Focusing on the feet: Understanding mechanics and orthotics
By Dr. Robert Weil
It’s hard to believe that I have been prescribing custom orthotics for youth athletes over the past forty years. Young boys and girls, from five-year-olds to teenagers in sports such as soccer, baseball, football, basketball, tennis, figure skating, hockey, running, and dance have all benefited from wearing proper orthotics for their sports. Athletes’ concerns and challenges both physically and mentally are usually the same regardless of the sport. Quite often their overuse problems or discomfort is related to their foot type or mechanics. Almost always the reasons are persistent pain or discomfort, not an acute injury. Their feet, heels, shins or knees hurt especially with aggressive schedule and playing demands.
More and more, however, especially in figure skating, the use of orthotics has also improved balance, stability, edging and performance. I have never had a skating coach or parent tell me: “The orthotics slowed my young skater down or they messed up their balance.” Never!
Orthotics for growing kids might be changed every year and a half to two years. Once their foot growth is over, (girls about fourteen and boys about sixteen), they might use same orthotics for the next ten years. Rarely is larger shoe or skate boot needed for these inserts.
We’ll get more specific with foot type, foot mechanics and joint position and alignment later this chapter.
Prescription in-shoe orthotics, properly done, ideally by podiatry, but also by well qualified physical therapists have really proven to be a major weapon in the treatment and prevention of foot related ankle, lower leg, knee, hip and back overuse problems.
The feet affect all areas above them from the ankles to the knees to the hips to the back in all our lower body movements. Just like the song, Dem Bones: The foot bone’s connected to the ankle bone, the ankle bone’s connected to the knee bone…all the way up the weight bearing chain. In running, jumping, skating sports – that’s where it’s at! So we have to realize how important it is to have healthy foot mechanics and support.
Orthotics are made from various materials. Often the demands and specifics of the sport can determine these materials. I have always liked flexible unbreakable polypropylene plastic for youth sport orthotics. Flexibility is determined by the athlete’s weight and their sport.
Orthotics do much more than support the arch. They help properly position and align the foot, ankle and lower extremity. Optimal joint position and structural integrity are the goals. Often the prescription is made using plaster cast molds of the feet in measured positions. These can be messy, but I believe they are the best method. Orthotics have various uses and indications. Examples are redistributing weight away from painful areas to control excessive or abnormal motion, or enhance alignment of the lower leg. Dissipating and reducing shock might be another important use.
A common misconception is that custom orthotics are arch supports. They are not. There are definitely uses and indications for over the counter inserts or supports, and often I’ll recommend them for temporary initial use while we’re waiting for the custom orthotics. But these are generic inserts by shoe size which do not have much effect on foot function or joint correction.
The main role of custom orthotics is usually to control the positioning of the feet and lower legs during the different phases of gait. Basically, the foot has three jobs in walking and running:
- Shock absorption when the heel hits the ground.
- Ground accommodation or shaping to the ground, (imagine walking on the sand).
- Pushing off the foot like a spring lever.
Each of these actions demands particular motions of the foot and rotational motions of the lower and upper legs, pelvis and spine. The terms used to describe these foot motions are pronation and supination. These are complex motions taking place in the joints of the foot and the lower ankle – three motions in three directions simultaneously.
Only our hands are as complicated, but we don’t walk on our hands! I mentioned that once in a talk I was giving to young gymnasts and one of them said: “Yes we do.”
Pronation (movement inward) and supination (movement outward) are normal motions of the foot. Problems can arise when the timing, velocity, or amounts of these motions are excessive or limited. Pushing off a loose hyper pronated foot is risky and can strain the supporting tendons and muscles.
Various inherited foot types and leg shapes create problems with these motions. Some examples are flat feet, high arches, bowed legs, knock knees and leg length differences. Each of these imbalances (quite common), can cause excessive pronation or supination leading to problems with overuse, wear and tear, arch, heel pain and knee pain and shin splints.
Foot type and leg shapes are commonly inherited. National health statistics and surveys show that over 75 percent of us exhibit some minor to major foot or leg imbalances. It’s not surprising then with so many young athletes “pushing the envelope” that overuse and repetitive motion injuries have exploded around youth sports.
FOOT TYPE AND MECHANICS
Many sports parents ask, “Does my son or daughter NEED orthotics?”
Better questions are:
“Would they benefit from them?”
“Will my young athlete be less susceptible to overuse injuries?”
“Will they help performance?”
Often the answer is yes to all the above questions!
Once sports parents understand that custom orthotics are designed to capture the optimum alignment and functioning position of the fee and lower legs, enhance the normal motion and position of the joints of the foot and ankle and that these devices are not crutches or arch supports, perhaps they will increasingly realize the importance of them.
Although not a cure-all, custom orthotics are a step up for both preventing overuse injuries and enhancing sports performance.
This excerpt was reprinted with permission from #HeySportsParents!, a book co-authored by Dr. Robert Weil and Sharkie Zartman. Weil is a sports podiatrist who has treated many of the world’s premier athletes in a wide variety of sports. He is the host of The Sports Doctor Radio Show and has written many articles for newspapers and magazines on sports parenting.
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