Are Shoe Orthotics Worth it?

March 2, 2020

 

We all know at least someone who wears some sort of shoe orthotic. We've heard that they can decrease pain and "fix" any problems we might have. We've seen them in stores, as well as custom made versions. Orthotics are becoming more and more popular, but do they really help? And if so, how do I choose which one is best for me?

 

Lets first look at the lower leg. You can't just look at the foot itself, but rather the leg as a whole - foot, ankle, knee and hip. It's very complex! It has to be determined why a person walks the way they do. It doesn't necessary mean that it is a foot issue. 

 

There are 4 common conditions that orthotics help the most: plantar fasciitis, arthritis, diabetes, and metatarsalgia. Other conditions such as Achilles tendinitis, bunions, shin splints and knee pain MIGHT help, but not exactly clear.

 

Runners are the most common sample that wonder whether they need orthotics due to increase repetitive strains and injuries. However, is this pain just because of repetitive stress, or much more such as genetics?

 

Yet research is conflicting. Some articles propose a superior benefit, while others suggest there's no evidence that supports improved mechanics:

 

A 2015 Australian trail for Achilles tenditinitis completely fails the custom orthotic test, supporting that they did not work.

 

However a 2002 study by BMC Muscoloskeletal Disorders associated orthotics with significant reduction in Achilles Tendon Load.

 

A 2018 study by Biomed Research International concluded that while their study showed significant pain regression in plantar fasciitis patients, pain did not fully go alleviate. However, no neural changes or restoration of locomotion was noted.

 

A 2011 study from the Journal of Foot and Ankle Research noted that semi-custom moulded orthotics reduced plantar fascia strain, but did no control peak rear foot eversion, tibial internal rotation, or arch deformation.

 

Based on all the research out there, I will label them into CONS (Against arch support) and PROS (Favor arch support)

 

CONS

- Can disturb the spring-like function in the feet

- Moderate pronation is not linked with higher risk of injury

-You hit the ground with more force (12%) when wearing padding.

- No improvements were seen in posture, strength, or stability.

- Arch type makes no difference

- Minimilaist shoes result in greater efficiency

-Cannot improve knee joint moments

-Little use for lower limb injury prevention

-Same arch support can have different results in different people

- Elevated cushioned heels or pronation control is no evidence based.

 

PROS

-Can help pronation (2%)

-Can help high arches with shock absorption

-Reduced loads on Achilles tendon

-Decreased ankle inversion and eversion

-More balance for flat feet

-Reduce plantar pressure and risk of ulcers in diabetic patients

- Can help decreased metatarsal pain

 

If you are uncertain if you need orthotics, the best place to go are pedorthists and orthotists, who specialize in the lower body anatomy and fabrication of custom foot orthoses. Podiatrists, who specialize in foot problems, do no always extend to include expert gait analysis and physical assessment in biomechanics dysfunction. 

 

In my opinion, I would not go out and spend 100s of dollars to find the right orthotic. For starters, I would try and get an evaluated analysis of why you are in pain, and try to correct the biomechanics problem. Whether you have flat feet or a high arch, you don't NEED to have a support especially if there is no dysfunction or pain. 

 

But if you want some pain relief, I don't see any harm in utilizing them. The one's I've heard to be extremely helpful which aren't too expensive are New Balance pressure relief, SOLE arch support, and Superfeet green comfort insoles. More research is needed to conclude for which conditions do orthotics really help.

 

A great side note which I discovered when doing my research are these:

 - The more arch support, the higher the shoe price

 -Recommendation from the salesperson has the 2nd biggest influence on shoe selection

 

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