A News Story About Orthotics
By Bob Neinast, a.k.a., Ahcuah
There was a story in the New York Times last week about the relative ineffectiveness of orthotics.
It seems that they often don’t do much.
The first story, published on January 18, is Close Look at Orthotics Raises a Welter of Doubts. It highlights Professor Benno Nigg at the University of Calgary. Here’s the money paragraph from the article:
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.
Of course, orthotists are up in arms (or would that be “up in feet”?). From the article:The key measure of success, said Jeffrey P. Wensman, director of clinical and technical services at the Orthotics and Prosthetics Center at the University of Michigan, is that patients feel better.
If all that is measured is “feeling better”, that could just be the placebo effect, which is all about unquantifiable feelings.That is not to say that orthotics are useless. There have been studies that show, for instance, that the right one (semi-rigid sole, not soft sole), can help reduce tibia stress fractures among military recruits. There are also studies showing that they help with plantar fasciitis.
The point of the article seems to be that orthotists all disagree as to what really works (and there are no studies supporting one particular type in a specific situation). Each orthotist has his own “style” of orthotic. As the article says:
Every new podiatrist or orthopedist, he told me, would invariably look at his orthotics and say: “Oh, these aren’t any good. The lab I use makes much better ones. Your injury is probably linked to these poor-fitting orthotics.”
Of course, the thing that I’ll note is that none of the studies compare the orthotic to bare feet. What they do is look at one odd distortion of the human foot and compare it to some different odd distortion of the human foot. I say this because any shoe makes some sort of distortion. A heel changes angles and stresses; a rigid or semi-rigid sole prevents all of the muscles, tendons, and ligaments from moving freely. Even things like Vibrams remove tactile information.It’s as if society dictated we should all wear space helmets, and the helmetists spend all their time trying to add something to the space helmet to remove the distortions from looking through the bubble. They spend their time affixing various combinations of lenses to the inside of the helmet. And they also all say, “But you cannot go without the space helmet. You could hit your face on overhanging tree branches! What if a bird drops a rock on your head?”
I’m sure there are times that orthotics can be helpful (just as I am sure there are times that it is helpful to put your arm in a sling). But it sure seems that they are all to often a hammer looking for a nail.
http://ahcuah.wordpress.com/2012/01/26/a-news-story-about-orthotics/