Not sure how relevant this topic will be nor how much input you guys can have but I thought I'd give the brains trust here a whizz.

I've got flat feet. Never had a problem with it until I saw a physio once for a separate injury and she vehemently recommended me to see a podiatrist about it. Obviously I did not and simply bought some over the shelf orthotics that seemed to have done the job. Though my feet now when I wear normal shoes, feel sore. The funny thing is I've never had a problem with my feet. I've spent the good half of my younger years running long distance and had no problem. The only time I had problems was shin splints after a few years of wearing footy boots that probably did not fit me right.

So this has got me thinking. We spend more time barefooted than in shoes; at home, in the backyard, at the beach etc. So I'm starting to wonder if orthotics are really a helper or a hindrance. Is it really helping your arch or are you better off doing exercises that will strengthen your arch because if you think about it, the orthotics are simply making your muscles that were originally maintaining that arch even weaker.

As you guys know, I am studying physiotherapy and not sure if it is right that I am starting to question all the research, the norms etc of what we are being taught. Tbh, I want to be someone that is going to know what I am doing and treating a patient right than simply seeing someone with flatfeet, mouthing what is in a textbook and telling them 'oh your feet look flat, you should go see a podiatrist' and make them fork out $$$ if they don't even need it.

I have extremely flat feet and have never worn any sort of orthotics. Spend more time in barefeet and thongs except for work.
I had a work injury many years ago and was sent to foot specialist. He was amazed that I basically had no instep but bsaid as long as I had no problems then I did not need any sort of orthotics or special shoes. I am now in mid-50's and have a bit of sciatica and sore back that is from work.
It does seem these days that there needs to be a cure or remedy for these sorts of things but do we really need them?? For some people its a good option.
My 2 bob's worth.

Ive got flat feet and used the cheap over the counter orthotics and eventually feet started to get too sore. Especially my calves. Anyway i now were 3/4 in everyday shoes and full foot in my running shoes and feel much better. I can even wear the new style thongs from Ripcurl but after a while of bare feet, i need to put my shoes back on

I also find the soft soled Sanuks work a treat..

i was in difence so had to do a lot of running, snowboarding etc. used composite orthotics for a long time. Good. the plastic ones just compress. best thing is they last for a very long time. I stopped wearing them because i stopped running i suppose. You should get it done. just have to watch the way your kneecap tracks and your knees pronate when you have flat feet. will cause back problems - the works

IMHO orthotics are a godsend if you over pronate and it buggers up your knees (patella tracking) and hips, even lower back. Keeping the foot at a less actute angle certainly works. Arches, dunno...... : /

A middle-aged woman arrived at my office last week complaining of heel pain and carrying a bag of custom-made foot orthotics (orthotics are custom made arch supports that are fabricated from a mold of the patient’s feet). Each orthotic this woman had with her was expertly fabricated by a different podiatrist and yet none of them had come close to alleviating her heel pain. At first I thought maybe these podiatrists didn’t know what they were doing. But, when I learned their names, I knew this woman had seen competent, skilled and reputable physicians. I asked myself “how could this be?” More interestingly, no two sets of orthotics were even remotely alike. Further, given that nearly all podiatrists learn similar principles of biomechanics, shouldn’t orthotics for a given patient be the same regardless which podiatrist makes them?

I examined the women and quickly noticed she had a nail in her heel.

Have a read www.painscience.com/articles/orthotics.php

Telling someone with flat feet (e genetic trait) to see a podiatrist is like telling blond jokes.

