Avoid Running into Trouble: Orthotics Can Cause Problems if Improperly Prescribed

New York, NY—July 1, 1999

Orthotics, or orthopedic shoe inserts, can be useful devices. But if improperly prescribed they can lead to pain and discomfort, and even cause serious injury, warns Rock Positano, DPM, a foot and ankle specialist at Hospital for Special Surgery. Dr. Positano cites the case of a patient whose mail-order orthotics resulted in a broken bone in each foot. The patient thought the devices would provide support for his running. They landed him in Dr. Positano’s office instead.

"Orthotics are like prescription drugs," Dr. Positano explains. "When indicated and prescribed correctly, they are beneficial to the user. When unnecessary or prescribed incorrectly, they can be dangerous." Some over-the-counter orthotics may exacerbate pre-existing medical conditions, Dr. Positano says. Those at particular risk are people with heel pain, achilles tendon pain, back or knee problems, or those who have a high arch foot type or flat feet. Exercise enthusiasts who engage in high impact or high velocity sports often buy orthotics to provide support or serve as shock absorbers. That, too, can spell trouble.

Orthotics are not used to correct foot and ankle problems. Health care professionals prescribe them to stabilize a joint, reduce pain, prevent deformity, provide better positioning or improve the biomechanical function of the foot, according to Dr. Positano. They work by removing pressure and stress from painful areas in the foot and ankle. Custom orthotics, which may also be useful in alleviating knee, hip and lower back pain, should not be confused with the prefabricated models found in shoe stores, ski and skate shops, pharmacies and sporting goods stores, Dr. Positano advises. There is a tremendous difference in quality and effectiveness.

"Orthotics alter the way a person walks, stands and absorbs shock from the ground," he says. "Anyone wishing to use them should have a good reason and be sure to consult a professional with the proper training and credentials, such as a podiatrist." He or she will ask about any medical problems or pain the person may have. The health professional will also consider gait analysis, orthopedic issues, level of activity, the type of activity, foot type, and biomechanics, which refers to ankle, knee and hip movement. X-rays may be taken, as well.

When prescribed responsibly and used correctly, orthotics can be extremely helpful. It's important for patients to follow the doctor's instructions on when to wear them to obtain the greatest benefit, according to Dr. Positano.