Orthotics – Part 2
In a recent post, we have discussed the blanket statement that ‘orthotics don’t work’.
We briefly looked at why people may feel this way, the importance of communication and need to set realistic and achievable goals.
Today, lets have a look at different types of orthotics (foot orthoses) and why some styles, shapes and material can be very effective for one person, but may fail miserably for someone else.
In the first post in this series, I outlined 3 things that orthotics need to do if we are to have a positive outcome. These 3 points are orthotics need to:
- Be working toward a realistic and achievable goal or treatment outcome.
- Support or move your foot into an appropriate position that will limit further damage and enable healing.
- Be used appropriately and long enough (often in conjunction with other treatment strategies) for that healing to take place.
Todays post is all about point number 2.
How can we use an orthotic to position the foot? or alter a force in a way that will limit further damage and enable an injury to heal?
First, we must know what is wrong. What is injured in the foot or lower leg? What are the structures involved and what is the actual diagnosis? Second, we must understand the movements or forces that are contributing to the injury? Is it an acute injury or a chronic, overuse type injury? The term currently being used by health professionals such as Podiatrist, physiotherapists and exercise physiologists is ‘load management’. An orthotic is just one of many strategies for effectively ‘managing’ these loads in the foot and lower leg. To do this, the person prescribing or making the orthotic must understand what the ‘loads’ are.
In some cases, both understanding and modifying a load can be amazingly simple. For example, a patient who works on a hard-concrete floor and reports pain in the ball of her foot, may simply require an increased cushioning inside the shoe. In this case, a simple gel innersole from the chemist or shoes shop may be perfect. However, for a long-distance runner who continually develops medial knee pain, 20km into an event, both understanding the biomechanics and altering the load may require a little more thought.
Unfortunately, the field of orthotics is plagued by an ever-increasing commercial market.
Facebook and the internet are full of adds for innersoles that are ‘guaranteed’ to fix your foot pain (even though they do not know what your foot pain is).
Most of these products are not bad, and some would quite possibly be perfect for you, unfortunately you have no way of knowing which one. This is one of the disappointing factors that can lead to the ‘I tried orthotics, and they don’t work’ mentality. It really is a lucky dip!
While it is a somewhat crude analogy, it would be similar to walking into a Chemist, without a diagnosis of your illness, and asking for a bottle of pills. The Chemist, happily provides you with a full bottle of pills from the nearest shelf. You may get lucky and have the perfect cure for your illness, but you also may have no improvement. Worst still you may get worse.
Foot orthoses are just like this.
Just as it would be grossly unfair to march out of the chemist and declare that ‘Pills don’t’ work’. It would also be disappointing to come to the same conclusion with ‘lucky dip’ orthotics. Unless we can clearly state what it is that we are trying to achieve with an orthotic, and be confident that your orthotic is doing that effectively, we really cannot come to a sound conclusion that the orthotic didn’t work.
The longer that I work with foot orthoses and the more feedback I receive from my patients, the more I am convinced that prescribing foot orthoses is not an exact science.
What works for one, may not be well received, or tolerated by someone else, despite presenting with almost identical symptoms.
Similarly, the same orthoses may have a significant difference on the foot depending on the footwear they are worn in. Patients regularly note that they feel different in new shoes. Comparing a pair that is several years old and may have collapsed or compressed on the inside. All these variables need to be considered when assessing the effectiveness of a foot orthotic.
Good communication and ongoing discussion with your health professional is essential in ensuring your orthotics are the very best they can be for your injury.
Just as your doctor may make adjustments to your medications, small adjustments to foot orthoses can really improve their effectiveness.
If you are not getting the results you expected from your foot orthoses; instead of thinking these don’t work, why not consider ‘how could these work better?’ or ‘who could I talk to about whether these are right for me?’ Remember, not all orthoses are the same. As with most things in life, you need to have the right tool for the job.
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