Foot Orthotics – Are They Worth the $?

I’m often asked about orthotics and the questions usually involve two basic issues:

     1.  Do orthotics really work?

     2. Why are orthotics so expensive?

I find it ironic that most people asking these questions own orthotics.  If they are wearing orthotics and they have to ask if they work, it must mean the orthotics are not doing their job.  No one seems to ask such questions about contact lenses or glasses.  If they’re wearing contacts and they question their effectiveness, the contacts probably aren’t the right lenses for that person.

Orthotics are no different.

As for the price, in many cases I think orthotics are grossly over-priced.  Sure there is tons of science and detail installed into a properly fitted pair of orthotics but there is little reason why someone needs to charged $600 for any shoe insert that isn’t covered in gold and diamonds!

I’m a fan of orthotics if fitted properly….for the right reasons and for the right price.  Approximately 40% of my athletes presently wear orthotics.  I owe a great deal of my knowledge about the lower kinetic chain and orthotics to David Tiberio, professor and friend from one of my alma maters, the University of Connecticut.  He’s a brilliant physical therapist and I appreciate him sharing his amazing insight with me over the past 25+ years.

What is an orthotic?

An orthotic is a specifically designed shoe insert which is custom-made to correct a biomechanical abnormality by correcting the poor alignment and enhancing the body’s ability to move.

How Do Orthotics Work?

As I tell my pro football players: “Orthotics bring the ground up to the foot.”  The foot is the base of support of the entire body and it starts the movement pattern when the foot is in contact with the ground during standing, walking or running.

If you were to put a smaller wheel on the front left side of your car, the car will still be driveable and get you to where you want to go.  It will be slower, it will be harder to drive, other parts of the car will be stressed more, the other tires will wear-out faster and the appearance of your car will change.  Poor foot alignment is no different.

To get that car alignment corrected without changing the tire, it can be done two ways.  1.  The car can be driven without the front left tire ever touching the road – not likely to happen or  2. The road can be brought up to the tire as if that tire was now riding on the curb.  This is a simple example of how an orthotic functions.

The Benefits of Orthotics

There are many reasons why orthotics are used.  Those reasons include leg length discrepancy, plantar fasciitis, heel pain, ankle sprains, tendonitis, arch pain, shin splints, foot pain, stress fractures, low back pain, muscle pain/injury, neuromas, bursitis, and sciatica. The influence of an orthotic, as with the base of support of any structure, can reach from the bottom to the top of that structure.

There is much discussion related to the best manner to create the orthotic and it goes well beyond the scope of this sports medicine blog posting.  Weight bearing status, casting, laser, standing, sitting, laying prone, hard orthotics, half-length, orthotic material, where to stabilize the arch,…etc. are just some of the factors related to orthotics.

The Truth About “Perfect Alignment”

The mechanics of the human body are amazing and a big reason why I love doing what I do as an athletic trainer and physical therapist in the NFL.  Every joint in the body has a three-dimensional movement pattern.  Unlike the hinges on your door that moves in only one plane of motion, the human body joints have what is called accessory movements.  These are subtle movements of a joint are necessary for full range of motions to occur.

I like to restore “proper alignment” because there is no such thing as “perfect alignment”.  This normal three-dimensional movement means that an orthotic must bring the ground up to the foot to allow for this normal movement pattern to happen naturally.  In other words, orthotics allow the body to do its job by moving naturally without pain.

I tell my players that the only time they will have bilateral symmetry on the football field is during the National Anthem.  It’s true.  Think about it: the field is never level and they are always changing direction throughout the game.

The A Factor

As for the athletes (A) themselves, one leg is usually longer than the other, injuries change joint motions over the years, flexibilities vary from side to side, the wear pattern of the shoe alters the mechanics of the foot, muscle weakness alters the running sequence and their joint laxity/arthritis changes how that athlete moves.

In other words, the athlete himself isn’t moving the same on both sides of the body.  With this being said, the theory of an orthotic is to help balance the manner in which an athlete moves on both sides of their body.

Back to Orthotics….

Now that we got all the kinesiology and body mechanics out-of-the-way, let’s get back to the orthotics themselves.  I emphasize to my athletes that a properly fitted pair of orthotics should fit like your favorite pair of blue jeans.  They “just fit right”.  No two pair of favorite jeans are the same.  The same is true for orthotics.  A well-fitted orthotic should have no hot spots, no pressure points, no uneasy feeling when they are worn and the athlete should almost forget that they are there.

Think about it this way:  if your orthotics are doing their job properly, the foot and the entire body above it is positioned to do its job.  Those previously noted movements can now happen with ease.  It’s like tucking that napkin under the leg of the wobbly table.  Now the table is both level and stable to do its job of being a table.

Getting the proper orthotic to meet your needs is the key.  The most important factor related to the orthotic is what YOU, the athlete, feel and think.  Speak up and give your medical team the necessary feedback to adjust your orthotics so they “just fit right”.  Don’t forget that it’s your feet and your money!

 

13 replies
  1. Christian Johannsen
    Christian Johannsen says:

    Thanks. Great article. However, I would like to point out that orthotics tend to require a gradual break-in process to start, which may be accompanied by minor aches and pains. After about 1 to 2 weeks the patient should feel at ease, just as you mentioned.

