Podiatrist · Specialist in Biomechanics · Founder of VOLKAN
"An insole should not try to build the foot we imagine. It should help the foot we have in front of us."
"Doctor, do you need insoles?"
It’s a question that comes up almost automatically when parents hear the words flat foot.
Many come convinced that the insole will be the next step.
Others feel fear if someone has told them that, without it, the foot "will deform forever".
I understand that concern perfectly.
When we talk about our children, we want to do everything possible to help them.
But before responding, I always try to pause the conversation for a moment.
Because the most important question is not whether a child has a flat foot.
The really important question is another.
What problem do we want to solve with the insole?
A tool with a purpose
Imagine some glasses.
They are not prescribed because the eyes are different.
They are prescribed when they help a person see better.
With insoles, something similar happens.
They should not be used simply because a foot has a certain shape.
Their indication depends on whether they can improve a function.
Reduce pain.
Decrease a overload.
Facilitate an activity.
Increase the comfort in certain circumstances.
The tool must always respond to a specific need.
Never to an isolated image.
The form does not always need to be corrected.
For many years it was assumed that a flat child’s foot should be modified as soon as possible.
The intention was good.
It was thought that if we could "create an arch," we would avoid future problems.
However, the research of recent decades has changed our way of understanding foot development.
Today we know that most of the flexible and asymptomatic flat feet evolve naturally with growth, without solid evidence that orthotics change the development of the arch.
That does not mean that orthotics are not useful.
It means that we should use them for the right reasons.
Helping does not always mean correcting.
An orthotic can modify the distribution of loads.
It can change some movement patterns.
It can relieve tissues that are bearing too much demand.
It can improve comfort during certain activities.
All of that can be extremely useful.
But none of those functions consist of "manufacturing" a perfect foot.
Modern biomechanics has stopped pursuing ideal forms.
It prefers to help the organism function better within its own reality.
And that difference completely changes the way we understand treatment.
Each child writes a different story.
Two children with very similar footprints may need completely different decisions.
One runs, plays and shows no discomfort.
Another feels pain when walking long distances.
One enjoys all physical activities.
Another avoids running because they end up exhausted or uncomfortable.
If we only observe the shape of the foot, both seem the same.
When we observe how they live and how they move, we discover that their story is different.
And the treatment must be as well.
What does this have to do with barefoot?
A lot.
Some people believe that barefoot and insoles are incompatible concepts.
That is not true.
Both are tools.
And, like any tool, they can make sense at different times.
There may be a child who temporarily needs help to relieve an overload and who, at the same time, benefits from footwear that allows good mobility of the toes and the foot.
There may also be an adult who uses barefoot for most of their daily life and resorts to an insole during a specific recovery process.
Biomechanics does not pit tools against each other.
It combines them when necessary.
Because the goal has never been to defend an object.
It has always been to help a person.
What I see every day in consultation.
One of the phrases I repeat the most is this:
—I am not going to decide by the shape of your foot.
I am going to decide by how it works.
Sometimes that means recommending an insole.
Other times it means reassuring a family and explaining that development is proceeding normally.
And, on many occasions, it means accompanying, observing, and reevaluating before intervening.
I have found that the best decision is not usually the fastest.
It is usually the one that best respects the biological moment that child is going through.
What you can do from today
If you are ever recommended insoles for a child, do not be afraid to ask a simple question.
What specific function do they intend to improve?
If the answer only talks about the shape of the arch, an important part of the conversation is probably missing.
If the answer explains how they will help the child walk, play, reduce discomfort, or improve their function, then you will be speaking the same language.
Because understanding the goal of the treatment is the first step to making a good decision.
🔬 In a sentence
Insoles make sense when they improve a function. Not when they try to correct a shape that, by itself, does not represent a problem.
The most important idea
Insoles are a therapeutic tool of enormous value when they are well indicated.
They can relieve pain, redistribute loads, facilitate movement, and improve the quality of life for many people.
But its usefulness does not depend on the existence of a higher or lower arch.
It depends on the needs of the organism that uses them.
In the child’s foot, especially when we talk about a flexible flat foot without symptoms, current scientific evidence invites us to act with caution.
Observe the development.
Assess the function.
Listen to the child.
And decide only when there is a clinical reason to do so.
Because the best treatment is not the one that modifies a foot the most.
It is the one that helps a person the most.
A question to reflect on
Think of any aid you have used at some point in your life.
A pair of glasses.
A crutch.
A lumbar belt after an injury.
Did you use it to change who you were… or to do better what you needed to do while your body required it?
Perhaps the same is true for insoles.
In the next article…
There is another question I hear frequently both in consultation and outside of it.
"Do insoles weaken the foot?"
Some say that they train the organism to depend on them.
Others argue that they can be used without any consequences.
As often happens in biomechanics, the reality is much more interesting than any of the extremes.
In the next chapter we will discover that no tool strengthens or weakens by itself.. What really changes the organism is the amount of work that each tissue performs while using it.
Because, as is the case with footwear, the question should never be whether an insole is good or bad. The question is what function it is assuming… and if the body needs to assume more or less at that moment.