How To Reverse Foot, Knee & Hip Pain with Orthotics & Insoles FAST

This is Dr. Tom Biernacki Today I'm talking about orthotics. There you go. They can really suck or they can be really amazing. So what's the story? When I have patients come in, I feel like they get amazing results. But there's so many bad opinions when people come into clinic. They hate orthotics. They're like, Hey, this guy's going to charge me another 500 bucks. So what's the deal on Barefoot Shoes versus orthotics and big shoes? What's the deal with expensive custom orthotics or cheap pre-made orthotic? It seems like there is no rhyme or reason, but that's where we're wrong. There's a lot of studies, there's a lot of science. There's whole books written on the subject. I've dispensed thousands and thousands of orthotics. I'm going to tell you what works, what doesn't work, and how to save your money. And we're starting now. In the 1970s and 1980s, orthotics became very popular. So initially, custom orthotics and pre-made orthotics started making people's problems go away. Then insurance got involved. Insurance was still pretty good then and covered most orthotics. Everybody started getting them. Every type of doctor and health care professional got in on the gold rush. They started making a ton of money and then everybody was dispensing crap here and randomly made orthotics. Nobody was really taking time making them, and the quality kind of went downhill. Right now Just an aside, it's not just orthotics. Look at the amount of administrators in health care. The percentage has risen 30 500%. Right now, there's about 20 administrators per health practitioner in America. And look at the reimbursement. All the money's going to hospitals, to medical equipment, to pharma and physician and practitioner pay has stayed level or actually decreased per inflation. And that's why a lot of people say becoming a doctor these days is actually a horrible decision. So why am I showing you all this? Well, this is the rise of the cost that the government is paying for medical equipment. As there's more administrators, as there's more bureaucracy. You, as the patient, don't actually get your wheelchair, your orthotics, your crutches, your ankle braces unless you're getting gouged. Huge amounts of money and at a certain point, it's not worth it. And that's what's happened to orthotics and doctors prescribing orthotics. That's why they fell off a cliff. And they're not really a good value anymore. you have a lot of false claims. You had a lot of snake oil salesman. People are selling orthotics for like $1,000 or more with no results. And people got pretty upset at these orthotics. Now, on the other hand, you have like $20, $30 orthotics that seem to make all the difference at the grocery store. So we're going to go over what works, what doesn't. We're going to review all the major brands. We're going to look at custom orthotics. And the good news is technology is improving. Now, there's a lot of great new methods out there, scanning technologies. There's boxes where you can put your foot and then they send you an orthotic. There's chiropractors, there's prosthetic labs, there's pre-made orthotics. So which one should you go with? Personally, for me, a properly made orthotic can help almost all biomechanical issues. How can bunions hammer toes the whole of the foot pain heel pain, arch pain, Achilles tendon pain, ankle pain, knee pain, shin splint pain, hip pain, lower back pain, literally all of these. If it's probably done, it should help with all of these conditions. And if you're in Michigan, you're looking at surgeries for any of these problems. Come check it out. I'll make you a set of orthotics on the house. Tell them you watch this video and I'd love to help take care of you. That's how I feel about orthotics. I just know that they work extremely well and there's a lot of good ways to do it. Adoption is very important. Ligaments connect bone to bone and tendons connect muscle to bone. This is a very important chart. Your nerves, your muscles, your bone and your fascia adapt very quickly within about the first 30 days. Those start to adapt, so you start to feel better when you start a workout program. When you start wearing shoes. When you start wearing orthotics, but your ligaments, your tendons in your cartilage, they can take 60, 80, 90, 100 plus weeks to adapt. So this is the trick with learning how to walk straight. It's going to feel a little bit better in the first couple of weeks, but it's going to take about a year to start walking straighter, to start being used to walking straighter. And that's one of the big keys of orthotics. So what determines whether an orthotics is going to be successful and where you start? So first thing I do is I start with the biomechanical exam. I have the person walk up and down the hall and come back and we're looking for very simple things. It doesn't have to be really