03/24/2018    Keith L. Gurnick, DPM

Foot Orthoses Not Superior for Improving Pain and Function in PHP

First let me state that I have not read this
specific study, but I would like to state what
will be obvious to all of our readers which is
that all foot orthotics are not the same, all
those who write prescriptions and order foot
orthotics do not have the same high level of
training and expertise and experience with
orthotics, and many similar studies are flawed.

An orthopedic surgeon, who specializes in foot
and ankle surgery and now practices in my
locality, wrote a similar article many years ago
that gave a similar impression as this article.
When I questioned him at a hospital staff meeting
about foot orthotics, I asked him directly the
following 4 questions to assess his knowledge of
biomechanics and orthotics.

1) Please define metatarsus primus elevatus.
2) Please define forefoot varus
3) Please tell me the reason and purposes of
including a rear foot post on a rigid functional
orthotic.

He was unable to either answer any of these basic
questions or answer them correctly. How can
someone with little to no knowledge of
biomechanics and orthotics author a valid article
about the purpose and usefulness of orthotics to
treat any condition? Also, orthotics designed by
trained experts are different than orthotics
designed by untrained doctors who do not know
they are not experts. Just naming an orthotic a
"custom orthotic" does not really let anyone know
how it was prescribed, what materials were used,
how the impression was taken, how it was used
and/or not used.
This article :
http://journals.sagepub.com/doi/abs/10.1177/10711
0079902000402

And the really sad note related to this article,
is that some insurance companies, specifically
Aetna (back then) used this article as a
reference source to deny reimbursement for foot
orthotics as an acute treatment for plantar
fasciitis. Sad.

Keith L. Gurnick, DPM, Los Angeles, CA

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