Do Foot Orthotics Really Work?

Of course they do. If anyone claims otherwise, they are making it up!

Interpod

Every single clinical outcome study (patient satisfaction; outcome study; controlled and uncontrolled study; randomized control trial), and there is now a lot of them, has shown that they work (except for one on bunions in kids); every systematic review of the evidence has shown they work; even the esteemed Cochrane Collaboration review has shown they work. The scientific published research on foot orthotics is unequivocal in that they work¹. There is not the slightest shred of doubt about that.

Yet despite that unequivocal data, you still see people claiming that they don’t work. You will notice that they never offer up a single scientific outcome study to back up their claim. More often than not, they might cite an anecdote of a few people in which orthotics did not help. Anecdotes are not data. Every single medical and physical intervention has times when they do not work. Foot orthotics do not work 10, 15, 20% of the time. Knee replacement surgery does not work 10, 15, 20% of the time. Antibiotics for a strep throat do not work 10, 15, 20% of the time. Foot orthotics are no different to any other type of intervention in their success rates.

I have even seen claims that foot orthotics should be banned as they don’t work (those making the claims are not citing any research, except a few anecdotes to back up their claims)². Do they also think we should be also be banning knee replacement surgery and antibiotics as they sometimes do not work? I even recently got into an online debate with a chiropractor who was arguing that foot orthotics should be banned. When I pointed out that there is substantially more scientific evidence for the efficacy of foot orthotics than there was for the efficacy of chiropractic and asked him why he was not also arguing for the banning of his own profession?³ He then shot himself in the foot and demonstrated to all what a vile human being he was by resorting to all sorts of threats rather than debate the actual issue, which is hardly the kind of behavior you would expect from a ‘professional’. Of course, he resorted to all the usual argumentative fallacies, such as cherry picking, confirmation bias etc. He actually got worse when I pointed this out. Dealing with these people goes with the territory and I always appreciate it when they prove me right. (Paradoxically, one of the biggest custom made foot orthotic manufacturing facilities in the world is one that supplies chiropractors!).

What is a responsible clinician to do? Do what the scientific evidence tells them or what a few bloggers and forum rants tells them? Responsible clinicians rely on scientific evidence to tell them when an intervention is better than a placebo to avoid falling into the trap of using ineffective treatments. Foot orthotics have clearly been shown to be better than a placebo according to the evidence.

As always, I go where the evidence takes me until convinced otherwise.

¹Not to mention all the evidence on foot orthotics treating and preventing diabetic foot ulcers and problems with the rheumatoid arthritis foot!

²Tell those with diabetes who have been spared loosing their limbs in an amputation because the foot orthotics healed their plantar ulcer that foot orthotics should be banned and see how they respond! What about those with painful rheumatoid arthritis in the foot. Try telling them that their foot orthotics are not working. Can you see the absurdity of these clowns?

³I don’t think chiropractic should be banned, I was trying to make a point that he did not get.

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40 Responses to Do Foot Orthotics Really Work?

  1. Jack McPheron October 18, 2013 at 6:25 pm #

    Craig,

    Could you please explain what you mean by they “work”. Work is very vague definition and could mean a variety of things. Also if you could point to the studies showing that they “work” and what it has helped. I do agree that there is a lack of evidence on both sides of the argument and a lot of it is anecdotal. I myself am on the other end of the argument and see orthotics as more of a partial cast to be used as a temporary tool to help strengthen and then be done away with as is the case with any other type of cast. One does not wear an arm cast their whole life because it “supports” them. They wear it for the necessary time and strengthen afterward to make up for the atrophy that occurs from a lack of range of motion due to the cast.

    Enjoying the website and thought provoking posts.

    All the best,

    Jack

    • Craig Payne October 18, 2013 at 8:56 pm #

      “They work” = improve clinical outcomes (ie symptoms get better)

      Sorry, I don’t have a reference list handy, but there are over at least 50 studies now, including a Cochrane Review (and the do not get any better than that). A simple lit search will turn them up. They all showed foot orthotics “worked” (ie improved clinical outcomes) in a whole range of conditions. Only one has shown they don’t ‘work’ (on bunions in kids).

      I not sure what you mean by this: “I do agree that there is a lack of evidence on both sides of the argument and a lot of it is anecdotal” – the evidence is really clear that they “work”! Only one side is lacking evidence!

      strengthen afterward to make up for the atrophy that occurs from a lack of range of motion due to the cast
      I not sure what you mean by that analogy. Three studies have looked at the issue of foot orthoses and muscle strength; 2 actually showed the orthotic group got stronger; and the other 1 showed no difference (ie no weakening). I am also aware of an unpublished 4th that looked at muscle strength and the strongest group was the group wearing foot orthotics – they were stronger than the minimalist/barefoot group!

      This is what the evidence is showing rather than the nonsensical rhetoric and propaganda.

