Do custom made Orthotics cure sore feet or knees?
It is a rare teenager in my neighborhood who doesn’t have expensive orthotics. Even when money is tight, families save to buy them because they are told they are essential to ‘correct’ rolling in (pronating) feet and knees knocking and to cure foot, knee and hip pain. What parent wouldn’t want that?
The claims for orthotics are BIG but the evidence to support these claims is TINY.
It’s not that there is not enough research. There is masses of it. Most find that orthotics are not much better than a sham treatment for pain.
An article in Melbourne’s Age recently reported on a systematic review (research that pools and reports on other research findings) by Dr Glen Whittaker, from Melbourne’s La Trobe University.
His study showed orthotics do not help foot pain .
He concluded that cheap off-the-shelf orthotics were as helpful (or unhelpful) as expensive, custom made ones. Foot pain usually goes away in a year, whether or not orthotics were used.
A year?
This research has made little impact. Orthotic prescription manufacture and sales underpin a huge industry. Sadly: they could be making foot pain worse in the long run (pardon the pun).
OK: Undoubtedly, supportive orthotics can help settle and soothe pain. Many LOVE their orthotics. I love my off-the-shelf orthotics when running. They can help correct a tendency to roll feet in (which puts more pressure on sore or stiff big toes and achy knees). But many tell me that they cannot walk barefooted without them. That is a problem.
Orthotics are based on orthopaedic/ musculoskeletal pain theory. This says that correcting mechanical faults or biomechanics solves joint pain and prevents arthritis. This sounds good because we are used to hearing it. But that doesn’t make it right.
Pinching, restrictive or high heel shoes and Western treatments that permanently splint feet with orthotics might explain why sore feet and toes (Plantar Fasciitis and/or arthritis) are huge first world problem. In contrast millions in third world countries lack shoes let alone orthotics. There is no evidence that they suffer more foot or knee pain than their western counterparts. They possibly have less.
Orthotics are like back brace or splinting. People who wear rigid back braces forever might feel better, but do not do as well as those who exercise to recover strength, flexibility, balance and stability. Strapping/ bracing / ‘correcting’ any sore joints should be a short term or occasional soothing and teaching strategy only.
That is: there is no harm in using braces or orthotics for short periods to settle or soothe a problem and for situations where more support is needed such as sport or when sore. But full movement, good ankle stability and the ability to self correct ankles when walking on rough ground is essential. Finally: avoid spending big money on custom made ones if off the shelf ones feel comfortable.
References:
Chris Hopkin - Expensive orthotics no better than a 'sham', review finds · Health & Body .The Sydney Morning Herald and the Age – 31 Mar 18
Whittaker, Munteanu, Menz, Tan, Rabusin, & Landorf. (2018). Foot orthoses for plantar heel pain: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(5), 322-328. doi: 10.1136/bjsports-2016-097355