Dr. Strasser's Wellness TipsCOPYRIGHT © 2017 Arn Strasser DC
Foot Orthotics: Do We Need Them?
Foot Orthotics or custom arch supports are intended to aid in the correction of foot pronation (foot arch flattened inward) and high arches. They are prescribed as a solution for foot pain, post-surgical foot injuries, and ITB (iliotibial band) syndrome. Do we need them?
What Are Foot Orthotics? Orthotics refers to the fitting of any appliance to help support or correct a deformity in the body. Foot Orthotics are inserts placed in the shoe. Orthotics can be “custom-made” and prescribed by a health practitioner, or prefabricated (“off the shelf”).
HOW ARE CUSTOM ORTHOTICS MADE ? A cast is taken of the foot and from this a custom insole is produced which fits into the shoe. Some practitioners prescribe orthotics based on having their patients impress their feet into a foam mold (either sitting or standing) which is then used to construct the orthotic. Custom orthotics can be rigid, soft or semi-rigid. Sometimes adjustments are made to the orthotic such as adding a heel or metatarsal lift, or a soft channel in a specific area.
HOW ABOUT RESEARCH COMPARING PRE-FABRICATED AND CUSTOM ORTHOTICS? This is THE question regarding orthotics. A few research studies have compared pre-fabricated and custom orthotics, and some indicate that custom orthotics are better in some cases. Again not enough good research answers this question. Pre-fabricated orthotics are considerably less expensive both to prescribe and purchase, and less complicated all-around.
RUNNING SHOE STORES AND FOOT SPECIALISTS EMPHASIZE THAT THE FEET ARE THE FOUNDATION OF THE BODY AND CRITICALLY EFFECT BODY STRUCTURE. IS THIS TRUE? Well, the feet are important and so is good footwear. However, the body is not a building and the feet are not it’s foundation. The body is architecture in motion, and very complicated. There is a dynamic relationship between all parts of the body’s structure. Pain syndromes have to be evaluated with an understanding of this complex relationship.
WELL, DO WE OR DO WE NOT NEED THEM? Here is my opinion: Custom orthotics are overprescribed, and can be prescribed too early, or as a substitute for understanding pain as the OUTCOME of a complex set of factors involving far more than the feet. Patients with pronation ( a turning in of the foot in movement which is different from “flat feet”) or patients with high-rigid arches who are in pain might benefit from orthotics, BUT only after, or in the context of, a treatment program. The same goes for patients with post-surgical foot pain as well as runners and people who walk or stand for long periods at work. Some of these patients will do fine with pre-fabricated off-the -shelf orthotics. A very few will need a custom orthotic. Some people just need good supportive footwear with a good arch support.
DO YOU PRESCRIBE CUSTOM FOOT ORTHOTICS ? I occasionally prescribe a custom orthotic. I have found using a neutral casting method works best. I do not feel orthotics made from foam-mold casting are accurate enough to warrant a custom prescription. In general, rigid orthotics are less effective than semi-rigid and softer orthotics. And what do our feet say? Enough about orthotics. How about a nice barefoot walk on the beach?