Thursday, January 20, 2011

To Orthotic or Not to Orthotic: That is the Question

To Orthotic or Not to Orthotic:  That is the Question: 
Whether 'tis nobler in the feet to suffer
The aches and stress of poor foot alignment
Or, to Spend a Lot of Money
And By Supporting Feet, End the Suffering.
Foot molds for orthoticsImage by .imelda via Flickr
To Ache, To Wobble, No More,
And by an Ache to say We  End
The Heartache to say We End the Aches and Instability
That Flesh is Heir to.

Tis a Consumation Devotely To Be Wished...

My podiatrist has just recommended orthotics for me.  My audiologist has seen that orthotics can make a big difference for many of her clients who suffer from balance problems.  My husband has just got MBT's and thinks that his tootsies are happier.  Then along comes this study that disses the use of orthotics. 

"For more than 30 years Dr. Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta, has asked how orthotics affect motion, stress on joints and muscle activity.

Do they help or harm athletes who use them? And is the huge orthotics industry — from customized shoe inserts costing hundreds of dollars to over-the-counter ones sold at every drugstore — based on science or on wishful thinking?

His overall conclusion: Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up."
Orthotic Shoe Inserts May Work, but It’s Not Clear Why -

Well, my podiatrist has also recommended doing certain exercises to help realign my feet and legs.  I think looking at my frame as a whole has a lot of merit.  When you look at the blogs at the NYT, there are a number of criticisms to the above article:

Studies on the effects of orthotics on the postural complex are difficult, but are not limited to the following reasons; 1) We cannot where the devices 100% of the time 2) Shoe gear differs 3) The permutations of the underlying criteria created by the quality and quantity of joint motions in the postural complex, muscle influence, osseous alignments, etc. are virtually infinite. We simply cannot take everything into account.
So, this is what makes the work-up for and the prescription writing for functional orthotic devices for the feet an art and a science. We must assess the patient statically as well as functionally in order to maximize the benefit of an orthotic device.
A significant number of patients benefit from this form of therapy. It cannot be discounted. In this time of managed care, many payers have realized their benefit as well by including this form of therapy as a covered service. Evidenced based medicine? I trust so.  From a Podiatrist

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