What is the Evidence for Using Foot Orthoses?

The Good, the Bad and the Ugly: The Wild West we call the Orthotics Industry – Evidence for Using Foot Orthoses (The Good)

“Education is a progressive discovery of our own ignorance.”

-Will Durant

It is not uncommon for medical professionals to claim that foot orthoses are an effective treatment for low back pain and a variety of other muscular complaints and indeed many “orthotics wearers” would agree.

But in this era of evidence-based medicine, clinical decisions and statements, should only be made where there are high levels of proof for using any particular treatment and the “proof” that orthotics work is rather weak.

Perhaps it is because so many patients “respond favorably” to foot orthoses that researchers have been slow to prove how custom-made foot orthoses actually work.

Four studies on custom-made foot orthoses (between 1985 and 1993) revealed patient satisfaction ratings between 70% and 91% and a recent questionnaire of 275 patients indicated the majority felt that custom-made foot orthoses had provided relief of their symptoms to a level of 60-100%.

Critics of these studies however point out that “patient satisfaction” indicates service satisfaction and not necessarily treatment outcome satisfaction.

The traditional notion that foot orthoses align the bones of the foot is being critically challenged by the scientific community because repeated research efforts show that bone changes are small, and differ from person to person.

Perhaps Researchers have been looking in the wrong place…

Replacing the traditional “re-aligning the skeleton” theory, are several possible explanations as to why custom-made foot orthoses seem to provide relief of common complaints:

  • The biomechanical theory suggests that full contact orthoses, (whereby there is complete orthotic-medial-arch contact) control the speed of moment.
  • The neuro-muscular theory for using full-contact custom-made orthoses suggests that the arches of the foot are sensitive to changes in pressure and vibration. The extra contact between the foot and the orthotics gives feedback to the brain allowing for a more ideal movement pattern.
  • There is some research to indicate that full-contact custom-made foot orthoses may decrease symptoms because they reduce the amount of walking effort with each step by helping to normalize the forces through each foot.

In summary, there is some recent evidence in support of certain custom-made foot orthoses for reducing complaints by improving the way we walk. There is however, not enough research to claim that all foot orthoses will work the same way.

Guidelines for the Conscientious Consumer

  1. There are no guarantees any foot orthotic will improve your symptoms so be suspicious of any such claims.
  2. Ensure that the literature you are reading is not promotional material distributed by an orthotic manufacturing company or a specific clinic.
  3. Ask your practitioner what they know about the research that’s been done on the orthotics that they want to use with you. Practitioners who keep up with the research tend to also be clear about the limitations of orthotic therapy.

 

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