Gait Retraining: A Better Solution?
Further up the kinetic chain, some research has shown that gait retraining may reduce pain and enhance function. For example, researchers at Ohio University in Athens were able to reduce patellofemoral pain in female runners by training them to improve their lower-extremity alignment.
Dr Vincent puts this information to work by analyzing what has caused her patients' pain.
"Some of the best and most meaningful information comes from getting the patient's history," she says. She starts by asking whether anything has changed in the type, volume, or intensity of the exercise the patient is doing, and whether they have recently changed shoes.
She next uses a 3D motion-capture system similar in technology to those used by video game developers and animation studios and a force-plate template to analyze the way the patient moves. On the basis of her findings, she may recommend gait retraining, strengthening, and flexibility exercises. "We have to get patients to a place where they can run more naturally," she says.
Dr DeSantis counters that this approach might work for young, fit runners, but he's not so sure that it can help many of his patients, who are overweight and middle-aged. "In those type of people, I think a minimal shoe would be a mistake," he says.
His own experience has taught him that making a custom orthotic can fairly quickly provide relief for a lot of his patients' pain. And once they are out of pain, they often don't want to give up their orthotic, he says.
Overlapping Schools of Thought
How to resolve these contradictory approaches?
Thankfully, the two schools of thought overlap in crucial ways. Dr DeSantis is willing to accept that strengthening and flexibility exercises have a role for most patients. "In almost all of them, I would think physical therapy is an integral treatment," he says.
And Dr Vincent can accept that foot orthotics have their role in taking pressure off temporarily until the right training regimen can address the underlying problem.
Between the two positions, perhaps a clinical way forward can be glimpsed for common musculoskeletal complaints: foot orthotics to address the problem in the short term, with exercise, stretching, and movement retraining as the longer-term prescription.
Medscape Orthopedics © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Do Orthotics for Foot Injuries Really Work? - Medscape - May 26, 2016.