Shoe Inserts Kick Into High Gear

Some runners depend on “lucky” socks, baggy shorts or favorite T-shirts to boost their running performance. Rick Tjader, 33, a Culver City computer specialist, swears by his orthotics, custom-made, prescription shoe inserts that cost him $180.

Not that he’s complaining about the price. “Without my orthotics, I can’t run at all,” Tjader says. “It’s too painful.” The runner, who logs 30 miles a week, says the orthotics ward off painful swelling on the balls of his feet.

Like Tjader, many athletes hold orthotics in high esteem--at least as high as a certain major credit card. According to a recently published survey, more than half the orthotic users polled said they wouldn’t leave home without them.

More than a million orthotic devices are prescribed every year. In the last three years, prescriptions have increased by at least 10% a year. Sales of soft, nonprescription orthotics--sold in sporting goods stores for as little as $10 a pair--are booming, too, industry spokesmen say.

Serious athletes and weekend warriors aren’t the only ones buying orthotics:

* High heel wearers are discovering an important pump accessory--an over-the-counter orthotic, more likely to be found at Nordstrom’s than Big 5, that reduces the torture potential on the toes.

* Pregnant woman are wearing specialty orthotics designed to compensate for the posture changes that can accompany weight gain.

* And even couch potato consumers are slipping the custom-made inserts into street shoes, hoping they will improve shock absorption and decrease pavement-pounding agony.

Properly prescribed, custom-made orthotics can ease the agony of such common ailments as runner’s knee, shin splints (painful muscle strain along the shin bone), inflammation of the soles of the feet, arch problems and other conditions, foot specialists say.

In Tjader’s case, the balls of his feet became so inflamed he could barely walk. “Orthotics eliminate abnormal motion and make you walk more correctly,” says Scott Rosenthal, a podiatrist at Daniel Freeman Marina Hospital.

In adults, orthotics are most often prescribed when the foot excessively pronates, or rolls inward as it lands, says Franklin Kase, a Burbank podiatrist and past president of the Los Angeles County Podiatric Medical Assn.

Excessive pronation can put abnormal pressure onto the tendons and muscles, leading to painful foot problems. Orthotics also are used to correct extremely high arches or abnormally rigid feet.

“But,” adds Kase, “orthotics, like eyeglasses, only work while you’re wearing them.”

However, the insert boom is prompting some foot specialists to cry overkill. “Most people do not need custom-made orthotics,” claims Dr. Carol Frey, an orthopedic surgeon who directs the USC Foot Treatment Center at Orthopaedic Hospital. “They are over-prescribed.”

A number of orthotics debates are raging among the orthopedists and podiatrists who provide foot care. Some foot doctors say over-the-counter orthotics are worth a try; others claim they are a waste of money and may do more harm than good. Some say prescription orthotics remedy ordinary children’s foot problems such as “pigeon-toes;” others insist they won’t make any difference.

On one point most foot doctors do agree: Consumers often have inflated expectations of orthotics. “Orthotic devices don’t correct podiatric ills such as flat feet,” warns Dr. Phillip Kwong, an orthopedic surgeon at Kerlan Jobe Orthopaedic Clinic in Inglewood.

Scientific studies of orthotics are scarce. One research paper, published last year in the Journal of Orthopaedic and Sports Physical Therapy, concluded that orthotics relieved pain in 96% of 53 respondents and that 70% of them returned to previous levels of activity.

Until more studies are completed, foot doctors emphasize the need to perform a thorough evaluation before deciding custom-made orthotics are the answer.

“Orthotics aren’t always the first line of treatment,” says Kase. “Sometimes shoe modification or changing shoes can solve the problem. Sometimes strengthening and flexibility exercises can help.”

Before even thinking about prescribing orthotics, Kase says a foot doctor should observe the patient’s walk and analyze his gait.

If the evaluation indicates a need for orthotics, the foot specialist should manipulate the foot into the position of greatest stability, cast it with plaster of Paris, then send the cast to a lab technician who makes the orthotic to specifications.

Some foot doctors have patients step in foam, a technique that Kase says should be avoided because “it captures the foot in an already deformed position.”

High-tech methods to evaluate foot problems are becoming more widespread.

A new optical scanner, for instance, provides foot doctors with a computerized image of the bottom of the foot that the doctor sends via telephone lines to the orthotic laboratory.

“It provides a more accurate evaluation than noncomputerized methods,” says Don Flake of Ammon Corp. in Mesa, Ariz., “and the computer base can be updated as foot problems change.” Of seven scanners in use throughout the country, three are in Southern California, Flake says.

Other experts place sensors under the foot to obtain a bio-mechanical profile akin to an EKG of the foot. But some foot doctors aren’t convinced that these high-tech methods give more accurate results than casting.

Costs of prescription orthotics vary widely. Inserts themselves range from $125 to $200, but the initial professional evaluation and six months of follow-up care can bring the bill to $500 or more.

Upkeep costs, though, are minimal. “For adults, orthotics usually last three to five years, barring breakage,” says Rosenthal. Some insurance policies pay for orthotics.

Given the care that goes into making these prescription orthotics, some foot specialists say there’s no way an over-the-counter orthotic can measure up.

“Anything you buy over the counter is not going to be that effective,” believes Rosenthal, who’s especially skeptical of the “high heel orthotics.”

Counters a representative of Spenco Medical Lab, which markets arch support orthotics: “Our orthotic is heated with warm water and molded to the foot.”

And manufacturers of high heel orthotics say the inserts do prevent sliding and toe pinch. The orthotics for pregnant women’s shoes work by shifting the weight to the balls of the feet. Some foot specialists see no harm in trying these over-the-counter devices because they may be an inexpensive first step to pain relief.

But if they don’t seem to provide any relief after two weeks or so, get professional help, suggests Michael Heaslet, an Irvine podiatrist and past president of the American Academy of Podiatric Sports Medicine.

When should consumers investigate orthotics? “When shoes and a good training routine--including stretching before and after--don’t remedy the problem,” Kwong says, “maybe it’s time to look into orthotics.”