    • Kevin A. Kirby, DPM November 7, 2013 at 5:13 pm #

      Comparing a foot orthosis to a “cast” that immobilizes a joint is laughable at best. A foot orthosis does not immobilize any of the joints of the foot. A foot orthosis does not immobilize the ankle joint, subtalar joint, midtarsal joint, LisFrank’s joint, the metatarsophalangeal joints or the interphalangeal joints. Anyone who suggest such things either knows very little about foot and lower extremity biomechanics or has a “barefoot agenda”.

      In fact, a foot orthosis does very little to limit motion of any joints of the foot. Stand on an orthosis and see if you can still move your foot just as much as if you were barefoot on the ground. You will see, a foot orthosis does very little, if any, to limit motion of the foot.

      What then does a foot orthosis do? It alters the locations, temporal patterns and magnitudes of ground reaction force acting on the plantar foot during weightbearing activities, nothing more, nothing less. Thousands upon thousands of runners have worn and currently wear both over-the-counter and custom foot orthoses regularly to run in with no ill-side effects and with no evidence of “weak feet” as some of the barefoot/minimalist running zealots suggest.

      Where is the evidence that foot orthoses weaken feet? Not in the scientific research literature…only within the dreams of the barefoot/minimalist running zealots!

      • Nick Campitelli May 9, 2014 at 3:55 pm #

        Kevin,

        Can you explain this concept to me with scientific data? Not your interpretation of the data, but that this concept of temporal patterns and magnitudes of ground reaction force acting on the plantar foot during weightbearing activities actually reducing running injuries.

        Nick

        • Kevin A. Kirby, DPM May 10, 2014 at 9:21 pm #

          Dr. Nick:

          You must start reading the research on how foot orthoses work a little more:

          Standard foot orthosis shifts more laterally located GRF to more medially located ORF, especially in midfoot
          (Redmond A, Lumb PS, Landorf K: Effect of cast and noncast foot orthoses on plantar pressure and force during normal gait. JAPMA, 90:441-449, 2000)

          11 runners that showed lack of symptomatic response to standard orthoses were fitted with both standard functional orthoses and Blake inverted orthoses
          3D motion analysis performed while subjects ran at 3.35 m/s (8:00 min/mile) with inverse dynamics. Internal rearfoot inversion moment and inversion work reduced significantly with inverted orthoses. Tibial rotation, knee adduction and knee abduction moment also significantly changed.
          (Williams DS, McClay-Davis I., Baitch SP: Effect of inverted orthoses on lower extremity mechanics in runners. Med Sci Sports Exerc, 35:2060-2068, 2003)

          42 subjects with metatarsalgia, orthoses decreased metatarsal head pain, force impulse and peak pressure at met heads.
          (Postema K, Burm PE, Zande ME, Limbeek J: Primary metatarsalgia: the influence of a custom moulded insole and a rockerbar on plantar pressure. Pros Orth Int, 22:35-44, 1998)

          Prospective study of 151 subjects with cavus, wore custom orthoses, after 3 months showed significant decreases in foot pain, increases in quality of life and 3 times more forefoot plantar pressure reduction when compared to sham insoles.
          (Burns J, Crosbie J, Ouvrier R, Hunt A: Effective orthotic therapy for the painful cavus foot. JAPMA, 96:205-211, 2006.)

          Orthoses caused 30% reduction in maximum peak pressure in 81 Type II diabetic patients.
          (Lobmann R, et al: Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study. Diabet Med, 18:314-319, 2001.)

          Peak pressure and pressure-time integral reduced in 34 adolescent Type I diabetic patients
          (Duffin AC, Kidd R, Chan A, Donaghue KC: High plantar pressure and callus in diabetic adolescents. Incidence and treatment. JAPMA, 93:214-220, 2003.)

          In 8 patients with plantar neuropathic ulcers that healed with custom orthoses, orthoses significantly reduced peak vertical pressure, reduced pressure/time integral and increased contact area versus the no-insole condition
          (Raspovic A, et al: Effect of customized insoles on vertical plantar pressures in sites of previous neuropathic ulceration in the diabetic foot. Foot, 10:133-138, 2000.)

          Custom orthoses most effective at reducing pain and all orthoses significantly reduced pressure under 1st and 2nd metatarsal heads in 12 RA subjects
          (Hodge MC, Bach TM, Carter GM: Orthotic management of plantar pressure ad pain in rheumatoid arthritis. Clin Biom, 14:567-575, 1999.)

          Both normal and RA subjects showed significant reductions in plantar pressures and loading forces during stance phase of gait
          (Li CY, et al: Biomechanical evaluation of foot pressure and loading force during gait in RA patients with and without foot orthoses. Kurume Med J, 47:211-217, 2000.)

          30 subjects with medial knee OA treated with valgus wedged orthoses had pain levels significantly reduced at 3 and 9 weeks after orthoses
          (Rubin R, Menz HB: Use of laterally wedged custom foot orthoses to reduce pain associated with medial knee osteoarthritis: A prelim. investigation. JAPMA, 95:347-352, 2005.)

