In our office, we evaluate and treat a wide variety of lower back and lower extremity injuries. Many times patients dealing with these types of conditions will present with a pair of foot orthotics or inserts in their shoes. These devices can range from relatively inexpensive prefabricated models to expensive custom pairs – sometimes costing the patient up to $500. One of the most frequent questions we receive as therapists when working with patients with these types of conditions is: are my foot orthotics effective? Patients are understandably concerned that their product is working as intended, particularly if they have made a significant financial investment.
The reality is that while there is quite a bit of research on this topic, the results are often contrasting or inconclusive. At Freedom – specifically at the Brookfield clinic location – we like to refer to orthotics simply as “a tool in our toolbox.” In other words, we feel that orthotics can undoubtedly be helpful, but completely resolving a patient’s symptoms generally involves addressing multiple factors.
The idea behind a foot orthotic – whether prefabricated or custom made – is simply to reduce stresses on parts of the foot that may be contributing to pain, especially during activity. We have found clinically that this reduction in stresses can be particularly helpful with two separate conditions: plantar heel pain and patellofemoral pain syndrome. However, as mentioned previously, the solution is not as simple as just wearing a pair of orthotics. Many times patients with these conditions have an accompanying range of motion restrictions, weaknesses, and poor muscular recruitment patterns that need to be addressed with physical therapy treatment.
It is important to note that there is a lack of sufficient evidence to support the use of foot orthotics in treating low back pain. Patients with low back pain are encouraged to seek physical therapy services as there is quite a bit that we can do to provide relief and restore function, but an orthotic recommendation to these patients may not be beneficial.
Our approach at Freedom as physical therapists when we suspect a patient could benefit from a pair of orthotics is first to perform a taping technique. We like to begin with this because it is inexpensive and gives us a great deal of information. If a patient has a positive response to the tape, it strengthens our assumption that the patient could benefit from a pair of prefabricated orthotics. We typically recommend relatively inexpensive over the counter orthotics – about $50 – that provide arch support and a deep heel cup. This is done to reduce lower extremity stresses, as discussed previously. Every so often, a patient with a more chronic condition may find benefit in custom orthotics. We are qualified and capable of fitting patients for custom orthotics within our clinic. And, we have a deep network of specialists we are happy to refer to if appropriate.
In summary, foot orthotics are a very popular product that patients with lower extremity injuries will often turn to in hopes of reducing pain. Many patients can receive benefit from an inexpensive over the counter orthotic. However, orthotic use alone is not usually enough to resolve the problem. Physical therapy can help to discover and resolve underlying pathology and get you back on your way to enjoying more Freedom!