Although they are often not used in the right way, I believe that under the correct circumstances, orthotics can offer massive biomechanical benefits, and compliment a treatment programme nicely. Here's why:
So, what are these circumstances? Well, I believe there are two. Firstly, let’s say that a patient has a permanent biomechanical dysfunction. Now, I want to be clear on what constitutes a ‘permanent’ dysfunction, as there are likely differences in what people think to be permanent, and some will probably have quite a loose definition of what it entails. For instance, a problem that has been going on for a long time won’t necessary be a permanent issue, it might just be that the true cause has not yet been isolated and treated, or if it has, pain may persist if the individual has not persisted with the appropriate level of aftercare. What is a permanent dysfunction then? I regard this as a biomechanical problem within the body that cannot be fully reversed, and the typical causes of this can be traced back to surgery or a trauma e.g. a break that has healed in the wrong position, or if the patient has some form of disability or congenital condition. Essentially, if the biomechanics have been effected in a way that cannot be completely reversed through more conservative methods, then I regard it as a permanent dysfunction, and I would always opt to go for orthotics to manage this problem wherever reasonable and realistic, in order to avoid potential further complications from surgery.
"if the biomechanics have been effected in a way that cannot be completely reversed through more conservative methods, then I regard it as a permanent dysfunction, and I would always opt to go for orthotics to manage this problem wherever reasonable and realistic"
The second scenario where I believe orthotics are helpful is as a temporary measure to tempt the body into a more biomechanically neutral position. After all, as we go about our daily lives, we form habits (many of them bad for our postural health), which can be difficult to alter. Therefore, in this scenario, the orthotics can act as a cue for the body to remind the brain of how it should be moving, which will aid in our skill development so that it will get to the point where it helps the brain become accustomed to this movement, until the body is strong enough, and the brain is technically developed enough, for you to hold these better positions, and execute better technique; such as walking and running, without a second thought. While I concede the fact that the role of the orthotics here are only temporary, and that it may therefore only appeal to those who don’t mind spending a significant amount of money on a short-term, complimentary measure, this may still be necessary to gain the best outcome possible for the patient.
Think of it this way - if a marathon runner was to come to you with an injury 2 months before they were due to run the event which was really hindering their training, then 2 months most likely would not be long enough to completely fix the problem, even if the patient is extremely disciplined and is willing to adhere to the suggested aftercare every day. This is of course because of the fact that strengthening and gait retraining take a long time, they therefore will not provide an instant benefit. This situation is of course worse if the patient's compliance to their aftercare programme is low. This is where the orthotics come in, as if we can start to positively affect the misalignment in the body that first came about from muscle weakness by using orthotics, we should hopefully get an immediate improvement. This then could help the patient to manage their pain while not having to significantly reduce their training load, until they get through the marathon. After this, the patient can then be encouraged to adhere to the longer-term strengthgening programme, and not be dependent on the orthotics long-term. After all, as humans, unless absolutely necessary, we shouldn’t be reliant on any external devices in the long-term to be able to move naturally. For instance, when was the last time you saw a wild animal wearing orthotics just to be able to walk and run around naturally? In sum, while in this situation the orthotics may not be needed to get better, as strengthening alone can do this, orthotics may be needed to allow the patient to achieve their short to medium term goals, and to relieve their short to medium term pain.
"orthotics may be needed to allow the patient to achieve their short to medium term goals, and to relieve their short to medium term pain"
So what would I say to people who are anti-orthotic? Well, we have to go with what the research evidence says, and generally speaking, the proper research does support their use and effectiveness, despite the fabricated horror stories that you can often read online (no doubt produced by someone with a preconceived bias). It is also unfortunate that they are often misused whereby they likely are not effective because they were not needed in the first place. However, to conclude, they can be powerful tools to relieve people from pain (even if it is just a short-term measure) and is that not the whole point?