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 How Mosquitoes Find You: Smell, Sight and Temperature

    How Mosquitoes Find You: Smell, Sight and Temperature

    How do mosquitoes find us before they bite us? Let me count the ways. One, they smell us, or more specifically, they smell the carbon dioxide that is exhaled every time we breathe out. Two, they also see us, or at least they use their eyes to detect dark objects, which are particularly attractive to mosquitoes who have already detected carbon dioxide. And three, they sense our body heat and move in our direction. How do we know this? Because […]

    Read more →
  • Pain How To Remove A Tick

    How To Remove A Tick

    Yes, ticks are creepy, especially when their pointy barbed heads are burrowed into your flesh. What to do? The Wall Street Journal has some advice, along with descriptions of several special tick removal devices that are, according to experts, no more effective at removing ticks than a good pair of fine-tipped tweezers. First, the journal warns, “although most tick-borne pathogens, including the one that causes Lyme disease, generally aren’t transmitted before the tick has been attached for at least 24 […]

    Read more →
  • Attitude Books Immediate Rewards Keep People Exercising

    Immediate Rewards Keep People Exercising

    Exercising to lose weight? Nice idea, unlikely reality. Exercising because it makes you feel good? Nicer idea, and one with a pretty good chance that you’ll actually follow through with it. That’s the thesis put forth by New York Times health columnist Jane Brody, who backs it up with personal experience and the wisdom of Michelle Segar, director of the Sport, Health and Activity Research and Policy Center at the University of Michigan. Segar, who is also the author of “No […]

    Read more →
  • Fitness Pain To Reverse Bone Loss; Squats With Weights

    To Reverse Bone Loss; Squats With Weights

    No, it doesn’t sound pleasant, but doing squats with weights has been shown to reverse bone loss in middle-aged men. Ditto for deadlifts, lunges and the overhead press, none of which is anywhere near as much fun as and good tennis game. A news release from the University of Missouri reports that researchers at the school studied 38 active, middle-aged men who completed either a weight-lifting program or a jumping program for a year. Both programs required 60-120 minutes of targeted exercises […]

    Read more →
  • Pain Non-Aspirin Painkillers Riskier Than Believed

    Non-Aspirin Painkillers Riskier Than Believed

    Ibuprofen (Advil, Motrin) and naproxen (Aleve) pose a greater risk to heart health than had been believed. That’s the word from the FDA, which, according to the New York Times, will soon ask drug manufacturers to change the labels to reflect new evidence that the drugs increased the risk of heart attack and stroke soon after patients first started taking them. The Times quotes Dr. Peter Wilson, a professor of medicine and public health at Emory University in Atlanta, and a member […]

    Read more →
  • Fitness Pain Uncategorized Two Weeks of Inactivity = Muscle Loss of 40 Years

    Two Weeks of Inactivity = Muscle Loss of 40 Years

    Two weeks. That’s how long you have to be inactive to cause appreciable muscle loss. How much is loss that? According to researchers at the University of Copenhagen, young men who have one leg immobilized for two weeks lose up to a third of their muscular strength, and older people lose approximately one fourth. Yikes! Futurity reports on the research, and the site quotes Andreas Vigelsø, a PhD student at the U Copenhagen’s Center for Healthy Aging and the biomedical sciences department, saying […]

    Read more →
  • Pain Women's Health Men and Women Feel Pain Differently

    Men and Women Feel Pain Differently

    He hurts; she hurts, but she hurts differently–and probably more often. That’s the opinion of researchers at McGill University, who took a close look at the longstanding theory that pain is transmitted from the site of injury or inflammation through the nervous system using an immune system cell called microglia. Their research, yes, on mice, not humans, shows that this is only true in male mice. When the researchers altered the function of microglia in a variety of different ways, […]

    Read more →
  • Pain Do Knee Braces Do Anything Useful?

    Do Knee Braces Do Anything Useful?

    Do knee braces to anything useful? That’s the question put to New York Times health columnist Gretchen Reynolds. The answer, says Reynolds, is possibly, but it depends on the brace and on the injury. Reynolds quotes Dr. Robert A. Gallo, an associate professor of orthopedic sports medicine at Penn State Hershey Medical Center, saying that for each study that suggests wearing a knee brace can produce a clinical benefit in reducing pain or feelings of instability there usually is a counterstudy which demonstrates […]

    Read more →