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are prescribed orthotics really necessary?

Posted by Missy on 3/10/05 at 10:34 (170872)

Two years ago I got a stress fracture from running. The Dr said that I had a collapsed metatarsal arch, and also ordered a Dexascan (sp?) to detect osteoporosis. Turns out I scored between a -1 and -2, meaning I had osteopenia. So, I upped my calcium and he prescribed these 'computer generated' orthotics, where I walked over this pad hooked to a laptop, and a program determined where my foot needed support. So I got these orthotics, with 2 supports-- one, the standard arch support, and then another bump just behind the metatarsal heads, for metatarsal support.

The arch supports have been fine. I did not have any more problems until recently, when I started running again after taking some time off due to pregnancy. I think I started back too much, too soon. I went to a different Dr., who said that I didn't have a fracture but I probably stressed the bone almost to the point of fracture. But when I showed him my orthotics, he wasn't really interested in them. He said that they were probably good for extra cushioning but that my foot looked fine structurally and probably some OTC supports would do just as well.

So, I wanted to get some more opinions on the use of orthotics for this problem? I should probably get another scan to check my bone density, but I really think that had my density not improved I would have gotten an all out stress fracture with this most recent injury. It would be nice not to have to deal with prescribed orthotics if I can get away with it, and just use OTC orthotics instead...

I should also mention that I have had other problems with this same foot-- plantar fasciitis, various ligament strains. All have been relatively minor and have healed with time off. I have seen numerous doctors for these ailments and none of them really mention strengthing the foot, but I wonder if that would help?


Re: are prescribed orthotics really necessary?

Dr. Zuckerman on 3/10/05 at 14:03 (170882)

The key is the outcome of your examination by your doctor. He stated that your foot looked fine. Did you have a gait ( walking) evaluation ?
Foot function and structure are very important to help prevent abnormal
stress and weight distribution in the foot.
So if there is no abnormal function and this is no excessive abnormal pronation your doctor is correct. Make sure you have your gait evaluated before you make that discussion

Re: are prescribed orthotics really necessary?

Eddie Davis on 3/12/05 at 17:08 (171051)

Sometimes orthotics are prescibed as the primary moality for a problem but other times they can be used as a secondary or adjuctive modality. The list is long but here are a few examples of secondary usage:
1)a patient had trouble walking due to circulatory problems; the orthotics did nothing for the circulatory problems but alowed him to singificantly increase the distance walked (which in turn is good for circulation)
2)a patient with osteoporosis or osteopenia has 3 stress fractures in 2 years. She tends to push off on the outside of her feet which is where the stress fractures occur. I can only refer her out for treatment of the osteoporosis/osteopenia but my othotics rectified her gait getting her to push off more on the big toe joint so getting further stress fractrures is unlikely even unitl enough years have gone by to reverse her osteoepenia.