Prevention Effect of Orthotics
J. Kim Ross, BSc., MSc., D.C. Ph.D

For more than 50 years, foot orthotics have been used to treat disorders of the foot, leg, thigh and the joints that separate those segments. Hence, they have been used to treat plantar fasciitis, metatarsalgia, shin splints, knee osteoarthritis, patellofemoral syndrome, iliotibial band syndrome, Achilles tendonosis and even low back pain. There is some evidence in the literature for orthotics being an effective treatment for each of these conditions. A recent review of the effectiveness of orthotics demonstrated that customized rigid foot orthotics have moderate to large beneficial effects in treating plantar fasciitis, and small to moderate effects in treating or preventing patellofemoral pain syndrome. (Hume et al, 2008)

If orthotics can be used to treat conditions when they are present, then it stands to reason that they should be able to prevent the condition from arising in the first place. However, few studies have actually tested this idea. In fact the only strong data supporting the use of foot orthotics to prevent conditions relates to stress fractures in the leg (tibia). Hume et al, (2008) concluded that there were moderate effects of custom foot orthotics in preventing posterior tibial stress fractures.

Interestingly, Willems et al (2007) were able to show that individuals that will eventually go on to have a lower limb injury of insidious onset, possess a unique set of pressure patterns under the foot compared to individuals that do not go on to have injury. That pressure pattern implies over-pronation (flat-footedness) as the predictor of injury.

Dixon and McNally (2008) found that foot orthotics alter the pressure pattern under the foot, and this alteration is similar to the pattern found in individuals that do not go on to have a lower-limb injury. The implication then is that orthotics may be able to alter the manner in which individuals walk and hence could reduce the likelihood of injuries occurring as a result of their everyday activities.

We hypothesize therefore that if asymptomatic individuals are provided with custom foot orthotics, those individuals will experience less lower limb injury over a period of two years than a control group that did not receive orthotics.

References

Willems, T. M., E. Witvrouw, A. De Cock,. De Clercq, D. Gait-Related Risk Factors for Exercise-Related Lower-Leg Pain during Shod Running. Med. Sci. Sports Exerc., Vol. 39, No. 2: 330–339. 2007.

Dixon, S.J. and McNally K. Influence of orthotic devices prescribed using pressure data on lower extremity kinematics and pressures beneath the shoe during running. Clinical Biomechanics. Jun;23(5):593-600. 2008

Hume, P., Hopkins, W., Rome, K., Maulder, P., Coyle, G. and Nigg, B. Effectiveness of foot orthoses for treatment and prevention of lower limb injuries: A Review Sports Med 38 (9): 759-779. 2008