Orthotics are not a bad thing. Let us be clear about that from the start. For the right person, following the right assessment, they can make a genuine difference. The problem is that the right assessment does not always happen. And when it does not, orthotics become something to put in a drawer after a few weeks, or worse, something that quietly shifts a problem from one part of the body to another.
We see this regularly. Someone comes in with knee pain, hip pain, lower back pain, or recurring plantar fasciitis. They have already been fitted for orthotics. Sometimes they have helped a little. Sometimes not at all. Sometimes the original problem has settled but something new has appeared. And in almost every case, the same question applies: was the whole kinetic chain assessed before the insole was prescribed, or just the foot?
What the kinetic chain actually means
Your body does not move in isolated parts. Every step you take involves a sequence of forces travelling upwards from the ground through the foot, ankle, knee, hip, pelvis, and spine. That sequence is what clinicians call the kinetic chain, and it functions as a unit. A restriction or imbalance at any point in that chain changes how every other part of it moves and loads.
This is why foot pain is not always a foot problem, and why knee pain is not always a knee problem. The site of pain tells you where the load is concentrating. It does not always tell you why.
The site of pain tells you where the load is concentrating. It does not always tell you why.
An orthotic changes the position and mechanics of the foot. That is its job. But if restricted hip rotation, a stiff ankle, or an imbalanced pelvis is contributing to how load travels through the lower limb, placing a corrective device under the foot addresses one variable in a complex equation. It may reduce symptoms. It may not. And it does not resolve the underlying mechanical issue that is driving the load pattern in the first place.
What a proper assessment actually looks like
A thorough kinetic chain assessment takes time. It is not just looking at foot posture or gait in isolation. It involves working through the whole lower limb and pelvis systematically, looking at how each structure moves and how each one influences the next.
Gait analysis
We watch you walk. Not just your feet, the whole picture. How do your hips move? Does the pelvis drop on one side? Is there asymmetry in stride length or arm swing? Gait tells you how the body is compensating in real time, and compensation patterns are where the relevant information usually lives.
Foot and ankle mechanics
Pronation, supination, heel strike pattern, ankle dorsiflexion range. The foot assessment matters, but it needs to happen in the context of everything above it. A flat arch is not automatically a problem. Whether it is causing a problem depends on how the rest of the chain is managing it.
Knee tracking and loading
We assess how the knee tracks through movement and where load is concentrating. Patellofemoral pain, for example, is very often a hip and foot problem presenting at the knee. Treating the knee without addressing those contributing factors produces incomplete results.
Hip mobility and strength
Restricted hip internal rotation and weak hip abductors are two of the most common contributors to lower limb loading problems we encounter. They change how force travels through the knee and how the foot contacts the ground. They are also frequently missed when the assessment starts and ends at the foot.
Pelvic and lumbar mechanics
The pelvis is the junction between the lower limbs and the spine. Asymmetry here, whether in muscle tone, joint mobility, or habitual posture, feeds down into the hip and up into the lumbar spine simultaneously. It is a common source of problems that look like hip or knee problems on the surface.
When orthotics are part of the right answer
None of this is an argument against orthotics. It is an argument for thorough assessment before any intervention, orthotics included.
There are presentations where orthotics are genuinely indicated and clinically appropriate as part of a wider management plan. Significant structural foot deformity, certain biomechanical presentations in runners, specific loading patterns in patients who spend long hours on hard floors. In these cases, a well-fitted orthotic, chosen after proper assessment and used alongside hands-on treatment and rehabilitation, can be a useful tool.
The issue is when the orthotic becomes the entire plan. When it is prescribed quickly, without a thorough look at the whole lower limb, and handed to someone as if it will resolve a complex mechanical problem on its own. That is where people end up frustrated, out of pocket, and not significantly better.
The orthotic is not the problem. The incomplete assessment that precedes it is.
What this means in practice
If you have been prescribed orthotics and they have not helped, or have only partially helped, it is worth having the whole picture assessed. Not because the orthotics were necessarily wrong, but because there may be other contributing factors that have not been addressed.
Equally, if you are being advised to get orthotics, it is reasonable to ask what assessment has been done of the structures above the foot, and how the orthotic fits into the wider management plan. A good clinician will have a clear answer to that question.
At Osteopath Blackpool, when we see lower limb presentations, we assess the full kinetic chain before drawing any conclusions about what is driving the problem. Sometimes that assessment confirms that orthotics are appropriate and we will say so. Sometimes it identifies restrictions, weaknesses, or compensation patterns that need to be addressed directly. Often it is both.
The goal is not to be sceptical of orthotics. The goal is to make sure that whatever intervention is recommended is based on an accurate picture of what is actually going on.
