As spring starts to feel dare I say closer, and if your anything like me and wanting to get out of your painful sneakers because that must be what is causing the pain, it can be the shoes or could it? Today I have an article for you on Orthotics from someone who knows!

Eric Tola, PT, DPT has a great article on choosing an Orthotics

Which Orthotic Should I use??

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When someone has pain with an activity like walking or running, it is important to get a global perspective of the patient. Even when the pain may be located higher in the body, such as in the knee, hip or back, part of the problem can stem from the ground on up. Examining one’s foot type and arch height can be an important piece in treating symptoms up the chain towards the knee and beyond.  There are a variety of techniques that a healthcare provider can employ to attempt to correct mechanics and decrease symptoms with these activities, and one commonly employed method is orthotics.

There are many options out there and it may be overwhelming trying to figure out what is the right option for you. Custom orthotics are touted as being support that is specific to your foot’s exact shape, but are much more expensive than generic over-the -counter orthotics, such as Superfeet or Sole orthotics.  Luckily there has been a fair amount of research conducted on the use of orthotics in runners.

A systematic review is a type of study in which researchers pool together a large quantity of studies on the same topic that meet certain standards called inclusion criteria. It is a higher form of evidence because it is able to find commonalities that multiple studies support, and the findings of the collective whole becomes much stronger than the findings of any one study. Collins et al, 2007 completed a systematic review entitled “Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis”, in which they examined several randomized controlled trials.  Below are a couple of take home messages from their conclusions:

There is substantial evidence to support the use of orthotics in the prevention of first incidence of lower –limb overuse conditions

The quality of evidence was not good enough to support or refute using orthotics as a treatment intervention for an overuse condition (if you already have the injury)

There was no significant difference between the use of custom and prefabricated foot orthotics!

You must be cautious in applying these findings to yourself, as most studies were performed on young, healthy military recruits. In general, the review found that there was no significant difference between using custom or prefabricated / over-the-counter orthotics.

Obviously, this does not apply to everyone.  If you have a significant structural deformity of your foot, you should listen to your doctor when he or she is advocating custom orthotics.

However for the majority of runners told that they have flat feet or collapsing arches, a generic orthotic is the cheapest option and likely to have similar outcomes to a custom orthotic.  So as a general rule of thumb, I recommend most patients start with trying a prefabricated orthotic that is the most comfortable and see how they respond.

There is not one single brand that is the best for prefabricated orthotics – I have seen good results in different clinics that use Superfeet or the Sole orthotic, for example, so I would recommend trying one based on comfort.

Also – make sure to TRANSITION into your new orthotics – they are very different from the normal insole of your shoe and may be too dramatic a change if you try to walk around in them all day.  So, gradually progress into using them for greater periods of the day by adding one hour of orthotic use per day until it is comfortable to wear all day.

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If you have an injury that you need checked out, obtain a prescription from your doctor and give us a call at 301-916-8500 to schedule an evaluation.

Eric Tola, PT, DPT

NRH Rehabilitation Network – Germantown

20500 Seneca Meadows Parkway

Suite 101

Germantown, MD 20876

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