NYT: Close Look at Orthotics Raises a Welter of Doubts

Orthotics.  It's a dirty word in our barefoot running group.  And if there is any grain of truth to the barefoot running movement, then it was only a matter of time before orthotics came under fire.  And boom, right on schedule, it turns out that the emperor has no clothes.  Scientists have no idea how orthotics work (or don't work).  The New York Times reports: Close Look at Orthotics Raises a Welter of Doubts.  The scientist who has been studying orthotics concludes:

"Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up."

His findings are corroborated by other bio-mechanics experts taking a closer look at orthotics.  Go to five different podiatrists, they'll make you five different types of inserts.  And they can't predict which inserts people are going to like for any given shape of the foot.  So what do orthotics do?

"They turn out to have little effect on kinematics — the actual movement of the skeleton during a run. But they can have large effects on muscles and joints, often making muscles work as much as 50 percent harder for the same movement and increasing stress on joints by a similar amount.
 
As for “corrective” orthotics, he says, they do not correct so much as lead to a reduction in muscle strength."

So if you want a reduction in muscle strength, now you know what to do!  Just incredible.  The most that they can say is that some inserts just feel more comfortable to some people (which isn't nothing), and may be able to treat plantar fasciitis and stress fractures of the tibia (shin).

Oh, and get this -- most studies that have been done on orthotics are garbage:

"In one recent review of published papers, Dr. Nigg and his colleagues analyzed studies on orthotics and injury prevention. Nearly all published studies, they report, lacked scientific rigor. For example, they did not include groups that, for comparison, did not receive orthotics. Or they discounted people who dropped out of the study, even though dropouts are often those who are not benefiting from a treatment." [my bold]

You mean you can get papers published that are bad science?  You mean it's hard to do good science?  You mean I've been had?  Yes, you've been had.  You are a sucker.  We all are.

Look, all this is not an argument for barefoot running (and my CrossFit pals will give me plenty of arguments against to much jogging), but it undermines the status quo put in place by the podiatry profession.

Want a healthier foot?  USE IT.

Comments

I'm going to print this out

Submitted by Lori on Fri, 01/21/2011 - 11:37.

I'm going to print this out and give it to my mother. She's in a wheelchair and her doctor has her wearing a big, unwieldy boot to support her foot. I've told her she needs to get out of the boot and use the muscles in her foot to regain her strength so that she might walk again. She's had success doing stretching to get her foot to go all the way down to the floor, so with a shove in the right direction, she might try this, too.

Hey John Thanks for this! My

Submitted by Contemplationist on Thu, 01/20/2011 - 20:11.

Hey John Thanks for this! My girlfriend has high arches and hence problems. Her podiatrist makes her order and wear orthotic inserts that cost a few hundred dollars. She says her feet and back feel much better with them than without, and her podiatrist obviously told her that going barefoot is a no-no (surprise!).However, what is the solution? Do you think high-arches are a problem for going barefoot? Any extra care needed? I have a suspicion that going barefoot will solve these problems though I'm not sure and she definitely feels better on the inserts and remains convinced that they "work." 

I don't have a lot of

Submitted by John on Fri, 01/21/2011 - 17:34.

I don't have a lot of specific knowledge about high arches, sorry. In all cases, I would strongly believe that a stronger foot is going to be better than a weaker foot.

Hey John, I'd love to know

Submitted by Molly on Thu, 01/20/2011 - 01:21.

Hey John, I'd love to know your opinion - this topic of orthotics fascinates me.  I was a ballet dancer growing up and when I was 15, I injured my right foot.  I went to a podiatrist and, on top of some tissue damage that occurred due to my foot injury (most likely from my pointe shoes), was told I have flat feet that pronate greatly inward. This doctor asked me if I wanted to "be in a wheelchair at age 30" and said if not, I'll need to wear orthotics for the rest of my life.  So, very discouraged, I attempted to wear these plastic-y inserts in many of my shoes for the past 10 years.  I stopped my intensive ballet dancing and started other activities wearing bulky sneakers (and I began yoga - but felt a loss of balance when barefoot). Just this past summer I purchased a pair of vibrams and tossed the orthotics away, deciding that perhaps what I need to do is rebuild my muscles, pronation or not.  Yoga had taught me that perhaps the most natural way for the foot (and body) to function is when it has no other constrictions.  In the vibrams (which are awesome, by the way) I'm still working on simply re-learning proper walking habits - it's funny to consider myself athletic and to have to "re-learn" something as basic as walking. However, I can not deny that I am a pronator.  I still have a worrisome feeling that I can easily get injured and am trying to figure out the proper route to my healthiest and strongest foot and general posture.  What are your thoughts about this?  I'm trying to gather as much information as possible since I believe the aforementioned doctor 10 years ago wasn't necessarily correct.  Being a healthy, active 26-year-old, I don't think I'll be in a wheelchair at 30. Point being - is there barefoot help for pronators? Thanks!

