Many people believe that custom orthotic insole prescription is not necessarily a natural solution. Drawing on the example of neck braces, which were chronically overused throughout the 20th century, we should be cautious of artificially supporting body structures. Muscles can waste away when we provide artificial biomechanical support. Those ridiculous neck braces are reserved only for the most severe neck injuries.

However, some specific considerations regarding foot support need to be made, completely reframing the idea of orthotics representing artificial support.

To consider whether custom orthotic insole prescription is natural or not, it is essential to reflect on the difference between natural surfaces and the surfaces we now live on in our urban environments.

Natural surfaces are nearly always soft and conform to the foot’s shape when you walk on them. The mark this leaves behind we call a footprint. When we walk on sand, mud, soil, and leaf litter, the ground constantly conforms to the shape of the foot and provides natural support. This is how our ancestors lived their entire lives, in bare feet, until a handful of generations ago.

An evolutionary split second ago, the Victorians invented ‘flagstones’ or paving stones for streets and floorboards for houses. Since then, we have spent more or less our entire lives on hard, flat surfaces. Concrete and tarmac provide no support for the arch and do not absorb shock when walking and running on them.

This means that we suddenly changed the surfaces we walked on in our very recent past and have had no time for our bodies to adapt to the new environment. At Severn Clinics, we subscribe very strongly to the theory that this is the reason why we struggle so much with lower body pain in our society. Pain in the lower body is the single leading cause of years lived in disability across the Western world, and the medical system seemingly has no answer for it. 

Consider what you may have observed about arthritis in yourself and/or the people you have known. If you know someone who has had a joint replaced or fused, there is a 99% probability it was somewhere in their leg or possibly the lower part of the spine. We believe that the hard, jarring impacts of concrete and tarmac on the body are a significant reason. And by extension, it may be that custom orthotic prescription is one of the primary keys to reducing the wear and tear these surfaces inflict on our bodies.

Wearing a quality custom orthotic prescription mimics natural surfaces so that the human foot has the arch support and shock absorption it was designed for. The correct way to make custom orthotics is to match the strength and flexibility of the arch itself when it meets soft ground. Flexibility is the key, but not too flexible, or there is no support.

When the foot interacts with a solid but flexible custom orthotic prescription it experiences the kind of support natural surfaces would have offered it when we lived in the big outdoors, hunting wild badgers and the like. Support of the arch (whether provided by sand or custom orthotics) prevents internal rotation of the ankle, knee and hip joints during the weight-bearing phase of walking and running. And that’s a wonderful thing because none of those joints are designed for excessive rotation during weight-bearing millions of times a year.

However, another major ingredient in the custom orthotic prescription recipe that is often overlooked in today’s healthcare system is the addition of strength exercises for the gluteal muscles. 

The external support of flexible orthotics, which provides soft ground, partly prevents arch collapse during weight bearing. However, the action of the gluteal muscles also prevents it. And the role of the glutes is at least as important as the role of custom orthotic prescription in preventing stubborn pains from developing in the lower body.

When your heel strikes concrete, massive deceleration forces are unleashed millions of times a year. The skeleton would completely collapse every time you take a step if it wasn’t for the role of your gluteal muscles firing to keep the arch (and the entire leg). So the glutes stop your arches collapsing and stop unnatural wear and tear from happening in the lower body.

So if you are considering a custom orthotic prescription, it is also vital to be prepared to work on the strength of your glutes. This needs to be done with extreme attention to detail, as opposed to brute force, which tends not to activate the deeper glute muscles. Glute strengthening for pain prevention is more in the rehab realm than the fitness realm. But is is worth the extra effort after doing your normal lifts and movements at the gym. For those who don’t go to the gym, this work can be done alongside custom orthotic prescription with bands at home.

The final word on our custom orthotic prescription philosophy is for barefoot runners, most of whom believe that custom orthotic prescription is the devil’s work. 

Barefoot walking and running is exactly what we evolved for, and its the most healthy thing we can do to rehab and prevent pain, degeneration and injuries in our lower bodies. Most lower limb injuries and pains would likely rehab themselves naturally with a few months of frolicking in the forest in bare feet. But the fact is we don’t live on the kind of surfaces where that truly serves the tissues in our lower bodies. For most pain sufferers, being on tarmac and concrete in bare foot shoes just exposes the tissues to increased stress and arch collapse. Barefoot running is for the big outdoors, not for cities. 

The great news is that we don’t need to bulldoze all of the world’s highways and byways to fix this hard-ground issue. The combination of sensible footwear, careful orthotic prescription with careful rehab exercises for the gluteal ‘stabilisers’ is enough to optimise our ‘wheel alignment’. Thus our bodies become able to endure the stresses of concrete and tarmac.