          24 month prospective trial on 156 patients with medial knee OA showed significant decrease in NSAID usage
          (Pham T, et al: Laterally elevated wedged insoles in the treatment of medial knee OA: a two-year prospective randomized controlled study. Osteoarthritis Cartilage 12: 46-55, 2004.)

          Orthoses significantly reduced postural sway in medial/lateral and inv/ev platform movements
          (Guskiewicz KM, Perrin DH: Effects of orthotics on postural sway following inversion ankle sprain. J Orthop Sp Phys Ther, 23:326-331, 1996.)

          Decreased frontal plane CoP length and velocity with medially posted orthoses when subjects stood on orthoses in single leg stance
          (Hertel J, Denegar CR, et al: Effect of rearfoot orthotics on postural control in healthy subjects. J Sport Rehabil, 10:36-47, 2001.)

          Orthoses improve balance in pronated feet via reductions in medial-lateral sway during bipedal standing
          (Rome K, Brown CL: Randomized clinical trial into the impact of orthoses on balance parameters in excessively pronated feet. Clin Rehab, 18:624-630, 2004.)

          You can also read my peer-reviewed published papers, book chapters and my four books on how altering the plantar locations, temporal patterns and magnitudes of ground reaction force acting on the plantar foot with foot orthoses can have a positive therapeutic effect on mechanically-based pathologies of the foot and lower extremity.

          Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997.

          Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002.

          Kirby KA: Foot and Lower Extremity Biomechanics III: Precision Intricast Newsletters, 2002-2008. Precision Intricast, Inc., Payson, AZ, 2009.

          Kirby KA: Foot and Lower Extremity Biomechanics IV: Precision Intricast Newsletters, 2009-2013. Precision Intricast, Inc., Payson, AZ, 2014.

          Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989.

          Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992.

          Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992.

          Kirby KA: Podiatric biomechanics: An integral part of evaluating and treating the athlete. Med. Exerc.Nutr. Health, 2(4):196-202, 1993.

          Kirby KA: Troubleshooting functional foot orthoses. In Valmassy RL(editor), Clinical Biomechanics of the Lower Extremities, Mosby-Year Book, St. Louis, pp. 327-348, 1996.

          Kirby KA: Biomechanics of the normal and abnormal foot. JAPMA, 90:30-34, 2000.

          Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001.

          Kirby KA: Foot orthoses: therapeutic efficacy, theory and research evidence for their biomechanical effect. Foot Ankle Quarterly, 18(2):49-57, 2006.

          Kirby KA: “Evolution of Foot Orthoses in Sports”, in Werd MB and Knight EL (eds), Athletic Footwear and Orthoses in Sports Medicine. Springer, New York, 2010.

          Kirby KA: Introduction to Recent Advances in Orthotic Therapy. In Scherer PR (ed), Recent Advances in Orthotic Therapy: Improving Clinical Outcomes with a Pathology Specific Approach, Lower Extremity Review, USA, 2011.

          Kirby KA: Footstrike and Running Form Controversies: What Does the Scientific Evidence Tell Us? Foot and Ankle Quarterly, 24(3):109-118, 2013.

          Fuller EA, Kirby KA: Subtalar joint equilibrium and tissue stress approach to biomechanical therapy of the foot and lower extremity. In Albert SF, Curran SA (eds): Biomechanics of the Lower Extremity: Theory and Practice, Volume 1. Bipedmed, LLC, Denver, 2013, pp. 205-264.

          Now, Dr. Nick, it’s your turn. Please provide us with peer-reviewed scientific research references for any of the following notions that you seem to be focused on in your blog.

          http://www.drnicksrunningblog.com/my-thoughts-on-the-vibram-fivefingers-lawsuit-and-why-minimalist-shoes-do-not-create-injuries/

          Here are a few of them that you seem to believe:

          1. Strengthening the intrinsic muscles of the foot prevents injuries and/or makes a runner faster.

          2. Wearing minimalist shoes prevents injuries during running.

          3. Wearing thicker soled shoes or shoes with a larger heel height differential (i.e. heel drop) causes more injuries than wearing minimalist shoes during running.

          4. The “proper way” to run is with a forefoot strike.

          Please provide just one peer-reviewed research reference that supports your above claims. Your anecdotal observations simply won’t do, Dr. Nick.

          I won’t hold my breath.

          Kevin A. Kirby, DPM
          Adjunct Associate Professor
          Department of Applied Biomechanics
          California School of Podiatric Medicine

          • Nick Campitelli May 11, 2014 at 11:36 am #

            Thank you. I’m still a bit confused though as your citing articles in regards to diabetic patients and pressure reduction. This is about running and not pressure relief with an accomadative insert. Also by citing a study that shows a reduction in pain by wearing orthotics without direct cause and effect relationship is not credible and analogous to anecdotal observations.

            I have provided peer reviewed literature Kevin and you accuse me of cherry picking.

