When to Use Foot Orthotic Devices

Hi Dr Blake,

I just wanted to get your thoughts on the question that I have which is some patients will ask me "Do I have to wear orthotics / or a heel lift for the rest of my life?''

I generally respond with

- it depends on the severity of the condition

- as the stress on the injured tissue is reduced which allows the tissue to heal and adapt to its optimal function over a period of time,

I can gradually reduce the correction of the orthotics and incorporate corrective exercises to see if the patient is able to adapt without orthotics.

If symptoms reappear when the orthotics is removed after the patient is asymptomatic, then I will explain that the patient will need to continue wearing orthotics.

Looking forward to your response.

Regards,

Dr Blake's response: 

     Most definitely. I explain that orthotics, like glasses, are necessary evils to be used as needed. For some injuries like sesamoid fractures, it can be easy two years of mandatory use, and other injuries like plantar fasciitis, only two months longer than the symptoms. That is the injury protection part. Now, when we are evaluating patients, some patients get the same problem over and over, so long term use of orthotic devices for activities that produce those symptoms are important. But, they may only wear them to run twice weekly, or if they have a big backpacking trip coming soon. 

     And then there are the patients who have very severe biomechanical problems that should always wear their orthotics if the orthotic devices can correct that problem. These are patients with severe pronation, PTTD, lateral instability with chronic sprains, etc.

     A subcategory of this are the preventative patients. Patients that wear orthotics to slow down the course of their bunions, forefoot neuritis, heel pain, achilles symptoms, knee degeneration, frequent ankle sprains, etc. They probably could get by without orthotic devices alot, but chose to use them AMAP. 

     And you bring up a great point about exercises. If you are using orthotic devices to reduce the effects of pronation or supination, you should place that patient on exercises done 3 times weekly to do the same thing. As they get stronger, than they can go longer without orthotic devices, and perhaps not have to use them at all.  Hope this helps. Rich