updated 7/28/10
The Trouble with Orthotics
A consumer’s guide to buying orthotics
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
“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 are reliable sources for these products and services: Certified Pedorthists (C.Ped) and Certified Orthotists (CO) are the professionals that I recommend. Unfortunately, many people are unfamiliar with these professionals, why they are the best choices, or where to find them.
Caveat emptor! Many orthotics are poorly made and for the wrong reasons
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.
Unfortunately, many orthotics sold to consumers may not be worth the clay the mold was made from — even when a professional appears to be expert about feet, the effectiveness of orthotics prescribed or manufactured by anyone but pedorthists and orthotists is questionable.
Only pedorthists are trained in both gait analysis, lower body anatomy and biomechanics and the actual fabrication of custom foot orthoses. (Orthotists have a more limited scope of practice and focus on the orthoses themselves.) 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 not 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 — a foot doctor — are necessarily of good quality. They may well be, but many probably are not. Unfortunately, the credentials of a podiatrist do not guarantee quality orthotics.
A podiatrist is a full physician, but specializing in foot problems. In Canada and the US, his or her expertise is primarily 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, and there are some prominent experts in the field who have really gone this direction, but they are not obliged to do so.
You could say that it’s not in their job description.
As a point of interest, most podiatrists outside of North America, are probably a different matter — and I have a large international readership, so this is a worthwhile clarification! Dr. Mark Heard, in Australia, agrees with my assessment that most North American “Pods” are surgery focussed, but explains that other Pods around the world are more focussed on biomechanics:
Undergraduate training around the world doesn’t go so far as the US in surgical training. It’s an option in other countries, but greater training is required. So most Pods here tend to be more biomechanically focussed, and more interested in a holistic approach to musculoskeletal health. We have the option of surgery, but it requires considerable post graduate training. My own training allows me to undertake superficial surgery (i.e. for ingrown toenails, removal of warts etc), but that only makes up a small amount of my practice.
— Mark Heard, Podiatrist D.App.Sci, M.A.Pod.A.
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, and for which orthotics have the most potential to aid:
- 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 potentially 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 even more advanced professional designations for pedorthists as well.
“The Pedorthic profession in Canada is moving in a great positive direction with integrity, attracting only University educated individuals to become certified pedorthists,” says Paul Rauhala of OKAPED in Canada’s Okanagan Valley. That training translates into an impressive experience for the patient: I have been a patient at OKAPED in the past, and was blown away by the thoroughness and technical expertise of their assessment, which included slow motion video. My own training in orthopedic assessment gave me just enough knowledge to realize how much more Mr. Rauhala knows know about it than I ever will — in the leg, anyway!
C.Peds and COs are not the only sources for good orthotics, but certainly the most reliable. If you think orthotics might be appropriate for you, please seek one out.
If any other health care professional wants to sell you orthotics, please ask them to refer you to a certified pedorthist instead.
How to find a pedorthist
In Canada, go to the website for the Pedorthic Association of Canada. In the United States, the Board for Certification in Pedorthics. You can easily Google similar associations in other countries — wherever pedorthists are practicing, they will have an association, a website, and practitioner information.
