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Are Physical Therapists Overlooking The Benefits Of Orthotics For Runners?

Last month, I attended the second annual Science of Running Research Symposium, sponsored by the California Physical Therapy Association and CAL-PT-FUND. I was the only podiatrist in attendance.

The main speakers included Irene Davis, PT, PhD (Harvard University), Bryan Heiderscheit, PT, PhD (University of Wisconsin-Madison) and Chris Powers, PT, PhD (University of Southern California). All are heavy hitters in the world of physical therapy research, specifically biomechanics and running. They have published over 250 scientific studies combined.

Each presenter oversees a biomechanics research laboratory with high definition multi-camera motion capture systems, computerized gait analysis and force plate instrumented treadmills. Interestingly, outside of their research, the presenters do real-time video assessment on their runners without markers or software analysis. However, none of the presenters consider gait or running analysis without high speed video capture as being worthwhile.

Over 200 physical therapists attended and I was surprised and impressed by the attendees’ comprehensive knowledge of lower extremity biomechanics and gait analysis. They followed lectures summarizing the lower extremity muscle activity of the glutes, hamstrings, quadriceps, gastrocnemius, soleus and posterior tibial muscles during loading, propulsion and swing phases of gait. They understood and were able to identify torsional abnormalities of the femur and tibia, and understood normal and abnormal motion at the hip, knee and ankle joints. Surprisingly, however, there was no mention of the foot, specifically the subtalar or midtarsal joints.

Not surprisingly, without this foundation, none of the lecturers recommended functional custom orthotics as an appropriate treatment for running … ever. Dr. Powers was the only lecturer who would keep a runner in custom orthotics as long as they were soft and the runner did not want to give them up.

I was shocked and appalled that 200 practicing clinical physical therapists were learning that orthotics are a waste of time and money, and that we can cure nearly every running injury with changes in stride length, upright posture or foot strengthening exercises. Even more worrisome, these practitioners are using lopsided scientific studies to prove their points. Unfortunately, when it comes to lower extremity biomechanical research, physical therapists are much more published than DPMs. This needs to change.

Why does this matter? Why should you care? If you are a podiatrist sending patients to physical therapy for rehabilitation, you need to know what your patients are hearing. Even better, get to know your physical therapists personally and make sure they are on board with your treatment protocols before your patients spend six to eight weeks in their care. Although many graduating physical therapists now hold a Doctor of Physical Therapy (DPT) degree, they are not medical doctors or physicians. They cannot interpret radiographs or magnetic resonance images, give injections, prescribe medications or perform surgery.

What they can do and what they should do is work with podiatrists to restore patients’ lower extremity mobility and function. What they should not do is recommend that patients throw away their orthotics.

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Jenny, Thank you for this excellent wake up call to our profession. Many of the original faculty for the past 12 PFOLA meetings were dismayed, if not shocked to see Physical Therapy PhD speakers who received PFOLA funding turn their back on the benefits of foot orthotic therapy in recent years. As you appropriately point out, physical therapists cannot prescribe foot orthoses and, in most cases cannot be reimbursed by third party payors for foot orthotic therapy. Therefore, the movement of physical therapy to move away from foot orthoses and recommend standard rehabilitation protocols must be interpreted from a simple economics perspective. If you can't get paid for foot orthotics, but can get paid for proximal core strengthening, which program would you endorse and implement?
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