The W.C. Russell Moccasin Company

FROM A DOCTOR:
ORTHOTICS: SHOULD YOU WEAR THEM?


“It doesn't seem to go away and people constantly ask the same questions. People want simple answers. Nobody is listening to the reasoning about the use of orthotics. So I am going to write in a simple way as much as possible.

My recommendation is to stop wearing them. Return them and get your money back, and start thinking differently about this matter.

According to Dr.Lyle J.Micheli (The Sport Medicine Bible, 1995, p.p.121-122), orthotics are shoe inserts designed to correct some abnormalities, such as flat feet, high arches, feet pronation and as a treatment for the ITB (iliotibial band) syndrome and knee pain. According to medical community beliefs, orthotics are providing: arch support for athletes with mild fallen arches support for the long bones of the midfoot, the metatarsals heel support through a wedge in the heel, which can help reduce the strain on the calf muscle - Achilles tendon unit

What do I think about orthotics?

I think it is not the right solution for these problems. It is a lazy approach. It is a temporary artificial support, instead of development of one's own body and one's own skills of movement, the athlete is given a cane as an invalid, which eventually lead to more weaknesses and problems.

Why they don't work?

Orthotics don't work, because they deprive muscles from performing their specific functions by substituting for their work. Orthotics do not teach us to move proper and they deteriorate our perception of movement.

In answer to a question from a patient this doctor responded:

“You should've never gotten the orthotics, it is not surprising to read that your running felt weird... why on earth would it be normal when you're running wearing "platforms".”

FROM A LEADING PHYSICAL THERAPIST

“In my opinion, there are four reasons clinicians prescribe orthotics. (There really should only be one reason, and unfortunately it’s usually the least common):

1) Lazy clinician

2) Greedy clinician

3) Soft tissue problem

4) Structural/postural deformity

Let me expand on that.

1) As physical therapists we are taught to find the biomechanical problem and fix it. But many clinicians don’t look at the body as a whole anymore. The patient comes in with foot pain, a fallen arch, a non-mobile MTP joint, etc., and rather than finding the true problem or weakness that is causing the issue, they use an orthotic to correct the biomechanics of the foot. This will help in the short term but won’t fix the real problem. An expensive, short-term crutch that doesn’t solve the patient’s problem? Seems pretty silly.

2) Think of an orthotic as a bottle of wine at your favorite restaurant. You want to splurge a bit, so you don’t mind the overpricing. Orthotics are marked up by clinicians who have contracts with manufacturers in a similar way as that wine — about 300-400%. Call it what you want… greedy, shady, ambitious? Bottom line, that prescribing clinician stands to gain a wad of cash from your purchase.”

FROM A LEADING SPORTS AND WELLNESS CHIROPRACTIC

DO I NEED ORTHOTICS?

The answer is most likely no. As discussed previously, most people have never trained their feet; since the age of 2, we have been put in a solid shoe that provides constant stability and support. Of course our feet are weak, our arches falling, and our movement patterns destroyed. The vast majority of conditions for which orthotics are prescribed can be corrected solely by doing a little work. Orthotics are nothing more than band-aids. They may make you feel better, and get rid of your symptoms, but it is only a matter of time before another ache/pain come creeping in because you have not corrected ANY of your mechanics.

FROM A LEADING MUSCLE ACTIVATION TECHNIQUE AND POSTUROLOGY DOCTER

Four bad things that happen when you wear orthotics:

Bad thing #1: Usually by mashing into the arch of the foot, Orthotics shut down the sensory receptors in the skin of the foot. These receptors are designed to communicate constant and accurate information to the central nervous system about weight distribution on the feet.

Bad thing #2: Unable to get accurate feedback from these skin receptors in the feet the central nervous system re-sends this inaccurate information to body’s postural muscles causing negative postural shifts like the one in my friend’s pelvis. It’s like typing in the wrong URL address. Wrong information in, wrong information out.

Bad thing #3: Orthotics act like a cast. If you’ve ever had a hard cast on your knee, ankle, or elbow you know the problem with that. The muscles immobilized by the cast atrophy and weaken. Well the same thing happens in the feet when presented with an orthotic. The joint(s) are immobilized and the muscles atrophy and weaken. There are 55 joints in your foot and like most joints in your body they are designed to move. Movement creates muscular contractions, which pump blood and force the exchange of nutrients and waste products. Joint immobility = Joint Death!

