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!


Outsmarting Heat Illness

With the recent heat wave that has gripped the country, many of us are struggling to tolerate the brutal heat and humidity.  It’s one thing if you decide to run in the hot summer heat but with this kind of heat, simply walking the dog or working in the yard is putting anyone at risk for health problems.

Help is here!  I’m a modest guy but I can say when it comes to heat illness prevention, I know it well.

Working with the Jacksonville Jaguars in the Sunshine State is a great start.  Athletically, I’ve competed in the three hottest Ironman Triathlons in the world.  Those three 140 mile races are in Brazil, Hawaii and Lanzarote and I finished each of them with my personal best times at that time.  Interestingly, the Lanzarote Ironman in the Canary Islands is labelled as the “toughest Ironman triathlon in the world” for over 15 years and no other race has challenged them for that title!

It’s safe to say that I know heat and how to safely exercise in a hot environment.

Heat illness is a dangerous problem but it’s important to note that heat illness is a very preventable problem.  If an athlete is smart in his/her approach to exercising in a hot environment, most problems can be completely avoided.  Educating athletes and others involved with their activities is the key first step to avoiding problems and even death related to heat stroke.

Common Results of Heat-Related Illnesses

Heat Cramps – Persistent involuntary muscle contractions and pain that continue during and after exercise.

Heat Exhaustion –  Symptoms can include dizziness, nausea, fainting, muscle cramps, headache and poor of coordination.  This is a moderate level of heat illness which can progress to a life threatening condition if left untreated.  This is usually a results of an elevated body core temperature and a loss of fluid or sodium.

Exertional Heat Stroke – Symptoms may include nausea, vomiting, headache, seizures, confusion, and potentially a loss of consciousness.  This is a life threatening condition that can progress rapidly if the body core temperature reached 104F.  Immediate medical care is needed if heat stroke is suspected.

 Mike Ryan’s Tips to Beat the Heat

  • Know Your Enemy – Know the warning signs of heat illness: dizziness, nausea, confusion, a sudden urge to cheer for the NY Yankees, headache and/or fainting.
  • The 50/50 Rule – The rule of hydration I use is what my Jaguars players call the “Ryan 50/50 Rule”.  Consume 50% water & 50% sports drink before, during and after the workout/race.
  • Take the Time – Your body needs time to acclimate to the heat.  Your body is adjusting with hundreds of bodily changes and that takes time to properly prepare.  Gradually increases both the duration and the intensity of physical activity. This process typically takes 10 to 14 days.
  • Know Your Carbs – When it comes to helping to keep the body core cool, simple carbs (sweets, soda, cakes,…etc.) are BAD while complex carbs (pasta, grains, sports drinks,…etc.) are GOOD.  Asking your body to cool itself in a hot environment is not the place to be trying a new diet or limiting your caloric intake.
  • Sleep is Key – Sleep deprivation limits the body’s ability to dissipate heat.  Get your sleep & you’ll tolerate the heat much better on race day.
  • Small Chunks – Take breaks and rest period when exercising in a hot environment.
  • Other Factors Contributing to Heat Illness – Knowing what factors predispose you to having problems in the heat is extremely important.  These include fever, stimulants including caffeine, prolonged air flight due an average humidity level in an airplane of only 5%, menstruation, cold medicine, diuretics, recent heat illness, dehydration and recent weight loss.
  • Open the Salt Mine– You need salt (sodium) and you need it early.  Start consuming salty snacks like pretzels and tortilla chips 24 hours before the start of the race.  Continue with the salty snacks up to and during the longer bouts of exercise and exposure to the heat.
  • Cool the Core – If you can keep your body core (the torso and abdomen area that contains your kinda important organs) cool, your body will tolerate the heat better and enhance your performance.  It’s that simple.
  • Adjust Your Pre-Race Routine – Minimize your exposure to the excessive heat and humidity just prior to your workout or race.  Two tips are to move some of your pre-race warming up into an air-conditioned area or shorten your pre-race routine when exposed to the heat and direct sunshine.
  • Look Cool – A valuable lesson that I learned during a brutal race in Ironman Brazil….Wear light colored clothing and hat because they absorb less heat and keep your body cooler.
  • Keep a Cool Head – Ice and cool water in your hat is a great way to get an upper hand during the Dog Days of Summer.
  • Burn is Bad – Sunburned skin is very inefficient in protecting you in the heat.  If you’re sporting that red lobster sunburn look, know that you body will not be at it’s best to handle the heat even if that sunburnt skin is not exposed.

Cool Closing

Taking care of yourself before you exercise in the heat is a smart start.  If you’re sick, taking stimulants or experiencing any of the previously noted conditions, you need to hyper-hydrate early and often and limit your time in the heat.

Most individuals from the professional athletes to the weekend warriors who have problems in the heat can trace the main reason for their problems back to a relatively simple cause.  Common sense is often missing.

Plan ahead, closely monitor how you feel, eat right, drink with the “Ryan 50/50 Rule”, limit your exposure with frequent breaks and you’ll be fine.

Remember, heat illness is very preventable with a few smart steps.  It’s time to get out and enjoy getting healthy!