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!

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