[Pr B]

It seems many of us here use off-the-shelf orthotics or inserts in our shoes.

I'm interested in collecting in one thread our experience and recommendations re orthotics/inserts.

Pls share your foot ailments (e.g., high arch or flat footed, superpronate or underpronate, etc.), what you've tried, what works, and what doesn't.

 

[Pr B]

PowerStep, Sole Softec, & Birkenstock Blue

I have high arches, underpronate (walk on the outsides of my feet, not surprising, given my high arches), and suffer from Plantar Fasciitis for weeks after wearing dress shoes, especially so with hard outsoles.

I've had much success with Birkenstocks Footprints, Birkenstock sandals and clogs, and phenomenal success with Dansko/Sanita clogs.

For proper shoes, I replace their inserts with PowerStep inserts and Sole Softec footbeds with much success. Even with Eccos, I replace their insert with the PowerStep or Sole Softec and that is like night and day.

For shoes without removable inserts, I've had great success with the Birkenstock Blue (partial) footbed. I should try them in shoes with their own inserts, e.g., Eccos.

I've ordered a pair of Pedag Vivas.

 

[tinytim]

I have high arches, underpronate (walk on the outsides of my feet, not surprising, given my high arches), and suffer from Plantar Fasciitis for weeks after wearing dress shoes, especially so with hard outsoles.

Just the opposite actually. My biggest problem is finding shoes that fit orthotics and aren't too big. If you size up to fit the orthotic the shoe is too long.

 

[DocD]

When a foot/ankle question appears, I usually "pop up". I've been performing surgery on the foot & ankle for 23 years, so I have a "little" experience in the field.

There are a plethora of products available over the counter, and there is no "one size fits all" product. It really depends on your foot type, since very few OTC products are made for patients with a very high arch/pes cavus or a very low arch/pes planus.

OTC products are really made for the average, and not for the extreme. And while there are some decent quality OTC products, the majority really don't offer significant biomechanical control to reduce pronation or supination, but really offer more arch support.

Of all the OTC products available, the product with the features I believe offer the best bang for the buck for the "average" foot are PowerSteps.

However, PowerSteps offers several varieties online and a different "professional" version available at doctors offices that are a slightly higher quality. As a matter of fact, they just came out with a new version that actually has a rearfoot "posting" system that mimics a custom orthoses, which allows the doctor to adjust the amount of correction by snapping on different posts to decrease pronation depending on the patient's individual needs.

Remember that if you purchase an OTC insert such as a PowerStep, you must remember to remove the existing insole that comes with the shoe, a simple but often forgotten fact.

 

[pt4u67]

I have had good luck with Super Feet and have recommended them to others.

https://www.superfeet.com/

 

[DocD]

I am not a big fan of SuperFeet. They have several different varieties, depending on your foot type, activity level, etc., but I don't find any of their products particularly useful or effective.

I have a sample of every one of their products in my office, and have approximately 125 other samples from other manufacturers. The only other product that's "okay" are Downunders, but the only product that I truly recommend are PowerSteps.

I also must state that I have absolutely NO financial interest in the company, but treat thousands of patients yearly, and have used every product imaginable. Other than custom devices, PowerSteps are the only product I can recommend without reservation.

 

[cdavant]

As a doctor who mostly treats above the feet and a runner for 50+ years (27 marathons, 4 Bostons) I've used orthotics for as long as I can remember. If you really need an orthotic you should invest in a couple of pairs of professionally fitted custom inserts. You won't do lasting damage to your eyes by using glasses fitted to someone else. The same isn't true of your feet.
You ought to save a bit by getting two pairs at once, they will last twice as long and switching one pair from running to tennis to dress shoes all the time is a pain.

 

[82-Greg]

Doc(s);

If you've gone to the expense of bespoke shoes, would you still recommend custom inserts? Or do you use the custom inserts for only OTR shoes? I have not only high arches, but a very high (and long) instep. Further, the ball of my big toe stands proud of the rest of my foot. I also underpronate when walking.

