Sifting the Wheat from the Chaff of Running Shoes & Orthotics [Part 2 of 2]
by Mr Tye Lee Tze, Registered Podiatrist, The Podiatry Centre Pte Ltd
This is the second of our two-part series on Running Shoes and Orthotics. In this article, we explore the topics revolving around insoles and orthotics.
Q: Aren’t all Insoles the same?
A: There are 3 types of Insoles / Orthotics.
i) Over the Counter (OTC) Insoles. These are mass produced to a standard. General price range: $20 – $80.
ii) Prefabricated Insoles which can be modified. These are like OTC insoles but they can be modified either by heating them up and bending them in the desired shape. They can also be modified by adding external wedges and / or grinding them. Price range: $120 – $200.
iii) Prescription Custom Made Orthotics. These are the “Gold Standard”. They are the only ones which are “custom made”. How you can tell they are custom made is that they are either done by a Podiatrist or a Podiatrist run Orthotics Laboratory. It is a 15 – 20+ step process. The price range: $350 – $475.
Q: How can you tell if an Orthotic is really custom made as opposed to prefabricated and modified?
A: There are a few tell-tale signs
1. If the measurement of the foot for the orthotic is only done as a footplate / foot imprint (no matter how many pretty colours are used). I’m not an engineer but I fail to see how one can make a 3-Dimensional product (the orthotic) from a 2-Dimensional measurement (the foot pressure mat).
The proper measurement for a Custom-Made Orthotic is by one of 3 accepted ways.
- A plaster of paris slipper cast
- A foam impression box (see photo at right)
- A 3-Dimensional foot scanner
Not one of these moulds are proven to be more accurate than the other as it is the skill of the Podiatrist of positioning the foot in the correct position when taking the mould that is paramount.
That leads me to the next tell-tale sign.
2. The measurement / mould of the foot should either be done with the patient lying down (non-weight bearing) or seated (partial weight-bearing) NEVER standing.
A lot of patients comment that since the orthotics are used when standing shouldn’t the mould be taken when they’re standing? Remember that the objective of the Orthotic is to position the foot in the most efficient position so when the patient is standing the patients foot assumes it’s compensated / incorrect position (think of someone taking the mould for a back brace when the patient is in a slouched position). When the Podiatrist is taking the mould he/she has to ensure that the foot is in the corrected position This can only be done accurately in either a non weight-bearing or partial weight-bearing position as the various muscles will be firing / activated when standing. Anyone who says that they can counter these firing muscles must be mighty strong – there are 26 bones, 33 joints and over 100 ligaments, muscles, tendons, & tissues in each foot.
3. If you take both the left and right sides of the Orthotic and place them mirrored together and they are exactly the same in all dimensions then there’s a pretty good chance that they are not custom made. No one has both their feet exactly the same so if the feet are different but the orthotics are exactly the same then ……..
4. The Prescription Orthotic should only be made by a Registered Podiatrist or a Podiatry Laboratory (btw: Orthotic Laboratory’s generally only accept prescriptions from Registered Podiatrists). How can you tell if it is a Registered Podiatrist. They will generally have their registration certificate from the country they graduated from or they will have their membership card from the Podiatry Association (Singapore). If the Podiatrist is unwilling to show you their Podiatry Registration then …..
Failing these I don’t think many professionals such as Doctors, Physiotherapists, Lawyers etc will set upbooths in shopping malls to ply their trade.
*Be careful of terminology
What some claim to be “custom-made” or “customised” or “custom-fitted” is really just prefabricated insoles modified or “altered” insoles.
Think of when you buy some pants and the length is too long – what do you do? You “alter” the length to fit your measurements ….. but altering the length is not the same as tailor made pants is it? However, these companies will argue that “since I’ve changed the insole to fit your feet then it is “custom-made / customised / custom-fitted” to your feet. Is it really the same?
Note: Podiatrists do use modified prefabricated insoles BUT professionally they should inform you that these insoles are NOT Prescription Custom-Made Orthotics. They should also charge accordingly and NOT as a Prescription Custom-Made Orthotic.
Q: Since some running shoes already are built for overpronators doesn’t that mean that using a Prescription Orthotic will overcompensate?
A: No. Prescription Orthotics work complementary with the shoe. The foot will still move (overpronate) in the shoe. Thus the Prescription Orthotic will position & guide the foot whilst it is in the shoe and then the shoe will position and guide the foot and the orthotic against the interface of the ground.
Q: So, do that mean I can use any type of shoe if I have a Prescription Orthotic?
