The Frustration and Disappointment of Custom Foot Orthotics

By Dennis Kiper

More and more people today understand the need for a foot orthotic device that helps alignment of the foot to the ground and posture of the lower extremity. Any orthotic including OTC and pre-fab do some of that alignment correction, however minimal.

For those with, stubborn painful problems in the foot, knee, hip and low back pain a custom orthotic is very often recommended.

My experience with the public perception of orthotics is that many have good experiences. They talk about how much better they got and couldn't live without them. Then there are some who always seem to be looking for something better, but can't go without what they have at the least.
Their orthotics work enough of the time than the discomfort of the orthotic.

The last group, is the group that most custom orthotics and other products and modalities tried, just don't seem to work for. They've tried a lot of things, a lot of orthotics, even a lot of doctors and others. Sometimes something seems to help, starts to help, does help, goes so far and those that just can't tolerate anything anymore.

The attitude of some of these people become so irate at the podiatric profession, this can be seen on message boards involving running, sports injuries and specific painful conditions.

I've encountered some who say "if we needed them we would have been born with orthotics", "for millions of years, cavemen didn't wear orthotics", or "our grandparents didn't wear them OR need them".

Part of all that is true, we're born to our purest naked form and there probably isn't even room for an orthotic in our mother's uterus. Aside from the fact that we may not even begin walking until our first year of life, we certainly don't need them at birth.

Cavemen, also didn't wear eyeglasses (also called orthotics), sunscreen or even a belt to hold the skin of an animal wrapped around themselves. So, the fact they didn't wear foot orthotics is not surprising to me, besides they wouldn't have had the money to buy a pair of Nike's or Florsheim to put them in.

Foot orthotics were not even around until the 50's, so depending on your grandparents age, it may not have even been an option. But did they need them??

I can remember several conversations with people who say their grandparents never complained about their feet, well, that certainly doesn't mean they didn't have pain. Previous generations were much tougher than we are today. They didn't complain, because it wouldn't do them any good, and there were little to no solutions. Most modern conveniences and modern medicine were unknown, most of that has only come into being in the last 100 years. So, now we can complain more loudly, because chances are there's something that can be done about it, or at the least help it.

When the concept of human biomechanics began, Dr Merton Root (the father of modern podiatric biomechanics) had very little references to go on. It was because of his interest and genius that led him down the path of alignment correction. Amazingly his concepts and research has borne out that Root mechanics is still valid today.

What resulted was a stiff orthotic (a shell to hold the foot) that would restrict the abnormal motion and compensatory mechanisms that resulted in our postural complex.

At that time, he thought that podiatric problems were caused by abnormal motions in our feet that caused these foot and postural pains. And these abnormal motions needed to be controlled so that the foot would more efficiently carry our body to the next step. Well, by restricting these motions throughout the foot, it did make it more efficient, but it didn't make it as efficient as it can or should be.

The problem with traditional technology is, instead of controlling abnormal motion it's restricting normal motion, and normal motion, is mechanically inefficient by its very nature. That's why we physically break down from general wear and tear, and most musculo-skeletal problems come to the surface between 40-60 years of age.

This is where is where that difficult group winds up. Your foot cannot tolerate the restriction of your normal motion, it's not efficient enough for you. Your biomechanics offers greater complexity. I used to think that this segment represented about 15%, but after 30 years I feel it's more like 25-33%. That's a big population that suffer most of the time.

In the last 50 some years very little has changed in traditional orthotic therapy (aside from newer materials and in some cases a little more flexibility). Clinical studies between podiatric custom orthotics-prefab and over-the-counter supports showed that none were that much better than the other. This is a very poor finding considering the cost of a custom orthotic.

One of the saddest things for me as a DPM is how many civilians and allied professionals don't trust and/or dislike orthotics. If you or your child needs eyeglasses or braces... barring the finances you probably wouldn't think twice.

That's the way it should be for the podiatry profession as a whole when it comes to prescribing an orthotic. You expect the technology to work, all or at least most of the time, not just some of the time, these are modern times aren't they?

Today there are websites that cater to people with irreconcilable problems, and they can ask questions, get answers that may or may not help and in most cases just vent. For anyone who has had one or more pairs of custom orthotics, their problems often got worse, as in the case of complex and chronic patients. The other half of those who have been somewhat helped and satisfied, half of them wear their orthotics because it helps and is better than nothing at all, but is uncomfortable to wear.

Every foot (aside from certain developmental conditions), has mobility, flexibility and dynamic motion throughout every joint. There's a reason for that, and that is, locomotion is a dynamic event and the structure is designed to absorb shock from the ground throughout our postural complex and carry us forward. The foot structure needs just enough motion to do that efficiently which will transfer throughout our postural complex. That's what every orthotic should do.

Walking and running on an orthotic should be easy and comfortable.

There are probably a handful of people that will go through life and not have some pain in their lower extremities.

Today, newer technology orthotics can change all that for the lower extremity.

Fluid technology orthotics, consistently works as it should based on principles of science and calibrated to specific measurements is on the scene.

Traditional technology, in the form of a shell orthotic can only go so far, or don't work at all.
Cushioning your footstep with a proper fitting orthotic as early in life starting from 10-12 years of age, would go a long way in reducing the amount of poor biomechanical health in so many people we see today.

Copyright 2006 Dennis Kiper, all rights reserved.
Dennis N. Kiper, D.P.M., specializes in Podiatric Sports Medicine.
Email: footdoc@drkiper.com
Web Site: http://www.drkiper.com