    Reply
  2. Jay McLaughlin, PT., MA.
    Jay McLaughlin, PT., MA. says:

    Good discussion, Mike! I have fit many people with custom made orthotics and I concur with you, that the most important aspect is the customization of the individual orthotic. No two people and no two feet are exactly alike. It is true that the orthotic fit should be seamless and no discomfort whatsoever should be present. I prefer using the neutral casting approach, in the prone position. Jay C. McLaughlin, PT., MA. (drjay40@aol.com)

    Reply
  3. Bruce Williams
    Bruce Williams says:

    Custom foot orthoses are expensive primarily because they are custom made for a specific individual. Foot types differ in structure and function in many measurable and quantifiable ways. You hit all the right points on limb length differences and asymmetrical function. In-shoe pressure data can give you the information you need to validate those asymmetries and to correct them utilizing custom foot orthoses.

    Reply
  4. Luigi F. Rende MS, ATC
    Luigi F. Rende MS, ATC says:

    Mike, nice article on the use and benefits of orthotics. What are your views on fitting orthotics, non weight bearing(casting) semi weight bearing, (sitting foam box impression), dynamic evaluation; (computerized gait analysis), or weigth bearing(standing evalutation for example foot dynamics,etc)
    Thanks for the insight?
    Lou Rende

    Reply
  5. Steve Button
    Steve Button says:

    I agree that in many cases, practitioners charge a lot for “custom’ orthotics. I’ve benefitted from wearing orthotics, and would encourage people with gait issues to try them. Many OTC will work.

    Reply
  6. Paul
    Paul says:

    Orthotics are not the right solution for problems. It’s a lazy approach. It is a temporary artificial support, instead of development of one’s own body and one’s own skills of movement, the athlete is given a cane as an invalid, which eventually lead to more weaknesses and problems.

    Orthotics don’t work, because they deprive muscles from performing their specific functions by substituting for their work. Orthotics do not teach us to move properly and they deteriorate our perception of movement.

    Reply
    • Mike Ryan
      Mike Ryan says:

      Paul, the great orthopedic surgeon Jim Andrews told me some wise advice one day: In sports medicine, avoid using the words “never” or “ever”.
      I have no relationships with orthotics companies but I know that orthotics can be greatly beneficial for some biomechanical pathologies and your “orthotics don’t work” theory is too general.
      How are you going to restore a normal gait pattern with flat feet and severe pronation?
      What muscles will you use to bend the 1st metatarsal bone to correct forefoot varus or a leg length discrepancy?
      I agree that orthotics are abused with the approach similar to: “If your only tool is a hammer, everything looks like a nail”. But sometimes, a good ol’ hammer is just what the doctor ordered!
      Thanks for not being on the fence, Paul, and taking a stance on this. MDR

      Reply
  7. Ian Adamson
    Ian Adamson says:

    Paul,

    As Mike points out, absolute statements are difficult to support.

    With that in mind, I believe there are many uses for orthodontics in our population, however many medical practitioners over proscribe them and treat them as a panacea.

    In my opinion orthotics are a valuable tool but are too often used to treat symptoms without addressing the cause. Intelligent treatment of kinetic chain, lower limb and foot problems should include balance, alignment, strengthening and range of motion treatment where relevant.

    Ian

    Reply
  8. Dan Prince
    Dan Prince says:

    Mike,
    Great article! I noticed you included a photo of an orthotic from TOG do you use their gait scan technology? I’m curious how you determine LLD on your athletes? Thanks for sharing.

    Reply
    • Mike Ryan
      Mike Ryan says:

      I assess leg length discrepancy (LLD) statically and dynamically. I look at levels at ankles, medial knee joint line, and pelvis (ASIS) supine and sitting. I also assess levels at the shoulders, lower shoulder blades and pelvis standing and walking. The big questions: Is there a bilateral asymmetry and if so, where is it and is is structural (unchangeable) or a dynamic compensation? A lot to do to find those answers but a very important step to getting my athletes balanced and pain-free. Thanks Dan.

      Reply
  9. Marilyn Holmes
    Marilyn Holmes says:

    Great article Mike-excellent explanation as to the orthotic’s role. Regarding LLD, I find it is important to check pelvic levels in standing and tall sitting, up on ischial tuberosities with a neutral pelvis. If the PSIS and iliac crest levels change from standing to sitting I expect there to be a LLD and I measure and advise my pedorthist regarding these findings. If the levels don’t change from standing to sitting, I assume there is no LLD, and that there is a lumbopelvic dysfunction (often and anteriorly or posteriorly rotated innominate) and do further assessment (position, mobility and stability testing) to determine what it is. Often clients with lifts in their shoes or built onto their orthotics have SIJ dysfunction which can be readily treated within 1 or 2 visits.

    Reply
    • Mike Ryan
      Mike Ryan says:

      Your thoroughness and biomechanical interest in the details of your evaluation is impressive, Marilyn. I’m sure your patients love you for it and they are getting better faster thanks to your knowledge of the lower extremity kinetic chain. Cheers to you and thank you for sharing your wise advice.

      Reply

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