When Can Patients Wean Off Orthotics?

A patient contacted me after wearing orthotics pretty much all the time for about a year and a half. The patient saw a physical therapist for bilateral knee pain. The physical therapist told the patient his feet were causing a dysfunctional gait cycle, leading to overall tightness and knee pain, said there was really no workaround with regard to improving foot function on his own and that he “pretty much needed orthotics 24/7” to move correctly. The patient says the orthotics do make a drastic difference with regard to the knee pain and tightness, but he still has some issues.

The orthotics keep the patient from over-pronating by stabilizing the left heel during walking, allowing him to push off the toe. The physical therapist said when the foot over-pronates when he walks (mainly the left foot), it anteriorly tips his pelvis and basically throws him out of alignment and into a bad position for working out or lifting weights. 

The patient has always worn custom insoles because he would get pressure calcifications but never had any biomechanical issues similar to what started bothering him a few years ago. He does not want to have to keep wearing shoes with orthotics all the time for the rest of his life. The patient wants to know when he can wean off wearing orthoses.

I have found that moderation with the use of anything is normally best. Normally, a great recipe is some use of orthotics when patients need them for activities, some time walking without orthotics and some time barefoot.  

One of the keys to great feet is strong feet. I have long emphasized strengthening the intrinsics with metatarsal doming, strengthening the Achilles with two-position heel raises, strengthening the arch with single leg balancing and utilizing TheraBand for the posterior tibial tendon and the peroneus longus. Patients will find as their feet get stronger, there is less need for orthotics and the most stable shoes. However, I said less need, not no need.    

Various types of orthotics give different support. Various types of shoes give different support. Various types of activities need different support. What do patients need to protect their feet and still participate at a high level of activity? Many use pain as their guide but some folks have such a high pain threshold that they have to use educated guesses.    

Aside from strengthening, the tightness this patient mentioned may play a major role in symptoms. Almost everyone should be on a daily regimen of Achilles, quadriceps, hamstring, iliopsoas and low back stretches. These should take five to 10 minutes to do before and after a workout, never with pain and done at least once on rest days. If patients experience tightness, I recommend stretching three times a day until it resolves. If patients feel tightness on one side of the body more than another, they should stretch that tight side 50 percent more than the looser side.     

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2017/09/can-i-wean-off-my-full-time-use-of.html . It is reprinted with permission from the author.