What don't we know about Orthotics

Earlier this week, the New York Times published an article called Close Look at Orthotics Raises a Welter of Doubts which called into question whether science would back up our anecdotal belief that orthotics could help relieve pain and prevent injury.  Dr. Benno M. Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary, has studied the topic for 30 years.  While conducting several experiments to determine the effectiveness of orthotics, his results were always inconclusive.  That is to say, despite real life evidence, he could not find scientific proof that orthotics do or don't work, or why. In fact, he was hoping to find a link between the type of foot issue and the reaction to a specific orthotic, but as the article states:

In his studies, he found there was no way to predict the effect of a given orthotic. Consider, for example, an insert that pushes the foot away from a pronated position, or rotated excessively outward. You might think it would have the same effect on everyone who pronates, but it does not.  One person might respond by increasing the stress on the outside of the foot, another on the inside. Another might not respond at all, unconsciously correcting the orthotic’s correction.

But elsewhere in the article, experts do mention that orthotics work for many people.  They make relieve people's foot pain, even though the specific reason remains unknown.  At Shoes-n-Feet, we see orthotics helping people's foot problems every day.  Granted, there is no one way to accomplish that success.

We know that there is no one perfect orthotic or arch support.  Different ones work for different people, so several should be tried.  Just because a patient tries a pair of orthotics and doesn't find them beneficial does not mean no other orthotic will work for that person.  And keep in mind, there is no real evidence to suggest spending $200-$400 on custom orthotics will help the average person any more than a $35-$65 over the counter pair.

People need to decide for themselves if they feel the orthotics are helping.  Experts can guide the process and fit the patient correctly, but only the individual can determine if they are making a difference (for the better or for the worse).

One very important factor not mentioned in the article was shoes.  Today's shoes (particularly athletic shoes) have corrective properties as well, such as: varying degrees of motion control, cushion, shock absorption, etc.  An orthotic and a shoe should be considered as a system working together.

In conclusion, there is a lot we don't know about orthotics -- specifically, the scientific reasons behind their benefits.  But what we do know about orthotics is that while people with no problems with their feet probably should not run out and get a pair, people who do experience pain should not be afraid to try them.  They are known to help, even if we can't prove exactly why.