We get this question a LOT in our profession. Much like every other question in our industry, the answer is not so straightforward. I’ve been working as a physical therapist for 25 years and have been casting orthotics for 20 years and I still don’t have the exact answer to this question! However, I have learned a great deal regarding this topic over time, and I’m here to share it with all of you.
First let me start out by saying that I truly don’t believe everyone needs orthotics. Sometimes it is a matter of wearing the correct shoe or supplementing with the correct exercise. That being said, by the time someone comes to see a physical therapist with a significant gait abnormality, it can be very challenging to fix it through manual therapy and exercise. We start walking around age 1, the arches in our feet finish developing around age 10, and it usually isn’t until age 30, 40, or 50 that we start thinking we are walking funny. That’s potentially 20, 30, 40 YEARS of an established motor program that needs to be reset. Now, I said “challenging” to fix it…. not impossible.
The way we decide if someone truly needs orthotics is if all our other avenues fail. As movement experts, we use external support as a last resort. We first assess your posture from head to toe. We look for things like scoliosis, leg length discrepancies, hip dysfunction, ankle restrictions, big toe mobility, balance issues and strength. We use manual therapy techniques like joint mobilizations, dry needling, taping, and myofascial release to improve quality of gait movement. We emphasize strength throughout core, hips, knees, ankles and feet to ensure proper motor control.
Depending on what the issue is, we typically can identify if someone is a good candidate for orthotics after 8-10 sessions of physical therapy. That usually equates to around 6-8 weeks of care. If we don’t see a significant change in gait AND you, as the patient, don’t report an improvement with our strategies, we dive into the orthotic discussion