By Dr. Kayla Wright, DPM
A better question is:
Are we using the orthotic to solve a defined problem while still maintaining the strength and capacity the foot needs?
Why the “orthotics are a cast” comparison is misleading
A rigid cast substantially immobilizes a body part. Prolonged immobilization is well known to cause muscle atrophy.
A shoe insert does something different. You still:
- move the ankle and foot
- flex and extend the toes
- load the calf
- push off while walking
- balance
- adapt to terrain
- activate intrinsic and extrinsic foot muscles
The orthotic changes the surface and forces under the foot. Depending on its shape and stiffness, it may reduce demand on some tissues while increasing or redistributing demand elsewhere.
That is why research measuring muscle activity with orthoses does not show a simple universal “on vs. off” effect.
The study most often cited to argue that orthotics weaken feet
A small 2020 study followed young adults with flat feet using custom orthoses for 12 weeks. Nine people used orthotics and nine served as controls.
Researchers reported decreases in cross-sectional area of three intrinsic foot muscles in the orthotic group, including the abductor hallucis. Muscle-activity measurements during the tested gait task did not significantly change.
That is a legitimate finding and should not be dismissed.
But it also does not prove that everyone who wears orthotics develops functionally weak feet because:
- the sample was very small
- participants were young adults with pes planus
- follow-up was 12 weeks
- muscle size is not identical to clinical strength, pain, function, or injury risk
- the result does not establish what happens after years of individualized use
The study's own authors suggested pairing orthoses with strengthening when appropriate.
Another trial found a different result
An earlier randomized study of 28 people with pes planus compared foot orthoses alone with orthoses plus short-foot exercise over eight weeks.
The cross-sectional area of the abductor hallucis and flexor-hallucis strength increased in both groups, with greater improvement in the group that also performed short-foot exercise.
So the evidence is not consistent with the simplistic claim:
“Support touches your arch, therefore the muscles shut down.”
Newer research shows orthoses modulate muscle activity
A 2026 laboratory study measured four plantar intrinsic foot muscles while young adults walked in different orthotic conditions. Muscle activation changed with orthosis design; textured orthoses increased activity compared with nontextured orthoses.
Other biomechanical studies have also shown reductions in activation of particular muscles with specific posted insoles.
Taken together, the useful conclusion is:
Orthoses alter neuromuscular demand. The direction and magnitude depend on the device, the person, and the task.
That is very different from proving universal weakening.
Support and strength are not opposing philosophies
The false choice is:
Option A: use orthotics forever and never strengthen your feet. Option B: throw away all support so your feet can become strong.
A more rational strategy can combine:
- symptom-relieving support when indicated
- progressive calf strengthening
- intrinsic foot-muscle exercises when relevant
- balance and proprioception work
- gradual exposure to the activities you want to tolerate
- footwear matched to the condition and task
If an orthotic reduces pain enough to let you walk, train, or rehabilitate more effectively, it may actually facilitate capacity-building rather than prevent it.
When long-term orthotic use may make sense
Some problems are not temporary strength deficits.
Ongoing support may be reasonable for selected patients with:
- structural deformity
- painful high arches
- significant progressive flatfoot
- arthritic joints
- pressure redistribution needs
- recurrent mechanical symptoms that reliably improve with the device
Using a device because it meaningfully improves function is not automatically “dependence” in a harmful sense.
The relevant question is whether the benefits still exceed the downsides.
When you should reassess instead of wearing the same orthotics indefinitely
An orthotic deserves review if:
- it no longer improves symptoms
- it creates new pressure or pain
- your diagnosis or activity has changed
- the device is visibly worn or deformed
- you have completed rehabilitation and want to test less support
- you were given orthotics years ago without understanding why
There is no universal rule that every patient must remain in orthoses for life, nor that every patient should “wean off” them.
Can you become psychologically accustomed to orthotics?
Yes, in the ordinary sense that people can prefer the feeling of a familiar shoe or insert. That is not evidence of muscle damage.
If someone wants to determine whether an orthotic is still needed, it can be tested methodically:
- Choose a low-risk activity.