 

[chatsworth osborne jr.]

After my arches dropped even farther, I went to this Foot Solutions place that stood me on some machine, felt up my feet and recommended a (I think). They work fine, I bought another pair. Forgot the actual speculative diagnosis, but flat feet.

 

[DocD]

cdavant brings up an excellent point regarding custom orthoses, however I simply responded to the question of OTC inserts because that's what the poster asked about.

I did state that OTC inserts were made for the "average" foot, and not for those with extremes. Naturally, nothing is better than having a pair or pair(s) of custom orthoses fabricated. However, the fact remains that not all patients really require the biomechanical control offered by custom orthoses, nor can all patients afford the cost.

The only real way for that to be determined (other than the patient's own financial knowledge) is for a hands-on evaulation and honest doctor, to evaluate the biomechanical needs and pathology of the patient's condition.

As far as the "Foot Solutions" store and their products, I can not tell you how many BAD EXPERIENCES my patients have had with those stores and their products.

The store has patients step on either a machine/mat or piece of carbon paper to obtain an "image". They than dispense a pair of OVER THE COUNTER inserts out of a box and usually charge a ridiculous price for these pre-made inserts that can be purchased for a FRACTION of the cost in a lot of other venues.

I personally find the Foot Solutions stores to be one of the largest predators and rip off artists of patients that I have seen in my 20 plus years of practice. This is NOT a store I would ever recommend to anyone.

 

[tinytim]

As far as the "Foot Solutions" store and their products, I can not tell you how many BAD EXPERIENCES my patients have had with those stores and their products.

Are they really that bad? I've been looking for a new set and considered checking them out. What exactly to they do that's so bad? I'm asking not challenging. Thanks ahead of time.

 

[chatsworth osborne jr.]

Better than the drug store but not admittedly real doctors

As far as the "Foot Solutions" store and their products, I can not tell you how many BAD EXPERIENCES my patients have had with those stores and their products.

This is because the people who had good experiences (like me) have not required your assistance.

It's like a Jiffy Lube: a convenient chain that will does low-level work at a decent price. Some franchises are better than others.

Yes, they sold me a $60 orthotic that I get via internet for half that, but the implied service cost is equivalent to an insurance co-pay and I didn't need to make an appointment or sit in a waiting room filling out forms. If I had more than a mild problem, I'd take the trouble to go to a real doctor.

 

[budrichard]

As a doctor who mostly treats above the feet and a runner for 50+ years (27 marathons, 4 Bostons) I've used orthotics for as long as I can remember. If you really need an orthotic you should invest in a couple of pairs of professionally fitted custom inserts. You won't do lasting damage to your eyes by using glasses fitted to someone else. The same isn't true of your feet.
You ought to save a bit by getting two pairs at once, they will last twice as long and switching one pair from running to tennis to dress shoes all the time is a pain.

Listen to the Doc! I have custom orthotics and they work real well and cured my problems.-Dick

 

[pinchi22]

Listen to the Doc.

I followed Doc´s advice 2 years ago, bought myself the Powerstep insoles, and my feet have been much happier since. This may only indicate my feet are fairly average. I recommend trying them on before buying them, though - I found them at a New Balance store.

 

[Pr B]

Shoes

The C.Ped. (Certified Pedorthist) at our local shop shoe just put me in a pair of Ecco Crosses (https://www.zappos.com/product/103914/color/1316) and Dansko Carsons (https://www.zappos.com/product/7380570/color/223).

Delightful. Arch support, cushioning, toe space, delightful to stand and walk in. And ugly as sin.

 

[DocD]

Chatsworth,

I never stated that a patient should come to my office or another doctor's office instead of going to the "Foot Solutions" store. I'm happy to hear that your one experience was pleasant, and wouldn't want to burden you with a co-pay and an actual REAL medical evaluation, rather than some salesman's pitch and an insert out of a box.

