Strategies for Utilizing Foot Orthoses to Reduce Pain
Research studies have provided evidence that using foot orthoses can substantially reduce musculoskeletal pain.
While not unequivocally conclusive, there are many studies demonstrating pain reduction in a variety of disorders including, but not limited to, foot pain1, plantar fasciitis2, tibial stress3, patellofemoral pain4, and knee arthrosis5.
Foot Orthoses & Function
As a result of the clinical success, hundreds of biomechanical studies have been performed to determine which kinematic and kinetic variables are altered by the foot orthoses. Knowing how the orthotic device alters function would be of great benefit for practitioners in formulating strategies as to how to design and implement orthotic intervention (either alone or in combination with other treatments). The research findings cover impact force, joint motion, the velocity of joint motion, timing of motion, and joint stress of not only the feet, but also the entire lower extremity.
Unfortunately for every study that states that a particular biomechanical variable improved, there a one that found that same variable unchanged.
Comparing studies that found improvements demonstrates that it is not the same variables that improve.
The conflicting evidence, as well as the methodological and procedural issues that might contribute to the contradictions is discussed in an editorial6 in the British Journal of Sports Medicine.
In the 15 years since that was published, the scientific evidence remains inconclusive with no coherence.
Why Does It Matter?
Why should it matter why the pain improves or resolves as long as foot orthoses help individuals?
Although studies show that a group of subjects obtained relief from orthotic intervention, that does not mean all subjects did.
As stated above, practitioners would benefit from knowing what factors to consider in selecting the proper orthoses for each individual in order to maximize their success rate. Without knowledge of how to alter specific aspects of function, movement practitioners must rely on experience combined with a logical strategy based on clinical biomechanics.
Powerful Tool or Harmful Intervention
Twenty-five years ago, Dr. Gary Gray realized that foot orthoses could be an extremely powerful tool; or a useless, and in some cases harmful, intervention.
Gary recognized that he, as well as most practitioners, was too focused on making the foot function perfectly, based on a static position called subtalar neutral. Gary stated that the foot should “travel through subtalar neutral, but never stay there”. He recognized that a correction that was too focused on the foot and too aggressive would negatively impact the global movement of the body. Gary observed that when a foot orthosis enhanced hip function the whole body benefitted. When the foot looked better, but the hips were inhibited, other symptoms appeared.
Increase Probability of Resolving Pain
Because the biomechanical effects of foot orthoses are unclear, because different body tissues respond differently, because the same symptom can have different causes, and because everyone is an individual, effective utilization of orthotic devices requires a logical strategy to overcome the unknowns and increase the probability of resolving the pain.
At the Gray Institute this strategy includes:
- A thorough understanding of the Chain Reaction biomechanics of the activities that the individual participates in
- Both weightbearing movements and non-weightbearing examination to determine the effect of the foot on the rest of the body
- Recognition that a foot orthosis is only a tweak to the interface between the foot and the supporting surface
- Making the function of the hips a primary consideration for the design (prescription) of the orthotic device
- Utilizing functional weightbearing movements to determine if the orthoses have produced the desired effect on mobility and stability, both initially and as the client’s body adjusts to the devices
Strategies based on the PST process of Applied Functional Science® allow for the ultimate decisions, about foot orthoses, to be not only logical, but specific to that individual. Individualized interventions maximize the chances of resolving our client’s pain.
- Amer AO, et al. Prosthet Orthot Int. 2014 38(6): 474-480
- Gross MT, et al. J Orttop Sports Phys Ther. 2002; 32(4): 149-157
- Loudon JK, Dolphino MR. Foot Ankle Spec. 2010; 3(1): 15-20
- Johnston LB, Gross MT. J Orthop Sports Phys Ther. 2004 34(8): 440-448
- Skou ST, et al. J Am Podiatr Med Assoc. 2013, 103(1): 50-55
- Heiderscheit B. Br J Sports Med. 2001; 35: 4-5
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