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Saturday, February 9, 2013

Research on Treatments can be very difficult: Take Foot Orthotic Devices For Example

     I received this email from a patient who is getting good help of his posterior tibial tendinitis secondary to over pronation from his orthotic devices. Due to the asymmetry of his pronation, his left orthotic device is much higher corrected than his right. This is what he needed to be stable.He is an extremely brilliant young man, and wants to know how things work and what works. Research on most products, like this article on orthotic devices, which have helped billions of people, is very difficult. Our medical directior, famous orthopedist Dr James Garrick, who loves his patients to stretch has always been frustrated at the fact that no research (only public opinion) has ever proved that stretching does anything. I know it does, you probably know it does, but put it under a microscope, exam it, probe and poke at it, and you will find it very hard to document scientifically how it works. Finally, after 50 plus years of the western medical world taking a negative stand on acupuncture for instance, now research is showing some of the reasons why it works so well.
     Foot orthotic devices are another one scrutinized. Most of the one billion people who wear and swear by their foot orthotics, and would not dream about doing at least some part of their daily life without them, would tell you have great they are. So why do famous orthotic researchers say to throw away your orthotic devices. I have reviewed some of the orthotic research and find many flaws in almost everyone of the papers. Orthotic devices are medical devices that must be individualized before they can really work. The research projects tend to miss the boat on this. As I review these papers I try to understand how the orthotic devices were made and the research flaws become apparent. Here are some of the questions I ask that point to the study's flaws. What type of orthotic was made? How individualized the orthotic RX was? What types of shoes and lacing techniques were they wearing? How long were they wearing the study orthotics, and had they been adjusted to the wear individuallly? Had the researcher documented that the orthotic devices completely eliminated the abnormal motion that was being studied? How many hours on the treadmill had the runner/walker done before being videotaped for the study? Were the orthotics coupled with good shoes, power lacing, and other typical day to day things that even the average orthotic prescriber would do? And on, and on, and on!! As you read the research, and you look at the lack of sophisication, it is typically on the guise of standardization. The researcher wants to only study the orthotics, so standardizes the prescription, shoes, surface, etc. But, this truly means that the researcher is really studying a generic device, not a custom made functional foot orthotic.
     When I prescribe orthotic devices, it is important that the left and right feet get different corrections when they need them, that the patient get shoes that stabilize them very well, that they power lace, that they wear lifts for their short side if it affects their gait, that they strengthen or stretch muscles that adversely effect how their bodies move, that they learn better running or walking styles when their gait is affected. All of this aims for stability and less shock to the body. So, when I see a great research paper that addresses this individualization of the process within the study, then I will look with more seriousness at the paper, and then the best research paper on custom made functional foot orthotics will have been written.


http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all&_r=0

 Dr. Blake, Thank you for my new orthotics. Again, it was good to see you and talk with you. Above is a link to the NY Times article I mentioned. Look at the January '11 date, its surprising its been that long since I read it. I'd be curious to hear what you think the next time I'm in your offices. Happy holidays and happy new year!


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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.