Shoes, Arch Support, Posture and Pain. Myths and Truths.
By Andy Park, DC
Dynamic Neuromuscular Stabilization (DNS) Specialist.
Shoes, Arch Support, Posture and Pain. Myths and Truths.
How many times have you heard that you need more arch support? Have you ever been told need more support to reduce pain or dysfunction in your feet, in your knees, your hips, your low back and maybe even your neck? What if I told you that arch support should actually be reserved for a much smaller and niche demographic than they are recommended for currently? While it is true that problems with your feet can create problems up the chain, having more arch support is not usually the answer. We will talk about these topics and more today in this post and hopefully illuminate for you the reader what things may ACTUALLY be helpful when it comes to local foot or global full body dysfunctions that stems from the foot.
Shoes. Pros and Cons of thick soled “supportive” shoes vs minimalist shoes
It is very likely that throughout your life, you have been told to wear thick foam soled “supportive” shoes and that would be what is best for your feet and your overall health. The notion was simple. If you have pain, find some sort of ergogenic aid to make you feel less pain. On the surface it does not seem like there is anything inherently wrong with that and to some degree this is true. What it does boil down to however are your priorities. Do you value pain relief or do you value fixing the underlying issue? If you were to come to my office and told me that your neck hurt, and I told you to wear a neck brace the rest of your life because it makes it feel better, is that technically bad advice? I am giving you a solution to help alleviate your symptoms right? If this sounds ridiculous to you as it does to me then you and I most likely agree. Perhaps addressing the underlying cause of the neck pain in that case may be the better more sustainable solution and so the same applies for your feet. If you get expensive supportive narrow toe box shoes or a stiff set of insoles (we will talk more about insoles later) that may make your feet more comfortable but over time is almost certainly weakening your intrinsic foot muscles and is also reducing the awareness and just general coordination of your foot in relation to the rest of your body.
This is when I would start to recommend a different solution for your foot pain or related dysfunction which is actually less support in the form of minimalist footwear and strengthening/re-coordinating drills. Less support and less material between your foot and the actual ground you are walking on generally results in strengthened intrinsic foot muscles over time, less chances for tripping with a lower center of gravity, and better proprioception or “feel” through your feet of the actual surfaces you are walking on. When your brain can better asses its surroundings and your brain receives more immediate feedback through your feet due to less material prolonging that force transmission that translates to better performance throughout your whole body and over time less pain.
It bears saying that I would not recommend switching to this type of minimalist shoe all at once due to the fact that too much of anything too quickly in regard to the body can result in injury, but with a proper planned transition over time this could be a great solution for the issue of foot pain and or related bodily pain elsewhere. I would also add that minimalist footwear was born out of the desire to be true to our body and the environment in which it evolved. Our bodies, however, did not evolve while walking on concrete all day either. Keeping that in mind, a little bit of padding to ease the blow of our modern society and city sidewalks may be a good thing. Shoes with padding so thick it feels like walking on marshmallows though may be detrimental for you when compounded over years. Honorable mention also goes to narrow, stiff, oxfords as well as restrictive high heels. The bottom line is we want a broad flat (zero drop) shoes with just a bit of padding that allows your foot to feel the ground and actually move.
What is arch support and why do we care?
When talking about the foot and foot health, arch support is almost always thrown into the conversation. I would ask, does it need to be? The one hypothetical situation that I would agree that insoles or “supportive shoes” to maintain arch support would be a good Idea is if you worked a job where you had to stand in one place all day without many opportunities to move around. Outside of this scenario your foot when in motion is supposed to pronate and the supinate during a normal gait cycle. If we use a stiff rigid arch support that might actually limit our ability to pronate when necessary or potentially weaken the muscles that control pronation over time. Not to mention a rigid arch support could make symptoms worse for patients when they need to walk without shoes on. Some might say “well just don’t take off your shoes” but one, that sounds miserable to me and two, that sounds like a good way to breed various types of foot fungus. All this to say too much support in a shoe may not actually be the best thing for you depending on your situation.
Do “flat feet” or “poor posture” actually lead to pain?
What exactly is flat feet or poor posture, and do they tie into each other? Historically podiatrists, orthopedists, and other people who know something about feet would have likely said yes. If you have flat feet, your feet need arch support and because they are flat they are throwing off the geometry to the rest of the body leading to poor posture and over time contributing to repetitive stress types of injuries. In the physical medicine world however, we have been noticing a slow but sure paradigm shift away from a structural approach to the body to a more dynamic functional approach to the body. Just because something appears a certain way does not necessarily mean there is dysfunction! IF a foot appears flatter but again is still pronating and supinating appropriately through gait then I see no reason to make changes to that individuals foot with any sort of external aid. Yes, we can all always improve how we are moving on the whole but from a clinical lens, if a person had a flatter arch and no pain and was pronating and supinating when appropriate then I would not take any specific action.
Closing Thoughts
At this point, let us revisit the idea of supportive shoes and arch support, being main tools in recent history to intervene when presented with foot pain. The long and short of it is that as a society, as technology improves often our activity decreases. As we habitually move less and less, when we ARE actually called to move or we choose to move for recreation, we may find that our bodies have so adapted to being sedentary that it is uncomfortable or painful to move. Therein lies the overarching problem. The solution then is to swim upstream, against the current of modern comforts and make sure to try and habitually inject a variety of types of movement into our lives so that we are prepared for movement when we are called to it, and so we can enjoy the things we love to do without major dysfunction or pain.
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