A: They work best together. If you use an unsuitable shoe then the shoe will cause the orthotic and the foot to be unstable.
Q: How come OTC insoles have a higher arch than some Prescription Orthotics (the “Gold Standard”)? Isn’t the arch the most important part of the insole?
A: That’s where the misconception lies. The arch is NOT the most important part of the insole. The objective of any insole / orthotic is to enable the foot to work in the most efficient mechanical way. This is done by controlling the excessive movements (eg. overpronation) and to enable proper synchronisation of correct movements at the correct timings during the stance phase of gait. Thus it is not as simple as increasing the arch height. That’s like saying the optometrist should give a higher power on my spectacles. It not only is the wrong principle but it can be dangerous.
The definition of Prescription Custom-Made Orthotics is:
“Custom made insoles to support, align, prevent or correct deformity or to modify position or motion and improve the function of the moveable parts of the body.” 1
Q: How come Podiatrists make Prescription Orthotics in a short (3/4 length) and a Full length version. What are the differences?
A: All Prescription Orthotics can be made either 3/4 length or Full Length. This is because the main area of control in the Prescription Orthotic is the rear-foot and the mid- foot. Remember – the objective of the orthotic is to control the mechanics of the foot.
The differences –
If there is no forefoot pain or injuries then the function between the 3/4 length and Full length orthotic is exactly the same. The main is difference is practicality – if you want to use the orthotic in only 1 shoe or shoes which are very similar shape & size then a Full Length Orthotic is suitable, however if you do want to move it from shoe to shoe then a 3/4 length is more versatile.
Q: What types of conditions can Prescription Orthotics help and what evidence is there to support Orthotic use.
A: Prescription Orthotics can help many conditions from those in the feet to the ankles, legs, knees, and even lower back. However, for those conditions in the knees and lower back they only help conditions where there is a mechanical contributing factor, and they (prescription orthotics) are best used in conjunction with other treatment modalities eg. Physiotherapy.
Some of the more common conditions that Prescription Orthotics can help are
- Plantar Fasciitis (heel pain):
- “Patients in the present study demonstrated the best compliance with the use of custom-made orthoses, which may indicate that orthoses provide the best long-term results.” 2
- In 90 percent of the children in our studies who had lower extremity symptoms and some degree of overpronation of the feet, treatment with foot orthoses relieved the majority of “growing pains.” 3
Running Related Injuries
- “Foot orthotic devices are used to treat a variety of running-related injuries. In terms of pain relief, success rates between 70% and 90% have been cited.” 4
Lower Back Pain
- “77% of patients demonstrated 50% to 100% improvement over a 2-year follow-up period when custom-made foot orthoses were used to cor- rect subtle aberrations in their gait style.” 5
- “Foot Orthoses have been shown to have a positive influence on subjects who have recently experienced an ankle sprain and on subjects with chronic ankle instability.
- There is evidence that foot orthoses can influence multiple levels of neuromuscular control of the ankle.” 6
Q: Whilst there is evidence that Prescription Orthotics are effective for certain conditions, are they a miracle cure for everything?
A: No. Orthotics WILL NOT:
- Make your child smarter
- Make you grow taller
- Make your child have better posture
- Improve respiratory function
- Improve blood circulation
- Improve the appearance of cellulite
- Tone your legs & buttocks
- “Clinical Guidelines for Orthotic Therapy provided by Podiatrists – Australian Podiatry Council 1998.
- Martin, Hosch, Goforth, Murff, Lynch, Odom. Mechanical Treatment of Plantar Fasciitis A Prospective Study. Journal of the American Podiatric Medical Association. Volume 91 • Number 2 • February 2001.55
- KIRBY KA, GREEN DR: “Evaluation and Non-operative Management of Pes Valgus,” in Foot and Ankle Disorders in Children, ed by SJ DeValentine, p 307, Churchill Livingstone, New York, 1992.
- Irene S. Davis, Rebecca Avrin Zifchock, Alison T. DeLeo. A Comparison of Rearfoot Motion Control and Comfort between Custom and Semicustom Foot Orthotic Devices. September/October 2008• Vol 98• No 5• Journal of the American Podiatric Medical 394.
- DINAPOLI DR, DANANBERG HJ, LAWTON M: “Hallux Limi- tus and Non-specific Bodily Trauma,” in Reconstructive Surgery of the Foot and Leg, Update ’90, ed by DR DiNapoli, The Podiatry Institute, Tucker, GA, 1990.
- Effects of Foot Orthoses on patients with chronic ankle instability. Journal of American Podiatric Medical Association Vol 97,1.2007.19.
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