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Traditional orthotics

Flawed concept

All mainstream foot orthotics are based on the original podiatry techniques which were worked out about fifty years ago and have not been evolved. They were conceived to treat foot problems but generally have a bad name, considered hard and uncomfortable to wear and their lack of success is well documented in studies. Angles are routinely placed under the medial (inside) heel, incorrect because most of the population roll in excessively at the forefoot. The techniques are inaccurate even to treat the foot. The situation is of real concern when it is implied or clearly promoted that they are beneficial for knees hips or spine problems. This is a misrepresentation as there is no technique in their prescribing of the devices to give such benefit.

I had been prescribed a collection which had caused other injury problems. It was apparent to me that the 'experts' I had been to did not have the slightest idea of how to deal with my problems. I explored the library at their campus and found there were only books on the foot. That is their study. Delving into the texts available to me as I studied the mechanics of the entire body, I decided their basic techniques were flawed but I believed correctly prescribed orthotics could be the answer to realign the skeleton and correct posture and running/walking function. There is such a degree of complexity in the skeletal structure of the leg that it cannot be analyzed or understood by someone who has studied just the foot. The entire leg needs to be understood and treated as a complete limb, the system of levers which move us over the ground.

Most patients I see bring previously made orthotics, (often a collection). They ask me, 'Why did the podiatrist tell me I roll at the front of the foot and then give me the terrible angle at the back when he made them?" The Podiatrist probably tried to do their best but the technique based on observation or measurements of the foot with no techniques to realign the knee or hip, although the hype used implies such benefits. The theories are not science based and have not been evolved despite their lack of success. The only advances have been in presentation using videotaping, computers and pressure plate readouts which look impressive but do not provide quantified angles of correction or restored arch structure, having been taken with the legs already turned out of alignment. Also, computer aided machinery is sometimes used to produce the orthoses but I saw how inaccurate it was and I rejected the idea when I saw it demonstrated.

I see thousands of podiatrists orthotics each year and they are usually inadequate because they are mainly an arch support. More ambitious ones are dangerous with angles incorrectly placed at the heel when forefoot correction is required. The arch support shape is usually exaggerated. This is uncomfortable, often causing injury to the skeletal structure of the arch and also causing external leg rotation. Apart from the arch length orthotics, full length orthotics are also presented but these still are the traditional arch supports with an inner sole on top but no angles of correction for the front of the foot.

As many patients realize, being measured or assessed standing weight bearing already has the feet rolled and legs twisted with knees, hips and pelvis out of alignment. The technique of viewing and measuring the heel and achilles line from the rear and placing all angles under the heel rather than differentiating heel from forefoot appropriately, leads to dangerously incorrect foot orthotics. This method described in Brukner and Kahn, 2005, considered at TRCC to be over simplistic and a serious flaw in the concept, leads to quite dangerous incorrect placement of any attempt at correcting foot strike.

People have infinitely different angles of foot contact which have to be assessed and placed correctly. Some roll out on one foot, roll in on the other and there are combinations of heel and forefoot angles which need to be accurately assessed. It is common knowledge amongst runners that most (over 90%) of people over pronate (roll in excessively at the forefoot) so for these people, orthotics with all angles of correction at the heel must be dangerously incorrect.

 

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