain that is felt by you. 

As we stated above, in the modern world the sole of your foot leads an unnatural existence, mostly sandwiched between paving slabs, bone and some plastic foam. Before we had streets, offices, and sneaker factories our plantar fascia lived naked in the mud and dirt for its entire life, a starkly different reality to what nature intended for this part of your body. 

The short term solutions to plantar fasciitis that assist with healing are designed to break up scar tissue and stimulate collagen regeneration. The longer term solutions for plantar fasciitis are designed to reduce strain and pressure in the sole of the foot, thus preventing recurrent problems. Custom orthotics is a powerful tool for reducing strain and pressure in your plantar fascia, they do so by encouraging more natural foot alignment while you are running and walking. 


Diabetic orthotics help prevent pressure sores from developing from friction inside the shoe. A common cause of excess friction and pressure on the foot is overpronation in any foot, diabetics are just far more sensitive to this issue. 

Over-pronation leads to unnatural weight bearing and friction most commonly under the ball of the foot and on the outer edge of the big toe. Orthotics reduce over-pronation and help distribute body weight over the entire surface of the foot, thereby reducing friction and pressure.

Essentially orthotics for diabetics target the exact same issues as they do in non-diabetics, they just do so more for the benefit of preventing skin lesions rather than preventing internal lesions. This drives the main difference between custom orthotics for diabetes and regular orthotics.. the materials. Diabetic orthotics are made of special materials that are designed to reduce friction on the skin of the foot.


From our perspective, the fact that we live our entire lives on unnatural hard surfaces means that it is likely many more of us could benefit from orthotics than we realise. It is a simple principle, like the preventative need for ongoing dental self-care if you are constantly exposed to dietary sugars. 

Beyond specific stubborn pain complaints like those we have covered here, other classic physical issues that might lead someone to need orthotics include but are not limited to…

Very high arches.

Flat feet or low arches.

Tight IT band.

Major lower limb traumas.

Genetic predispositions.

Scar tissue from old injuries. 

Weakness in hip & knee muscles.

Glutes not firing properly.

Old injuries and sprains.

Problems with running technique.

Weight gain. 

Work that involves a lot of standing on concrete. 

The best way (and really the only way)  to know for sure if custom orthotics may help with any issues you have or work preventatively for you is to seek trusted professional advice, from those who have trained specifically to understand the interconnectedness of your feet, legs, pelvis, and lower spine. 

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