Have you been told you need orthotics? Maybe you already have a pair sitting in the cupboard, because they were hard, only fitted your running shoes, or just didn't help.

It's one of the most common questions we get at our Tauranga clinic. My honest answer is: maybe, but probably not forever. As I told UNO Magazine, "Orthotics will work for a percentage of people, but not everyone."

What do orthotics actually do?

Orthotics are inserts that sit in your shoes and change how load is spread across your foot. They can take pressure off a sore area and ease your symptoms, which is why many people feel some relief when they first wear them.

Dr Courtney Conley, founder of Gait Happens, describes orthotics as a "load modifier". She likens them to the bumpers on a kids' bowling lane: they keep the ball out of the gutter, but they don't teach you to bowl straight.

When orthotics can help

I'm not anti-orthotic. They have a place, and there are times I'd happily recommend them:

• To settle a flare-up. When tissues are really irritated, taking some load off can give them a break while you work on the cause.
• Short term, with a plan. Dr Conley says orthotics should be a temporary therapy, used as needed, and that research shows they can be very helpful for heel pain for a short period of time, "not 30 years". Her advice is to always have an exit strategy.
• Some longer-term cases. She also notes there are a small number of people, for example after trauma or with a structural difference, who may need them long term. Even then, she keeps working on strength and function.

Why orthotics often don't fix the underlying cause

Orthotics are like reading glasses: they only work while you're wearing them. They can ease symptoms, but they don't correct the underlying cause. If your joint alignment isn't corrected, you could end up relying on them for the rest of your life.

In my experience, most foot pain comes down to two things: misaligned joints in the feet, and weak foot muscles. The two are linked, because the position of your joints affects how well those muscles can work. (Read more about the top 2 underlying causes of foot problems.)

There's also a "use it or lose it" side to this. A small 2020 study in Clinical Biomechanics by Protopapas and Perry followed young adults with flat feet who wore custom orthotics for 12 weeks. By the end, three of the small muscles under their feet had become measurably smaller. The researchers suggested adding a strength programme alongside orthotics to prevent this.

What natural and barefoot podiatrists recommend

Many practitioners who focus on natural foot function share a similar view:

• Dr Ray McClanahan, the podiatrist behind Correct Toes, points out that a true arch is supported at its ends (the heel and the ball of the foot and toes), not underneath the middle. In his article on arch support, he argues that pushing up under the arch can weaken the small muscles that span it, and he blames shoes with raised heels, narrow toe boxes and upturned toes for much of the problem.
• Dr Courtney Conley says the goal is to settle the pain and restore function, so that the orthotic is no longer needed. She recommends working on foot strength and mobility to carry you pain free into later life.
• The research on foot strengthening backs up the idea that the foot can be trained. A systematic review of 13 trials by Jaffri and colleagues found that exercising the small muscles inside the foot improved balance, strength, foot posture and day-to-day function. To be fair, it didn't find a clear effect on pain on its own. The "short foot" exercise came out as the most effective.

That last point matches what I see in the clinic. Exercises alone often aren't enough, because if the joints aren't back in the right position first, the muscles can't do their job properly.

How Foot Mobilisation Therapy (FMT) works

This is where we do things a bit differently. Early in my career, I got frustrated seeing patients come back with a bag full of orthotics that hadn't worked. I thought there had to be another way of treating the foot and leg, without putting someone in an orthotic or referring them to surgery.

Foot Mobilisation Therapy (FMT) is a gentle, hands-on technique. We:

1. Assess your feet with a hands-on joint assessment, and weight-bearing x-rays where needed, to find the underlying cause.
2. Gently guide the joints back into position.
3. Strengthen the muscles with specific exercises to support the change.

Everything works better in the right position. My aim is to get you from A to B, and then get you self-sufficient, walking better barefoot rather than relying on a device. And yes, that usually means you can keep wearing the shoes you love. You can see how this worked for one patient in Fixing foot pain without orthotics.

Simple things to try at home

These won't replace a proper assessment, but they're a good start:

• Spend some time barefoot at home on safe surfaces, to let your feet do the work.
• Try the short foot exercise. Sitting with your foot flat, gently draw the ball of your foot towards your heel to lift your arch, without curling your toes. Hold for a few seconds, relax and repeat.
• Spread your toes. Lift and spread them apart, then place them back down one at a time.
• Check your shoes. Look for a toe box wide enough for your toes to spread, and a flexible sole.
• If you already wear orthotics, don't throw them out overnight. Talk to us about a gradual plan to wean off them while you build strength.

If something hurts more when you try these, stop and get it checked.

When to book an assessment

Book in if you have heel, arch, ball of foot, bunion, ankle or knee pain that isn't settling, if you've tried orthotics and they haven't helped, or if you just want to know whether you really need them. The sooner a problem is treated, the better the results.

Call our Tauranga clinic on 07 925 0269 or book an appointment online. You'll find us at 1260a Cameron Road, Gate Pa.