updated 3/11/06
The Trouble with Orthotics
A consumer’s guide to choosing a supplier of orthotics
by Paul Ingraham, Registered Massage Therapist (Vancouver)
This document expresses my opinion only, and does not replace medical advice. More …
“We train for many years and we take our jobs very seriously. It's great to see support for pedorthists, and recognition of the difference between podiatrists and pedorthists. I have a problem with a professional who is allowed to diagnose, prescribe, and dispense within a 15-minute appointment. Prescribers are not providers for a reason!”
— T.Moffitt, C.Ped. (C) Certified Pedorthist, Edmonton, Canada
People often tell me that they think they “might need orthotics,” but they rarely know more than that. Custom foot orthoses, custom orthopedic footwear, or orthopedic shoe modifications can be invaluable in the right circumstances. Unfortunately, it is difficult for consumers to determine whether or not they actually need any of these products, or where to get an expert prescription and a quality product.
Fortunately, there is a reliable source for these products and services — certified pedorthists. Although many of my clients are interested in orthotics, surprisingly few of them know what a certified pedorthist is, why they are the best choice, or where to find one.
Caveat emptor
Foot, ankle, knee and hip biomechanics are extremely complex. Gait analysis is an art as well as a science. In my opinion, non-specialists cannot navigate this maze successfully with every patient, and orthotics should never be prescribed without a thorough examination — at least a half hour, and more if the case is complex.
Yet across North America — and I’ve seen it myself in Vancouver — you can find lab-coated charlatans hawking corrective shoe inserts in shopping malls, using flashy displays and entertaining technology to “assess” your feet with lasers or infravision or anything at all that will distract you from their lack of skill and knowledge.
Only certified pedorthists are trained in the actual fabrication of custom foot orthoses.
Unfortunately, even many orthotics sold to consumers by health care professionals may not be worth the clay the mould was made from — even when a professional appears to be expert about feet, the effectiveness of orthotics prescribed or manufactured by anyone but a certified pedorthist is questionable.
Only certified pedorthists are trained in both gait analysis, lower body anatomy and biomechanics and the actual fabrication of custom foot orthoses. All other health care professionals are obliged to order orthotics from an external supplier.
For instance, a physiotherapist or a chiropractor selling orthotics — and this is a common practice — generally asks a client to step in some special foam in a box, fills out a form specifying features of the insert, and then ships the foam off to a manufacturer who sends back some shoe inserts. Like lasers at the mall, this procedure may create the illusion of a customized product, but in reality nothing much is being done except making a piece of plastic that fits your foot: it is not necessarily corrective or therapeutic in any way.
Even podiatrists don’t necessarily make good orthotics
It’s a common misconception that orthotics provided by a podiatrist are necessarily good quality. They may be, but most probably are not. Unfortunately, the credentials of a podiatrist do not guarantee quality orthotics.
A podiatrist is a physician with a specialization in feet. His or her expertise is usually concerned with foot pathology and corrective surgery, and does not always extend to include expert gait analysis and physical assessment of biomechanical dysfunction of the lower limb as a whole. Obviously some podiatrists cultivate an interest in this, but they are not obliged to do so. You could say that it’s not in their job description.
In any case, even a podiatrist skilled in the prescription of custom foot orthoses is still obliged to have them manufactured by someone else. For this reason, many podiatrists prefer to refer their patients to certified pedorthists.
Who needs orthotics?
There are four common conditions that pedorthists treat:
- plantar fasciitis (see Save Yourself from Plantar Fasciitis!), a painful inflammation of the sole of the foot, most easily recognized by its tendency to cause pain first thing in the morning
- arthritis, which often affects joints of the foot
- diabetes, which intereferes with circulation in the feet, requiring custom shoe modifications or custom-built footwear
- metatarsalgia, a painful foot disorder that affects the bones and joints at the ball of the foot
Other treatable conditions include patellofemoral knee pain (see Save Yourself from Patellofemoral Pain Syndrome!), shin splints (see Save Yourself from Shin Splints!), achilles tendonitis, and bunions, as well as numerous systemic pathologies that (like diabetes) affect the function of the lower limbs.
If you have foot or leg pain, by all means seek the opinion of a certified pedorthist. Even if orthotics are not necessary, he or she may recommend shoes that may be more appropriate for you — a factor that is often overlooked.
The credentials of certified pedorthists
Certified pedorthists must have a relevant degree, spend at least three years in apprenticeship, and then pass demanding exams. That entire period of work experience is devoted to the lower limb, and to the ankle and foot in particular. There are more advanced professional designations for pedorthists as well.
In my opinion, certified pedorthists are by far the best source of orthotics. If you think orthotics might be appropriate for you, please seek out a pedorthist. In Vancouver, I recommend Paris Orthotics. Many of my clients have received excellent care there. Clients have also reported satisfaction with Kintec Foot Labs.
To find a pedorthist elswhere in Canada, contact the Pedorthic Association of Canada. In the United States, the Board for Certification in Pedorthics.
If any other health care professional wants to sell you orthotics, please ask them to refer you to a certified pedorthist instead.
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