Ask the Doctor: Do Orthotics Work?

The question this week is something that came from a patient of mine last week:

"What do you think about orthotics? Is it better to go without them?"

I'm probably diverging from quite a few chiropractors and podiatrists out there on this topic, but I'm going to say that, in large part, I feel that orthotics are not helpful for the average person with foot pain. A lot of chiropractors and podiatrists make quite a bit of money selling these in their office, promoting that the lab they use is better than brand X. Many insurance companies do not cover foot orthotics - barring some special medical condition - so the cost is thrown to the patient. Are the $15 Dr. Scholl's gel inserts much worse than the $250 orthotics specifically molded to your foot? There's not a whole lot of science and studies to actually back this up. 

The purpose behind orthotics is to ease tension on the joints and fascia (soft tissue) in the foot. If you have plantar fasciitis, flat feet, supinated feet (the opposite of flat feet), or an unequal leg length, orthotics are presented as the cure all. My opinion is that orthotics prevent normal biomechanics of the foot and further weaken muscles of the foot and ankle, making the problem worse when you don't wear orthotics. Normal biomechanics of the foot when walking or running include a phase where the foot is lengthened as it absorbs most of our weight - orthotics keep our feet from lengthening out completely. Why is this a problem? Well, when muscles or fasia are chronically shortened, they get locked in that position and fatigue easily and lead to pain or tension They also become relatively weak so that when needed to perform a task, the muscles just aren't up to it. 

So, all that being said, I recommend strengthening your feet by walking barefoot, wearing minimalist shoes, not wearing high heeled shoes, and some strengthening exercises (like rolling a towel with your feet, picking up objects with your feet, amongst others). Chiropractic adjustments to fix any joint dysfunction in the foot and ankle and some soft tissue work to break up any adhesions also go a long way. These steps help treat the issue. 

However, I do recognize that some people do better with orthotics. So, if some of the steps I listed above just aren't helping, I usually tell people to try the Dr. Scholl's gel inserts (or some similar brand) first before spending a minimum of $100, or more likely $200 and up, on more expensive ones.

I was also reading an article in the New York Times that said some doctors are not sure why orthotics help, but they seem to help some people. What was interesting too, was that one type of orthotic won't necessarily work for different people with the same problem.  So it may be worth it to try a few different ones. This article also pointed out that there is a lack of evidence that really supports the use of orthotics and the claims that various companies make orthotics to treat and prevent certain foot, ankle, and knee issues.

In large part, I'm not a huge promoter of orthotics, but I know there are people that do better with them and there are certainly conditions that may require people wear orthotics. My recommendation is to try exercises and stretches first, then try a few of the cheaper inserts before spending money on the expensive ones.

Thank you for reading and if you'd like to have your question featured next week, please submit in the comments or email me directly at QureshiDC@gmail.com.