complicated, but is one hip lower than the other? Does one knee turn in more than the other? Does one foot turn out more than the other? And what we're trying to do with orthotics is just to get you walking straighter. And we want those muscles not to be overworked. If you're leaning on one side more than the other, then predictable like a series of dominoes, you're going to get sore in your body from overload The key is how your position superinfection neutral or over pronation. In this example. This is a neutral foot. Look at how straight his ankle, his foot is when he runs. This guy will do great because he has a neutral foot. Probably won't have as many issues. But take a look at this person. This is over pronation. Look at the bend of the leg compared to the ankle. Compared to the flattening of the foot. I can tell you right now this person will have Achilles tendinitis, plantar fasciitis, and both of the foot pain. And that's just the foot. What about the knee? What about the There is actually software that can measure the angle of your hips, your thighs, your knees, your feet. And we utilize some of this motion capture technology to calculate this. When it's green, you might do okay when it's red. You're probably going to have some muscle strain and some overwork. to the biomechanical exam. I will sit you down and I essentially check how flexible you are through your hips. I'll bend your knees in your hips in your thighs. Up and down will extend the knees in and out. I'll look at the ankles will bend the ankles in and out will bend the big toe joints in and out will bend the feet in and out. And I write down where you're tight and where you're not tight. We just want to get both feet equal and get you held straight. Most people don't realize how uneven they are. And if we can simply hold you a little bit straighter, the majority of your soreness will go away right off the bat. There are definitely undeniable differences between wearing good supportive shoes and the barefoot shoes or barefoot walking. When you're barefoot walking, you're leaning forward more. You're taking shorter, more focused steps. So that means you're not taking its widest steps in some people. That takes pressure off your hips and your knees. But the trade off is it puts more pressure on the ball of your foot, your ligaments, your joints, your tendons, which for some older people is not a good idea. So, for example, as your muscles, bone, nerve and fashion adapt and you don't have cushioning, you impact and you have zero millimeters of cushion on your shoe. That means if the proper amount of time has not gone by, you're going to develop stress fractures, ligament ruptures, damage, whereas with a shoe you have 8 to 12 millimeters of cushioning. So that means at the beginning that's easier to get used to. There's less of a transition time. But as at 60, 70, 80, 90, 100 weeks goes by. That's when it might make sense to get used to. What I like to do is start with something soft a pre-made orthotic that's soft. The first step should actually be assessing the patient's foot gear. We want to go from crappy shoes to good shoes. Now I go over all my favorite shoe guides, but essentially good shoes are brands that can fit and orthotic. And for the first week or two, you just want to get used to those. These are shoes like Brooks on Saucony, even a good pair of Nike's, even a good pair of Adidas. But there's also other great brands like Ortho Feet, which is an orthopedic shoe. Then they're sandals with arch support. They're slippers with arch support. Just getting used to these will kind of take you to level one of correction and the way we want to come up with a correction plan is kind of think about a dentist. If you have a crooked tooth, you don't want to straighten it all at once. You want to gradually straighten, straighten, straighten. And that's what we're doing with your body. You want to start with a soft and gentle orthotic, then a more aggressive orthotic, then a more aggressive orthotic, and then you're walking straighter as a few months go by. Just like teeth. So for the first week or two weeks, just get used to a good, comfortable shoe. The second step is get a good premade orthotic, good pre-made orthotic. I give my links below, but I also go over them in detail. There's a lot of different companies. There's a lot of great companies that do a really good job. And then as one month goes by, as two months go by, you're used to the good supportive shoe. You're used to the good supportive insert. And in the office, what I would do is I would modify that pre-made orthotic even more and see how much help it gets. For about 70% of people. Their knees get better, their hips get better, their feet get better. A lot of their foot problems go away, their muscles start working a lot better and you get used to walking straighter. A good plan is to start slow that five, six, seven weeks. Don't start