Close Look at Shoe Inserts Raises a Welter of Doubts

Over-the-counter and prescription orthotic shoe inserts are widely promoted as a way to properly align your feet to avoid and treat injuries. In all, the orthopedic orthotics market is expected to grow to nearly $5 billion globally by 2015, and a prescription pair of top-of-the-line orthotics can easily set you back $500 or more, which is often not covered by insurance.

But despite millions of Americans wearing these inserts dutifully each and every day, there is little evidence that they actually work, and confusion over what's triggering the benefit when they do.

Are Orthotic Shoe Inserts Worth It?

Expert opinions vary on whether or not orthotics are worthwhile. Some say the majority of their patients feel better having them than not -- but no one seems to know why.

As the New York Times reported, Dr. Benno M. Nigg, a professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta:

" … found there was no way to predict the effect of a given orthotic. Consider, for example, an insert that pushes the foot away from a pronated position, or rotated excessively outward. You might think it would have the same effect on everyone who pronates, but it does not.

One person might respond by increasing the stress on the outside of the foot, another on the inside. Another might not respond at all, unconsciously correcting the orthotic's correction.

"That's the first problem we have," Dr. Nigg said. "If you do something to a shoe, different people will react differently."

Adding to the problem, it's not unusual for a person to be offered a different type of orthotic from each practitioner they see, each with its own purported benefits, with some feeling more comfortable to an individual than others, again with little rhyme or reason as to why.

Studies into this area have also come up short, with some suggesting they may help treat plantar fasciitis, a common injury to a foot tendon, or stress fractures, or keep some athletes or soldiers more comfortable, but the research is lacking to make any solid recommendations either way.

The end result seems to be the old adage "if the shoe fits, wear it" -- if you're having pain due to an activity or injury, and it improves with an orthotic, it may be a good choice for you. That said, you may actually be able to get an even better fit, and less pain and injury, by opting for less correction instead of more.

And when I say less, I mean much, much less …

Your Feet Actually Work Best Without Shoes

Your feet were designed to work best without shoes. So when you surround your feet with the extra padding and protection that most athletic shoes offer, your foot muscles are not being used appropriately. Prescription and over-the-counter orthotics may interfere with the workings even more (although in some cases may help counteract the imbalances that shoes are causing).

There are obviously some concerns with going barefoot, namely stepping on a sharp object or rock and injuring your skin. But if done properly, walking and even running barefoot can be quite safe. Marathon runners in Kenya actually do it all the time.

In fact, research by Michael Warburton, a physical therapist in Australia, found that running barefoot decreases the likelihood of ankle sprains and chronic injuries, such as plantar fasciitis.

He writes in the journal Sports Science:

"Running barefoot is associated with a substantially lower prevalence of acute injuries of the ankle and chronic injuries of the lower leg in developing countries, but well-designed studies of the effects of barefoot and shod running on injury are lacking.

Laboratory studies show that the energy cost of running is reduced by about 4% when the feet are not shod. In spite of these apparent benefits, barefoot running is rare in competition, and there are no published controlled trials of the effects of running barefoot on simulated or real competitive performance."

Upon reviewing the handful of research studies he could find, Warburton found:

• Running-related chronic injuries to bone and connective tissue in the legs are rare in developing countries, where most people are habitually barefooted
• Where barefoot and shod populations co-exist, as in Haiti, injury rates of the lower extremity are substantially higher in the shod population
• Wearing footwear actually increases the likelihood of ankle sprains, one of the most common sports injuries, because it either decreases your awareness of foot position or increases the twisting torque on your ankle during a stumble
• One of the most common chronic injuries in runners, planter fasciitis (an inflammation of the ligament running along the sole of your foot) is rare in barefoot populations
• Running in bare feet reduces oxygen consumption by a few percent.

Your Natural "Fox" Gait is Best

Much of the problem of wearing shoes comes from the way they cushion your foot, to the extent that your feet no longer naturally adjust your gait for optimum efficiency and safety.

Because of this it's been suggested that shoes lead to what's called "cow-walk."

Cow-walk puts tremendous pressure on your joints. Starting with the squeezing of your foot inside the shoe, jarring the knees as they're locked straight upon the pole-driving impact of the heel, which then travels straight up your spine, all the way up your neck.

In contrast, "fox-walking" is the walk of the natural hunter-gatherer -- the graceful flow of your body in total synchronization. Your knees are bent, rather than locked, the ball of your foot touches the ground first, followed by your heel, in a virtually soundless step motion. This is the natural gait that should occur when you walk barefoot (and you can often still observe this in action in children).

As an aside, another primary reason why going barefoot might be helpful is that it allows free electrons from the earth to pass into your body and essentially provide you with loads of great antioxidant potential. When you are "grounded" free electrons can easily come up from the earth and essentially nullify free radicals in your body.

An Alternative to Orthotics?

It is difficult to say conclusively whether or not orthotics will help or harm your natural gait, or help to deter some of the damage that conventional athletic shoes can cause. Again, if you currently wear them and feel they make you more comfortable, then you should listen to your body.

But for those of you who are experiencing minor aches and pains, for instance during exercise, you may want to try Vibram Five Finger shoes before ordering a costly pair of orthotics. Vibram Five Finger shoes have no arch support and have a pocket for each of your toes.

They do take some getting used to, but I believe they are superior to most shoes and provide a modern-day equivalent to going barefoot that may help you get back to a more natural, pain-free gait.

Two cautions though … one is that they are an insulator so you will not be grounded when walking outdoors. Additionally, if you are prone to getting fungal infections in your toenails this shoe could worsen them as they create a micro environment that is ideal for fungal growth.

So ideally walking barefoot is best, and I encourage you to try to incorporate this as much as possible. I am grateful to be able to do this about 75% of the time.