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Do Orthotics for Foot Injuries Really Work?

If you read any of my posts on orthotics, this one is a must.

Over the past 20 years I have had experience using orthotics for treating injuries while studying athletic training in college, through orthotic creation and implementation in podiatry school, and finally using them in practice over the past 11 years. I have used over- -the-counter inserts, custom orthotics, as well as semi custom orthotic (created and molded to foot from pre-fabricated shells). Do they work? That’s a hard question to answer. I think the real question is “WHAT do they work for?”.

Our society has developed a false misconception that our arches “need support”. Each day in the office I hear patients tell me that they wear “good shoes” with lots of “support” yet they’re still developing pain. Many will present with bags of inserts and shoes asking why they aren’t working and if I can make a better orthotic for them. Simply put, most people think they need to support their feet.

If our feet need support, then we must conclude we all were born with the inability to walk and function unless we wear shoes with a biomechanically engineered device made from precise measurements. In other words, we were all born with a defect. I find that extremely hard to believe. Especially if you look at the history and literature in regards to how long we have been using shoe-gear as we know it today and orthotics. Not long. Fifty years give or take.

Why do so many believe we need orthotics? Here’s a simplified explanation of what I believe has led to the over utilization of shoe orthtoics.

I can almost assure that the overwhelming majority of those reading this blog post do not need an orthotic device in their shoes. In fact, for you runners out there, if you truly NEED and orthotic, then you probably shouldn’t been running. WHAT?!!! My point- orthotics are generally only needed when a deformity is present. A TRUE deformity and not a variance.  Meaning a foot may be perceived by some as being flat or having no arch and it’s really a variance of arch or foot type. I truly believe there may only be a small percentage of feet that have true pathological deformities such as a flat or high arch. We have somehow, through the implementation  orthotic devices and structured rigid shoe, increased the characterization  of what would be varying foot types (flat and high arch variances) into what we are calling a flat foot or high arch – meaning deformity.  The envelope was pushed for using orthotics to the point where one could make an arguement that every foot has some biomechaincal deformity which could be corrected using an orthotic. The true question I have is- is it a deformity or a variance?

I have transitioned numerous patients, runners especially, out of orthotic devices that they have been wearing for years which were unecassary. As previously mentioned patients will present to my office with bags of orthtoics and shoes requesting a new or better orthotic be created for them.  Many of these patients are transitioned out of the orthtoics and educated on proper foot strengthening, shoe gear and lifestyle changes, as well as modifications in their running and training patterns. The results have been consistent. Improvement or resolution of symptoms and no need for shoe inserts. 

Do some people still need orthotics? I think the “need” should be categorized as those who need them temporarily to help overcome an injury or overuse, and for those who have severe deformities who need support. Most of those who need true support will do far better with an ankle foot orthosis- a rigid customized brace that controls ankle and foot motion combined. Those who benefit from the device temporarily may see improvements in their symptoms at which point they can stop wearing it.  An analogy would be that of a baseball pitcher who is wearing a sling. When the injury resolves the sling comes off.  One would never expect a pitcher to throw a ball while wearing the sling.  Why then do many of us think we need to immobilize our inctricate foot structure with a rigid orthotic device?

See the recent literature discussing orthtoics below which reveals many are moving away from this “permanent” treatment option. 

The orthotics business is booming, but experts differ on whether these devices really correct underlying biomechanical problems for many types of foot injuries or whether gait retraining is superior.

Source: Do Orthotics for Foot Injuries Really Work?

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