My point is/was that I've been in the foot/ankle business a long time, and have seen a lot of what I consider charlatans during those years. I wouldn't mind if you walked into a store and someone made a recommendation and sold you a product. But in most Foot Solutions stores, they OVERSELL and act as if they actually know what they are talking about, and actually diagnose and treat conditions.

Then they break out the "bells and whistles" by having patients step in machines, on mats or on fancy carbon paper tracings to then do nothing more than go in the back of the store and walk out with a pair of inserts that came out of a box.

And I've had dozens and dozens of patients that were NOT charged $60, but were charged several hundred dollars for products that could have been purchased elsewhere for a fraction of that cost.

I'm certainly not worried about these stores taking business away from me. There isn't even a "Foot Solutions" store close to me. My concern has always been the consumer who is ripped-off by these snake-oil salesmen.

Yes, there will ALWAYS be an exception, and a patient that was happy with the product sold. But I can tell you that they are selling a product that can be purchased elsewhere for a fraction of the cost and are often over selling to patients that don't even need the product being sold.

Buyer beware. They are the used car salesmen of shoe stores.

 

[pt4u67]

Chatsworth,

I never stated that a patient should come to my office or another doctor's office instead of going to the "Foot Solutions" store. I'm happy to hear that your one experience was pleasant, and wouldn't want to burden you with a co-pay and an actual REAL medical evaluation, rather than some salesman's pitch and an insert out of a box.

My point is/was that I've been in the foot/ankle business a long time, and have seen a lot of what I consider charlatans during those years. I wouldn't mind if you walked into a store and someone made a recommendation and sold you a product. But in most Foot Solutions stores, they OVERSELL and act as if they actually know what they are talking about, and actually diagnose and treat conditions.

Then they break out the "bells and whistles" by having patients step in machines, on mats or on fancy carbon paper tracings to then do nothing more than go in the back of the store and walk out with a pair of inserts that came out of a box.

And I've had dozens and dozens of patients that were NOT charged $60, but were charged several hundred dollars for products that could have been purchased elsewhere for a fraction of that cost.

I'm certainly not worried about these stores taking business away from me. There isn't even a "Foot Solutions" store close to me. My concern has always been the consumer who is ripped-off by these snake-oil salesmen.

Yes, there will ALWAYS be an exception, and a patient that was happy with the product sold. But I can tell you that they are selling a product that can be purchased elsewhere for a fraction of the cost and are often over selling to patients that don't even need the product being sold.

Buyer beware. They are the used car salesmen of shoe stores.

As a medical professional I think you should preclude yourself from giving such strong opinions unless you are prepared to back it up with empirical evidence. You're using your professional standing as a launching pad for calling a OTC foot orthotic a "snake oil salesman".

Are your opinions based on research that has been published in a peer reviewed journal or are they your own opinions? Please refer us to the appropriate studies that can back up your claims. Otherwise, I'm afraid your 23 years of experience means little.

 

[cdavant]

Nonsense. As a professional, I only offer strong opinions based on "evidence based medicine" where evidence is available--but based on years of experience where no good studies are available. I've yet to see a study comparing surgical removal of an inflamed appendix vs. dancing around and shaking rattles.
The onus of proving OTR orthotics compare with custom made ones falls on the purveyor of the cheap ones, not the other way around. I don't have to prove chiropractors aren't qualified to treat diabetes by spinal manipulation (although some do), they have to provide evidence that they can.
Society sets up certain minimal standards that those of us who practice the "learnered professions" like law. accounting, medicine, and barbers and beauticians must meet to protect the public. (I'm sorry tailors and clothing salesmen don't have to meet any standard.)
And it's definitional that lawyers define what the practice of law is. A layman is not in any way qualified to proffer what amounts to a professional judgement about a product or service. Res Ipsa no more applies to a foot bed worn for a few weeks than a good looking suit that lasts less than a year.
If you're into fashion, go cheap and it probably won't make much difference a year from now. But if you want to be running 20 years from now, go for experience and style.

