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Benefits of In-Shoe Orthotics In Athletic Shoes Robert H. Sheinberg, DPM
Michael Jordan takes off from the top of the key, sailing through the air and jamming in a dunk. Jaromir Jagr skates deftly through a sea of defenders, fakes out the goalie and puts the puck in the back of the net. Eddie George swings out of the backfield, catches a pass, sidesteps a would-be tackler and streaks down the sideline to score a touchdown. Lance Armstrong rises up out of the saddle, starts pedaling at 120 RPM, and leaves the best bicycle riders behind him on his way to winning a fourth Tour de France title. Other than being excellent athletes, these individuals share something else common- they all have lower extremity problems, of which part of their treatment plan has been receiving custom-molded in-shoe orthotics. Orthotics have been used by a wide range of health care professionals for decades. An orthotic does more that just "support the arch". The primary purpose of an orthotic is to capture the proper alignment of the foot and ankle bones relative to each other and retain this proper alignment. The foot and ankle form the foundation of support for not only the legs but also the entire body in general. Just as you would be careful when building and/or buying a house and you want the foundation to be strong, you should want your foundation of your entire body to be stable as well. There are very few individuals walking around on the face of the earth with a "perfect foot type and function." However, there is a range of "abnormality". A person may have subtle or severe mechanical imbalances. Depending on the level of imbalance, activity level of a person, either occupationally or athletically, a person may or may not be able to go throughout life without any type of problems, symptoms, or injuries related to their mechanical imbalances. When a person walks, he or she is putting 1.9 to 2.1 times their body weight through the foot, ankle, legs, knees, hips, and lower back. When a person walks fast or jogs slow, that is increased to 5-6 times their body weight. When a patient is running, that increases to 8- 9 times their body weight. One can appreciate the potential for overuse types of injuries with this amount of stress placed on the lower extremity during athletic activity. Below are signs and symptoms noted in individuals who may benefit from orthotics:
Unfortunately, the vast majority of athletic shoes do not take these factors into account, with the exception being running shoes. Most athletic shoes, such as soccer shoes, football cleats, baseball cleats and basketball shoes, are designed by the manufacturers with the business of selling the shoes in mind, and not proper support and stability. There are varying degrees of "quality" in shoegear, but if the athlete in question is suffering and an exam is performed that reveals mechanical imbalances, a custom-molded in-shoe orthotic will provide proper mechanical support for their athletic activity. Soccer shoes are notorious for their poor quality and lack of support. Soccer shoes are made for pedal dexterity- the ability to be able to feel the ball for touch passes and accuracy. However, the proper support of the shoe is sacrificed. If you have your child put on their soccer shoes, have them stand on a solid surface such as a sidewalk and then visualize the support, you will note that the sole of the shoe is usually not even wide enough to support the sole of the foot. Usually, the edges of the foot are actually resting on the soft upper and aren’t even being supported by the platform of the sole. Also, the inside of the soccer shoe is usually completely flat. This will not help a person with an extremely low-arch foot who needs support or a person with an extremely high arch foot where the insole of the shoe doesn’t come up enough to "fill" the arch.
In-shoe orthotic treatment by a foot and ankle specialist should include a thorough lower extremity exam, including a measurement of the range of motion of various joints in the lower extremity, visual examination of the patient walking(visual gait exam), occasionally x rays of the feet with the patient in full weight bearing position to evaluate the positional relationships between the bones of the foot and ankle, and then taking an impression of the foot with plaster while holding the foot in neutral position. Neutral position is the most stable position the foot can be in while contacting the ground. From this impression of the foot, the orthotic is then created. A prescription is written by the doctor, including any balancing (known as posting) of the rearfoot and forefoot. The type of orthotic chosen is tailored to the athlete by taking into account a multitude of factors including gait, flexibility of arch, muscular tightness, activity and shoe gear. Occasionally, a computerized gait analysis may also be performed, both without orthotics and with orthotics, in order to determine the level of abnormality and how well the abnormality is being corrected by the orthotics, respectively Orthotics will NOT change the structure of the foot; they will not help your child’s arch to be permanently adjusted higher or lower after wearing the device for a finite period of time. They will provide significant support to the foot as glasses do for the eyes. However, by creating a proper and stable foundation of support, your child will be able to participate in sports with a decreased potential for overuse and chronic injuries. |
