Why Walgreens orthotics are just as good as customized orthotics, and other secrets

There are a few jewels I’ve come upon at my time here as a physical therapy student. Keep reading for my favorites.

Over-the-counter orthotics are just as effective as $300 ones.

Foot orthotics come in many flavors, ranging from ankle foot orthotics to accommodate foot drop, to simple heel pads to survive high heels. Frequently at UCSF, students complain of heel pain and plantar fasciitis, and are subsequently recommended an orthotic to remedy the issue.

Prefabricated orthotics cost $30 to $40, while customized orthotics can be upward of $300, so what you’re about to read could save you big time. Basically, Landorf et al. reviewed several studies in 2004 that all showed the same thing: The evidence thus far suggests that over-the-counter orthotics are just as effective as customized orthotics in alleviating plantar fasciitis pain. One study included in the review, by Pfeffer et al., actually found that prefabricated orthotics were better than customized orthotics.

The bottom line: The methodological quality of the studies in the review above is not the greatest, but three out of the four studies comparing customized to prefabricated orthotics found no difference. My takeaway: If you need an orthotic, consider making a pit stop at Walgreens first.

Fancy running shoes aren’t the end all.

A quick glance at Runner’s World reveals that running shoes dominate nearly every issue. This is for good reason too, as running shoes, alongside entry fees and Fitbits, are likely the biggest source of revenue in the running world.

I would personally like a dollar for every time I’ve heard, “I’m a pronator, so I like my Nike Air Cesiums,” because at one point, I actually succumbed to the all mighty power of gait analysis and selected the $150 ASICS Kayanos to address my own pronation problem. I want a refund. But not really—they’re pretty decent shoes.

Ryan et al. published a fascinating study in 2010: Wearing stability or motion control running shoes doesn’t actually fix the pain or the problem—it can make it worse. In a nutshell, Ryan et al. found that after stratifying runners based on foot type and providing the corresponding Nike shoe, participants matched to shoe type had more pain than non-matched participants. Knapik et al. 2014 also provide support for not prescribing footwear. Their meta-analysis revealed no difference in injury risk among military recruits running in shoes based on arch height versus not.

For some populations, however, footwear is standardized. Therefore finding the one-size-fits-all shoe is paramount. For example, in military recruits, Sinclair et al. 2014 found that running shoes, compared with army boots, are associated with a reduction in Achilles tendinopathy. So, don’t run in army boots.

The bottom line: The research is controversial at this point. Gait analysis continues to get fancier, as does the design of running shoes. It’s tempting for us in physical therapy to prescribe corrective footwear. Depending upon which study you find most convincing, you may want to shell out some serious dollars for “the right shoe,” or you may choose to try on a few pairs at Famous Footwear, pick the comfiest, and move on … unless you’re expected to run in army boots.

Stretching is not the holy grail of injury prevention.

For years as a competitive swimmer, I started every workout with a stretch warm up. Traditionally, most P.E. classes in grade school begin with some version of the fingertips-to-floor, straddles and arm-across-the-body maneuvers. Most of these regimens have been adopted with the thought that tight muscles lead to pulled muscles. So what’s the verdict?  

Witvrouw et al. 2004 make a convincing argument that although literature on stretching is contradictory, conflicting results can be amended if we stratify sports: In sports that require a compliant muscle–tendon unit (aka. flexible muscles that can accommodate explosive movements in sports such as football and soccer), stretching reduces injury rates in otherwise stiff athletes. In sports that do not have these requirements (i.e. cycling, jogging), stretching is kind of a waste of time.

What does slightly newer evidence suggest? McHugh and Cosgrave in 2010 reviewed several more studies, and came to the conclusion that stretching doesn’t do a whole lot in terms of injury prevention for overuse injuries, but may be somewhat useful in reducing the risk of muscle strains (Oh hey, that makes sense!). Stretching also has an annoying tendency to reduce muscle strength immediately after. The authors therefore made some practical recommendations: To stretch muscles that are at risk for strains (adductors, hamstrings and hip flexors), stretch long enough to be confident that you actually stretched, and to allow enough time after stretching before your big event, for the muscles to regain what strength they may have lost, since strength deficits are neurally induced.

Bottom line: Let’s keep in mind that with stretching, as with any hot topic, there are a lot of ifs, ands or buts. Consider the dance population. If ballet is your thing, you had better be sitting in a split basically 24/7 to acquire the requisite turn out (disclaimer: I’m not suggesting this is good for the hip joint.). On the other side of the coin, if you’re a sprinter, you may want to shy away from stretching just before an event, as basic research has shown that stretching leads to an acute loss of strength. So the best thing for you is to consider a) what type of activity you’re engaging in, b) your goal for stretching, and c) how seriously you want take all of this.  

References:

Landorf K, Keenan A, Herbert R. Effectiveness of different types of foot orthoses for the treatment of plantar fasciitis. J Am Podiatr Med Assoc. 2004; 94(6): 542-9.

McHugh M, Cosgrave H. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports. 2010; 20: 169-181.

Ryan M, Valiant G, McDonald K, Taunton J. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomized control trial. Br J Sports Med. 2011; 45: 715-721.

Witvrouw E, Mahieu N, Danneels L, McNair P. Stretching and Injury Prevention: an obscure relationship. Sports Med. 2004; 34(7): 443-449.