The NY Times discusses orthotics – Why it takes more than the foot orthosis to get you relief.
A recent article in the NY Times discusses the pro’s and con’s of foot orthotics. As a consumer of health care services, what are you supposed to believe? Do you buy off the shelf orthotics, custom, maybe both? How can we define whether they work or do not? Is the recommendation appropriate for you? You can check out a good discussion I participated in as an advisor on the barefoot running society web site http://thebarefootrunners.org/threads/a-news-story-about-orthotics.13347/#post-122087. If it makes sense that you do need them and they can help, how much should they cost and who should you trust to make the recommendation. While I have seen complicated machinery used to evaluate someones gait (the way they walk), honestly, a treadmill and a cellphone video will do just fine. If you see over and under striding, then foot orthotics are for you.
Some stores push their pseudo custom orthotics such as Roadrunner sports. Many people are talked into these devices which are about $80. When they are evaluated mechanically (do they level out your hips and create symmetry in the way you walk?), they usually fail, yet the superfeet orthotics that are about 1/2 the price which are also sold in the store and are off the shelf do just fine and do the job (their store branded inserts are also effective). The problem with off the shelf orthotics is that we are all built differently and when we purchase them, we are assuming that the company’s one size fits all approach to the perfect arch will work for everyone. This of course is a poor assumption since some people are heavier, need a high arched insert (some brands such as powerstep address this effectively however, you also need to consider if this insert will work in all your shoes). For men, this is a simpler question than for women whose styles vary greatly.
Part of the problem is that if someone is built asymmetrically, they require correction in all their shoes, not just the athletic ones. This is why it makes little sense if a health care practitioner makes a large device that fits in only one type of shoe, it will not be very helpful; you need to have the insert in all the shoes or have a better idea on how to incorporate orthotics into your lifestyle while allowing yourself to wear the types of shoes you wish to wear. Women who wear heels over 2 inches do not require foot orthotics in them since this does not allow the person to overpronate or feet to flare out. As a rule, if you like to wear sandals in the summer, those that require foot orthotics should stick with those that have arches built into them such as Teva or Reef. Read more about that here.
If your health care practitioner asks the right questions, he can find the right fit of custom, off the shelf or both custom and off the shelf inserts to suit your needs. Unfortunately, to feel this works, you must understand that foot orthotics are just part of the equation. The myofascia molds according to the forces we place upon it and asymmetry, which is what brings most patients to chiropractors and to pain doctors of other disciplines. Most people are not aware that by the age of 6, we tend to walk in a similar fashion to the way we do as adults, and unfortunately, the way we feel at that age is what we see as normal. When we experience pain, we see this as abnormal and then begin our search for the person who could cure us or the medication than can relieve us. This has led to the piecemeal approach of treating symptoms when structural integrity is really the problem and pain is the result. Since symptoms do not tell us why we hurt, just that we do, many people try different things including orthotics for relief and if the orthotics are not accompanied with some type of body work, the person is likely not to get the results they want because of the tightened myofascia which needs to be loosened and then retrained with orthotics in place.
In the book Cheating Mother Nature, what you need to know to beat chronic pain, this concept is discussed in detail and in our offices, this is how we keep patients out of pain. Using orthotics as well as chiropractic manipulation and myofascial treatment, we cheat the system or cheat mother nature (as is the title of the book). While we cannot change your structure, we can modify how it behaves with orthotics which is not much different than leveling a home with a tilted foundation. Once you level the foundation, you can modify the structure with long lasting results.
What do you think? As always, I value your opinion. Read Cheating Mother Nature, available through Amazon.com and other booksellers.