I've had various orthotics most of my life starting in the 1960's with adjustable metal ones which I wore for quite a while but then stopped. In the 70's early 80's when the running/fitness craze began, & I joined in, I used to get terrible pain in the thoracic area of my back. At the time could not figure it out as I was working in an office so had recovery time, yadda yadda. Fast forward to about 1995, after I'd left the office environment (redundancy) & had taken up lawnmowing. Whole new era of pain, in the thoracic area & everywhere else. I tried the hard orthotics from podiatrist, which helped the back pain but because I was on my feet all day started to kill my feet, especially my heels. I then started the medical process again & ended up seeing a specialist, cannot think of his name at the moment & in discussion with him it seems that his, or the latest opinion, was that the arch was designed to flex & so he gave me red foam orthotics with a blue foam section glued to them, on the bottom, just under the inside of my heel & the instep of the ball of my foot. Havn't had a problem since.

not long ago after good surfing session when I got in I found a farken bunion on my left foot (I am goofy).must've been pushing too hard.
did some research on the net. looks like my flat feet caused that. I have to wear split toe booties now all the time otherwise its quite painful especially when duckdive. apparently I should've worn them before all the time to prevent that bunion happening.

I know this is a bit old, Have you finished your studies waveless? The argument of orthotics is as old as the hills - i'm not going to go into it, but here is my 2c worth.your theory is exactly right, over time being in orthotics will decrease the ability of your intrinsic foot muscles to control your arch. However, if there is a load issue, such as in shin splints - they can be favorable for a period of time to assist deloading the tibial periosteum.However, you can often achieve the same thing with a good low dye taping or modified low dye taping... If the person gets a good response from initial low dye tape, i might suggest a period of time in orthotics. However, I wouldn't refer to a podiatrist personally, I feel my level of anatomy, biomechanics and understanding of motion is just as good as a podiatrist (same argument of upper limb OT vs Physio...but that's another story) I would tend to order patients a pair of decent off the shelf jobbies at retail ~ 60 bucks... do exactly the same thing as a 500 dollar pairhave a look into the evidence regarding barefoot running, it ties in nicely. Also, remember that pronation is not bad. It's natural, we have to pronate for force attenuation and to let the windlass mechanism store energy for toe off. OVERpronation CAN be pathalogical however.

Hey mate,

here is a great podcast about the foot by BJSM

soundcloud.com/bmjpodcasts/does-the-concept-of-the-abdominal-core-apply-to-the-foot-too-professor-irene-davis-harvard

This is just one example of an issue that requires a case per case basis and I won't chime in on whether the practitioner was right or wrong as I wasn't there, there are times orthotics are appropriate and are not, and you should research and have that conversation with your tutors if you are genuinely curious). It's good that you're critical of current thinking and skeptical. In the grand scheme that's necessary to improve on previous concepts or find better alternatives. You will find that any good researcher / practitioner will be aware of the evidence for their thinking (I.e have a listen to Peter O'sullivan for LBP or SIJ conditions) and also know the limitations, there are few hard and fast rules and you might be surprised but the limited evidence there is for some of the things that are done (i.e NSAIDS pre 48 hours vs post 48 hours and affect on inflammation and healing) it will be your job to take what you know and to simplify it for the person in front of you and help them with their problem. Physio isn't black and white, thankfully because it wouldn't be an interesting job otherwise!

Good luck with your studies mate!

Hey thought I'd chip in on this one.
I'm a sports podiatrist based in north Island NZ.

Firstly this article linked www.painscience.com/articles/orthotics.php is really a load of bollocks. As a podiatrist we spend 3-4 years at uni studying anatomy, physiology, biomechanics etc as well as material science and the fabrication of orthtoics.

Unfortunately orthotics have in the past been over sold by both podiatrists and physiotherapists hence why I think they have a dodgy reputation.

Firstly do they work...that depends wholly on whats wrong with the individual, there is a strong body of evidence indicating the use of orthtoics for a number of lower limb complaints. Conversely there is evidence contraindicating orthtoic therapy for other complaints

Will they "correct" none problematic flat feet...no of course not, nothing short of major reconstructive surgery can do that.

Interestingly enough if you ask how they work...well to be honest no one has a clue at the moment. a lot of the traditional ideas have been proved wrong. There is however a huge amount of ongoing research conducted in the hope of increasing patient outcomes who use orthtoics.

My advice seek a good podiatrist if you have painful feet or legs, combine that with a good physio I find that works in most cases