 

[pt4u67]

There have been posts in this thread referring to "BAD EXPERIENCES" with certain OTC orthothes made by an individual who is presumably a professional in the field in medicine. Years of experience are no substitute for empirical evidence. No one is comparing science to voodoo here: There is good science saying that reading chicken entrails will offer no cure for an inflamed appendix.

Making blanket statements about the viability of a product and the marketing strategy of a particular company is a bold move. It assumes that the individual making those statements is an expert and can back up his claim with evidence. It does not have to rise to level 1 evidence but it should be backed up by data. That someone has "heard" or that they "can't tell how many" patients have presented with BAD EXPERIENCES from a particular company is insufficient. Using the same terms, I can't tell you how many of my patients have come to me with bad experiences of botched bunionectomies from podiatrists.

When we use our professional standing and put ourselves out as an authority on a certain topic, we owe it to the public to back up our claims with more than just anecdotes. Otherwise, we should not be offering opinions backed by the strength of our professional credentials.

 

[DocD]

pt4u67,

People like you really amaze me. Every time a doctor offers an opinion, people like you now love to use the new buzz words "evidence based medicine" and "peer reviewed" studies.

There's a huge difference between discussing my opinion on one store's quality, based on "only" 23 years of treating feet & ankles medically and surgically on thousands of patients vs. discussing a new revolutionary surgical technique to reconstruct the ankle that has not been "peer reviewed".

"Layman" love to dissect every comment made by medical professionals, and then ask for "literature" to back every comment made. There aren't studies for every opinion that every doctor has on every subject. I don't believe that there have ever been any peer reviewed/evidence based studies that show that dropping a refrigerator on your foot would cause significant injury, but my opinion is that it would cause harm. And I think it's safe to say that you don't need a study to verify that finding.

If you read my post correctly, I never told the original poster not to purchase an over-the-counter (OTC) insert/orthoses. On the contrary.....I highly recommended a pair of PowerSteps, since in my experience my patients have had the most success with this product compared to products such as Soles, Sof-Sole, Birkenstock inserts, Spenco products, Superfeet, Downunders, Lynco's, Accommodators, JSB OTC devices, Bauerfiend, and the dozens of other brands that I've tried in my office.

I did state that some patients can not wear OTC inserts if they have feet which are "extremes", meaning very high or very low arches, since OTC products are manufactured to fit a more average type of foot.

I often recommend OTC inserts/PowerSteps and even stated that not all patients require custom orthoses or the biomechanical control that custom orthoses provide.

What I DID state is that one particular store, Foot Solutions has consistently ripped off many patients prior to these patients coming to my office. The story is always the same. The patient walks into the store, and is "diagnosed" by a salesperson and is then told what he/she "needs". The patient is then measured via some useless hocus pocus device or machine or has a tracing via a carbon paper type device.

The salesperson then dispenses a highly priced device (none of my patients ever spent less than $250) for a product that was taken out of a box. These same items are available in other stores or online for between $25-$40 maximum.

And ironically, the patient could have had a custom orthoses for not much more than a product taken off the shelf.

So, I don't need an evidence based, peer reviewed journal article to form an opinion. I believe that many people would disagree with you that 23 years of practice is "worthless" regarding the ability to form an opinion about a matter such as this one.

Once again, if I was making a claim that I just developed a revolutionary new surgical procedure, I would expect that to undergo the scrutiny of a peer reviewed study with evidence based research.

So go back and read my post and you'll see that I DO highly recommend OTC products such as the PowerStep, and don't believe all patients need custom orthoses. I simply stated that one particular store has salesmen that act like snake-oil salesmen and in my opinion are the used car salesmen of the shoe stores. That's an opinion that simply does not need a peer reviewed journal article or evidence based research.

By the way......you don't happen to be a used car salesman do you???