Letter to the editor: "Putting shoe orthotics to the test" (December 2017)
To the Editor:
Dr. Shawn Thistle's article, "Putting Shoe Orthotics to the Test" appearing in the December 2017 issue1 presents a concise and transparent review of a recent study that supported the effectiveness of prescription shoe orthotics in improving low back pain and dysfunction after 6 weeks compared to the lack of use of the orthotics. What is lacking – and which doctors need to be aware of is the extensive description provided by the authors of this study regarding the unique materials and steps that went into the crafting of these orthotics by the manufacturer (Foot Levelers):2
1. The materials employed were specific to the gait cycle and included a shock absorbing polymer placed in the heel to assist during heel strikes.
2. A stiffer polymer was used to support in mid-stance.
3. A springy polymer in the forefoot of the orthotic was included to assist in toe-off.
4. The size and shape of the orthotic supports were crafted based on the height, weight, and activity level of the patient related to the foot scan and measurements taken.
The point is that the orthotics employed in this particular study were designed to relieve excessive strain on the ankle ligaments and reduce postural sway. Recent investigations have shown, in fact, that custom-fit orthotics may restrict undesirable motion of the foot and ankle, enhancing joint mechanoreceptors to detect perturbations and providing structural support for detecting and controlling postural sway.3 Also clear is the indication that the custom-made flexible foot orthotic from Foot Levelers produced statistically significant improvements in weight-bearing foot alignment, as shown by radiography.4 Indeed, in subjects with hyperpronation, immediate changes of the quadriceps femoris angle which produced this condition are noted upon insertion of the custom-made orthotic device.5
The Foot Levelers orthotic featuring a patented gait cycle system that provides the necessary feedback through the joints and corresponding muscles along the kinetic chain to maintain balance and reduce the likelihood and duration of back pain.6 In this instance, it is not unreasonable to attribute at least a portion of the positive outcomes obtained in Cambron's study to the quality of the orthotics utilized and its ability to stabilize the spine and pelvis.2 Long story short: Not all shoe orthotic devices are the same. It is prudent to recognize that foot orthotic devices other than those supplied by Foot Levelers have yet to demonstrate the depth and variety of the positive effects experienced by patients already shown in the scientific literature.
Anthony L. Rosner, Ph.D., LL.D.[Hon.]
1Thistle S. Putting shoe orthotics to the test. Canadian Chiropractor December 2017; 38.
2Cambron J, Dexheimer JM, Duarte M, Freels S. Shoe orthotics for the treatment of chronic low back pain: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2017; 98(9): 1752-1762.
3Guskiewicz KM, Perrin DH. Effect of orthotics on postural sway following ankle inversion sprain. Journal of Orthopedic Sports and Physical Therapy 1996; 23(5): 326-331.
4Kuhn R, Shibley NJ, Austin WM, Yochum TR. Radiographic evaluation of weight-bearing orthotics and their effect on flexible pos planus. Journal of Manipulative and Physiological Therapeutics 1999; 22(4): 221-226.
5Kuhn DR, Yochum TR, Chery AR, Rodgers SS. Immediate changes in the quadriceps femoris angle after insertion of an orthotic device. Journal of Manipulative and Physiological Therapeutics 2002; 25(7): 465-470.
6Cakar E, Sormus O, Tekon L, Doncer U, Kiralp MZ. The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. European Journal of Physical and Rehabilitation Medicine 2010; 46(3): 363-368.
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