            Even Simon has published literature that shows that traditional running shoes with a 10mm heel height do not reduce injury and may increase Achilles’ tendon injury. The point of this study was that running shoes with a 10mm heel actually increased the tensile load on the Achilles’ tendon. The findings question the therapeutic role of standard running shoes in Achilles tendinopathy.

            Wearing SC, Reed L, Hooper SL, Bartold S, Smeathers JE, Brauner T. Running Shoes Increase Achilles Tendon Load in Walking: an Acoustic Propagation Study.
            Med Sci Sports Exerc. 2014 Feb 4.

      • WA August 23, 2016 at 5:45 pm #

        Orthotics can easily be directly compared to a cast. Orthotics for flat-feet literally do the work of the arch, muscle, connective tissue, and bone. Allowing all of it to atrophy.

        It doesn’t really matter if you can wiggle your foot around on an orthotic outside of a shoe. You don’t wear orthiotics outside the shoe. When you put your foot in the shoe with the orthotic and lace-up. Your foot is in fact immobilized, tied down to the orthotic. So your “no-shoe” test is an act of pure farce. A fake test that does not match the condition of usage.

        That’s like having people wiggle around in a seat-belt to determine if they are strong enough to withstand crashes. Instead of using crash-test dummies and actually testing the belts in a high-speed settings.

        • Craig Payne August 23, 2016 at 7:15 pm #

          Here is some questions for you:
          1. Why do people make this stuff up for?
          2. Have you even read the scientific evidence on foot orthotics and muscle strength?
          3. Why are you posting comments about the topic when yo clearly have not read that evidence?
          4. How do you explain that every scientific study on foot orthotics says the opposite of what you said?

    • sean parker October 19, 2015 at 5:42 am #

      To state that ‘orthotics work’ is misleading.
      The Cochrane Review didn’t show that ‘orthotics worked’.
      the cochrane review showed that

      “there is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain.”

      It suggests that “there is gold level evidence for painful pes cavus and silver level evidence for foot pain in JIA, rheumatoid arthritis, plantar fasciitis and hallux valgus.”

      If you don’t have these specific conditions than I suggest ‘caveat emptor’.

  2. Mark Richard February 15, 2014 at 3:37 pm #

    The lady doth protest too much, methinks

  3. Mark Richard February 15, 2014 at 4:01 pm #

    Kev/Craig,

    Why are you obsessed with barefoot runners?
    I race,train,coach and have never even seen a barefoot runner!

    This obsession is eventually going to distract from anything of value you produce.

    “We’ll be remembered more for what we destroy than what we create.”
    ― Chuck Palahniuk

    • Kevin A. Kirby, DPM May 10, 2014 at 8:42 pm #

      Mark:

      Let’s see, good old Chuck P said: “We’ll be remembered more for what we destroy than what we create.”

      What do we remember Cassius Clay for? Destroying Sonny Liston.

      What do we remember Bill Rodgers for? For destroying the rest of the Boston Marathon field four times.

      What do we remember Michael Jordan for? For destroying his competition for a total of 6 NBA Championships.

      Sounds like Craig and I are in very good company. 😉

  4. dingle May 10, 2014 at 11:19 pm #

    I think you putting yourself in the same company as those mentioned is an act of egotism beyond the pale. Enjoy patting yourself on the back.

    • Kevin A. Kirby, DPM May 11, 2014 at 12:21 am #

      It was a comment meant to be funny, not serious. For your information, Dingle, a 😉 at the end of a comment does indicate a smile and a wink. I just was responding with as ludicrous of a comment to Mark as I thought his comment to me and Craig was.

      In all honesty, what I did (and maybe Craig agrees with me here on what he did also), during the barefoot running fad that is now swirling rapidly down the toilet of infamy, was nothing more than educate the public to an alternative view in the hopes that our input would prevent more people from getting injured in the sport they loved to do by running barefoot. I don’t obsess over barefoot running and I don’t hate barefoot runners since I once trained regularly barefoot during my competitive days.

      However, as a health professional that specializes in treating runners, and having been a distance runner myself for over 40 years, and having taught running biomechanics both nationally and internationally for 30 years, I am concerned when people start making statements that are not based on fact but rather on misrepresentations of available scientific research regarding running training methods, running shoe recommendations and running biomechanics research. I stick my neck out because I don’t want any more runners coming in my office, or any other health professional’s offices, from being injured due to their listening to self-proclaimed experts who told them that running in thicker soled shoes was bad, that heel striking was bad and that barefoot running and Vibram FiveFinger shoes were the best ways to run.

      What have you done, Dingle, to try and protect the public from misinformation from the likes of companies like Vibram that is now facing a 3.75 million dollar class action suit for their false health claims of their products?

      I eagerly await your reply.

      Kevin A. Kirby, DPM

      • dingle May 15, 2014 at 10:08 pm #

        Wow. Protecting the public … do you wear a cape or have a bat phone?

        • Kevin A. Kirby, DPM May 16, 2014 at 12:04 am #

          After a reply like that, I will no longer waste my valuable time reading or replying to your comments.

