Do Orthotics Really Help?

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In the Personal Best column in Tuesday’s Science Times, Gina Kolata asks Benno M. Nigg, a professor of biomechanics at the University of Calgary, whether orthotics, those inserts that athletes and others slip in their shoes, really help to prevent injuries and improve mechanical alignment.

Do they help or harm athletes who use them? And is the huge orthotics industry — from customized shoe inserts costing hundreds of dollars to over-the-counter ones sold at every drugstore — based on science or on wishful thinking?

Dr. Nigg’s overall conclusion: Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up.

Read the full column, “Close Look at Orthotics Raises a Welter of Doubts,” then please join the discussion below.

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Very intriguing information. I was debating orthotics that I was told would slow bunion development and aid patella alignment. I suspect I will not be shelling out the $650 for the inserts….it would be my third set over 15 years, and the first two sets only increased pain in my arch. Needless to say, I have been skeptical.

The number of variables in any study of orthotics is considerable and understandably difficult to address.

I had a plantar fasciitis with a heel spur in my left foot for years. I had pain every day and had to take NSAIDs to the point where my stomach was completely messed up. Then I went to a new podiatrist who told me to wear New Balance inserts for walking shoes and 3/4 Spenco inserts for dress shoes. I was skeptical, but they worked! The pain was gone in few weeks, and I haven’t had any problems since. I have to wear shoes with inserts all the time, except for sleep and the shower, but it’s worth it to be pain-free.

I am assuming we are talking about orthotics for people with either no or minor problems with their feet. I have had “hammer toes” and other deformities of my feet that have required orthotics since I was a child and interestingly enough bought them at Hersco Orthotics when the were in Manhatten and I went through steel orthotics to the current flexible ones made of leather and plastic.

The studies all seem to ignore the idea of putting less between your feet and the floor, e.g. a flat minimalist shoe. They even report a reduction in muscle strength with some orthotics. In my experience, when I have less between my feet and the ground, my legs and feet are stronger, healthier and pain free.

Furthermore, arches are not vestigial as Dr. Nigg would have us believe. As I know them, they are a powerful set of tendons and bone that store and release energy while running, much like a spring.

I have fallen arches and superfeet (on the expensive side of OTC orthotics ~$30) have been amazing.

#3 Richard

“and I went through steel orthotics to the current flexible ones made of leather and plastic.”

Your current orthotics sound like a blessing as compared to the “steel” alternative. Leather. “Flexible ones”. We all could use a bit more of them, i.e. flexible ones… in many arenas of human endeavour.

Good thing for you Richard that you’re not a vegan… the “leather” and plastic alternative would be an unpardonable mortal sin. Richard… you may now be on a “hit” list. A “PETA/vegan fatwa”.

Hopefully for you, the PETA and vegan extremists don’t know where you live. You might want to consider changing your posting name… to “not” include your last name. The extremists have an uncanny ability to find out where you live and work. Just like the Jehovah’s Witnesses’. Or the IRS. Or telemarketers.

If they root you out, “hammer toes” will be the least of your troubles. You might wind up with a “hammered-head”… and ink thrown all over your orthotics.

Now, wouldn’t that be embarrassing at your office or home… in front of your family and/or boss?

I got custom made orthotics a few years ago. Supposedly, they would help my balance, among other things. My balance is worse than ever and so is my leg pain. While I don’t blame my orthotics, necessarily, I don’t think they help with those issues, either. I can only wear shoes with either ties or straps, so my shoe selection is really limited, especially when it comes to dressier shoes. I don’t mind not being able to wear anything with heels, but the selection out there for orthotic-friendly shoes is really dismal, not to mention expensive, for the most part. I don’t have very many shoes. It is just too much of a hassle to try to find something compatible with the orthotics. On the other hand, I don’t pronate as much with orthotics, so I guess they are good for something.

I have had orthotics that “helped” and those that just killed my feet. Having gone from prescribed orthotics to OTC ones – my take on it is that a nice cushioned OTC insert makes my legs hurt less when I run on pavement. On the track – I wear a very unstructured x-c shoe – nice and flexible. Less is more.

I remember as a child having my feet X-rayed at a Buster Brown store.

I haven’t had any foot problems before or since…

It was easier than having my chest X-rayed a few years later in that truck parked on Public Square, by the way.

My Bozo the Clown bedroom lampshade always glowed dependably in the dark…are any of these things related to current orthotic treatments? Or should they be?

