Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
News

Orthotics work in mysterious ways

Roger Collier
CMAJ March 08, 2011 183 (4) 416-417; DOI: https://doi.org/10.1503/cmaj.109-3802
Roger Collier
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Most drivers don’t think much about spark plugs and carburetors. They just want their vehicles to run, leaving the details to their mechanics. Most homeowners trust electricians to worry about voltages and alternating currents. They just want their lights to come on. In the same way, most patients who use medical devices just want the devices to work. Knowing how they work is the domain of clinicians and researchers. Unless, that is, the medical device is a foot orthotic.

According to Benno Nigg, professor of biomechanics and codirector of the Human Performance Laboratory at the University of Calgary in Alberta, even medical experts aren’t sure exactly how orthotics relieve pain or prevent injury. “Orthotics can work and can have fantastic effects, but we don’t know how they work,” says Nigg.

The growing orthotics market could reach annual sales of US$4.7 billion by 2015, according to Global Industry Analysts, Inc. (www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2011/01/13/prweb8061575.DTL). Orthotic devices are used by the public primarily to relieve pain, and by athletes to prevent injury. It is also a diverse business, including everything from custom products made from high-tech materials to inexpensive insoles.

Though prescribed in large numbers by podiatrists and orthotists, clinicians still struggle to determine which type of orthotic will work for a particular patient. In his new book, Biomechanics of Sport Shoes, Nigg describes sending a long-distance runner to five orthotics makers to seek help correcting a problem with pronation. Each made a very different type of insert, varying in thickness, hardness and other ways.

“What this means is that specialists come to completely different conclusions on what to do,” says Nigg. “It also shows that we don’t really understand what we do.”

One hypothesis is that orthotics correct skeletal alignment problems, though Nigg says there is no evidence to support that proposition. Rather than moving bones around, it is more likely that orthotics affect muscle activity, he says. Figuring out how they affect muscle activity — and how to correct activity that is causing pain or injury — could lead to more consistent prescribing of orthotics.

“Maybe we should not think of pushing the skeleton around, but rather about finding ways to give signals to the body to do the right thing,” says Nigg.

Dr. Michael Nirenberg, a podiatrist in Crown Point, Indiana, says he is not surprised by the lack of consensus on how orthotics work. “There isn’t even a consensus on what an orthotic is,” he says, noting that the term is used to describe both pricey custom-made inserts and cheap insoles available at any drugstore.

Determining which orthotic will work best for a patient is difficult, says Nirenberg, because so many factors come into play. Even if two patients are similar in many ways — weight, gait, foot structure — they may still experience very different outcomes after using similar orthotics. “You can’t guarantee anything is going to work for everyone, because people are so variable,” he says. “Orthotics can do amazing things for many people, but not for everyone.”

The basic function of an orthotic is to put the foot into a better position, which alleviates pain, says Nirenberg. If a muscle is strained or hurting, a properly chosen orthotic will do some of the muscle’s work for it, thereby reducing its workload and bringing relief. Of course, giving muscles a permanent vacation also has a down side.

Figure

Chronic foot pain commonly results in treatment using an orthotic, which is believed to put the foot in a better position and thus alleviate pain.

Image courtesy of © 2011 Jupiterimages Corp.

“When you brace the foot, that may alter the function of the foot for the better, but in doing so it negates the need for many of the muscles in the foot to do anything,” says Nirenberg. “Common sense tells us that if you don’t use a muscle, it’s going to weaken.”

When visited by a patient in pain, Gordon Ruder, a practising orthotist and the coordinator of the prosthetic and orthotic programs at George Brown College in Toronto, Ontario, won’t prescribe orthotics right away. First, he will recommend such things as better shoes, strength training, stress reduction or lifestyle changes that could alleviate the problem. Sometimes, however, these things aren’t enough.

“You might have chronic pain that can’t be managed by other means, and you still need to work 12-hour shifts, and you can’t change jobs to one that will stop you from spending time on your feet,” says Ruder.

In such cases, Ruder will recommend orthotics, though, like others in his field, he warns that picking the right type for a patient is not an exact science. “It’s not as simple as replacing brake pads on a car after they’ve worn out,” he says. “The human body doesn’t work like that.”

As a researcher, he would like to see more resources put into studying orthotics. Existing research has been lacklustre, mainly because it is difficult to quantify the biomechanical changes that result from wearing orthotics. There is a need for more-sensitive tools that are capable of detecting these subtle changes, says Ruder. “I very much want to see research become a bigger part of what we do.”

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 183 (4)
CMAJ
Vol. 183, Issue 4
8 Mar 2011
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Orthotics work in mysterious ways
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Orthotics work in mysterious ways
Roger Collier
CMAJ Mar 2011, 183 (4) 416-417; DOI: 10.1503/cmaj.109-3802

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Orthotics work in mysterious ways
Roger Collier
CMAJ Mar 2011, 183 (4) 416-417; DOI: 10.1503/cmaj.109-3802
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Saying goodbye to CMAJ News
  • National survey highlights worsening primary care access
  • How Canadian hospitals are decreasing carbon emissions
Show more News

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire