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Orthotics a Placebo?

post #1 of 18
Thread Starter 


An article in the NYT calls into question the reliance on orthotics to correct alignment issues. 


For more than 30 years Dr. Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta, has asked how orthotics affect motion, stress on joints and muscle activity.

Do they help or harm athletes who use them? And is the huge orthotics industry — from customized shoe inserts costing hundreds of dollars to over-the-counter ones sold at every drugstore — based on science or on wishful thinking?

His overall conclusion: Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up.



What will skiers do now?

post #2 of 18

Laugh at his name.

post #3 of 18
Originally Posted by karpiel View Post

Laugh at his name.



i've ridden without OTS insoles and my arches collapsed and hurt like hell.  put them in and i was skiing fine all day long.  it may not be a proper fix, but a proper fix is basically surgery.

post #4 of 18

Don't be too quick to 'blow off' the research (although the article really doesn't say much).  The Human Performance Laboratory at the University of Calgary is arguably the world leader in biomechanics and related research and has developed and tested numerous products and patents in use by various sporting goods manufacturers such as Adidas (TechFit Powerweb clothing, Predator Pulse soccer shoes for David Beckham, etc.)  If you read something that comes for the U of C's Human Performance Lab, you can pretty much take it to the bank.


Here's an excerpt from something I found online.

The U of C’s Human Performance Laboratory is renowned internationally for its expertise and contract research in computer modelling and biomechanics.  The Human Performance Lab, and namely its co-director Dr. Benno Nigg, have contributed about half of all research knowledge on sport shoes, a product that annually earns billions of dollars worldwide for companies like Adidas and Nike.  “ Dr. Nigg is one of the pioneers of footwear biomechanics research. He started this work at a time when less than a handful of people were doing it.”



Orthotics and walking/running, however, is a different animal than foot beds and skiing.  Lou Rosenfeld has written some excellent articles on the subject of ski boot foot beds.  Here are a few.


Footbeds. Necessity or Nicety?


Footbed Facts (Ski Racing Canada article)


Footbeds.  What Should We Expect?

Edited by exracer - 1/18/11 at 4:00pm
post #5 of 18

I guess it depends on the sport. Perhaps the conclusions are valid, with exceptions for specific activities. Have I found any substantial performance or mechanical advantages to having a custom footbed in my running or cycling shoes? Not in any way. But I have definitely found that a custom footbed helps reduce fatigue and allows a more balanced and neutral feel when my foot is jammed inside of a cold, plastic ski boot. 


Also, the term 'Injury-prevention' comes up a lot in the article. It isn't clear from the article if the researcher was basing the primary value of a footbed on the ability to prevent injury.



post #6 of 18

I have a couple of friends that ski and are podiatrists and do foot surgery as well. I thought for sure they would always reinforce the need to have a custom footbed its benefits etc. What's weird is they never have. In fact one of the doctors years ago I was on  trip to Colorado with purchased new boots out there and skiied in them after taking out the stock bed.


Never could figure out why they didn't associate more merit in stabalizing the foot in the boot. I pronante and for years had sore ankles. Had my first footbeds made 30 years ago and have never had sore ankles since.  Custom foot beds made a huge difference for me.

post #7 of 18

Not a placebo. I have absolutely no doubt that they can and do work for some people. I've felt them work and seen them work on others. That doesn't mean that all people need them of course.

post #8 of 18

My guess is the researchers did not consider orthotic use in winter sports. Given that a custom ski Ohrtotic can cost upwards of $200-$300, they would not generate enough interest or sales if they provided no substantial benefit to the consumer. They have been around for quite some time now and people are still opting to open their wallets and buy them. I am cheap as all tomorrow but even I will put a crowbar in my wallet for footbeds and fitting. The consumer trend is circumstantial evidence for sure, but at least an indicator that something is working for some people. IMO, the off-the-shelf's are the placebos. They make your feet feel nice and comfy but provide minimal functional benefits. Which leads me to wonder if the study considered custom-made orthotics or a variety of off-the-shelf models, or both.


Also, studies that rely on personal testimony to draw conclusions can be risky when it comes to assigning facts. Like the judged competitions in the Olympics, you never really know for sure what is going on in the mind of the person judging the results. It's not an exact science and testimony is subjective. As far as injury stats, that is pretty straightforward.  When users report the footbeds were comfortable and offered benefits, does that mean functional benefits? A pair of 106mm lasted ski boots with thick, plush liners are certainly comfortable but not that functional when you are on the snow. Perhaps in studies like this there is a proclivity for the tester to confuse comfort with function.


I am sure the researchers took all of this into consideration. They are scientists. I see no reason why they would attempt to trash the orthotic industry or why they would publish such a study if they were not convinced of the scientific merits of their results. It's not a case where someone is putting out a new product or technology and they are hunting for 'evidence' to disparage the competition. They have nothing to gain and no reason to be biased. Putting out a bogus study would only ruin personal reputations and harm the institution, which a poster already pointed out is pretty prestigious.  

post #9 of 18

I had orthotics in high school and they definitely helped comfort-wise, but they did nothing to alter my alignment issues.  I have not worn them in years, but I'm guessing the technology has advanced quite a bit in 20 years.

post #10 of 18

 Interesting. I had my right big toe joint replaced about 3.5 years ago. It was better for a while, but then started hurting just as bad, but in a different way. I changed doctors and he made me a new orthotic last May. Turns out my joint space had closed back up, and instead of bone on bone, I was bone on titanium. (Bone on bone feels better, by the way.) The new orthotic has a little wedge cut out that does something better than the old orthotic did. It definitely works ... I'm not 100% better or anything, but I can play tennis without suffering nausea-inducing pain when I jam my toe.