I came out of the womb with flat feet and as a child my parents diligently put me in orthopedic shoes and then in orthotics. I remember the orthotics as utterly torturous, and as soon as I was able to buy my own shoes, I stopped wearing them.

Now, as long as I wear generally supportive shoes and replace my worn-out sneakers regularly, my feet are fine. I even dance barefoot five hours a week with no pain! Glad to see that, really, nobody knows why the stupid things work and why they don’t…just wish there was a way to know which it would be before paying hundreds of dollars for them.

(In the expensive shoe vein, though…I have a pair of MBT shoes that are fantastic, and I wear those if my hip, injured in a fall, bothers me.)

…oops — my question. Does it matter that these studies seem to focus on athletes and people like soldiers who are, perhaps, more physically active than the average population?

I had an episode of plantar fasciitis on one foot last year, I think in part due to wearing the same set of work supplied shoes for ten years and not paying attention to how worn they were. I ended up with a new pair of workout shoes, some new everyday shoes, went thru a number of over the counter insoles for several shoes, and without them it was painful to walk. Most places were good about returns on the insoles if they didn’t work, and I found that ‘not too thick’ full length cushioned insoles with a noticeable arch support worked best for me. I also wore shoes with the insoles in the house as well as doing exercises on the stairs, heels hanging off and doing raises while standing on the front of my foot. After a couple of months I didn’t need to wear shoes with arch support insoles in the house, and after a couple of more months all symptoms disappeared. I removed the insoles with arch support from some shoes but kept them in my workout shoes. Some of my boots came with decent cushioned insoles, and while some are better than others for colder weather none are as good as felt insoles provided the boots are big enough for them.

In boot camp we didn’t have ‘running shoes’ as we wore either combat boots or dress shoes for all activities, and we received regular inspections for heel contusions. Some good insoles would have helped to minimize the number of impact injuries.

After spending more than $500 on orthotics, the only thing that helps my feet is Dr Scholl’s Memory Fit insoles. I buy my shoes 1/2 size larger to accomodate them. No more pain!

I have been wearing and making orthotic devices for over 30 years. There are many schools of thought on the need and use of orthotics. My initial foray in orthotics was from the Ski Boot and hockey skate industry, where pressure points and excessive pronation can create bone spurs and painful syndromes. Orthotics can be a game changer. There is substantial literature support for the use of orthotics with Heel Spurs, Plantar fasciitis and Chondromalacia(Runners Knee). I have seen a well manufactured orthotic help thousands with these conditions. As mentioned in the article a foot insert should allow flexibility and control motion not prevent motion. Seek a provider with experience. If a OTC products helps a custom orthotic may be very helpful. Limb alignment, balancing, and attaining a neutral foot should be reproducible by a practitioner or technician in order to produce a consistently good quality product.

I think they foster lazy feet. Strengthen your feet with exercises.

Who makes the orthotics – ie their level of skill and knowledge, and by which method makes all the difference in the world. I am a Podiatrist in Canada, and have had the ” pleasure” of starting to need orthotics while I was studying all about it. I have personally tried every methodology from the latest computerized whiz-bang to the old-fashioned messy plaster of Paris mold. It’s how I evaluate out all the labs that come calling for my business.

In my practice all of my orthotics are made from a plaster of Paris mold, after I complete an extensive biomechanical and gait analysis. I have told many patients that they do not require custom-made orthotics – the OTC ones at the drugstore are enough.

And bad shoes (that is, bad for your feet) can make the world’s best orthotics be all but useless.

Some years back, we were social acquaintances with a young orthopedist. Or whatever foot doctors are called. At the time, I never thought about his professional work.

One day we were standing next to him outdoors, looking down at the festival that was going on.

Out of the blue he said, softly but with surprise in his voice, “My feet hurt!”

I thought, well, we’ve all been on our feet for several hours, standing and walking around, why wouldn’t they?

Then he brightened up and said, “I forgot my orthotics!”

I thought it was a wonderful, inadvertent proof that what he did actually worked.

This proves nothing about athletes and serious runners. But for ordinary people, apparently they can make a big and positive difference.

The best thing for my running was the discovery of minimal shoes imitating barefoot run . I am spending my life in them . Every fancy high-tech shoes I have been wearing for the last few decades were just compromises , this is the closest to perfection . Seems to me , as with everything else in life , tempering with nature , unless it is really unbearable , is a futile attempt from the consumer side but very profitable from the businesses who sells orthotics .

