Rebuttal New York Times Article on Orthotic Devices

http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?ref=science

First of all here is two comments from my patients.
Patient #1:

They just never wore the ones you make! Signed Shirley to me!!

Patient #2:
Dear Dr. Nigg:


Orthotics are the greatest invention since corn flakes! I may very well be one of the first people to wear them, having obtained a set in 1959 (they were made from plaster casts of my foot of 100% cork in those days and suggested by my Podiatrist Dr. John Pagliano, of Los Angeles. His son, Dr. John W. Pagliano, DPM, is a famous sports medicine Podiatrist in the greater Los Angeles area).

My current pair are state-of-the-art orthotics made by Dr. Rich Blake, DPM of St Francis Memorial Hospital (Catholic Healthcare West) in San Francisco. They have cork heels. They aid in preventing of my previous lower back problems and sore arches.

Sincerely,

Richard

      I want to thank Shirley and Richard for bringing the New York Times Article to my attention. I have been practicing for 30 years, average making 200 pairs of orthotics per year, giving me 6000 pairs of orthotic experience to bring to this table. And I am Past President of the American Academy of Podiatric Sports Medicine, and Past Editor for Sports Medicine of the Journal of the American Podiatric Medical Association.
      Orthotic devices are shoe inserts prescribed for a specific function, normally to relieve pain. And the orthotic devices must make the patient walk or run more stable, more fluid, with less stress at heel impact, produce better alignment at pushoff, be comfortable, and so on. These are heavy demands placed on the prescribing doctor/therapist/orthotist, but the sophisication is there to accomplish these goals. The advances in the orthotic industry have been so immense in my 30 years in practice that I find poor orthotics only made by those disinterested in the process. The patients demand success. And success is normally delievered by the health care system. I am very proud of my podiatric colleagues for their work in this regard. There are podiatrists, like myself, that specialize in orthotic devices. But, great orthotic devices are being made all over.
     Much of Dr Nigg's comments (and I respect him immensely) show he does not dwell in the world of foot pain. My last patient of the day Toni will never ever take Dr Nigg's comments (and I hope he was just misquoted). Toni had severe foot pain, 4 years ago orthotic devices eliminated that pain, and you can not convince her to not wear her orthotics. And I do not blame her!!
     In my practice, I make routinely probably 20 different types of orthotic devices. And I take very seriously my need to get it right since many insurance companies will only pay for one pair a year. I do not have the freedom of a researcher to experiment away with every patient. So I try to analyze what type of orthotic device is appropriate for this patient with these symptoms at this time. It does not mean that this patient could have 10 reasonably different pairs made for them, each doing something alittle differently, each affecting different change at their feet, ankles, knees, and hips.  But that would be so confusing to the body. I am glad I do not have to research these changes from subjective data from the patient.
     Orthotics Work Wonders!! I believe that because I have see that every day in my practice. Many patients can not consider walking a step without them due to nerve damage in their foot that no strength gain in their foot could ever compensate for. Who is Dr Nigg to send negative energy into this realm? Medicine is all about healing, about hope, about positive energy. Orthotics, even in the most challenging patient, with the most difficult symptoms, are a symbol of that hope. I know enough about the world of orthotic devices to know that if they fail to help a patient it is because I am not understanding the situation enough. It has nothing to do with orthotics, it is the imperfect humans prescribing them. I ask Dr Nigg to do research on how long it will take a patient with nerve damage to strength their feet so they can avoid orthotics all together?
     Why do patients get orthotics? They are in pain, and their mechanics seem to indicate that some change produced by an orthotic device would be helpful. So they get orthotics. The pain goes away. Some good research should be done on how long should the patient remain in orthotic devices after it cures their problem. The average patient does not want that pain back. They may be very happy to wear orthotics forever, like I wear my eye glasses. Yes, I should do some eye exercises, but I am taking the easy way out. Yes, I need to have all my orthotic patients doing 2 to 5 minutes every evening foot strengthening exercises. So, they won't be so frail.
     So, I applaud the New York Times for bringing this to the forefront. Being from San Francisco, where William Randolph Hearst made yellow journalism famous, I understand how you want to sell papers. But, why don't you give hope, because orthotic devices have stood the test of time in medicine, and deserve praise for how well they have helped millions over the last 40 years since modern day orthotics were introduced to the world by Drs Root, Weed, Sgarlato, and Orien. Boy, have they changed the world. I, and my patients, salute you gentlemen.
  Thank you. Dr Rich Blake