Orthotics: Do We Really Need External Support?

As a Physical Therapist, one of the most common questions I get is, “Should I be wearing orthotics or supportive shoes?” And, in true PT fashion, the answer is—it depends! There’s no one-size-fits-all solution when it comes to our feet. But let’s break down the basics.
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At the heart of this question is whether we truly need external support—like arch supports or extra cushioning. There are absolutely times when additional support can be helpful, such as during an acute injury or pregnancy, when the body may benefit from temporary assistance.

My Experience with Orthotics

I’ll use myself as an example. When I was in elementary and middle school, I had custom orthotics that went into every pair of shoes I owned. I had been told I had “flat feet,” even though I didn’t have any pain or functional issues. So, I wore those orthotics for years.

Ironically, as a dancer, I never used orthotics in my dance shoes. But outside the studio, I became someone who sought out shoes with extra arch support. I used to look at people wearing flat sandals and wonder—how are they walking comfortably in those?

What Changed

Then came a major shift. I started Pilates and began strengthening not just my core, but also my feet. Around that time, minimalist and barefoot shoes started trending, and books by experts like Katy Bowman made me rethink my dependence on external support.

I slowly transitioned to flexible, minimally supportive shoes—and I felt amazing. My feet got stronger and more mobile. Before long, I became that person who could comfortably wear flat sandals all day. I also became a bit of a “shoe snob”—if the sole isn’t flexible, the toe box is narrow, the heel is too high, or the shoe isn’t securely attached to my foot, I’m not wearing it!

That said, if I know I’ll be walking all day, I might choose something with a bit more cushioning or support. But for most of my daily movement, I prefer my feet to be as mobile (and as free) as possible—often barefoot.

Building Internal Support

So, do some people need extra external support? Possibly. But it’s worth asking: do they have enough internal support to begin with? If not, that can often change with targeted strengthening.

In Pilates, for example, we typically recommend working barefoot to strengthen the intrinsic muscles of the feet. When clients ask if they can wear shoes on the reformer, I usually ask why—and, when appropriate, encourage them to try without.

Reformer work, like footwork in supine (essentially a lying-down squat), allows movement without the full load of body weight. It’s a safe and effective way to build strength and control from the inside out.

Finding Balance

Ultimately, my goal is to help people develop as much internal support as possible so they can gradually decrease their reliance on external supports. That might look like not needing to wear shoes around the house all the time, or being able to enjoy those cute sandals for a night out—without paying for it later.

As with most things in life, it’s about balance. External supports can be useful tools, but they shouldn’t replace strong, capable feet.