I was prescribed orthotics for knee problems. I went to a well known chicago company. My fitter basiclly could not tell me what kind of running shoes to use with the orthotics and didn’t think it mattered even though every shoe had a different fit and arch. The orthotics fit radically different in each shoe and did nothing to help with the knee pain.
At my two follow up appointments they added more and more stuff to the orthotics to ‘correct’ them eventually making them unwearable. I contemplated hacking some of the stuff off myself but eventually just threw away my $450 useless uncomfortable orthotics.

Thank you, Dr. Nigg, for making me feel pretty smart for having figured this out, on my own, over the past few years! Four years ago a landed from some height on the balls of my feet and bruised the area between the padded areas. My GP recommended I see a podiatrist for orthotic inserts to ease the pain. $400 and a year later, little improvement until ….. wait for it…. I got rid of the orthotics and replaced them with simple padded inserts. Also, I began taking the stairs again at work (7 flights), thereby strengthening my quads and eliminating the pain in my left knee.
There are certain conditions that really do need some kind of insert: when I discovered that my left leg is slightly shorter, I added a small felt heel wedge, and my low back pain improved significantly. Otherwise, I agree with Dr. Nigg: just because it looks inelegant doesn’t mean it’s really a problem, and improving muscle strength can help with many joint aches and pains.

1. I spent a lot of time visiting labs and looking at this problem.

2. The first issue is a measurement one. Measuring the feet, their pressure distribution, and how they function is critical. A correctly sized shoe (not common) is the first foundational step.

//www.aetrex.com/istep

3. Classifying and treating the feet by shape doesn’t work (variety of US Army studies):

//www.scribd.com/doc/43455514/Gait-Distribution

4. Both flat feet and high-arched feet are injury prone, but the flat foot is more easily treated.

5. I recommend simply trying off-the-shelf orthotics before making a major investment in custom ones. My personal experience is the high-arched foot needs lateral shims (only bike companies are doing this now).

6. The only new shoe technology with some science behind it is //www.oeshshoes.com

I thought my backpacking days were over thanks to my Hoagland’s Deformity and mildly protruding heel bones destroying themselves (and irritating my achilles) against the rear of my boots climbing hills. My polypropylene wick socks would affix themselves in the coagulated blood from ruptured blisters. Peeling my socks of was a bloody mess.

My forefoot was skidding backward inside my boot, grinding my heel bones against the boot interior with each step.

I noticed that wearing simple two strap Birkenstock sandals with nothing to prevent my foot from flying off the rear of the platform, my feet did not move.

I can’t function without the forward metatarsal support hump that fixes the ball of my foot immovably so it won’t slide backward. My feet become sore as if a spoke has broken on a wheel walking long distance barefoot.

3/4 length Birkenstock insole/orthotics have made the difference for me.

The reason that some of us can’t simply go out and buy whatever shoes feel good is that pronation (foot rolling inward) and supination (foot rolling outward) not only make walking more difficult, but also make the soles of shoes wear out unevenly and very quickly. Think orthotics are expensive? Try buying a new pair of walking shoes each month, in a wide size that can’t be found in just any store.

The premium OTC orthotics recommended by my orthopedist worked great initially for my tendonitis, but it wasn’t too long before I experienced the only bout of plantar fasciitis I had ever had, despite having been a runner for more than a decade. It lasted for over six months, during which time I was unable to exercise as I could barely put any weight on the affected foot. Whether it had anything to do with the orthotics, I don’t know. I still use the orthotics, but my shoes continue to wear down unevenly and just as fast. I had thought the next step would be to request a prescription for custom orthotics, but it would appear that they probably wouldn’t help, if they can’t correct mechanical problems.

The best thing for my running has been OTC high-arch insoles. At $50 they’re expensive, but far less expensive than anything else the doctor came up with for my knee. As implied in the article, a fair amount of comparison and trial-and-error went into finding the ones that work.

Considering that people respond so individually, it would seem that one problem podiatrists or orthopedists have is working with only one lab with a high-cost product, when a menu of lower-cost options might be more helpful.

Custom orthotics have been a lifesaver for me, though I should clarify that I’m no athlete. Mine are to compensate for an ankle joint that doesn’t bend all the way, after shattering my tibia and fibula, followed by 4 rounds of surgery, years of physical therapy, and much scar tissue. Oh, and now the neuroma in one foot. I limp when barefoot, but with shoes and orthotics, you can’t tell I was ever injured. I wouldn’t trade my orthotics for anything – they sure beat the hell out of daily prescription anti-inflammatories and limping!