  5. Kevin A. Kirby, DPM May 11, 2014 at 3:18 pm #

    Dr. Nick:

    The study by Wearing et al, that you cite:

    Wearing SC, Reed L, Hooper SL, Bartold S, Smeathers JE, Brauner T. Running Shoes Increase Achilles Tendon Load in Walking: an Acoustic Propagation Study.
    Med Sci Sports Exerc. 2014 Feb 4.

    is a study on walking, not on running. If you insist that running related research be used, then why don’t you do the same?

    In regards to cherry picking, which the barefoot and minimalist shoe zealots often do in their blogs to support their myopic view of reality, this has nothing to do with using, or not using, peer-reviewed research. This is, rather, about them only sorting through the available research and not discussing the research papers that are contrary to their opinions, but only discussing research that supports their pet views. Chris McDougall, in his book, Born to Run, raised the skill of cherry-picking to new heights in that he only discussed research literature and anecdotal stories about running shoes, running biomechanics and injury production his opinion that thick-soled shoes are bad, Nike is evil, that most podiatrists only want to make orthotics for runners and that barefoot running and running in “minimalist shoes” is always the best. I have to say, Dr. Nick, that you are also quite an accomplished cherry-picker when I read the articles on your many blogs. Seems like some of McDougall’s talents have rubbed off on you.

    With that in mind, Dr. Nick, I have seen many of your blog comments. However, have you ever published any peer-reviewed research papers? If you want to become more well-respected by your podiatric peers, you need to start getting some peer-reviewed papers published, not just write blogs and e-books about how great barefoot running and running in Vibram FiveFingers shoes is for everyone.

    This is something to seriously think about since, so far, your name is now only known in the podiatry community as the Consultant for the Medical Advisory Board for Vibram FiveFingers…probably not the best company to be associated with these days.

  6. Nick Campitelli May 12, 2014 at 2:24 pm #

    I am not a consultant for Vibram USA.

    • Kevin A. Kirby, DPM May 12, 2014 at 3:40 pm #

      OK, NIck, you are a member of the “Medical Advisory Board for Vibram FiveFinger”..isn’t that the same as a consultant?

      Nice photo!

      http://akronpodiatrist.blogspot.com/2011/03/vibram-five-fingers-medical-advisory.html

      However, I see now that Vibram FiveFingers no longer has you listed on their Medical Advisory Board. Are you still on their Medical Advisory Board, or have you decided to ditch them once they got into legal trouble falsely advertising about the health benefits of their shoes?

      • Nick Campitelli May 12, 2014 at 11:43 pm #

        Again, as I have explained countless times, I was never a consultant for Vibram USA or FiveFingers shoes. I was a member of their medical advisory board which simply meant I helped provide education to their company in regards to lower extremity. You continue to use the word consultant as I assume you think I was paid or had financial interest. I was never paid by Vibram USA to sell or recommend their shoes or to make false claims regarding their shoes.

        It’s pretty clear that you have financial interest in utilizing orthotics to treat lower extremity injuries. I have no problem with that. If less health care professionals use them then this means less revenue from your orthotics laboratory.

        Any educated health care professional can review the literature and understand that there is no clear evidence to support either side. I make my claims and you make yours. Yours are based on no further scientific data then are my claims. I have never discredited any literature that you may reference even when they’re biased self published newsletters or articles. When I provide my scientific data you interpret it otherwise. And that’s fine. But, there are two sides to this discussion and to say that my side has no scientific data demonstrates your unwillingness to debate this from a professional standpoint. Even The Huffington Post and many other media outlets have come to the realization that the shoe industry alone has not fixed running injuries.

        Our feet were meant to work without shoes that the last 40 years have come to produce. That’s pretty intuitive. There is no reason to look for scientific data to prove traditional running shoes do not work as they were intended as it is pretty black and white. If they did, you wouldn’t have seen a change in the industry as we have these past five years and we wouldn’t be having this discussion.

        Saying that Simons article is only about walking is a tropical comment from an abstract scientific one sided mind. So they’re bad to walk in, but they never tested to run in. If this is true and you stand by that, then you cannot argue this, – if your orthotics are meant to run in that you prescribe to your patients, then they must take them out to walk as it’s completely differently from a biomechanical perspective. But then hey, you could sell another pair only made for walking which only increases your bottom line!
        😉

        • Kevin A. Kirby, DPM May 13, 2014 at 12:31 am #

          So, Nick, you are claiming that you allowed Vibram FiveFingers to use your photo and your name and your professional degree on their website proclaiming you as a member of the Medical Advisory Board for no financial compensation whatever to you or your practice? No free pairs of Vibram FiveFinger shoes? No paid trips from Vibram to lecture at seminars?

          I find it hard to believe any physician would allow a multi-million dollar corporation to use them this way, using their name, photo and medical degree all for the purpose of selling more of their product without the physician getting some financial compensation from that company.

