Most of us are aware of the importance of posture in relation to our health and well-being. Some may be aware of the connection of the posture of our feet in relation to the rest of the body. As the saying goes, “When the foot hits the ground, everything changes”. First, let’s look at the foot. Think of the foot as having two different personalities: One that is forgiving and absorbing (pronation); and another that is rigid and stern (supination). When we walk, there must be a balance between the foot’s two personalities. When there is too much pronation (over-pronation), the foot has to absorb more force than it is used to. This excessive absorption is transferred to the rest of the body until it dissipitates. This causes the body to work more than it has to which can lead to musculoskeletal pain. When there is too much supination (over-supination), the foot is not absorbing enough of the ground reaction forces and the resulting stress is a shock to the body. This can also lead to musculoskeletal pain. Just think of a car without any struts (shock absorbers) and imagine how bumpy of a ride it would be to go over a bump or pot hole.
Most people tend to overpronate and as a result may develop some form of overuse injury or pain elsewhere in their body. “Flat feet”, or fallen arches, and “pre-bunions” are usually dead giveaways of an overpronator. Some overpronators use orthotics in an attempt to correct their faulty foot mechanics. My experience with orthotics is that they are too expensive and overused as a treatment modality and do not appear to get consistent results with patients. My two main personal problems with orthotics is that they are based on the theory of controlling motion at the heel and not the forefoot and that they tend to be too firm and restrictive. When you restrict a motion in the foot too much, the restriction will be compensated elsewhere in the body. The most popular complaint I get in my clinic after orthotics are prescribed is the development of sacroiliac joint pain. As far as controlling motion at the heel, I find that helps “sometimes”, but not as often as I was trained in school to expect in the clinic. In school, I also never heard of the foot structure called a “Morton’s”, or “Rothbart” foot. This is a term used to describe a foot where the big toe and 1st metatarsal (the long bone underneath the big toe connecting it to the rest of the foot on the inside portion of the foot) are raised off the ground in relation to the other four toes. What this means is that when you walk and the heel hits the ground, the rest of the foot rushes to make floor contact with the elevated 1st metatarsal and big toe in order for the foot to get to the next stage of propulsion (remember, when we walk we do so in a heel-to-toe manner). This “rushing” can lead to overpronation causing the ankle to roll inward and the inside foot arch to collapse.
Posture Control Insoles (PCIs) address the Rothbart foot structure by filling in what is called the functional first metatarsal deficit, which is the space between the floor and the raised 1st metatarsal. In this respect, PCIs are not restricting motion like orthotics would, but rather are improving the proprioceptive function of the foot musculature. Think of proprioception as the awareness of joints and muscles. PCIs are thin, flat insoles with a thickened portion underneath the big toe and 1st metatarsal. They literally act as an extension of your foot allowing for more natural motion which helps balance out the two personalities of the foot.
Keep in mind that PCIs are not for everybody. But they may be appropriate for about 80of the population. It is important to be properly evaluated and followed-up by a healthcare provider who provides PCIs. Many people feel an immediate improvement; some do not feel anything for awhile. Some people also report feeling soreness initially that resolves once they are broken in. I generally recommend patients to wear their PCIs for only two hours the first day and gradually increase two hours every day or so until they are wearing them all day.
I have experimented with PCIs and have become impressed with the results so much so that I am currently selling them in my clinic. Oh, yeah, I almost forgot to mention, the company that makes the PCIs have this Clinical Performance Guarantee where they will take back the insoles if you find they are not helping you at all. What have you got to lose? Call today and schedule an appointment for a Posture Control Insole Evaluation.