Bad thing # 4: Orthotics make you weaker. In the health section of the January, 18th edition of the New York Times, Dr. Benno Nigg, a professor of biomechanics at the University of Calgary in Alberta, said that, ‘orthotics often make muscles work as much as 50% harder for the same movement and increase stress on joints by a similar amount.’ Why would you want to work harder for maybe the same result, (see my friend’s wrist extensor test) and stress your joints out more?

So what’s the answer?

Get the muscles of your feet and lower legs activated to support you and propel you through space like they are meant to do. I have found both Muscle Activation Techniques (MAT) and Posturology excellent modalities to activate muscles of the foot and lower leg and improve mobility and posture. If anyone you know is wearing orthotics please send them in. I will gladly give them a free postural assessment and show them a much healthier alternative to the shoe bomb!

FROM A LEADING CHIROPRACTIC PHYSICIAN

Are Orthotics Really Ever Necessary?

The prescription and use of orthotics is a hot topic. Some physicians don’t appreciate that fact that I think orthotics are expensive pieces of carbon graphite, neoprene, and other material that most often serve as a disservice to the patient. My stance on orthotics is such due to how I evaluate, treat, and manage patients. It is a 100 percent holistic approach. I see professional athletes – dancers, runners, hockey and soccer players – and professional people – CEOs, attorneys, medical doctors, accountants – and everybody in-between. These patients have injuries of all kinds – foot, hand, back, neck, etc. and ailments ranging from the common cold to infections such as Lyme disease, as well as hormonal problems, digestive disturbances, and sleep issues. Using foot orthotics is not natural, so it is not part of my practice to prescribe such devices; I’m more interested in correcting a problem at its root source rather than only address the symptomatology.

Orthotics Help Relieve Symptoms In Unhealthy People

While I have had to refer patients for surgery or to their medical doctor for a necessary medication such as an antibiotic to overcome illness or perhaps save their life, I have never had to refer a patient to receive an orthotic, and yes, I have seen plenty of extreme cases of foot pain and gait imbalances. With no disrespect to those who treat their patients with orthotics and with no arrogance I feel confident saying that based off my education, experience, and understanding of the human body (not just the foot), that those who wear orthotics are suffering compromised health and those who prescribe them are not restoring their patient’s health to its fullest potential.

An orthotic is a support device meant to either control motion or change foot function, and therefore the function of other areas of the body. It’s not natural and unless all other means have been exhausted, (which they rarely have), then reconsidering orthotic use should be a priority. Orthotics may serve a very temporary purpose to help a person overcome acute pain and discomfort, but anything more than short term “emergency” use will only harm the wearer. Yes, they support some dysfunction somewhere – whether it is in the foot itself, the gait, or some other imbalance anywhere in the body.

A healthy person does not need an orthotic. Orthotics alter the somatosensory system in the body, which is how various stimuli is received and transmitted through the nervous system to the brain. This is major part of one’s proprioception (body position), along with one’s vision, inner ear mechanism, and other important reflexes. Actually, any footwear alters one’s proprioception to some degree, which is why going barefoot as much as possible is a great way to help balance, foot strength, and overall health.

Orthotics Will Weaken Your Feet and Dampen Your Senses

“Custom” orthotics, as well as other footwear devices such as heel lifts and arch supports negatively affect proprioception and foot health more than most footwear because they support muscles, tendons, and ligaments in such a way that they don’t have the need to function as they normally should. Essentially, the feet become weaker and weaker, and soon it spreads to other areas of the body including the nervous system. Then the orthotic user has to rely on other aspects of proprioception such as vision, because their feet are in such disarray. Put this common situation in an elderly individual who often already has poor vision and you’ve got an unstable person who will soon fall, break a hip, and die soon after. That’s a sad, common occurrence.

Are there exceptions outside the very temporary use? Yes, but they are rare. Orthotic use is a sensitive subject especially since many physicians rely heavily on them to treat patients as well as their own financial security. If orthotics are their major tool to help a patient deal with pain or walk properly then I completely understand that they are going to fight hard about their necessity. Currently the only patient who I treat who actually benefits from an orthotic suffers from post-polio syndrome. Her left leg is approximately three inches shorter than her right. So she walks with a lift throughout her entire (left side) footwear and this benefits her; she’s been wearing it for decades. I also treat another woman who suffered a different childhood disease which resulted in her left leg being approximately two inches shorter than her right. She came to me because of hip pain and fatigue when walking. The orthotic in her shorter leg not only helped her gait but also diminished her pain to about 50 percent for the many years she was using it. Eventually, over a period of four to five visits, her muscle imbalances were corrected by using various manual medicine techniques such as trigger point therapy, muscle reflex points, and nutritional therapies, so the orthotic only made things worse so she removed it entirely. Obviously this was a big step for her as she had worn it for over twenty years and because of the leg length discrepancy. Of course I was not able to make her leg lengths equal but by helping her muscles adapt to the way her body currently is, she was able to be pain free for the first time in her life and without an orthotic or supportive device of any type.

