The Bad and Good News About Orthotics

January 18, 2011 8:33 am 6 comments

Do orthotics work? That's the question explored in this less than definitive piece by Gina Kolata of the New York Times. The first answer, from professors of biomechanics at two different universities, is "If they do work, we don't don't know how they work." The second, and perhaps more meaningful answer, is "The vast majority of patients are happier having them than not." Kolata consults Dr. Benno Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta, who says orthotics have little effect on kinematics — the actual movement of the skeleton, but they can have large effects on muscles and joints, often making muscles work as much as 50 percent harder for the same movement and increasing stress on joints by a similar amount. As for “corrective” orthotics, he says, they do not correct so much as lead to a reduction in muscle strength. Nigg, who dismisses most studies of the benefits of orthodics as lacking scientific rigor, did his own study of 240 soldiiers, half of whom wore orthoditcs. What did he find? Those who used orthodics had half as many injuries, but there was no obvious relation between the insert a soldier chose and his biomechanics without it. Yes. It's confusing.

Read more from Gina Kolata.

 

6 Comments

  • They worked for plantar faciitis, when I had that. Yay!

  • Lisa Lanham-Friesner

    Perhaps, you should talk to a physician, like a podiatrist, who specializes in biomechanics, to get a better understanding of how the foot functions and why orthotics work for most people. If the appropropiate research is done and the appropriate professionals interviewed, it’s doubtful that there would be any confusion. The truth is that that orthotics help the midtarsal and subtalar joints function more optimally, thus reducing stress (thus injury) to the joints in the foot, ankle, knee, hip and back. Orthotics decrease jamming forces and can provide shock absorption. Any podiatrist will educate you so that you may gain a better understanding. Happy are those who wear custom orthotics:)

  • But Ms Lisa, the article quotes professors of biomechanics, and quotes studies evaluating the effects of wearing orthotics in an evidence based apporoach, whereas podiatrists have a vested interest in the financial aspects of prescribing orthotics and are therefore not unbiased.

  • Doc Gary and Lisa-
    While the article quotes professors, it is essentially inconclusive. It does however highlight that knowledge of exactly how orthotics function is unclear. There is certainly disagreement amongst practitioners on appropriate prescription. That said, there is benefit from orthotics, many times dramatic, for those with plantar fasciitis.
    My personal belief is that as humans, we are designed to be on our bare feet, walking significant distances daily. This is simply not practical in our modern society. As a result, we wear shoes, and have de-conditioned foot and leg muscles. People with flexible, loose ligament structure seem to suffer the most, incurring a pronated foot attitude, bunion deformity, hammer toes. As a Physical Therapist, who fits orthotics, I find that orthotics with arch support help significantly. Could strengthening the feet and ankles help? Yes, but probably not enough, after over-stretching and deformity have occurred.
    (BTW, I have no $ incentive, our clinic only charges the lab fee, no markup.)

  • Rest is the best treatment. For most competitive athletes, this is the one word they don’t want to hear. However, a sports therapist should be able to help in designing a cross-training program that will maintain cardiovascular/muscular strength and endurance while resting a specific injury. A good program of this type will incorporate strength, anaerobic and aerobic training, using equipment and exercise protocols that protect the injured area by avoiding weight-bearing exercise for a brief healing period. In some cases, rest is required to enable the damaged tissue to repair itself optimally with minimal scarring. Sometimes you simply cannot train or play through the pain without consequences that far outweigh the benefits of continued training or competition. The athlete, coach and sports therapist should work as a team to decide the best way forward.

  • The interesting thing, as I’ve increasingly moved away from “bracing” orthotics, is there seems as many bad orthotics out there as good ones. Too often better, long term alternatives are not considered for the patient. I see heaps of “overserviced and undertreated” problems, and many whose foot type does not need an orthotic, ditto for symptoms. As footwear is often part of the problem, not to mention overstriding, simple devices to restore proprioceptive function can produce immediate and lasting benefits, improving posture, gait and pain levels Without adding to the problem as braces can do, long term. Hence, the de-volution back to barefoot function, minimalist shoes etc.Believe me, Nike didn’t get it wrong this time!So how come my Podiatry colleagues are so slow on the uptake? I have to “de-orthoticise” feet all the time to restore posture and gait parameters AND patients love the alternatives!

