Golden Arches: Orthotics

Have you run out of topics yet? How about orthotic devices? I have mild metatarsus adductus—my first metatarsal bone in my foot is bent toward my instep. My foot looks like I have worn pointy-toed shoes for 40 years, but I am only in my 20s. When I was in my early teens, I was given hard orthotics made from a cast of my foot, which I used for 10 years until they wore out. Now, instead of buying another pair (since they are not covered by insurance), I try to find very high-arched athletic shoes. I was surprised to see a posting on James Randi's Web site called "the orthotic scam." This guy said that orthotics prescribed for problems other than foot-related were inappropriate. But for me, without those inserts, I would have been essentially lame. What do you think? Quality material for one of your columns?
--Heather, Macon, Ga.

Being too often accused of taking the low road, I hereby commit to no Tom Cruise/heel-lift jokes. That being said, we can still be grateful we live in the age of celebrity and fashion; had you been born 20 years earlier, your only choice for orthopedic shoes would have been those awful black-and-white saddle oxfords. Of course, they're now back in style, thanks in part to Ugly Betty, but at my elementary school, girls in orthopedic shoes were prime targets for taunting. Shameful, without question, but at least it allowed me and my leatherette briefcase to fly under the radar.

Inside many of those oxfords were molded bottoms intended to support foot abnormalities. These days, foot orthotics are produced independent of the shoe. This makes the correction, if not cheaper, at least a more private affair. Although I don't fit orthotics in my practice, plenty of chiropractors, podiatrists and other specialists do because they have been proven effective when prescribed properly. A major podiatric study shows three-quarters of those wearing fitted insoles report good to excellent results.

Functional orthotics—the kind you had—are used mainly for stability of the foot or to correct a difference in leg lengths. These molded supports, usually made of a rigid plastic or graphite, are primarily intended to prevent an abnormal foot from worsening. Feet with unusual anatomy may have (or develop) fallen or flat arches, where weakened ligaments cannot properly support the foot structure. Avoiding bunions (enlargement of bone or tissue at the base of the big toe) is another purpose of rigid insoles. A firm orthotic works as a perfect platform to improve the biomechanics of walking.

Perhaps I should hire Ugly Betty, because I could not locate the article you reference. Having searched www.randi.org, I'm left to guess the "scam" discussed was in regards to some orthotic marketer's claim of miraculously healed headaches, neck pain or menstrual cramps through use of their product. Almost certainly bogus, but at the heart of these claims lies a tiny kernel of magnified, massaged and misrepresented truth: Lack of a strong arch has a domino effect up the skeleton, often leading to postural and joint abnormalities. When the foot rolls inward from a weak arch, the ankle follows, the knee falls inward, and the pelvis drops. Called overpronation, the result is often lower back strain. Additionally, these joint stresses are amplified by physical activity, so the effect can be multiple problems from a single cause.

Legendary product-pusher Ron Popeil's maxim seems to be, "Any crap can seem indispensable with the proper infomercial." Enter the WalkFit company, now marketing a pre-fabricated shoe insert using all the standard TV shtick: sincere customers on the verge of tears, inspiring background music, a white-coated authority figure and a cheering audience. At one point, a voice-over introduces a guy who was "afraid his life was falling apart" until he found shoe insoles. Although the impression left is that orthotics must be the key to Middle East peace, WalkFit doesn't actually exaggerate claims to any great degree. And at $20 a pair, they may be a reasonable and durable basic arch support. Any cease-fire is simply a bonus.

Custom-made orthotics sell for quite a bit more: $250 to $500 a pair. Typically, a mold or impression taken of your feet is shipped to a lab, where a precise orthotic is created. As you stated, Heather, most insurance companies won't pay for these, but you should reconsider them; medical literature recommends a specific semi-rigid orthotic for your condition. As for my endorsement of an infomercial product, I'm now planning to categorically deny ever doing so—despite the written evidence. I promised not to ridicule Tom Cruise, but I didn't exclude Alberto Gonzales.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send moleskins and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).