          Dan Lieberman got lots of money for his lab and his Harvard website. Nick Campitelli got absolutely nothing for writing that “Step by Step” manual for Vibram Inc. and allowing them to use your name and degree and education? Doesn’t sound like a fair deal for you at all.

          Why would you do such a thing?

          What was in it for you?

  7. Nick Campitelli May 12, 2014 at 2:34 pm #

    I am currently working on and have submitted for publication. As far as blogging, it is analogous to your newsletters that you have combined and printed and sold. I just choose to not sell mine. I make no money from my blog and the ads serve only to cover hosting fees which they do not cover in total.

    I regards to your comment on cherry picking, it’s pretty clear how you want to approach this. You do not mention the studies that I do in regards to the matter so by your definition, you are cherry picking as well.

  8. Shawn May 12, 2014 at 10:49 pm #

    I just want to throw in my two cents as a 30 year old guy with regards to Orthotics and barefoot running. I’ve spent a lot of time today reading through blog posts and articles from Craig and responses between a few of you DPMs, etc. Here is my experience.

    I was a runner in Jr High & High school. I weighed 125-135 in that timeframe. I went to college, stopped running, gained weight until I hit 190. I worked in retail until I was about 28 and switched to a desk job. After college, when I started my retail career, I was cognizant of how bad my feet hurt. I bought better shoes for work, got those store-bought “orthotics” from Walking Company, and used that for about 4 out of the last 4.5 years.

    In October of 2013, I started exercising again. I had occasionally run in the prior 3-4 years but always found my feet hurt to much to sustain a running program. After 2 months of using an elliptical in October-December, I finally made an appointment for metatarsal pain with a DPM.

    She thought I might have some “bone bruise” on my feet. At the time, my right foot hurt the most. She set me up with some orthotics with a cutout near 2nd/third metatarsal. Within a couple weeks, my right foot stopped hurting. My left foot has not, but in regards to orthotics – I am satisfied. I can run again … on my right foot. Pain I have delt with for half a decade gone.

    Now, after about 2 weeks of not wearing my orthotics, my right foot is still fine. The issue is my left foot – it hurts, but only when wearing shoes. Any shoes I’ve tried. Dress shoes, new shoes, old shoes, running shoes, walking shoes. Its the moment as I put pressure on the ball of my feet. The last 6 weeks I’ve gotten 3 cortisone shots to try to reduce inflammation, last one was just 6 days ago and the pain is less. (She now thinks it may be a nueroma, as I have thought the whole time)

    But what’s strange to me is if I take off my shoes and throw on some socks, I can go outside and run to my heart’s content and no pain. I can run around the house, do jumping jacks, etc. Something about my foot in a shoe is killing me.

    So even admidst all this anti-barefoot and pro-barefoot rhetoric, I do not know what to think. My new balance nimbus 16’s (new model that came out recently) are amazing and comfortable, but I still get some of that pain from what I’m still thinking is a nueroma.

    I’m going to REI to try on some VFF’s and see how they feel. I’m not a hardcore runner, I just want to be able to go on a short jog for 15-20 minutes a day and get some cardio in and not want to rip my foot off my body. I want to be able to jog across the street and not feel pain. For now, I’m coping, and I may try alcohol injections to kill off the neuroma (after an MRI to try and confirm diagnoses).

    But I will say this. DPM set me up with orthotics, and it helped my foot pain. I’ve been about 2 weeks without them and my right foot hasn’t gotten worse. Once I get them back in a few days here (modified to try and put a ridge to reduce pressure on the possible nueroma), I will see how that goes for a few weeks.

    Anecdotal evidence it may be, I think both camps have something. Because if i can be pain free with barefoot, but also wear shoes with orthotics / nice cushioned gel running shoes, then maybe there is some truth to what each side has said. I’m willing to try anything I can to make my feet stronger and heal. All this bickering and between-the-line-name-calling is just silly. You’re letting your egos get in the way of having a real conversation, and pointing to science as gospel. People come nad read Craig’s articles and go “Thank you for pointing out how the research that supports your opinion really IS good research” and “thank you for pointing out how that research is bad” but I doubt any of them have done the analysis themselves.

    Sigh. Maybe I will come back and read a response and post an update some time.

    One final thought. When I think about the running shoe industry kicking off in the ’70’s, it REEKS of the infant formula marketing fiasco that started sometime near the 40’s. A product is invented that is more “sciency” than doing things naturally, so we assume it *must* be better. Maybe our evolution did some things right and we should trust our bodies instead of cramming our babies with lab-made milk… maybe we should take off our shoes and learn how to walk again?

    Maybe not… but I’m willing to try.

    • Kevin A. Kirby, DPM May 13, 2014 at 10:42 pm #

      Shawn:

      Thanks for your comments and observations.

