Short or Long Term Use of Foot Orthotics?

While the evidence of the efficacy of foot orthotics is really clear on them working, what is not so clear is if they are really needed over the longer term or if they should just be a short term intervention. Like a lot of other clinical decisions, there is no evidence to guide this, just a lot of rhetoric and propaganda, especially from bloggers with no clinical experience! There are plenty of people who have worn orthotics long term and none of them have become infertile, got brain damage, gone bald or got heart disease form wearing them over the long term. There are also plenty of people who seem to only need to wear their foot orthotics in the short term and they are fine and have no more problems.

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So, should they be used in the long term or only as a short term measure? Firstly, there is absolutely nothing wrong with the long term use of foot orthotics. There is no evidence of any harm from them. Two studies have shown that they increase muscle strength and one study has shown that they do not weaken muscles, so any one who makes the claims of them weakening muscles are talking through a hole in their head, as the evidence on that is really clear. They certainly can’t point to any evidence to support what they are saying. Surely, if someone is going to make such claims, then the onus is on them to come up with the evidence to back up the claim.

So when should they be considered short term interventions vs a long term intervention? In the context here of overuse injuries¹ being due to cumulative loads in the tissues beyond what the tissue can take, foot orthotics are a good way to reduce that load in the tissues to a level that the tissues can tolerate. What is wrong with that? Problem solved. If someone is happy to keep wearing them knowing it won’t weaken the muscles nor make them infertile, bald or give then heart disease, then what is wrong with that? Keep in mind that in some injuries and in some tissues, foot orthotics can not reduce the load, so should probably not be used in those situations (unless there is another compelling and rational reason to use them).

What if they don’t want to wear them over the medium to longer term? That is fine and there is nothing wrong with that. The only way for this to happen is to increase the ability of the tissues to take the load or find other ways to reduce the load on the tissue that is a problem. Keep in mind that this is not a short term measure and is more of a medium to long term measure. If someone is in pain or having a problem with an injury today, then the short term use of foot orthotics is wise (assuming that they are properly designed to reduce the load in the problematic tissue) and they do not want to wait until the medium term strategies have a chance to work. The ability of the tissues to take load can be enhanced with things like the emerging concepts of mechanobiology (eg eccentric loading exercises). This takes time and effort (as compared to foot orthotics which are easy!). Other interventions can also be used to reduce the load in the tissues that are problematic such as changing the running form and gait retraining, but this is more of a medium to longer term measure.

When might foot orthotics have to be worn in the longer term? They will need to be used if the tissues can not be adapted to the load. This can probably happen in two situations: One, when the loads are just so high that there is no way for the tissues to adapt to those high loads, so a more long term reduction in those loads is needed with foot orthotics (invariably this is due to higher joint moments from variations in joint axes positions; or a problem with high body weight). Two, the runner does not comply or is not willing to carry out the exercises needed to help adapt the tissues. Additionally, some people are just more comfortable wearing them. There are no problems with that.

It all comes down to personal preferences in the context of what evidence there is.

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

¹Obviously we are not talking about the type of foot orthotics used for treatment and prevention of plantar diabetic foot ulcers, painful plantar rheumatoid nodules, etc

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4 Responses to Short or Long Term Use of Foot Orthotics?

  1. Kevin A. Kirby, DPM April 5, 2013 at 11:12 pm #

    Craig:

    Nice article.

    When discussing such things as whether one should wear foot orthoses long term or not, I first ask the person asking these questions whether they believe eyeglasses should not be worn long term for fear of the eyeglasses “weakening the eyes”.

    Foot orthoses do not prevent the foot from undergoing full ranges of pronation and supination motion. They only prevent the extreme ranges of motion in the foot that cause tissue damage and they optimize gait function, just as eyeglasses optimize visual function.

    In addition, due to their ability to specifically reduce the pathological stress on injured anatomical structures in the foot and lower extremity, they very frequently allow individuals to become much more physically active than when they were injured before they were treated with orthoses. I have thousands of patients who have worn their foot orthoses daily for well over 10 years with no apparent ill effects just as many optometrists have thousands of patients who have worn their eyeglasses for years with no apparent ill effects.

    There is no evidence that foot orthoses weaken foot muscles. Those who claim otherwise don’t know what they are talking about.

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

  2. Craig April 5, 2013 at 11:49 pm #

    Not only is there no evidence that they weaken muscles; the evidence is that they strengthen them! Why are those who make the claim that they weaken them ignoring the data?

  3. Kevin A. Kirby, DPM April 6, 2013 at 2:34 am #

    Because they are ignorant of the facts, have an agenda based on misinformation and bias, and have never followed hundreds of very satisfied patients over many years to see the results that may be achieved with properly made custom foot orthoses.

    If orthoses were so harmful, why am I being asked to make so many 2nd and 3rd pairs of custom foot orthoses for my patients in my podiatric practice? Because they are weakening my patients feet? Please, give me some evidence that they weaken feet…not weak conjecture based on internet websites and biomechanics researchers who have the odd notion that foot orthoses are somehow like neck braces

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

  4. Dennis Shavelson DPM September 5, 2016 at 2:03 pm #

    Craig:
    When you keyboard:
    “When might foot orthotics have to be worn in the longer term?
    when the loads are just so high that there is no way for the tissues to adapt to those high loads, so a more long term reduction in those loads is needed with foot orthotics (invariably this is due to higher joint moments from variations in joint axes positions; or a problem with high body weight):.

    Can we add to this a third possibility:
    3. There needs to a change in the structure of the feet of that runner in order to improve the ability of the muscle engines and orthotics to increase therapeutic joint moments via foot surgery or vaulting foot orthotics.
    Dr Sha.

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