Hi Molly -- I don't pronate,

Submitted by John on Thu, 01/20/2011 - 18:20.

Hi Molly -- I don't pronate, so I can't speak from personal experience. I'd focus on strengthening your feet from walking, going up stairs, light jumping (see my other comment for exercises). If something is painful, don't do it! I'd do some googling, check out The Barefoot Book, etc. You can always try a little running, but start super slow...100 yards. See how it goes. If you feel pain, stop. Tweak your form. Take it slow.

Hi there,When I was

Submitted by Malcolm on Wed, 01/19/2011 - 19:22.

Hi there,When I was first fitted with orthotics I was told by the orthotist in the hospital that they would 'hopefully' train my arch to lift itself up more. Sadly, that hasn't happened and I am still as reliant on the insoles as I was nine years ago.But in defence of them if I try walking around at home for even a short period of time I get incredible knee pain- so it looks like I'm stuck with the orthotics whether I like it or not.Funnily enough though, I can walk around on a sandy beach without any problems!It would be interesting to know if anybody has any ideas for strengthening the arch of the foot using just exercises..?Best wishes,Malcolm

Hey Malcolm, yeah I'd start

Submitted by John on Wed, 01/19/2011 - 22:40.

Hey Malcolm, yeah I'd start with a few exercises. Just standing, go up on your toes and back down. Do that over and over. Also, depending on how it feels, you could do some light jumping up and down...as if you were jump roping without the rope. that may be something you graduate to. you can also grip a golf ball with your toes, and clench it and hold on to it. All this barefoot! If something hurts, don't do it. Let me know how it goes...

Orthotics? Grrr... don't talk

Submitted by Mike on Wed, 01/19/2011 - 19:05.

Orthotics? Grrr... don't talk to me about orthotics. I wasted the most amount of time and money dicking around with the world of podiatry. I was running  small distances (up to 5ks) and constantly getting shin pain, for several years. Wrong trainers right? So, I went from normal trainers, to mid-pronation, to extra heavy-weight Brooks Beasts for heavy pronators for people who slap so loud when they hit the ground, you're not allowed to run after nightfall. Each time, some improvement, but a couple of months later, back to the same shin splints.I went to a podiatrist. Three in fact. I got insoles, and those insoles  got bigger, relief, followed by pain and bigger insoles and so on and so on. It felt like wearing high heels by the end of it I swear. Eventually, the podiatrist told me, you're not built to run - your feet aren't up to it. Limit your runs to 10k max. This was the McDougall moment that logged in my mind. And then I was given Born to Run and it all made sense.I ditched the trainers, picked up a pair of Feelmax (bit like Vibrams minus the toes), and that was the end of it. Took it slow for the first few weeks with odd muscle twinges but after a month or two that was it. Diet became an issue, addressed that too. 12 months later, ran my first  marathon in Evos with zero blisters and never looked back.Looking back it's kind of ridiculous. How you expect to improve the marvel of the human form with a bit of cheap foam is beyond me, but then telling people to take off their shoes and never come back isn't a sustainable business model I guess...  

Great story...though sorry

Submitted by John on Wed, 01/19/2011 - 22:43.

Great story...though sorry that it had to happen in the first place!

Barefoot running may be great

Submitted by wtx on Wed, 01/19/2011 - 17:38.

Barefoot running may be great for people with little to no pronation, but I think you will find there is actually sound science behind orthotics for people with major pronation.  Biomechanics are real, and if left uncorrected for some people will cause cartilige damage and other muscle compensation issues - depending on your level of physical activity -  that usually result in chronic pain.No doubt some people are prescribed orthotics who don't need them, or are given poorly designed orthotics (and often your feet will change shape *because* of orthotics requiring reassessment that few people follow up) but I think it's ignorant to assume that all this science is dead wrong and therefore the answer is barefoot running. You can injure yourself no matter what you.   Anyone engaging in long term strenuous activity or experiencing pain or numbness should seek the advice of an orthopedic.

Agreed that you can injure

Submitted by John on Wed, 01/19/2011 - 22:48.

Agreed that you can injure yourself no matter what you do. I agree that bio-mechanics are real...but the reality is that the shoe industry AND podiatry have been IGNORING actual bio-mechanics. First, the shoe industry ignored the bio-mechanics of forefoot strike vs. heel strike, and second, podiatry has just been shown not to be based on actual bio-mechanics. So the burden of proof has shifted to the podiatrists and big shoe companies. They've been discredited, so now it's up to them to PROVE IT. Something they never did in the first place.

