DIFFERENCES IN COMFORT
Is there a difference in comfort between different types of orthotic devices? A review of the current scientific literature reveals that very little research has been done to specifically answer this question. Most studies to date have focused on orthotics and the prevention and/or treatment of lower extremity injuries such as iliotibial band syndrome, Achilles tendinitis, plantar fasciitis, rheumatoid arthritis, and diabetes.5,6,7 There is also conflicting evidence in terms of differences in comfort between custom and over-the-counter orthotics. Some studies indicate that there are no differences in comfort,3,4,12 whereas others suggest that custom orthotics are more comfortable.6,9 In addition, other studies simply suggest that soft orthotics in general are more comfortable regardless of how they are constructed.1,2,8,10,11 Since comfort has been shown to be the most important consideration when purchasing an orthotic device9, the question remains, which is more comfortable, a custom-made or an over-the-counter orthotic?
A study was done out of the University of Delaware to determine differences in custom versus semi-custom orthotics and if they changed mechanics of the foot for high and low-arched runners.12 This study involved 37 recreational runners and each subject rated their level of comfort for each orthotic condition on a 10cm scale, where 0 was totally uncomfortable, and 10 was the most comfortable. The results indicated that there were very few differences in subjective comfort between the two different orthotic devices. Therefore, these researchers concluded that purchasing a semi-custom orthotic device would be a more feasible option.
Another study was done with male Israeli infantry recruits to determine if orthotic construction had an effect on comfort and the incidence of overuse injuries.4 There were two parts to this study. The first part involved 451 recruits who were split into two groups; a soft custom orthotic group, and a soft over-the-counter orthotic group. At the end of 14 weeks of basic training, the recruits were asked to rate comfort on a four-point scale, where a score of four was considered the most comfortable. The second part of the study involved another group of 423 infantry recruits from a different military base, who were also split into two groups; a semi-rigid custom-made orthotic group, and a semi-rigid over-the-counter orthotic group. At the end of 14 weeks of basic training, these recruits also rated comfort using the four-point scale. The results of this study indicated that the soft custom and soft over-the-counter orthotics were the most comfortable compared to the semi-rigid devices. Interesting, none of the orthotic conditions were superior to another in reducing the injury occurrence. Thus, these authors concluded that a soft orthotic device is the most comfortable and the most feasible.
The University of Calgary conducted a study in 2002 to determine if subjects are able to determine differences in comfort between different orthotic conditions while running.9 The researchers collected data from 9 subjects who wore a standard running shoe and 4 different inserts; no orthotic, a soft over-the-counter device, a hard over-the-counter device, and a custom-made orthotic with a standard medial wedge. The results indicated that in general, subjects preferred soft over hard orthotics, but all the orthotic types were rated as comfortable.
Finally, another study out of the University of Delaware in 2008 was conducted to determine if there were any differences in comfort while wearing custom or semi-custom orthotics during walking and running.3 The researchers collected data from 19 healthy runners who were given a custom and semi-custom orthotic, and given 2 weeks time to accommodate to each device. The results indicated that the subjects found both devices equally comfortable.
Based on the results of this research, it can be concluded that there are no differences in comfort between custom-made and over-the-counter orthotics. However, several limitations are apparent in these few studies. First, with the exception of the military study, all other studies performed their research on a small group of people, and therefore, it is hard to apply the results to the general population. Second, some studies have investigated a semi-custom orthotic device which is not structurally or functionally similar to an over-the-counter device sold commercially. Third, only the University of Delaware and University of Calgary studies asked questions regarding how comfortable different parts of the orthotic were whereas most others simply asked the runners to rate overall or global comfort. Thus, future research involving large subject populations, over-the-counter devices, and location-specific comfort questions are necessary. Most importantly, only one study has been conducted to investigate whether orthotics, custom-made or over-the-counter in design, can reduce the incidence of injury. However, the military recruits involved in that study were only followed over a 14 week period of time. Thus, larger prospective studies are needed.
- Burns J, Begg L, Vicaretti M. Comparison of orthotic materials on foot pain, comfort, and plantar pressure in the neuroischemic diabetic foot: a case report. J Am Podiatr Med Assoc. 2008;98(2):143-148.
- Chen H, Nigg BM, de Koning J. Relationship between plantar pressure distribution under the foot and insole comfort. Clin Biomech. 1994; 9:335-341.
- Davis IS, Zifchock RA, DeLeo AT. A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices. J Am Podiatr Med Assoc. 2008;98(5):394-403.
- Finestone A, Novack V, Farfel A, Berg A, Amir H, Milgrom C. A prospective study of the effect of foot orthoses composition and fabrication on comfort and the incidence of overuse injuries. Foot Ankle Int. 2004; 25(7): 462-466.
- Gross ML, Davlin LB, Evanski PM. Effectiveness of orthotic shoe inserts in the long-distance runner. Am J Sports Med. 1991;19(4):409-412.
- Hodge MC, Bach TM, Carter GM. Orthotic management of plantar pressure and pain in rheumatoid arthritis. Clin Biomech. (Bristol Avon). 1999; 14(8):567-575.
- Landorf KB, Keenan AM, Herbert RD. Effectiveness of different types of foot orthoses for the treatment of plantar fasciitis. J Am Podiatr Med Assoc. 2004;94(6):542-549.
- McPoil TG, Cornwall MW. Rigid versus soft foot orthoses. J Am Podiatr Med Assoc. 1991; 81(12):638-642.
- Mundermann A, Nigg BM, Humble RN, Stefanyshyn DJ. Orthotic comfort is related to kinematics, kinetics, and EMG in recreational runners. Med Sci Sports Exerc. 2003; 35(10):1710-1719.
- Mundermann A, Nigg BM, Stefanyshyn DJ, Humble RN. Development of a reliable method to assess footwear comfort during running. Gait & Posture. 2002; 16(1):38-45.
- Richie DH, Olson WR. Orthoses for athletic overuse injuries. Comparison of two component materials. J Am Podiatr Med Assoc. 1993; 83(9):492-498.
- Zifchock RA, Davis I. A comparison of semi-custom and custom foot orthotic devices in high- and low-arched individuals during walking. Clin Biomech. (Bristol Avon). 2008;23(10):1287-1293. Epub 2008 Aug 30.