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Overperscription of Orthotics

Discussion in 'Break Room' started by Barry Onion, Nov 17, 2011.

  1. Barry Onion

    Barry Onion Member

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    Good Afternoon All,

    I am writing this because of my concerns regarding the overperscription of orthotics.

    More and more I am meeting people who have received orthotics to overcome one issue only to have, after a period of time, several new biomechanical problems arise.

    May I respectfully suggest, that there appears to be an epidemic of orthotic over perscription going on. This can only end in tears in the long run.

    Podiatrists one and all, please discuss. :good:

    Barry Onion
  2. Craig Payne

    Craig Payne Moderator

    Where are you getting your data from to make the claim of overprescription?
    I have never seen that. Where are you getting the data from? In every single study that has looked at clinical outcomes with foot orthoses, every single one of them has shown they work and not one of them has shown what you are claiming.
  3. Barry Onion

    Barry Onion Member

    My own research (unpublished) indicates this. Also anecdotal information gleaned from colleagues and aquaintances indicates a tsunami of orthotics being prescribed on a daily basis, these are in addition to the over the counter orthotics that people "think" they need. From my personal viewpoint many of these are unecessary, this position is supported by the current research, including leading sports scientists who debunk the need for orthotics. :good:
  4. Craig Payne

    Craig Payne Moderator

    Care to share that research with us? I have never seen any research that shows that.
  5. Barry Onion

    Barry Onion Member

    For example my research has uncovered the following from an orthotics user:

    Orthotics should be banned for all but extreme cases of need. Foot strengthening exercises, i.e. barefoot walking should be used instead of these foot weakening “walking stick” devices....

    ....After wearing orthotics for 10 years the original problem has long gone and now I have five more problems that I never had before the orthotics. Think carefully folks if you have these foisted your way.

    Although these are strong words, one needs should take an objective view with such statements. However, notwithstanding the aforementioned, the overprescription of orthotics will be one of the greasted challenges to be faced by the podiatry profession in the future. Like I said in my first posting, it can only end in tears.:good:
  6. Craig Payne

    Craig Payne Moderator

    How about answering the other part of my question and show us the reference for that? Where is all this research from leading sports scientists? (What do they know about foot orthotics anyway!)
    All the outcome studies on foot orthoses generally show at least a 75%-80% success rate, so you have a few quotes from some in the 25%-20% group!! Thats just blowing hot air. How do you even know that the problems in this person were even related to the foot orthotics??? Sound like really bad science to me.

    The success rate of knee replacement surgery is 75-80% - should be ban this because they do not work in 20-25% of the time?
    The success rate of antibiotics in strep throat is 75-80% - should we ban them because they do not work in 20-25% of the time?
    The success rate of .... etc etc etc

    You do realise that the minimalist/barefoot trend is an 'economic stimulus' package for podiatry and running injury clinics due to the extremely high rate of injuries happening in this group! We have all got busier because of this.
    Do you actually have any idea how many orthotics podiatrists actually do? On a numbers basis Podiatrists are small players in the overall foot orthotic market.

    Here some questions for you:
    How many cases of posterior tibial tendon dysfunction have you treated in the last month or so?
    How many cases do you think I have treated?
    If I used orthotics in them all, am I over prescribing?
    What should I have done for them rather than use foot orthotics?
  7. Here I thought this was going to be an interesting discussion. Instead it is just more bullsh!t re taking your shoes off to go for a run.

    Barry - good for some bad for others. Repeat so it makes you think good for some bad for others.

    Now here's the problem before anyone starts running we in general can't tell what injuries a person will get too many factors. Bad training, increased or decreased leg stiffness, kinetic and kinematics changes which occur with different speeds and ground interface changes etc etc etc ie there are many more factors - we can estimate but never truely know if these changes will cause injury until injury occurs.

    Taking off your shoes is another factor to be considered.

    Good for some bad for others - problem is some of us are intersted to find out what conditions are good for whom, others promote crap.
  8. Orthican

    Orthican Active Member

    Hey, just had dejavu! ........It seems to me I've read all this before.....Mr. Onion did you read any of the information on the barefoot threads?
  9. Barry Onion

    Barry Onion Member

    My experience from barefoot walking has been a 90 to 95% success rate. The walker inevitably finds themselves with better balance and coordination, which I believe increases their quality of life. Additionally with their greater interconnectedness to the natural world there is a holistic pre-emptiveness to overcoming their physical difficulties. I note that barefoot walking is not for all, i.e. those with dangerous foot pathologies. My challenge to you is how can a piece of plastic or carbon fibre, in most but not all cases, overcome the natural bone, tendon and ligament structure of the foot and lower extremities. I think that in western society there is a tendency to find quick and fast solutions to problems, i.e. orthotics, without fully understanding the long term consequences of these actions.
  10. Barry Onion

    Barry Onion Member

    Respectfully this has nothing to do with barefoot running, it is to do with a prevailing contarian viewpoint that turning to orthotics occurs far too readily without an investigation of the underlying causation, which in turn may or may not require orthoses but more often than not a course of barefoot walking will cure.
  11. Tuckersm

