The Center for Podiatric Care and Sports Medicine

Sure, Orthotics Work, But Why? It Turns Out, Nobody Knows

Posted by on Tuesday, April 9th, 2013

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When I was a soccer playing little kid, it seemed like everyone on my team had orthotics. I grew up in a suburb of Boston where girl’s soccer was something practically every family participated in. In a town with the huge number of affluent and educated doctors, the health of our feet was taken very seriously. It has become common knowledge that orthotics – shoe inserts designed to correct abnormalities in the feet and gait – help. It makes intuitive sense that supporting the feet in a customized way will fix in-grown problems, leading to healthier feet and, by extension, healthier bodies. This seems like it would be especially true for children whose foot problems are only just starting to influence their muscular and skeletal development. “Catch it early” is a mantra here just like it is elsewhere in medicine. The same goes for first-time runners who are worried about early injury. Unfortunately, new research suggests these inserts may not be as universally effective as we once thought.

 

So much of what we accept as scientific fact is actually based on common sense. It feels right that orthotics would work. It’s logical. And, in practice, they do seem to help a lot of people. But the downside of something feeling right is that it often isn’t subjected to the same kind of rigorous testing as something that seems counter-intuitive. We’re less likely to test something if we don’t think we’ll be surprised by the results. But, in the case of orthotics, we are surprised… somewhat unpleasantly. The benefits of these inserts aren’t nearly as clear-cut as we assumed they would be.

 

Benno M. Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta, has been investigating orthotics with rigorous attention. His 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.”

 

So what does that mean for podiatrists and their patients? It doesn’t mean we should abandon orthotics all together. In many cases they do help, albeit in mysterious ways. But choosing the right one may be difficult and we need to use caution. These aren’t a cure-all and they aren’t always going to confer benefits. Orthotics should be one more tool in the podiatrist’s toolbox, and if they don’t appear to be helping (and even more importantly, if they cause additional pain) they should be re-fitted or replaced with other preventative treatments.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.