Orthotics are good. They are bad. Hard vs. Soft Orthotics. Custom vs. store bought? Hard Casted, foam casted, Static vs. Functional? So many debates about such a seemingly simple concept. There are hundreds of theories out there, so what is the true answer? As always, it somewhat depends. First, the answer is different for everyone and should be evaluated by someone who truly has done their research. Caution here: many providers that sell orthotics choose their type solely because that is what worked for them; many providers have not truly research WHY certain types of orthotics are best, the rules have changed drastically in recent years. Just because you are told you need them, does not necessarily mean that is the case.
While this article represents my "opinion" based on the current research and theories, these are the best guidelines and backgrounds I can currently give to help muddle through the quagmire of information.
DO I NEED ORTHOTICS?
The answer is most likely no. As discussed previously, most people have never trained their feet; since the age of 2, we have been put in a solid shoe that provides constant stability and support. Of course our feet are weak, our arches falling, and our movement patterns destroyed. The vast majority of conditions for which orthotics are prescribed can be corrected solely by doing a little work. Orthotics are nothing more than band-aids. They may make you feel better, and get rid of your symptoms, but it is only a matter of time before another ache/pain come creeping in because you have not corrected ANY of your mechanics.
If you supposedly have a "leg length discrepancy" make sure you find out if it is "anatomical" (meaning actually a different in length of bone) or "functional" (meaning one leg functions longer than the other, but the bones are equal length). Basically, if you did not have a difference at birth, a fracture during childhood through a growth plate, or a major joint replacement (and the surgeon told you there would be a difference)- it's almost guaranteed functional! Functional discrepancies will get worse with an orthotic or heel lift, and can be corrected through corrective exercise. Anatomical differences should only be corrected if significant symptoms accompany the discrepancy.
IF you have performed extensive foot training and/or corrective exercise with the help of a knowledgeable professional, and still find yourself stuck- then and ONLY then should an orthotic even come onto your radar.
CUSTOM VS GENERIC ORTHOTICS?
Custom orthotics are almost always the way to go for a long-term solution (IF you need them). These orthotics are designed just for you; but be careful because there are many different types, and research has changed its tune in recent years about what is best!
Generic orthotics can be great for several purposes, however. First, using an orthotic during your foot training to encourage new patterns as strength is built. Second, to provide additional support during recovery from some sort of injury. Think of generic orthotics as short-term band-aids but not as permanent solutions.
HARD vs. SOFT ORTHOTICS?
There was a reason for the old saying: everything in moderation!
Rigid, or hard orthotics have been shown very effective in supporting the arch and forcing the foot into proper positions and patterns. They do not break down as easily, and can just be "re-soled" to add life to an expensive venture. However, there is a downside. They force the foot into proper positions. This can cause pressure points and sores (absolutely a no in diabetic patients, or those with reduced sensation in their feet). This also stops the dissipation of force. Remember our discussion last post about pronation actually being a good thing?
Soft orthotics have been shown very effective in absorbing forces and cushioning. They typically do not allow for sores or pressure points. Very soft orthotics create a relatively unstable surface; this causes the intrinsic muscles of the feet to work much harder and can actually make some symptoms worse. They also can break down quickly, losing their ability to support the foot as they once did.
You're best bet is to look for an orthotic in the middle. Some companies have a rigid plastic that actually gives under load (and will be ordered according to your weight and type of activity); they do not deform over time. Cork orthotics are also available (although these will deform more long-term and will need to be replaced). These can provide the best of both worlds.
TYPES OF ORTHOTIC FITTING?
There are many types of fittings for orthotics. From making a cast or foam mold of the foot, to standing or moving across a board with sensors. The best way to cover all of these concisely is to group them into two main categories: Static vs. Dynamic Fittings.
Static Fittings include casting the foot in plaster or foam, standing in one position on a sensor board, etc. They typically are performed either sitting or standing and are based on only one position of the foot. These do not evaluate the actual motion of the foot, and are almost always not the best choice.
Dynamic Fittings include using a sensor board, or ink mapping to evaluate the motion of the foot during an activity. While they take longer and are slightly more difficult to get an accurate read, these are the best choices. Your gait and movement will be assessed in any number of activities from standing or walking to running. What your foot does at any point during an activity can be vastly different than the snapshot of you standing!
Orthotics should be viewed as either a temporary training aid, or last resort unless there is a very real and true anatomic reason the body cannot perform its proper functions. While it takes a little elbow grease (or tow jam in this case), the work you put into your foot fitness will determine what you get out. IF an orthotic is deemed necessary (by a very knowledgeable provider only), request a custom orthotic that is dynamically fitted and is moderately hard.
Stay tuned. Final post this series: The Gift of Frog Shoes.