That said, I sort of feel slower in orthotics. My daughter was having some foot pain in her soccer shoes, which have NO support, and we put some blue Superfeet in there, which helped the pain. She seems to be not as fast as she used to be, though. Of course, she's 12/13, and growing straight up, which also affects speed. And, of course, I have foot arthritis and am older and have an artificial joint, so no wonder I'm a little slower, too. But I wonder if this is a common occurrence. Track spikes are awfully thin and unsupportive, so I guess there's something to it.

post #11 of 18

"Shoe inserts or orthotics may be helpful as a short-term solution" Agreed.

Some people have serious misalignement problems that an insert will not fix only surgery will. If they are lucky the insert may prolong the surgery. "The idea that they are supposed to correct mechanical-alignment problems does not hold up." I don't think they were ever designed to correct Biomechanics of the foot just add a little support. I pronate pretty bad on my right foot as I broke my Fibula (which is the bone that runs down your leg to the anke on the outside) right near my ankle. I had a plate with some screws put in and some pins on the other side. The plate is still there and may not be the main cause but is aiding in the misalignement of my foot. I went to a podiatrist a couple of months ago between running long distances and skiing my feet have been killing me. I have spent around $100 on OTC footbeds which have done nothing. Insurance didn't cover anything for orhtodics so I spent $400 on some and have no more issues when running but, I still have a misaligned foot that can only be corrected by surgery. I don't use the orthodics in my ski boots because I can't get them in there but, I do have some nice heat moldable one so at least there is more support than the stock footbed. My feet hurt a little while skiing but, I think waring the orthodics in my shoes everyday and while running has made the pain while skiing tolerable and only when I'm standing straight up with a lot of weight on my feet, if i'm in the proper skiing position not as bad. Mainly lifts line is where it hurts the most.

post #12 of 18

Everything adults do for recreational sports has a significant placebo effect. Every time I buy new golf clubs I get much better for half a season only to fall back into old habits. I love thinking about the mechanics of skiing, hypothesizing a solution and then trying it for myself. I recently purchased new custom footbeds.  My old footbeds (purchased 10 years ago) I thought were great.  They were heat molded plastic that was formed to my foot under load bearing conditions. They allow me a much more snug foot in my boots without discomfort and I swear by them.  Since it was time for a new toy I thought I would see what is new and improved with footbeds. My friendly neighborhood pedorthotist convinced me that UNLOADED foot beds were superior because they support my arch better.  I am a pronator which makes this benefit even more pronounced. I actually took both footbeds (new and old) with me for my first trip this year and switched them back and forth over three days. (I know that puts me in the gear geek hall of shame)  I became very convinced that the new footbeds help tremendously.  I feel I can stay out of the backseat much better and I feel that my skiing is better.


Do I really believe it was the footbeds? Probably not. Am I convinced that my skiing has improved? Absolutely. The act of educating yourself enough to make an intelligent decision hopelessly biases towards your chosen intervention.  Your observations are now much less objective but who cares? The process of exploring the notion and trying new "stuff" has always given me great pleasure on the slopes.  So if I can pay $100 for a placebo that will last from 3-10 years, I count that as a win! 

post #13 of 18
Originally Posted by nolo View Post


An article in the NYT calls into question the reliance on orthotics to correct alignment issues. 

is overall conclusion: Shoe inserts or orthotics may be helpful as a short-term solution, preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanical-alignment problems does not hold up.


What will skiers do now?


Ignore him.


Honeslty, can he point to any randomized/controlled studies that prove they don't?

post #14 of 18
Are the findings of how orthotics function in a shoe really applicable to how they function in a ski boot?
post #15 of 18

One thing that is hard to dispute is when you see before and after pictures of skiers that are bowlegged or knock kneed edging their skis before and after being canted. Yes, I'm now inserting canting into the discussion, but believe stabalizing the foot in the boot in a neutral position and then canting- balancing the boot makes a dramatic difference.


Have to have the footbed right to get to achieve the final desired result. Skiers pay alot of money for"gear" A one time $150-$200 foot assessment and custom orthotic is well worth it. I would argue you'll get more utility out of this money beiing spent than maybe anything else. (most people).

post #16 of 18
Thread Starter 



Are the findings of how orthotics function in a shoe really applicable to how they function in a ski boot?

It's good to have our cherished assumptions challenged every once it a while. Speaking for myself, the article didn't blunt my enthusiasm for my 1987 Peterson footbeds that I had made when I weighed 50 lbs. more than I do now. (Talk about load-molding.)  I do have tons of respect for the work that comes from the Human Performance Lab at Calgary.

post #17 of 18
Originally Posted by onyxjl View Post

Are the findings of how orthotics function in a shoe really applicable to how they function in a ski boot?

No, and the article makes no claim about it.  As far as I know, the HPL hasn't done work related to ski boots, which is why I posted the links above (post #4) to articles written by an expert about how the foot functions differently in a ski boot, and how a foot bed needs to function differently in a ski boot versus an orthotic in a shoe.

post #18 of 18

If you have a particular spot on your foot which causes pain when you apply pressure to it, you can put padding around it, to keep that spot from making hard contact with the footbed.

This is how I solved my problem of skiing with Morton's Neuroma. The location of the neuroma is protected from pressure; it never makes hard contact wtih the footbed. The materials for my home made orthotic cost me about 2 bucks.

Now I ski all day without pain, until i take my boot off and start walking in shoes again.

The same principle applies to other foot problems, i'm sure.

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