By Michael J. Velsmid, DPT, MS
(Part I in a series on orthotics)
Depending on whom you ask this question, you will get different answers. Some will say that everyone will benefit from orthotics, but those who prescribe to minimalist running will tell you that you should never use anything in your shoes.
When I determine whether custom orthotics might be appropriate for a client, there are three main criteria I use.
(1) There must be a problematic symptom. Usually pain somewhere caused by walking or running.
(2) The biomechanics need to be abnormal in some way. There could be a slightly shorter stride on one side, a turned out foot, over pronation, or a heavy strike as some examples. This can involve both sides or be unilateral.
(3) The biomechanics are unable to be corrected with training techniques. A good gait analysis will identify the abnormal movement pattern. Often times, working with a trainer can eliminate these problems.
If all three of these criteria exist, a structural anomaly is causing the symptom. Some examples of this can be a flat foot, a leg length discrepancy, a slightly twisted tibia, or a pelvic socket that is slightly shallower on one side. The solution is to either eliminate the activity that caused the symptom or correct the biomechanics with an orthotic. Among other things, an orthotic can equalize the leg lengths, turn a foot in, raise up the arch, align the joints, and absorb a heavy impact when the foot hits the ground.
The responsibility of any sports physical therapist is to restore an individual’s ability to perform at their best. We never take sides on this issue. Time and care must be taken to do a proper evaluation to determine whether an orthotic is the best option or if the symptom will resolve with training.
Dr. Velsmid is a Physical Therapist at Boston Sports Medicine