No argument about the shoe

Submitted by wtx on Thu, 01/20/2011 - 14:06.

No argument about the shoe industry.  But there is actual proof, not just in podiatry, but in physical therapy and chiropractic .  Biomechanics are very difficult to treat and many people get inadequate treatment, but that doesn't discredit the science behind it.  The fact is that if you have a biomechanical problem it needs to be corrected before you can safely run.  It's difficult to do with orthotics, but when done correctly it can save your knees, hips, and back.  There may be a way for pronators to go barefoot safely, but there is certainly zero proof right now that running barefoot with severe pronation will do anything other than slowly injure yourself. 

"there is zero proof running

Submitted by Mike on Thu, 01/20/2011 - 20:53.

"there is zero proof running barefoot with severe pronation will do anything other than slowly injure yourself". Hold on a minute, you've twisted mother nature around the bend in one sentence: There is zero proof running barefoot with severe pronation *will* slowly injure yourself.... is what you should really be saying. And I'm one of the "heaviest pronators" my podiatrist had even seen. Lucky me. The default appeal to authority that podiatry knows best is simply cobblers - no pun intended. We're not born with a pair of Adidas on our feet.  The onus is on manufacturers/science to prove they're improving health, not the other way around.     

Look, I'm not trying to

Submitted by wtx on Fri, 01/21/2011 - 18:17.

Look, I'm not trying to discredit barefoot running.  It makes sense, works for many people, etc.  However, for all practical purposes, many of us *have* been born wearing cushy Adidas, and for most pronators along with it the biomechanics of our bodies drastically altered, possibly permanently.  Perhaps with the careful attention of a trainer or physical therapist, some can retrain their feet to not pronate - although for most, feet will not be the only factor in that process; the entire posterior chain has become adapted to pronation with cushy shoes and flat surfaces.  But I'm not saying it's not possible.  I'm just saying that at best - for a severe pronator - it's certainly no easier nor riskier than orthotics or well fitted shoes.  And I am saying that without tested barefoot running programs for pronators, you are at more risk for injury running barfoot than with well fitted orthotics, so consider the risk and be extremely careful whatever you do.

go barefoot..a year ago docs

Submitted by salim on Wed, 01/19/2011 - 14:44.

go barefoot..a year ago docs told me i should nothing but walk on flat surfaces...after i started barefoot running, all my injuries gone away in one week, i run, jump over rocks, rock climb, bike, slackline, lifth-thow rocks, climb treee...Never used any orthotics...it makes you weak...even injuries are beneficial since it teaches you how to move efficiently and give you so much body awareness and you learn to communicate with your body. that is the most valuable investment to yourself

 That part at the end about

Submitted by Mountain on Wed, 01/19/2011 - 14:09.

 That part at the end about arches being an unneeded evolutionary remnant from our tree-dwelling ancestors is interesting. I'm curious to see what the paleo community says about that. I always thought the arch was a spring mechanism for absorbing shock on impact and redirecting it on lift-off.

Yeah, I thought that part was

Submitted by John on Wed, 01/19/2011 - 15:18.

Yeah, I thought that part was bullshit, but didn't comment on it. The purpose of an arch isn't to grip (look at the hand, is that an arch?), but to bear weight. Nice eyes.

Hey John, Its your facebook

Submitted by Ron Scott on Sun, 01/23/2011 - 21:34.

Hey John, Its your facebook buddy here. Any suggestions for those of us who work construction and are confined to steel toed boots? I've got some of the most expensive soft leather ones you can get, and still my feet hurt constantly. 8 to 10 hours on concrete really takes it's toll, and buying insoles every other month is expensive.

This is a tough one, Ron.

Submitted by John on Mon, 01/24/2011 - 12:18.

This is a tough one, Ron. Guys in the military face the same problem. I don't know of a solution off the top of my head. Maybe google how military guys deal with their boots (the ones who also like to wear Vibram Five Fingers). Let me know if you come across anything

Dude, I got orthotics as

Submitted by Nate on Wed, 01/19/2011 - 14:03.

Dude, I got orthotics as a child because my feet started to hurt.  I had foot and ankle infuries for the nect 20 years.  I started walking and running barefoot six months ago- and my feet/ ankles are better than I've ever remembered them.  Funny thing, I grew up in the boonies and didn't wear shoes much- until I had to.  My feet hurt, so the answer was orthotics.  Wrong direction, I think.

as for growing up in the

Submitted by John on Wed, 01/19/2011 - 15:20.

as for growing up in the boonies...there's always been a stigma associated with going barefoot. barefoot = poor. now barefoot = enlightened!

A nickname I had in college

Submitted by Nate on Wed, 01/19/2011 - 18:16.

A nickname I had in college was hillbilly.  But by then I was in a shoe trance... just getting back to my roots.