Leave a Reply


Recent Posts

  • Fitness Pain For Torn Meniscus, Try Exercise Before Surgery

    For Torn Meniscus, Try Exercise Before Surgery

    Many doctors, mainly orthopedic surgeons, would like us to think that surgical repair is the best fix for a torn meniscus, and for some particularly large tears, that may be true. But now comes a study from orthopedic surgeons at Martina Hansens Hospital in Sandvika, Norway, which tracked outcomes for 140 meniscal tear patients, half of whom had surgery and half of whom did knee exercises three times a week for three months. HealthDay reports that after two years, pain, […]

    Read more →
  • Pain Women's Health 40 Percent Of Sunscreens Don’t Cut It

    40 Percent Of Sunscreens Don’t Cut It

    The seasonal advice “Don’t forget the sunscreen” should be amended this year to “Don’t forget the sunscreen that actually works,” a category that includes only 60 percent of the top-selling sunscreens. How do we know? Because when researchers at Northwestern University looked at the top rated 1 percent of the 6,500 sunscreens with four or more stars sold on Amazon.com, they found that about 40 percent of them don’t meet the American Academy of Dermatology’s guidelines for sunscreens, mainly because of a […]

    Read more →
  • Fitness Pain Exercise Does More For Some Than For Others

    Exercise Does More For Some Than For Others

    Life isn’t fair, and neither, apparently, is exercise: it appears to help some people more than others. Researchers at Brown University analyzed the results of 160 clinical trials of the cardiometabolic benefits of exercise showing which health indicators improve most with physical activity and for whom. Who were the winners? Men, people under 50, and people battling type 2 diabetes or other cardiovascular conditions. A Brown University news release reports that the researchers also found that while exercise appears to affect […]

    Read more →
  • Pain Women's Health Exercise Improves Memory of Breast Cancer Survivors

    Exercise Improves Memory of Breast Cancer Survivors

    Many breast cancer survivors have trouble remembering things, a problem that researchers attribute to stress, rather than to chemotherapy or radiation. Now comes research from Northwestern University linking physical activity to higher levels of self-confidence, lower distress and less fatigue, which in turn is associated with lower levels of perceived memory impairment. A Northwestern news release reports that when investigators looked at memory and exercise in breast cancer survivors in two studies: one in self-reported data for 1,477 women across […]

    Read more →
  • Pain Sex Another Attempt To Predict Lethal Prostate Cancer

    Another Attempt To Predict Lethal Prostate Cancer

    Someday medical experts will figure out what everyone wants to figure out about prostate cancer: how to distinguish aggressive, life-threatening cancer from indolent, unusual cell growth that will harmlessly hang around until something else kills you first. On recent attempt at the Brigham & Women’s Hospital has persuaded researchers that measuring PSA levels in younger men (between the ages of 40 and 59) could predict future risk of lethal prostate cancer later in life. Science Daily reports on the research, […]

    Read more →
  • Eating Well Pain Chronic Fatigue: It’s In Your Gut

    Chronic Fatigue: It’s In Your Gut

    After years of doubt about whether the condition known as chronic fatigue syndrome is really a syndrome, researchers have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood of chronic fatigue sufferers. A Cornell University news release reports that researchers at the school correctly diagnosed chronic fatigue syndrome in 83 percent of patients through stool samples and blood work. When researchers sequenced regions of microbial DNA from the stool samples they found that […]

    Read more →
  • Attitude Pain Stressed? Make Some Art

    Stressed? Make Some Art

    Feeling stressed? Paint a picture, even a bad picture. Researchers at Drexel University are convinced that making art, pretty much any art, reduces the stress hormones in our bodies. Most of the time.  A Drexel news release reports that the researchers studied 39 adults, ranging from 18 to 59 years old, who participated in 45 minutes of art-making. Cortisol levels were taken before and after the art-making period. The participants, half of whom had no real experience making art, were given markers […]

    Read more →
  • Attitude Pain How You Argue And What It Means For Your Health

    How You Argue And What It Means For Your Health

    How you argue says a lot about how your health will fare, according to research recently conducted at UC Berkeley. A Berkeley news release warns that people who rage with frustration during a marital spat are likely to develop high blood pressure, and those who keep a stiff upper lip may experience musculoskeletal ailments such as a bad back or stiff muscles. The study, based on 20 years of research, found that the link between emotions and health outcomes was most […]

    Read more →