Categorized | Injury

Open Letter to All Podiatrists: “Our Profession Needs to Keep an Open Mind in Regard to Shoes and Treating Running Injuries…”

Posted on 19 May 2013

The following excerpt is from an essay by Nicholas A. Campitelli, DPM, FACFAS that recently appeared on a popular podiatry forum and website: http://www.podiatrytoday.com/blogged/defending-my-position-orthoses.  Dr. Campitelli, or as he likes to be known on his blog as Dr. Nick, does not represent the majority view and practice of most podiatrists who use orthotics as one of their main “cure” for many feet ailments. But Dr. Nick, like others here at the NRC such as the Sock Doc and Dr. Ray McClanahan, are also in what can loosely be called the anti-orthotics camp (at least, relying on them as a default “remedy.”) They are progressively lending their influence to the new movement toward re-establishing and understanding natural foot health, albeit the education process is still in its nascent stage. But let’s hope it’s one that continues to grow and have a noticeable impact, and not only with runners and walkers, but among podiatrists themselves. — Bill K

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Defending My Position On Orthoses

by  Dr. Nicholas A. Campitelli

Our profession needs to keep an open mind in regard to shoes and treating running injuries. People do not change what they are doing unless they have a reason to change. I continue to see runners not responding to orthotics and stability control shoes in my practice so I have provided a change, one that is working for others and myself. Of course, there is not a preponderance of evidence to support this change but there are emerging studies that support my thinking regarding the use of minimalist shoes. I have cited these studies in the past and will continue to do so. If the prior literature on orthotics were conclusive about their effectiveness, I would not be so strong-minded in my approach. I still feel there is a lack of clarity and consensus in the literature to support the use of orthotics.

Can orthotics work? Absolutely. How and what exactly do they do? It is very difficult to prove given the variability of one’s form, training pattern, shoe gear, strike pattern, biomechanics, body weight, training intensity and change in surfaces. My stance is that orthotics can treat an injury but this is a very haphazard approach. I think they are a crutch for treating the underlying problem, which may be overuse, poor form, weak musculature or improper training patterns.

I use orthotics in my practice, albeit rarely. I have found that by spending more time educating my patients on proper training patterns, form, foot strike, surface consistency, strengthening and shoe gear, I can make more of a difference in improving their injury. It can be more time consuming and challenging, but very gratifying. I do not encourage patients to discontinue using an orthotic if it is working for them. Again, I find this is very rare in my practice as most of the patients I see have already failed this type of therapy. The same applies to traditional running shoes. Many of the runners I train with wear traditional running shoes (yes, even ASICS) and I do not persuade them otherwise if it is working for them.

I love running, podiatry and making a different in people’s lives. I am trying to change the way we think of feet in our society. We live in a society that has the stigma that we need to support and cushion our feet, which has yet to be proven. Shoes have evolved with no basis of evidence as to why a raised heel is present among many other features. I encourage others to be open-minded and consider my approach. I certainly have leaned more about orthotics and minimalist shoes as a result of being challenged by my colleagues. Thank you for stimulating my interest and encouraging me to read more…

Click on the Podiatry Today link at the top to continue reading Dr. Nick’s essay.

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One Response to “Open Letter to All Podiatrists: “Our Profession Needs to Keep an Open Mind in Regard to Shoes and Treating Running Injuries…””

  1. Graeme Hadlow says:

    A refreshing article. I am a runner, was an age group uk national duathlon champion and a podiatrist working within the uk national health service as part of an assessment triage team to reduce orthopaedic foot and ankle surgery lists.
    I utilise orthoses mostly as part of the acute and sub acute rehab regime eg when utilising your PRICE or POLICE (protection, optimal loading, ice, compression, elevation), I use orthoses to reduce load to a painful structure , this could be a lift for a torn calf or offloading a metatarsal fracture. But it’s temporary, mostly, gait re education , flexibility, conditioning, strength and proprioception are key to return people back to fitness. Therefore orthoses to me are not mainstays but, they have a place for some pathologies as one tool within my management toolbox.. Just like a crutch as described above by dr nick, people should be encouraged to remove them when appropriate. For the non running community, they provide a really helpful solution especially where a structural deficit exists eg, ligament and tendon tears or degenerative joint conditions where manual therapies are limited to a point.
    Our knowledge has evolved, minimalistic footwear are my orthoses for runners if you like, it would seem less always has been more and that there is sense in keeping things simple.
    The website is great , keep running (pain free!) all
    G


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