Discussion: Orthotics: do they work?

Can anybody who's lived through this help me set my expectations appropriately? I'm struggling with doubts about the basic competence of my orthotics provider, and what to say when I go back for my 1-week check tomorrow morning.

A bit of history. A year or so ago I was diagnosed with plantar fasciitis in the left foot and among a lot of other good advise from my sports med doctor, given a prescription for orthotics. Didn't get them at the time. Got by with icing, stretching, naproxen, and some pain. Eventually I found my 20-year old orthotic that a PT had made for me, which I hadn't used in 10 years. It's not rigid like the new ones. Shortly after putting it in my shoe all symptoms went away. Yay, except that it's falling apart so needs to be replaced.

More recently I was diagnosed with metatarsalgia in the right foot. Significant pain just under the front center ball of foot. More debilitating that the left foot ever was. Sports med doctor prescribes orthotics again. This time I get them made. Last Monday I picked them up and was given a schedule of gradually increasing hours to wear them throughout the week. Every time I put them on I wonder how anyone could possibly like these things. (Is it supposed to be like this?) They hurt my feet. It feels like someone has put rocks in my shoes. Buy I play along thinking maybe it's just an adjustment period I have to suffer through before foot nirvana is eventually achieved.

Today I finally went back to the 20-year old orthotic in the left shoe. The plantar fasciitis pain has returned, and I haven't even been running lately due to a sinus cold. Thanks a lot.

So, am I dealing with completely incompetent orthotic fitters? Do I just need to go through a more lengthy fine-tuning and break-in period? How exactly does one ask for their insurance company's money to be refunded and the doctor's prescription to be returned so it can be taken to a different fitter?

Well.... don't take your orthotics for granted! I recently had my beloved orthotics stolen! and now I have 2 sore hips and 1 sore shin for going feet naked (so they do work!)

on a mroe serious note, I've had several pairs of orthotics made for me. A couple from your everyday podiatrist and 1 (soon to be 2 when my replacements come in) from a sports podiatrist. I used to find the orthotics made from the non sports specialist podiatrist extremely uncomfortable and painful, i had to keep going back so she could sand them down to make them less painful.
The orthotics made from the sports podiatrist where great! very comfortable and with time they helped fix my injuries. So I would say make sure you see a podiatrist who specialises in sports.

At least you have insurance! it was'nt just my orthotics that got stolen!

When they work they work. And they work for Ilks. But you need a good diagnosis. I had a persistent knee problem that made running longer than 15 minutes impossible. It was variously and inconsistly diagnosed. The orthopedic surgeon went for bursitis.One diagnosis suggested orthotics. I had orthotics made, but they made no difference. My problem was eventually correctly diagnosed as an unusual cartilidge tear. A runner physio and a sports medicine specialist came to agreement. Of course, the surgeon then claimed he had diagnosed that all along. I bit my tongue as I needed him to undertake a minor bodily invasion through a tube. Within a week of the operation I was running again. The orthotics sit unused in my cupboard.

So, how good is your diagnosis?

The thing you need to remember about orthotics is that they largely treat the symptoms not the causes of the problem. For example a common reason for getting orthotics is to correct overpronation. The symptoms of overpronation are that your foot tends to roll inwards which can then cause shin soreness, knee pain etc. By using orthotics you essentially put a barrier in your shoe which through blunt force helps to stop your foot rolling inwards. This can work but will often just move the stress to another part of your body and cause further problems.

The real cause of the overpronation are weakness in the foot and lower leg muscles which control pronation and/or weakness/flexibility problems at the hips causing misalignment of your legs when you are running and/or incorrect running technique (commonly overstriding).

Possibly getting a proper running technique analysis and then a comprehensive strength and flexibility program would be a better way to go than just getting orthotics. In any case if your podiatrist expects your orthotics to be a cure-all and doesn't give you any information on strengthening/stretching to go along with them the chances are they don't know what they are doing and you should go to somebody else.

Pensioner if you'd gone to a physio in the first place they would have realised it was a meniscal tear! and they would'ne have siad to get orthotics hence you would'nt have wasted your money.

Excessive pronation can be caused by calf weakness or the excessive pronation can cause the calf weakness. When you over-pronate your calf contracts eccentrically, harder and for longer than usual to decelerate the pronation putting increased strain on the calf leading to fatigue and weakness.
Which comes first the excessive pronation or the calf weakness? or is it just a nasty cycle?

The answer to everyones problems are different depending on what your specific predisposing factors are. Go see a good physio (it helps if they are a runner too) a good assessment will determine what the contributing factors to your injury are whether you need a bit of realignment from orthotics or just strengthening of specific muscle groups, or both.

Trouble is, the solution to the physios diagnosis was an operation, but the surgeon had a different diagnosis. He wasn't going to operate. Physios don't wield knives. In the world of medical politics, I had to get a reliable opinion from a medical colleague to change the surgeons mind..... hence a trip to Olympic Park. Thats how the medical world works, and I know you know that.