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

  • Pain Women's Health Common Drugs Linked to Dementia

    Common Drugs Linked to Dementia

    No, not marijuana. The researchers at the University of Washington were looking at drugs like Benadryl, anti-depressants like Sinequan, anti-histamines like Chlor-Trimeton, and antimuscarinics for bladder control like Ditropan.  A university news release reports that the scientists, who tracked nearly 3,500 Group Health seniors participating in a long-running joint Group Health-UW study funded by the National Institute on Aging, found that such drugs, with anticholinergic effects, significantly increased risk for developing dementia, including Alzheimer’s disease, in people who took them for longer […]

    Read more →
  • Pain Uncategorized Women's Health Research Suggests That Exercise Cuts Breast Cancer Risk

    Research Suggests That Exercise Cuts Breast Cancer Risk

    Can exercise really help to ward off breast cancer? Researchers at the University of New Mexico in Albuquerque think so. The Wall Street Journal, reports that scientists at the school have been studying the cancer fighting effects of irisin, a hormone that is released from muscles after vigorous exercise. When the researchers tested genetically engineered irisin on aggressive breast-cancer cells and on nonmalignant breast cells, they found that irisin treatment reduced the number of malignant cells by 34 percent compared with untreated cells, […]

    Read more →
  • Eating Well Fitness Gear The Beet Juice Conundrum: Does It Boost Blood Flow?

    The Beet Juice Conundrum: Does It Boost Blood Flow?

    For years, athletes have been drinking beet juice before working out to increase blood flow to muscles and boost performance. Now comes a study from researchers at Penn State suggesting that the beet juice strategy was all for naught. A Penn State news release reports that while beetroot juice is in fact rich in nitrates, it did not enhance muscle blood flow or vascular dilation during exercise. The good news, although not necessarily for athletes, is that the researchers found that […]

    Read more →
  • Fitness Gear Sitting Is The New Smoking

    Sitting Is The New Smoking

    Yes, it’s yet another study on the health risks of too much sitting, which is now described, in some circles, as the new smoking. This study, a meta-analysis of others, comes from scientists at Toronto’s University Health Network (UHN) and Institute for Clinical Evaluative Sciences, and like others, identifies a definite relationship between the amount of time a person sits everyday and heart disease, cancer, diabetes, and death. Wait, there’s more unsurprising news.  Science Daily reports that study found that the […]

    Read more →
  • Attitude Fitness Gear Get Up. Stand Up. Stand Up For Your Health

    Get Up. Stand Up. Stand Up For Your Health

    If sitting is the new smoking, is standing the healthful alternative? The Boston Globe reports that many experts think it is. The Globe cites a recent Harvard study of more than 92,000 women that found that the more time participants spent sitting at work, driving, or watching TV, the greater their risk of dying from heart disease, cancer, or strokes. Wait, there’s more, such as a Canadian study involving 17,000 people that found that those who reported the most time […]

    Read more →
  • Attitude Fitness Pain Want To Build Muscle? Think About It

    Want To Build Muscle? Think About It

    Can just thinking about building muscle actually build muscle? Researchers at Ohio University’s Ohio Musculoskeletal and Neurological Institute think so. HealthDay reports that scientists at the institute put 29 people in casts that completely immobilized their hand and wrist for four weeks. Fourteen of those people were told to routinely perform an imagery exercise, imagining that they were intensely contracting their wrist for five seconds with five seconds of rest. Wait, there’s more: As they performed this imagery exercise, they were […]

    Read more →
  • Fitness Pain Staying Warm Really Can Ward Off A Cold

    Staying Warm Really Can Ward Off A Cold

    Some wives’ tales turn out to be true. Maybe. A Yale University news release reports that researchers at the school are convinced that the common cold virus can reproduce itself more efficiently in the cooler temperature found inside the nose than at core body temperature, suggesting that there is truth to the popular notion that people are more likely to catch a cold in cool-weather conditions. The researchers examined cells taken from the airways of mice, and compared the immune response to […]

    Read more →
  • Attitude Pain The Most Common Cause Of Cancer: Bad Luck

    The Most Common Cause Of Cancer: Bad Luck

    Are you worried that what you eat, where you live, or your own genes might increase your chances of getting cancer? Well, those factors might contribute to cancer, but according to a recent study at the Johns Hopkins Kimmel Cancer Center, the most likely culprit is bad luck. A Johns Hopkins news release reports that scientists at the center created a statistical model that measures the proportion of cancer incidence, across many tissue types, caused by random mutations that occur when […]

    Read more →