|
  
ARTICLES:
Shoe Inserts
by
Carol Frey, M.D.
Foot and Ankle Specialist,
Manhattan Beach, CA
WCSMF - Education
Survey
finds Shoe Inserts as Effective as Custom Orthotics
People with heel pain often can get better relief from using over the counter
shoes inserts than from more expensive custom made orthotics, according
to a two-month multimedical center study of 236 patients.
Carol C. Frey, MD, associate professor of orthopaedic surgery, University
of Southern California, said that the results indicated that custom orthotics
are not useful for all diagnoses and often are over-prescribed.
In a report at Orthopaedics Update '96, the sixth annual science writers
seminar of the American Academy of Orthopaedic Surgeons, Dr. Frey said all
patients in the study were told to do stretching exercises of the Achilles
tendon and plantar fascia, and non had previous heel problems.
The percentage of pain relief for patients who used over-the-counter orthotics
was as follows: 95 percent, a silicone heel cushion; 88 percent, a heel
cup, and 81 percent, a felt heel pad or arch support. Only 68 percent of
those who used custom-made orthotics gained relief. Of the patients who
only did stretching exercises without an orthotic, 72 percent had diminished
heel pain.
"Heel pain is the mist common foot problem seen in medical practice,
in addition to bunions, corns, calluses and hammertoes," said Dr. Frey.
"Custom-made and over-the-counter orthotics cushion, support, align
and improve foot functions, and prevent or correct foot deformities,"
said Dr. Frey. "They are made from felt, viscoelastic material, silicone,
closed cell rubber or polyethylene, and are temporary, permanent, soft,
semiflexible or rigid."
If a patient needs custom orthotics they can be designed by an orthopaedic
surgeon after the foot is examined in a variety of positions. A mold is
made of the foot through a casting process, with modifications made to the
mold as necessary.
However, limitations of many custom-made orthotics, she said, are that people
need different devices for sports and for dress shoes, which becomes even
more expensive.
"In addition, rigid orthotics can cause a neuroma (tumor that results
in a pinched nerve) as well as a sesamoiditis (Inflammation of a small bone
embedded in a tendon or joint in the foot). These harder orthotics also
may reduce the energy of running athletes and contribute to their foot disorders
including stress fractures," she said.
"Refraining from prescribing expensive $300 to $400 custom-made orthotics,
when $15 to $40 over-the-counter inserts will prevent the pain is common
sense," said Dr. Frey. "It also saves money for the patients health
care providers and insurance companies."
In many cases then need for orthotics could be eliminated, said Dr. Frey,
if people would select the proper shoes for the size and shape of their
feet.
An orthopaedic surgeon is a medical doctor with extensive training in the
diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal
system, including bones, joints, ligaments, tendons, muscles, and nerves.
The 17,000-member American Academy of Orthopaedic Surgeons is a not-for-profit
organization that provides education programs for orthopaedic surgeons,
allied health professionals, and the public and is an advocate for improved
patient care. |
|
BACK
|
