Image via CrunchBaseReporter Gina Kolata published an excellent article today in the New York Times that discusses what we do and do not know about how custom orthotics work. She interviewed renowned running biomechanists Benno Nigg (University of Calgary) and Joesph Hamill (University of Massachusetts), as well as several orthotic makers. Here are a few choice quotes:
“His (Dr. Nigg’s) overall conclusion: Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up.“
Joseph Hamill: “I guess the main thing to note is that, as biomechanists, we really do not know how orthotics work.”
Scott D. Cummings, president of the American Academy of Orthotists and Prosthetists: “… when it comes to science and rigorous studies, he added, “comparatively, there isn’t a whole lot of evidence out there.”
Benno Nigg: “there is no need to “correct” a flat foot. All Jason needs to do is strengthen his foot and ankle muscles and then try running without orthotics.“
I was however, a bit perplexed by this statement: “Dr. Nigg says he always wondered what was wrong with having flat feet. Arches, he explains, are an evolutionary remnant, needed by primates that gripped trees with their feet. “Since we don’t do that anymore, we don’t really need an arch,” he wrote in an e-mail. “Why would we? For landing — no need. For the stance phase — no need. For the takeoff phase — no need. Thus a flat foot is not something that is bad per se.”
Chimpanzees have no arch, but humans do, so I find it a strange argument that it’s a remnant left over from our days climbing in the trees (see photo to the left – human foot top, chimp foot on bottom).
I’m not a podiatrist, nor have I ever worn orthotics, but my basic sense from reading the article is that the biomechanists quoted feel that they can be useful for short term treatment, but using them long term is not warranted as they can, quoting Nigg again, “lead to a reduction in muscle strength.” Treat them more as a crutch rather than a permanent solution seems to be the take home message. All in all an interesting read. Here again is the link: http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all
About Peter Larson
Funny timing. I went to a podiatrist today (I had e-mailed you about wider minimalist style shoes last week). He wants me to wear an orthotic short term until the inflammation goes down in my foot. He even stated that the top of my arch hitting against the shoes (which are not wide enough for me) when my foot is at a bend may have been the cause. He even said having a flat foot would have made it so that didn’t happen and that flat feet are not necessarily “bad”. My chiropractor wanted me to wear one permanently, which I declined to do. Since I started working on foot strength and went to minimalist style shoes my adjustments are holding better than before.
That seems to be the position of the guys in the article – they can be effective for managing a current injury, but perhaps not as a long term solution. Curious to hear how it goes.
Regarding the human foot, one of the ideas postulated in “Catching Fire” is that the ability to make fires, among other things, allowed human ancestors no sleep on the ground, safer from predators, so that their feet no longer needed the dexterity of their ancestors necessary to, say, make a bed in a tree. Don’t know how that effects the evolution of the human vs. the chimp foot, but I think it interesting.
The idea would be that by being free from arboreal life, we could do
away with the opposable big toe that chimps have, and develop the arch
that we have and chimps don’t. As Mark says in another comment, the
arch is thought to be an adaptation for bipedal locomotion since it is
not present in chimps. We also have much shorter toes than chimps.
Pete
Ha! Interesting but I think erroneous idea about the origins of the human arch. Biological anthropologists, paleoanthropologists, and comparative anatomists, who specialize in functional anatomy all generally agree that the longitudinal arch is actually an adaptation FOR upright walking and running, providing longitudinal strength/rigidity in the foot that is needed for human style bipedal locomotion. Professor Niggs may be well schooled in human biomechanics, particularly of the foot, but he appears not to have a very good grip on evolutionary context of human locomotion. Or maybe he does, and most of the other specialists are just whack.
Yep. When I was in grad school, the human biomechanists were at one
end of the hall, and the comparative/evolutionary types were at the
other end (myself included). There was very little interaction between
the two groups at a professional level. Funny that I now teach
Comparative Anatomy, Human A&P, and Human Exercise Physiology.
Personally, I feel that there is great value in being
multidisciplinary.
Pete
I am on day 64 since I stopped wearing mine. So far no issues with my heel or foot. I wore them everyday for walking and running for 15 years. I also switched from very cushioned shoes to minimalist style shoes. So far so good. Both my chiro and podiatrist agree that orthotics should only be worn long enough to help heal the injury. That time may vary from individual to individual but both agree I wore my way too long.
Seems like a reasonable approach – glad to hear that it’s working for you.
i asked jay dicharry about orthotics when i was at his lab last week and his opinion is that they are very much overprescribed. i think he said maybe 5% of people with orthotics actually need them…and they are primarily for people who have a forefoot and rearfoot that are out of alignment with each other.
Not just prescriptions: nearly every shoe incorporates orthotics in the form of a heel raise and arch support, so just about everyone has to use them.
What you say makes sense, but until I started using orthotics (currently using off the shelf Spenco inserts) I had chronic back pain which disappeared almost immediately after using orthotics. I’m flat footed, and I still experience some back pain if I’m on my feet for several hours at a time, but it’s very minor compared to what I suffered with when I was younger before I discovered orthotics. I also used to get shin splints from running before using orthotics, now none, although I rarely exceed 30 miles a week. Maybe they are a crutch, but for me, orthotics have been a blessing
I absolutely believe that orthotics can have a role, and that they can be very helpful in some cases. Just trying to interpret the article, which seems to imply that their efficacy is hit or miss and that other approaches (such as stregnthening work) might be effective as well (and perhaps less costly). Just trying to think this stuff through. Thanks for the feedback!
If arches are left over from our tree climbing days, why can’t I grip branches with my feet? Do our hands have arches for gripping?
Orthodics seem like a great tool for recovering from an injury but not a permanent solution.
Not to go off topic but this made me think of another article. Pete- did you see this in Runner’s World?
http://peakperformance.runners…
Yes, I did see that article. I have the book that is referenced there and am slowly working through it. Some controversial stuff in it, but an interesting read.
Maybe we’ll get a book review…? :)
In some form, eventually yes :)
Pete
Pete,
Thanks a ton for posting this. I have spent years in the specialty running industry with around 8000 shoe fittings. We saw a ton of orthotics. As Dr. Nigg alluded to orthotic use for long periods could create muscle weakness and my own anecdotal evidence would support this. And these weak feet would generally be recommended stronger orthotics by well intentioned practitioners.
The other element I noticed was a certain level of emotional dependence on the orthotics. Runners would be so conditioned to think that this device was the only means of them being able to run, regardless of the efficacy. For some, orthotics became a crutch that had huge control over their running experience. It wasn’t until the past two years that I saw people slowly experiment with abandoning them and work on balance, strength and mechanics.
Patton,
I think the situation is very analogous to shoes – I was terrified of moving
away from stability shoes at first, and a lot of runners get put into a shoe
category and are afraid to branch out, even when it’s not working for them.
Personally, people need to be made aware that it’s OK to try something
different if what you are doing is not working well. If you wear typical
shoes without problem, that’s great and probably no need to switch. But if
you have injury issues, don’t be afraid to experiment with something
different. Part of me wonders if simply changing to a different style of
shoe should be a first, and cheaper, step before shelling out big money for
custom orthotics. If a shoe change or OTC orthotic doesn’t help, then maybe
a custom orthotic treatment is warranted. It’s complex, and we don’t have a
lot of answers right now, but I love the discussion.
Pete
I stumbled upon your blog. Great articles and great blog. I look forward to reading more.
Hi, I’m not sure why she doesn’t like orthotics so much but I use Tamir Kfir’s orthotics and I love them so much. I got to him through the Dallas Mavericks- they all got his orthotics and I have it almost 3 years. they say its good for 2 years max but I feel I can still wear it.