Orthotics and “Arch Supports” Don’t Support Your Arch

Many people wear orthotics or various types of “arch supports” because they have either flat feet or pain in their arch. Flat feet are normal in a toddler; as they get older the tendons in the foot strengthen and tighten to form the medial longitudinal arch, often by the age of three. Some never fully develop this arch in the foot, often due to poor footwear. Many adults have what appears to be an arch when they are non-weight bearing but the arch flattens or fatigues when they stand due to muscle, tendon, and ligament weakness in the lower leg and foot.

The problem with orthotics and arch supports that are used to treat flat feet, fallen arches, and painful feet is that they don’t support the arch of the foot where it actually needs to be supported. To properly support any arch, such as a bridge over water or the arch of the foot, either end of the open space should be supported. In the case of the foot, the heel and the forefoot should be supported, not the space in-between the ends of the arch.

To truly strengthen the entire foot and all the arches, it’s important to position the foot correctly at all times. This means that the heel should be flat on the ground, as should the forefoot (think barefoot -“zero-drop”) and the toes should be allowed to naturally splay apart for proper support. Typical shoes with a heel higher than the forefoot and a toe box that is narrow will only further weaken the foot and arch, especially with the addition of an open-space arch support or orthotic. More at my DRG site: Flat Feet – Causes, Prevention, and Treatment.

Orthotics Support Dysfunction

One can see, whatever the case, an orthotic is not the ideal treatment – addressing the root cause is. Figuring out that root cause and working through it can sometimes take a very long time, an hour if not much longer, which is not something most physicians have the time, energy, or ability to do either physically or mentally. So many have to resort to orthotics. And for those who practice this way and get a person walking, moving, and out of pain then that is entirely fine. But again, it is treating the symptom, not the cause, and it is not addressing the patient’s overall health. The use of the orthotic will hopefully be temporary to truly benefit the patient.

Orthotics will always support a dysfunction. If they were supporting normal function then they would not be necessary because function would be restored in the first place. I don’t quite understand the term “functional orthotic.” There is nothing functional about controlling motion. If an imbalance “appears” to be restored with an orthotic, it is only that – an appearance. Yes, I know that’s not something any physician wants to hear and I got some slack for that statement after speaking to a several hundred chiropractors at a conference, but I can’t think of any exceptions. Feel free to kindly comment if you have an exception, (I’ve received some nasty ones from a couple docs whose livelihood is based off prescribing orthotics). But even in my one patient with post-polio syndrome, we both fully realize that we are supporting her dysfunction with the orthotic. For most all patients though, dysfunction can be restored, even if they have tremendous foot pain. It may take time as they wean out of their orthotics like they would transitioning from a traditional shoe to a minimalist shoe, but as overall health is restored, so is foot health. Some other devices, like Ray McClanahan’s “Correct Toes” is a great product to use for feet that have suffered structural mis-alignments due to years of poor foot health and improper footwear, (not an orthotic).

Address Your Problem – Ditch Your Orthotics

So you can see there is not necessarily any specific exception for using an orthotic; it is all very individualized and even in what some might consider an extreme need for an orthotic, perhaps isn’t so. Treating an individual fully is a lost art. Sure, all physicians want to say that they treat everybody differently and every case is unique. But how many physicians evaluate the entire body every time? In other words, how many evaluate the state of an individual’s hormones, diet, exercise regime, and entire musculoskeletal system when investigating any major problem let alone a foot dysfunction? How many examine the integrity of all the joints in every limb and their relationship to the present foot ailment? I’d say very, very few. It takes a lot of time, a thorough understanding of the entire body, and proper evaluation skills – many of which require proper muscle testing and other challenge parameters, which is a skill acquired over years, and one that is not regularly taught in any school of medicine – conventional or “alternative.” The many “specialists” in the field of medicine typically fail to see the whole picture of a patient, including the ones who prescribe insurance-covered foot orthotics. This is the concept of what I like to refer to as systems health care – the inter-relationship between everything in the body and how every organ, muscle, bone, movement, etc, is related to each other in some fashion. In other words, poor health results in poor foot health which results in the appearance to need orthotics. What comes to mind is that marijuana commercial from the 80s. This is your foot (egg). This is your foot in orthotics (egg on frying pan). Any questions?

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