Feet Myths and Confusion

The biggest myth about feet is fallen arches.  The term seems better applied to the aftermath of the Roman Empire than an anatomical description of your feet. 

What are fallen arches?  Fallen relative to what?  How far will they fall?  Why are they falling?  Does every person who spends a lot of time on their feet ultimately end up with flat feet?   

The best way to understand some of these issues is to take a look at children.  They surely aren't old enough to have "Fallen Arches"!  Yet a lot of them do.  So why does this condition seem so prevalent? 

The answer is quite logical.  It isn't the foot structure that has changed.  Adults just finally feel all the aches and pains from having spent a lifetime walking, running and participating in sports with an unstable foot structure.  Athletes often feel it sooner. 

The myth is that your arches have fallen.  Your arches have been collapsing since  you were a child.  If you have a child in the house, do this.  Have the child sit in a chair with their feet flat on the floor.  Take a look at the arches.  How high are they?  Then ask the child to stand up.  Now what happened to the arches?  Fallen!  (typically, but there are exceptions)

The correct term for those fallen arches is Rothbart's Foot Structure.  It is an issue of the bones in the foot - specifically the head of the Talus.  Because of a rotation of the head of the Talus, the first Metatarsal and the big toe literally have to travel a small distance toward the ground to become weight bearing, and in the process the medial side of the foot, (the arch) collapses.  It also causes the ankle to roll in and the leg to internally rotate.   Chances are you were born with those "Fallen Arches". 

Do Fallen Arches Require Custom Orthotics?

Most people who have flat feet when they stand, have flexible flat feet.  There is a visible arch when they are sitting down, and the foot flattens out when standing.  People with flexible flat feet usually benefit from wearing moderate arch supports with their Posture Control Insoles(TM), but if you have visible arches when standing, chances are that arch supports will not give you any extra benefits.  They may even feel uncomfortable. 

What are custom orthotics?  That depends entirely on who you are speaking with, and where they received their training.  Some will simply have you step in a box full of soft foam, send the foam footprint to an orthotics laboratory and voila, you receive a pair of custom orthotics.   They don't do more than the average pair of $20 pharmacy arch supports, but since you paid a lot more for them, you might as well wear them, right?

Wait a minute!   You take off your shoes and socks.  You step into a box of foam.  Your foot is fully weight bearing.  Your foot is in its collapsed "Fallen" configuration.  What is the magic formula that transforms a footprint of your collapsed foot into a pair of functional orthotics that are supposed to give you correct foot mechanics?  Throw them in the trash, and by the way, if you stepped on a pressure plate, or placed your foot on an optical foot scanner you get a fancy color picture and the same pair of orthotics. 

Another more scientific specialist may carefully make a casting of each foot after manipulating your foot into what is called a Subtalar Neutral Position.  Then they use the cast to make rigid or semi-rigid orthotics that are supposed to hold your foot in that position when you stand, walk and run. These are the $250+ orthotics.   1] There is consensus that finding the Subtalar Neutral Position is very subjective, so three different practitioners could put your foot in three different positions before casting it.  2] The theory that the foot should operate around its Subtalar Neutral Position is over 50 years old and was never proven.  3] When you shift your weight to the forefoot and your heel lifts off the ground (as in walking or running), the orthotics don't do anything for you.  Your ankles roll in as well as they ever did before. 

So why do custom orthotics sometimes feel better?  For the same reason a recliner feels comfortable.  When you are standing and shuffling around on a flat surface, the arch support makes it unnecessary for you to use your calf muscles to control your arch, so it is relaxing.  The torque in your legs is reduced and that helps your posture.  Don't misunderstand, custom orthotics do provide some benefits.  The myth is that you need "Custom" orthotics. 

You are the beneficiary of two industries in confusion.  The footwear industry, which is really a "fashion industry", is all of a sudden claiming they design shoes that are better for your feet.  Funny that you need one shoe for walking, another for running, and a third for just going to work.  And,  if you examine all those insoles you see at the drug store you will notice they are more about materials (cushion, moisture and odor)  than geometric shape and foot mechanics.     

The "Holy Grail" for the orthotics industry, "Roots biomechanics theory" is over 50 years old, and is being seriously re-examined for its validity by professionals in the musculoskeletal field.  It would seem the orthotics industry is more focused on flashy high tech devices to demonstrate that you need "custom" orthotics than the final result - what they do for you.    

What about custom shoe inserts and foot beds?  If you insist on arch supports and cushions, they are probably your most economical alternative.