Minimal Footwear, Orthoses and Supportive Footwear
There can be some controversy on custom foot orthoses and some statements that they weaken the feet. There is a belief that minimalism is one approach and the other is to believe in supportive and durable footwear. My goal is to provide information on both to allow one to make the best decision for their individual health needs.
The reality is that some activities which require repetitive movement, such as walking or running, on a regular basis, can lead to tissue overuse. People who wear minimal shoes have come into my office with injuries and those who run in minimal shoes still do end up with injuries.
There have also been people who wear supportive footwear and still end up coming into my office with injuries. The point here is that footwear is part of the puzzle and not the entire puzzle. Strength and rehabilitation of the entire kinetic chain, along with footwear will yield better results, than footwear or orthoses alone.
To break things down from a treatment approach, when there is an injury, the ability to maintain some relative load on the tissue is part of rehab. Allowing this to take place by also dissipating the amount of complete load on the tissue can be mitigated by taping, orthoses, supportive footwear or bracing.
What support and orthoses can do is help one maintain a quality of life or continue their life to help lessen the load on the injury so it can get stronger from exercising and maintaining some load on the area. Orthotics do not zap the strength out of the foot, In fact, there are studies that suggest strength is improved when orthotics are combined with exercise.
What the Research says :
The study “Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: a randomized controlled trial”, found orthoses combined with short foot exercises increased the strength in the toe flexor and abductor hallucis. This proves that orthoses do not diminish foot strength.
In another study orthoses used in isolation without strengthening does not strengthen the feet. Which I do agree with. Orthotics alone are not meant to strengthen the foot. They are meant to help unload forces on an injury in conjunction with strengthening.
Some injuries are quite severe, but for most conditions suitable for orthoses, pain reduction is possible. For those who work on their feet all day, or an avid active person who can resume exercise with a reduction in pain, an orthotic can be a great option for them.
An example of a study which demonstrates how runners benefited from an orthotic was a study “ Effects of foot orthoses on Achilles tendon load in recreational runners”.
The results indicate that running with foot orthotics was associated with significant reductions in Achilles tendon load compared to without orthotics. The unloading allows the runner to continue their activities while they rehabilitate. This should be weaned off in time.
Also, if one stayed in that device long term there would be changes that could in fact weaken the area and shorten it. So another part of the puzzle is to properly use the devices and have the proper prescription for the injury and foot type.
If someone was injured I would not advise them to continue standing, walking or running for prolonged periods of time in a minimal shoe. That being said, when strengthening the foot I would advise being barefooted or in minimal shoes. There is a time and placenfor minimal footwear. The longer the high load activity there is, muscle and physical failure happens and that is where injuries are most likely to arise.
I think minimal footwear is great for deliberate strengthening, or the odd time running on the grass or sand. However, pounding the pavement, rehabbing an injury or setting personal bests may not be best sought out in minimal footwear.
How you can try utilizing support prior to getting orthotics:
An easy way to see if you would benefit from support when combating an injury is to try some taping and padding. We can provide this for you. Over the counter insoles can also be used to see if there is any small improvement. There is generic support in these and they are not custom with posting or specific prescriptions needed for certain injuries, but can provide some help.
To summarize, I am not against minimal footwear. Track spikes are very minimal. I do think some minimal footwear for deliberate proprioception/ foot strength is okay to wear. However, for prolonged walking, standing and running, especially when injured, can benefit from more supportive and protective footwear tools.