      For your information, I am not against barefoot running or running in minimalist shoes since I was running barefoot and in minimalist shoes well before you were born. I ran my first marathon in minimalist shoes at the age of 17 and ran a 2:39 marathon at age 18 in 1975 in minimalist shoes as a senior in high school. However, back then, we called the shoes “racing flats”. In addition, I ran interval workouts barefoot numerous times while running track and cross-county for the UC Davis Aggies.

      What I am against are self-proclaimed experts telling people that running in thicker-soled shoes or running in a heel-striking fashion or running in orthotics is bad for all runners. I am also against these same self-proclaimed experts telling people that running in orthotics or in thicker-soled shoes somehow weakens feet.

      Why am I against these people? Because there is absolutely not a shred of scientific evidence that supports any of these notions and plenty of scientific evidence that refutes these conjectures. However, if you go onto many of the barefoot-minimalist websites, they act like these notions a proven fact by cherry-picking and misinterpreting and lying about what actual scientific research shows. Craig Payne, who I have known and lectured with now for over a quarter century, has been a leader at exposing these people for what they are. You are on his latest website, Running Research Junkie, which is intended to bring some truth and objectivity to these important subjects .

      The preaching of these false and fraudulent ideas by this group of people, a group of people which is getting smaller and smaller every month now that the barefoot/minimalist running fad is rapidly dying off and Vibram FiveFingers is being sued for 3.75 million dollars for false health claims in it’s advertising, , to me is harmful to many runners and causes injury to unsuspecting runners.

      Yes, the barefoot/minimalist running fad has been great for my and many other podiatrists, orthopedic surgeons and physical therapists practices. We have made more money from all the injured runners that tried to run barefoot or in minimalist shoes, listening to the advice of these self-proclaiimed experts. However, it is bad for all those runners who were duped by the lies of these self-proclaimed experts and got injured as a result. That is what I am against.

      As far as your neuroma symptoms, in my 30 years of clinical practice, I have a few suggestions for you. I would suggest wearing only looser fit shoes that don’t compress your foot from side to side. Stay away from loafer shoes, tight fitting dress shoe and walk or run only in sandals or loose fitting lace-up shoes all the time. You may even try wearing a toe-spacer pad between the affected digits of the intermetatarsal neuroma. In addition, I prefer cortisone injections to sclerosing injections of alcohol for treating neuromas since there are fewer risks of complications with cortisone injections. You may also ask your podiatrist to try adding a metatarsal pad on top of the orthosis on the affected foot. Icing the bottom of your foot in the area of the neuroma 20 minutes once or twice a day will likely resolve your neuroma symptoms without alchohol injections or surgery.

      Good luck and thanks for your comments. 🙂

  9. blaise Dubois May 19, 2014 at 11:23 pm #

    Kevin,
    You are not really credible for me when you speak about minimalisme/barefoot
    http://www.therunningclinic.ca/blog/2012/05/les-defendeurs-de-la-chaussures-moderne-modern-shoes-defenders/
    I prescribe thousands of minimalist shoes with success … things are changing (like all the industry)… we realize that just protecting the body (orthotics, big bulky shoes, braces, …) is not the solution after the initial acute treatment for a ‘body alive’… able to adaptation … made for movement, stress, load, …
    Blaise

  10. Trevor June 22, 2014 at 5:01 pm #

    The conclusion of your Cochrane review of the literature

    “Now, there is peer-reviewed scientific evidence to confirm…custom orthoses are effective in treating plantar fasciitis, metatarsalgia, hallux limitus, adult acquired
    flat foot, rheumatoid arthritis foot, tarsal tunnel syndrome and lateral ankle instability.”

    Plantar fasciitis, or more properly called plantar fasciopathy – can be treated effectively a number of ways. Soft-tissue work, stretching, self-release or in severe cases a Strasbourg sock or night splint. But hey if you want to wear orthotics the rest of your life by all means.

    Metatarsalgia – any cushioned shoe should have this effect.

    Rheumatoid arthritis – fair enough

    Tarsal tunnel syndrome – again why rely on an orthotic the rest of your life when there are other equally effective treatments available.

    Lateral ankle instability – treating lateral ankle instability with orthotics, aside from a rare case of someone with a complete tear and is opting non-operative, is just lazy.

    When you have clinics charging $350-$650 for custom orthotics and pumping them out to just about everyone (not those limited to PF, metatarsalgia, RA, TTS, etc) it’s down right criminal. Is there some evidence for select use of orthotics – yes. But sadly the business side of it takes over and they’re grossly over prescribed.

    • Craig Payne June 22, 2014 at 8:35 pm #

      There are now >100 studies that show foot orthotics work and 1 on bunions in kids that show they don’t work. I think I will stick to what the evidence tells me until it says otherwise or listen to rants by those affected by the Dunning–Kruger effect.

      I also find it interesting that those who choose to criticize orthotics, tend to advocate approaches that there is no evidence for or so little evidence for that there is not even enough for there to be a Cochrane review! … go figure … using your logic is it criminal to charge for those treatments?