with an unsupportive shoe. Start with a good shoe. Otherwise you're going to get bone soreness, muscle soreness, fascist soreness right off the bat. Start with a cushioned shoe with a soft, gentle orthotic. You don't need a hard, restrictive orthotic. Get used to it. You can see as ten weeks, 20 weeks go by your shot, your muscles are adjusting, the orthotic is preventing you from rotator, compressing, stretching, and then you could potentially go to a more supportive orthotic as your ligaments, your tendons in your cartilage get used to it. If that's still not getting used to it. If you're having a hard time adjusting, there's absolutely nothing wrong with using a walker. a cane ankle, braces, knee braces, massage sticks, massage back braces or back massagers? I use them too. It warms me up in the morning. It's a great start. At this point, you have to kind of decide, am I feeling better or do I need more correction? Now is when you can come work with a podiatrist like myself or another foot, an ankle specialist, like an orthopedic surgeon, if you broke your ankle, if you have some trauma, if you have severe nerve disease. And that's where custom insole can come in. Now, custom insole is going to be much more aggressive, most likely than a pre-made orthotic. The problem is, if you start with the custom insole, it's going to be way too aggressive and it's kind of like going to the dentist and asking him to fix your tooth all in one go. It's going to be really painful. You won't be able to tolerate the braces so tight and it's going to cause you so much pain. And then there is a step in between. This is where I consider brands like Up Step with the Foam Box, where you sit into it, or there's another great company called Fit's Perfect, where you can use your iPhone to scan your foot. These technologies are getting a lot better. I'm probably giving away my podiatrist Ferrari right here. If you step into a box, if you scan your foot, then what happens is they can make you a pretty good orthotic be use prosthetic labs. But the difference is no one's actually giving you a biomechanical exam so they can't make it aggressive. And the problem is these companies, they can't get too aggressive because you won't like your orthotic if it's too aggressive, even though it's probably the perfect orthotic for you if you had gotten used to it over time. If you go from the left hand side, which is the overprotected sore foot to the straight foot, it's going to mess up your knees, it's going to mess up your hips, your back's not going to be able to absorb it because you can see it takes almost a year for those ligaments, tendons and cartilage in those other joints to adapt. And that's the real secret with these orthotics. There's whole books written about modifications for orthotics and getting used to it. There's great studies for plantar fasciitis, there's great studies for Achilles tendonitis. There is great studies for flat feet and orthotics. Knee pain and orthotics. Hip pain and orthotics. These are unbelievably well studied and it's undeniable. The problem is if you wear too aggressive of an insult, it's going to make you too straight too quickly and you're going to get sore in your compensating joints like your knees, your hips, your back. If you start too soft, it's going to help a little bit, but not enough to really change anything long term. So you have to work with a biomechanical specialist where you can accomplish a five stage program. You want a number one biomechanical exam, you want to evaluate where your sore is at your back, your hips, your knees, your feet. Sometimes arthritis has to be unglued, so sometimes an injection, sometimes joint stretching with a physical therapist, sometimes massage therapy, sometimes a massage gun's needed, sometimes specific surgeries or procedures may be needed. And then as you start to walk a little bit straighter, those good shoes, those good slippers, those good sandals hold you better. The premade orthotic holds you straighter. Then you can work with podiatrists like myself for good custom orthotics. And then as you're walking straighter at that point, you get used to the custom orthotic and you're walking straighter. Now you can go on the barefoot shoes. Now is when everything makes sense because you're soreness should go away, you're much more straight, you're more uneven. But at the same time, if you have a limb length discrepancy or some type of permanent arthritis, you might need to wear the orthotics permanently. And that's really the trick because Barefoot walking is great. I love barefoot walking, but if you're injured, if you're sore, if you have ruptured damaged ligaments, then barefoot walking is really bad for you. If you're already straight and healed, that's when barefoot walking makes a lot of sense for you. There is no specific numbers, but I would estimate 70% of my patients over pony about 15 supine. It's rare. I