PT on the Net Research

Orthotics - Good or Bad?


Question:

I have a client who has been using orthotics when running for about a year now. She was advised to wear them after suffering bursitis at the hip joint during training for the London Marathon. She has never been comfortable running in them, and we now feel she is in a "catch 22" situation. Do we throw the orthotics away and run naturally or has her body become reliant on them? Will we be causing more problems than we are trying to solve, or have we done that already? In short: Orthotics - good or bad?

Answer:

Thanks for your question! Although I can’t see your client move, I hope to spark some thought that will lead you to a greater understanding in your further analysis.

The key in this situation is to find the CAUSE and not get caught up in the symptom. An orthotic is simply an artificial interface that is placed between the foot and what the foot comes in contact with. Therefore, the interface (orthotic) should create a biomechanically efficient REACTION, which should improve the loading capability of the entire lower extremity. To understand this, you must have an understanding of how the lower extremity (entire kinetic chain) functions in all three planes of motion during the task of running (see reference below). Once understood, compare efficiency to your clients function and then finally with the orthotics.

  1. known biomechanical efficiency
  2. client's function without orthotics
  3. client's function with orthotics

This 1-2-3 process should be followed with a strategy to enhance loading and unloading for efficient running (remember, this is a YOU vs. YOU approach).

A note on orthotics: Be careful that the orthotic doesn’t decrease your client's ability to load efficiently. I often see orthotics built where they “block” the ability for the foot to collapse correctly and therefore cause a delayed collapsing on foot contact, eventually leading to greater problems. So, to answer your question - orthotics good or bad? It depends. If the artificial interface improves the intended function of your client, then good. If the orthotic doesn’t improve, then bad for that person or maybe the orthotic needs to be “tweaked” to create the right reaction at the right time and in the right plane. This is not an easy answer due to the complexity of the foot. However, the answer should come from your analysis of your client's function and not the symptom!

Please consider Gary Gray's Functional Video Digest Series DVD on Running. Gary does a great job explaining the multiplanar biomechanics of running followed by solutions on what-to-do with what you see.

Good luck!