  11. Kristoffer October 10, 2014 at 11:16 pm #

    I have a question that I’m trying to find the answer for, but I seem to come up empty. Is there any historical evidence of what kind of foot injuries were common before complex shoes became commonplace? Any sort of historical evidence seems like it would be interesting to look in to, even though it might be hard to verify the validity of such information.

    Thanks,
    Kris

  12. Eric November 9, 2014 at 5:21 pm #

    This is a really shitty attempt at an article, resorting to arguments like “I have even seen claims that foot orthotics should be banned as they don’t work”. Like what? Come on dude. All I just read was someones biased interpretation of a painfully small amount of supportive evidence (and from what ive read, non-pier reviewed) from studies that use at the most 50-60 research subjects, which by the way is not satisfactory as empirical evidence.

    • Craig Payne November 9, 2014 at 5:30 pm #

      Seriously? How do you explain the Cochrane Review that showed they worked? Do you even know what a Cochrane review is? Have you even read the evidence? Why do all the systematic reviews and meta-analayses of that evidence come to the same conclusion that they work? How is that a biased interpretation?

      Every single study has showed they work, except 2 (one on bunions in kids and now another if you use them in every case of achilles tendinitis which no one actually does). Sorry, I will stick to the evidence rather than a nonsensical rant.

      If you want to argue that they don;t work, you going to have to come up with something better than that.

  13. Alex April 23, 2016 at 8:56 pm #

    Hello,
    You probably have some research showing that orthotics work, however there is hundreds of neuroscience research showing the catastrophic influence of them on the posture and specially the the VTA. It occurs that the brain consider the orthotics as a wheel chair, and induce a perish meant of the VTA leading to an increase of the degenerative disease.
    Moreover it has a huge impact on the development, and kids (most of the time) with orthotics will have a lower neuro-motor development.
    So please consider all the possibilities before writing something
    Regards

    • Craig Payne April 23, 2016 at 9:01 pm #

      You are just making that up. There is not one study showing they have any negative or catastrophic influence on posture, let alone 100’s of studies!
      As for huge “huge impact on the development, and kids (most of the time) with orthotics will have a lower neuro-motor development.”; you are also making that up as well. The published research evidence on that says the opposite. have you even read it? What are you hoping to achieve by just making stuff up for?
      I will stick to what the evidence says and change my mind when it says otherwise.

  14. Alex April 23, 2016 at 9:14 pm #

    You running this website, so instead of crying and answering straight away, at a 2 years old post, that I made everything up. Take your computer and read neuroscience articles.
    Thank you

    • Craig Payne April 23, 2016 at 9:20 pm #

      I have read all the papers on this. There is not ONE study in the neurosciences literature that says what you claim, let alone the 100’s you claim there are. You are simply making this up.

      If what you are saying is true, then this would be big news. I can’t find the studies and no one else I know can either. Perhaps you could help us out by citing the 100’s (or even just one) of references that claim what you say.

    • michigan Biomech April 23, 2016 at 10:00 pm #

      @Alex. I too am very familiar with the foot orthotic and neuroscience literature (I teach in the neurosciences program) and have never come across what you are claiming. Can you please share your references as I would like to read that. That is if that literature really exists, which I doubt.

    • Peter Bird May 7, 2016 at 6:03 am #

      Come on @Alex, I have been checking in every day since you posted looking for you to come up with the goods. You have failed to provide 1, let alone the hundreds that you claimed there were. So, we have no recourse but to conclude that you were making it up. ie you are a liar.

      • Craig Payne May 7, 2016 at 6:07 am #

        Yep; I think we can safely call BS on this one.

  15. Jacob June 4, 2016 at 7:42 am #

    I know that there are many large studies, which show positive outcomes for the things they were studying. But you have to balance that against my gut feeling that in some vague way orthotics are not natural.

    Besides, vested interest, orthashill, appeal to nature, ad hominem (Craig smells), pseudosciencey words, another appeal to nature, vague analogy between orthotics and something not orthotics, illuminati, WTC 7 and the children! Will nobody think of the children!

    So as you see, there are compelling arguments on both sides which should be considered comparable.

    • Craig Payne June 4, 2016 at 7:45 am #

      Not really. The science is really clear: they work (except for that one study on bunions in kids)

      • sean October 4, 2016 at 12:14 am #

        Depends what you mean by work, Craig.

        The Cochrane review that you are fond of citing states this in its conclusions:

        “There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain. Currently, there is gold level evidence for painful pes cavus and silver level evidence for foot pain in JIA, rheumatoid arthritis, plantar fasciitis and hallux valgus.”

        So, whilst it is true that orthotics have been demonstrated to assist in foot pain with patients with these specific conditions, it is not true that orthotics ‘work’ for all conditions for which they may be prescribed by all practitioners.

        The average man on the street seeking expert advice for treatment for foot pain is not served well by comments like ‘orthotics work’. This information is incomplete.

        Surgery works better than orthotics for many of the conditions that othotics are used for but I don’t see you advocating for surgery over the prescription of orthotic devices.

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