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Sorry to be bringing up such a basic issue. I know that root theory is dying and not every deviation from 'normal' should be treated unless one links pathologies to these deviations. But what would constitute as symptomatic?

let me use my self as an example: the most obvious deviations from the 'norm' would be -1 FPI,slight forefoot equinus,slightly pf 1st ray to result in a slight cavoid foot. I have had a couple of running injuries in the past such as plantar fasciitis and achilles tendinosis. Have been using a semi-rigid insoles with a 1st ray cut out and not sure if this is needed or whether simply I just got used to this. Now if I do not wear the insoles the muscles supporting my arch (particularly tibialis posterior) get tiered quickly and am not sure if this is a sign that I need the orthoses or if these muscles simply need to get back into working shape

Any thoughts please on cases such as mine?

 

Now you are in the tricky area of preventative medicine. Orthotics are not like polio vaccine where we have a good idea of risks and benefits. There is very low risk to taking the vaccine and the rate at which the disease is prevented is very high. We don't have the study that correlates the amount of plantar flexed first ray with the likelihood of injury occurring because of that first ray. On top of that we don't have the study that will tell us how much injury will be prevented by how much force reduction on the first ray with a given amount of walking. This is the art of medicine. We have to admit that we don't have a precise answer. Life is just one big experiment. That said, if you had previous injury that you can attribute to a foot "deformity" then that certainly is a good case for preventative treatment.

I certainly have not problem using varus or valgus wedges when I see extremes of STJ axis deviation even in the absence of complaints from the patient.

 

I think I understand what you are saying. Each patient is different so it is important to take a good history and decide if the insoles would benefit the patient. Thanks :)

 

Also, orthotics should be comfortable. If you try an orthotic with a first ray cutout (and perhaps a small forefoot valgus wedge?) and it's comfortable - then by all means keep wearing it.

You mention muscles. supporting, and arch, all in one sentence :eek:. The muscles don't support the arch. You will not weaken the muscles by wearing orthotics for some of the time.

I've worn rigid orthotics for the last 30-odd years. Guess what? I still have two medial longitudinal arches without them. Toes are pretty straight too, and both 1st MPJs work just fine. My feet have been well-used over 67 years and I would say that orthotics have kept them in good condition (n=1).

You are correct in supposing that each patient is different, but orthotics do not do the harm that certain "experts" (mostly currently from the barefoot brigade) say they will.