Dr. Conway McLean, DABFAS, FAPWHc

Retail footcare products are big business, available in every convenience store and pharmacy in the land. Twelve billion dollars is spent annually on these items and that’s a lot of aching feet. But how often is an over-the-counter approach truly effective? When it comes to arch supports, the answer is both surprising and very complicated.

These devices are intended to go inside a shoe and should serve some function or benefit our health in some way. A walk through the aisles of most stores will reveal some version of this item, including local pharmacies, department stores, and every shoe store in the land. An internet search can lead to a migraine from the ridiculous abundance of in-shoe foot supports available.

Perhaps the most common reason someone purchases a pair of supports is because of plantar fasciitis, which is basically a strained arch ligament. This painful condition, experienced by most of us at some point in our lives, is typically a result of poor foot-leg-spine biomechanics. This may mean their arch flattens too much or, in contrast, an arch that’s too high, stressing one’s arch ligament. Not infrequently, it’s a tight heel cord. Supporting the arch better sometimes provides some measure of relief.

Another explanation for why supports are bought is inflammation of the tendon supporting the arch, the Posterior Tibial tendon. This tendon doesn’t have to work as hard when the arch is properly supported. How much support is appropriate? As should be obvious, this will depend on the person, like so many things regarding human anatomy and physiology.

Many Americans develop discomfort from the ball of the foot, leading eventually to a chronic, dull aching pain. This is often due to excess pressure to the bottom of a metatarsal head, which has multiple potential causes. Weight bearing pressures to the bottom of the feet can be easily altered, and ideally improved, with some type of supportive device inside the shoe.

Surprising to many, an effective, comfortable arch support can serve to improve motion of the heel bone and provide relief from Achilles tendonitis. This is a chronic problem for many, typically treated with a cast boot. Immobilization often helps with this pain but does nothing to aid in the sufferer’s biomechanics. Consequently, the pain resumes when they return to their prior “normal” gait, which is what leads to the repeated irritation of the Achilles.

This brief list is the proverbial tip of the iceberg since multiple painful conditions are a result of poor foot and leg mechanics. Consequently, the right kind of support can safely reduce many types of orthopedic pain. But what is the right kind of support? Answering this question is not made easier by the multitude of products on the market. How is one to know and what determines which type to seek out?

We know that the perfectly aligned foot functions well, correctly, and comfortably. The optimal arch height, allowing the healthiest amount of motion, will tend to provide for a lifetime of healthy orthopedic function. The well-aligned foot won’t stress the posterior tibial tendon or lead to abnormal tension on the plantar fascia. But the corollary is also true: the farther one is from “normal,” the greater the chance of pain-inducing biomechanical problems developing (over years).

Some people vary only a little from the norm as far as foot function, and so don’t require a custom device to achieve relief. The problem here is the volume of choices for generic supports. As should be predictable, some of these are well designed and have some benefits while many are sold strictly to profit the manufacturer and aren’t able to provide relief due the materials and design. How is one to know?

To further complicate this discussion, prescription arch supports, typically referred to as foot orthotics, aren’t always better. Both the benefits and comfort of a pair of orthotics will depend largely on the skills of the prescribing healthcare provider. What is their background and how much training and experience do they have in human biomechanics? Unfortunately, too many Americans have prescription foot orthotics dispensed to them and find them uncomfortable or ineffective.

Is the answer to simply use off the shelf supports? Absolutely not, since properly prescribed foot orthoses can conservatively relieve a smorgasbord of painful conditions, from the ball to the back, knees to nails. Because they should alter function, people often note gradual, continued improvement in various musculoskeletal complaints, especially low back and knees.

Studies have been performed. We’ve examined the effects of custom orthotics as compared to generic supports, but the results are unclear and inconsistent. The difficulty inherent in research into this topic is the nature of prescription foot orthotics: each pair is unique, as is each physician. The benefits of a pair of custom foot supports are largely dependent on the training, experience, education, mindset, etc, of the prescribing healthcare provider.

The topic of human biomechanics and how to alter it is a complex one and multi-faceted. Where does one go for effective arch (and body) supports? Is a shoe salesman, using a box of foam, able to provide effective supports? How accurate is a technician’s analysis of a body’s gait, their structure and function?

Unfortunately, these are relevant concerns when you are dealing with body mechanics that are not the norm, not in the middle of the bell curve of humanity. And yes, many questions have been asked herein, with few answers provided. But have no fear, enlightenment is forthcoming, to be found in the next issue of Health Matters.