Dear RunDoc: I read in the NY Times that orthotics often don’t work and I should try running barefoot to strengthen my feet. I tried and my feet got a lot worse. I know you wear orthotics and make a lot of them for your patients. Why do you think custom foot orthotics work in your hands?
RunDoc answers: Hmmm….Good question! I read the article in the New York Times and laughed then cried. They are so biased against orthotics that this is bout the tenth time in the last few years they are trying to make them voodoo. Fortunately, they are wrong and there is science behind it.
Many tens of millions of patients have been helped by custom-made foot orthotics over the past 50 years.
There are many studies published in peer reviewed medical journals showing the effectiveness of orthotics in reducing injury and relieving pain.
One of the most important factors creating the need for orthotics is that we usually walk on essentially hard, flat surfaces that do not exist in nature.
Walking or running barefoot does not change the above.
The science of biomechanics relating to orthotics is complicated and requires years of study. This is why you should have your orthotics made by a well-trained podiatrist in biomechanics and even better, one who has an understanding of your specific sport.
The process of getting an orthotic to be most effective is iterative, often requiring serial adjustments. This is because everybody is different and may not tolerate “perfect” biomechanics.
The conditions for which orthotics are prescribed often take years to develop. They are not going to disappear overnight with the use of orthotics.
Orthotics should not be chosen by how comfortable they feel. Often, they are uncomfortable at the beginning because they are “correcting” your biomechanics with an external device and you have to get used to them.
The reason foot impressions (casts) are taken off-weight-bearing is so the foot can be positioned in an optimal shape that will allow it to naturally bear weight on its own. A three dimensional scanner can also be used to get a “true” picture of the foot without a cast.
Orthotics are not arch supports. They guide the foot through a proper gait cycle, allowing the foot to achieve various optimal positions at the correct time and creating a means for shock absorption, weight bearing, and propulsion.
A flat foot by itself is not good or bad. A high arch by itself is not good or bad. How the patient functions with those features is the issue.
If you have been told you need orthotics and you’re in doubt, get a second opinion. If you have orthotics and they are not working, get them adjusted.
Correctly made functional foot orthotics work! I have built my reputation with them.
Run Happy! And in orthotics if you need them!
Geovany Soto and His Os Trigonum
12 years ago
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