    Tuckersm Well-Known Member

    You haven't provided ANY evidence for anything you have said. We have a few anecdotes presented as proof of an opinion?
    I don't understand the scientific method that you used to show that this means podiatrists and others are over prescribing.
    To use Craig's example, are the orthopedic surgeons over prescribing joint replacements?
    If there is evidence that something works, it could be considered unprofessional conduct not to offer such a service to a patient, and instead offer a treatment based on anecdotes.
  12. Barry Onion

    Barry Onion Member

    Dr Nigg in the NYT.
  13. Tuckersm

    Tuckersm Well-Known Member

    Try a rebuttable scientific peer reviewed journal, not a newspaper.
    And I thought you said you had conducted some unpublished research.
    Did you apply for and have ethics approval for such a study?
    Did the patients know that they were involved in a study?
    These are both required ethical practices for any researcher, and again anything less could be considered unprofessional conduct under the AHPRA definitions.

    Is it still April 1st in WA, because this is a good laugh
  14. Barry Onion

    Barry Onion Member

    Seriously, I would just like to discuss the concept that orthotics are sometimes prescribed unnecessarily.
  15. I'd say they are Barry. Yet probably not by podiatrists. I visited a Foot Solutions store the other day with a friend, I kept quiet. Basically this shop assistant who was at pains to point out that they were "all about arch supports" and "nothing to do with chiropody or podiatry" went about the hard sell not realising that both my mate and I are podiatrists. I quote: "It's all supination, pronation".

    I've had a number of people come to me now complaining about their experiences with this company. The latest in this growing list was a lady with plantar fasciitis, she was (like all the others) sold a pair of custom devices plus a pair of cheaper (£90) prefab devices. As I pointed out to her, if she needed custom devices to get a positive outcome for her problem, why did they sell her the prefabs? And if the prefabs should have been efficacious why did they sell her the more expensive custom devices? What she doesn't know yet is that when the custom devices arrive they'll attempt to sell her a pair of shoes at around £150 too.

    Similarly, there was the case of the young girl who'd had a nasty fracture which had resulted in a considerable limb length discrepancy, again sold a pair of custom devices which had a lift to the shorter leg and a pair of prefabricated devices which did not. Neither device really contacted the arch area of the cavoid foot present on the shorter limb side.

    Unfortunately, there is no legislation which prevents any Tom, Dick or Harry selling foot orthoses- "it's all supination, pronation". And the slick sales staff are clearly able to convince the general public.
  16. Tom Quinton

    Tom Quinton Member

    Hi Barry,

    I think it would be helpful if you were a little more specific. Overprescribed for which conditions? It appears that you might be leading into an argument wholly against orthotic prescription?

    Slightly of topic, however, still relevant, I would like to see some thoughts on this idea.

    Is it possible that two opposing treatment modalities could be equally effective for the same condition? For example, orthotics vs minimalist shoes for an overuse injury? I think you could apply the tissue stress model to both modalities?

    Orthotics may be effective by reducing stress at the injured structure. Whereas if the minimalist shoes were prescribed the patients gait may significantly change again reducing stress at the injured structure?

    Biomechanics is not my field so please correct if I’m wrong or feed me some literature. Also I have been away from podiatry arena for while and if this has been discussed elsewhere I apologise. :drinks
  17. Griff

    Griff Moderator


    1. There is no research (I mean proper research here - not asking some bloke down the pub) that foot orthoses 'weaken' feet

    2. Is it possible that over the last decade other factors may have contributed to 'new problems'? (Clue: answer is yes). Or is it easier for the unknowledgeable to just blindly attach causation to the orthoses? (Clue: answer is yes).

    Perhaps you should tell us more about your 'research'. In particular I'd be interested in the research question, and the methodology implemented to answer that question. Oh, and what lens you are looking through (i.e. What your background and your current profession are)

    Care to elaborate on this point?
  18. Tuckersm

    Tuckersm Well-Known Member


    With that I totally agree. Not sure how often it occurs though.

    At our hospital, the orthopods refer directly to a private Orthotist, who, low and behold, makes a custom device, that the hospital pays for, that is likely to be never used.......

    I have now at last, since becoming more of an administrator and less a clinician, been able to stop this, and at least have a third party (podiatry) review 1st.
  19. Craig Payne

    Craig Payne Moderator

    BTW, you do realize that only two studies have looked at muscles strength and foot orthotics. One showed they actually increased muscle strength and the other showed no change in muscles strength .....

    I go where the science takes me, not where the propaganda and rhetoric takes you.
  20. Peter

    Peter Well-Known Member

    Barry, I would prefer if you were less general in your phraseology. "Commercial Orthoses" are probably over sold by eager shop salespeople, but prescribed (as in for a diagnosed lower limb pathology) orthoses are probably not.

    I consider NHS and private practitioners to be in the latter category!

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