- Reduce support gradually rather than changing everything at once.
- Track symptoms during the activity and the following day.
- Maintain strength/loading work.
- Reverse course if pain or function meaningfully deteriorates.
People with significant deformity, neuropathy, diabetes-related pressure risk, recent injury, or other higher-risk conditions should not make major device changes without appropriate guidance.
Does barefoot or minimalist training strengthen the feet?
Some research suggests minimalist-footwear or barefoot-style training can increase intrinsic foot-muscle size or strength in selected healthy populations.
That does not establish that minimalist footwear is a treatment for every painful foot condition, or that everyone using an orthotic should suddenly switch to barefoot running.
Training stimulus and tissue tolerance both matter. A person can benefit from strengthening while still using support for a separate mechanical problem.
A better long-term plan: orthotic + capacity test
If an orthotic is prescribed, define its job.
For example:
Problem: painful pressure under the second metatarsal. Orthotic job: redistribute that pressure. Rehab job: improve calf/foot capacity and address contributing movement deficits. Follow-up question: can the patient do more with less pain, and is the device still necessary at the same level?
Or:
Problem: rigid arthritic deformity. Orthotic job: accommodate the foot and reduce painful joint motion. Rehab job: maintain surrounding strength and mobility where safe. Follow-up question: is support still improving function?
The answer is individualized because the goals are different.
Frequently asked questions
Will my arch collapse if I stop wearing orthotics?
Not necessarily. Some structural deformities persist with or without an orthotic, and others are flexible. Whether symptoms return after stopping support depends on the underlying condition, not on a universal “dependency” rule.
Should I do foot exercises if I wear orthotics?
Often, yes, when weakness or capacity is part of the problem. Strengthening can complement an orthotic rather than compete with it. The exact exercise program should match the diagnosis.
Do orthotics shut off the foot muscles?
No. Walking with an orthotic still requires substantial muscle activity. Studies show orthoses can increase, decrease, or otherwise modify activation of individual muscles depending on the design and task.
Can I wear orthotics only for running or work?
Sometimes. Situational use can make sense if symptoms occur primarily during a specific high-load activity. Other conditions benefit from more consistent support. The use pattern should match the reason for the device.
What if my orthotics hurt?
Persistent or escalating pain is not something to simply tolerate. The device, footwear, fit, prescription, and even the original diagnosis should be reassessed.
Orthotics and foot-strength planning in Tempe
You do not have to choose between supporting a painful foot and building a capable foot. The best plan defines what the orthotic is supposed to accomplish and separately addresses strength, mobility, and load tolerance when those are relevant.
Metro Foot & Ankle provides custom orthotic evaluation in Tempe and the East Valley. If you are unsure whether an old orthotic is still useful—or how to combine support with strengthening—request an evaluation.
This article is for general educational purposes and does not replace individualized medical advice, diagnosis, or treatment.
Sources
- Protopapas K, Perry SD. The effect of a 12-week custom foot orthotic intervention on muscle size and muscle activity of the intrinsic foot muscle of young adults during gait termination. Clinical Biomechanics. 2020;78:105063. https://pubmed.ncbi.nlm.nih.gov/32521283/ (opens in a new tab)
- Jung DY, Koh EK, Kwon OY. Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: a randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2011;24(4):225-231. https://pubmed.ncbi.nlm.nih.gov/22142711/ (opens in a new tab)
- Robb KA, Perry SD. Plantar Intrinsic Foot Muscle Activity Across the Foot Posture Spectrum When Walking in Nontextured and Textured Foot Orthoses. Archives of Physical Medicine and Rehabilitation. 2026. https://pubmed.ncbi.nlm.nih.gov/42031355/ (opens in a new tab)
- American Academy of Orthopaedic Surgeons. Orthotics. OrthoInfo. https://orthoinfo.aaos.org/treatment/orthotics/ (opens in a new tab)
- Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database of Systematic Reviews. https://www.cochrane.org/evidence/CD006801_custom-made-foot-orthoses-treatment-foot-pain (opens in a new tab)