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This is the kind of conclusion that orthotics makers really do not want anyone to know about. Achilles tendinitis is exactly the kind of condition that custom orthotics can supposedly treat, and failing this test so completely is really damning for that industry. Unsurprisingly, the researchers were harshly criticized, and they responded at length — and I don’t think any of the criticisms hold up.
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Sadly no, probably not, and for all the same reasons that they aren’t exactly a magic treatment bullet. You should definitely be skeptical of any sales pitch for orthotics or custom shoes if you have no particular problem to solve. Many orthoses are sold with the promise that they will prevent injury. Even if prevention is not the main reason for the prescription, it is often thrown in as a bonus reason to buy. But it has been tested, with poor results. Running and walking shoes that try to be like orthotics The Pedorthic profession in Canada is moving in a great positive direction with integrity, attracting only University educated individuals to become certified pedorthists,” says Paul Rauhala of OKAPED in Canada’s Okanagan Valley. That training translates into an impressive experience for the patient: I have been a patient at OKAPED in the past, and was blown away by the thoroughness and technical expertise of their assessment, which included slow motion video. My own limited training in orthopedic assessment gave me just enough knowledge to realize how much more Mr. Rauhala knows about it than I ever will — in the leg, anyway!Many chronic problems like shin splints, tendonitis, sciatica, sports injuries, stress fractures and others, can cause immobility and put a damper on your everyday quality of life, when they just don’t have to. A review of studies of foot orthoses to treat overuse injuries of the lower limb with a mostly negative conclusion: “no difference between custom and prefabricated foot orthoses” and “the evidence was insufficient to recommend foot orthoses (custom or prefabricated).” (One thin ray of light was that the evidence supposedly supports the use of foot orthoses to prevent a first injury … but, even if true, hardly anyone seeks out orthoses before they develop an overuse injury. And why would they be good only for a first injury? Makes no sense, therefore likely not true.) But it was worth trying. The orthotics did help my chronic low-grade plantar fasciitis in that foot, and the experiment was fairly cheap (compared to, say, a year of chiropractic adjustments) and safe. So why not? If you have foot or leg or knee pain, by all means seek the opinion of a certified pedorthist/orthotist. Even if orthotics are not likely to help, he or she may recommend a shoe type that may be more appropriate for you — a factor that is often overlooked. Can orthotics prevent injuries?
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It was the right kind of study (prospective), but perhaps a bit underpowered with only 89 subjects and just 12 weeks of monitoring for new injuries. I wish I could see the same data for a couple hundred runners over six months. Subtle vulnerabilities might take quite a while to crop up, particularly in runners who have already gotten through at least six months without any injury. Still, 24 of these runners did get injured in those twelve weeks — which is a lot! — and “we did not find significant associations between lower limb length discrepancy, Q-angle, subtalar angle and plantar arch index and injury occurrence.”
A little: “Currently, there is gold level evidence for painful pes cavus and silver level evidence for foot pain in juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, hallux valgus.” But silver-level evidence is really not great, and I find that terminology annoying because it invariably makes evidence sound better than it is. For plantar fasciitis, the authors also comment that it is “unclear if custom-made foot orthoses were effective.” Unfortunately, you can’t count on wise prescription and skilled crafting: there are many unscrupulous and shoddy suppliers of these products who will prescribe orthotics for almost any problem, or none at all. The science is complex and incomplete. Regulation is a confusing mess. It is nearly impossible for consumers to know if they actually need any of these products, or where to get an expert prescription and a quality product. The good news: there are good sources And yet orthotics could still be worth trying for some conditions — particularly if you do have a fairly obvious biomechanical problem. Good orthotics are a reasonably good way of trying to “tinker” with any gait or postural dysfunction that may have contributed to your pain in the first place. For instance, unusually high arches are a plausible factor in runner’s knee. 12 My own example: orthotics that helped plantar fasciitis (but not IT band syndrome)
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