would say about 30% of people are straight like this. And it's young, healthy, fit, athletic people. Most people that see me are overprotected. They get plantar fasciitis, they get Achilles tendinitis, they get bottom of the heel pain they have inside of the knee or M.S. all pain. And they have hip pain, lower back pain and sciatica. Pain. It's extremely common and there's a lot of variability. Consider your lifestyle inactivity. If you're on your feet all day, you probably need a both a cushioned and a supportive shoe. There's lots of good shoes that can help you stand all day. What are the costs of these orthotics? A premade orthotic can cost between 20 to 50 to $70, whereas a good custom orthotic can range from about $200 for one of those male options to a little bit more, probably like three or $400. Working with a specialist who's going to adjust them for you. The real key is to work through those stages and get that biomechanical exam. I'm telling you, if you follow this method, nearly 100% success with these orthotics. And when I say success, I mean people get a whole lot better. They always make a big difference. Even if you do need surgery, even if you have severe long term problems, you want to work up to it that way. What's the big secret on orthotics? Well, the problem with orthotics now, insurance companies don't like covering them because everybody started doing it And more accurately, the 20 administrators that are supervising that doctor have to get paid as well, including the people manning the phone for your pre-authorization, for your orthotic. and now there's no money in orthotics. There is not a whole lot of money in promoting these things. Hospitals and surgical centers don't make any money by dispensing orthotics. If I gave you an orthotic, I can now no longer do my bunion surgery or my heels for surgery on you if it works. And those are worth tens of thousands of dollars to hospitals to health care systems and everybody's kind of in on it. Haven't you seen that in the health care system where the solution that's the most expensive and makes people the most money is the most advertised one? That's really what's happened with custom orthotics. Now, there are so many studies on how great the surgery is, but there's almost no studies on how great the orthotics are. It's almost like we're living in Bizarro World because we know the orthotics walk like it's crazy to me. They work close to 100% of the time. They're safe and they're effective. But insurance and health systems now push towards the surgery. And then if that's not working, you want to come in to see a podiatrist like myself. And if you're in Michigan, I would love to see you. I usually follow with pre-made orthotics that I have available for free in my office in most cases to start off with. And then we have a 3D printer that can print custom orthotics. A lot of the times for very cost effective rates, much cheaper than the preordered ones, even online. What I do is I do a biomechanical exam. I check your hips, your knees, your thighs, your hamstrings, your calf muscles. I bend your ankles up and down your big toe joints up and down. I see where it's tight. What kind of adjustments do we have to make? And the thing is, you can adjust them from appointment to appointment. And when your foot is now straight, that soft tissue gets used to it. Your hamstrings, your thigh muscles, your hips, your lower back over a couple of months, get used to walking straight. That's when walking barefoot. Makes sense. That's when strengthening your muscles makes sense. At first you want to just get used to walking straight in. Your muscles will adapt. Using this method, virtually 100% of patients that come see me do see improvement. And there's no real risk because does not have to be high. What's a 20 or 30 or $50 pre-made orthotic when you're weighing surgery as a result? And here's the real big secret. All of this stuff is around for a reason because it works. There's happy people and there's unhappy people with all of these. You just have to use it correctly. The reality is, in my opinion, orthotics work amazing. This stuff all works. The barefoot walking works, the orthotics, the good shoes. They all work, but they have to be used at the right time and the right sequence. I go over my favorite shoes, my favorite orthotics and my condition specific guides. If you're in Michigan, come see me. But the big secret as well is you have to get a biomechanical exam. If something's hurting when you wear your orthotics, you have to get it looked at. Is it a bad knee, a bad hip, a bad foot? You might have to massage, you might have to use a foam roller, You might have to get physical therapy, you might have to get an injection, you might have to get shockwave therapy and to your body start walking straight. And if you want to walk straight or check out my 30 day guide to transform your health, you won't regret it.