The Ghost in the Machine

If you have been to the drug store or grocery store lately you may have noticed the Dr. Scholl's machine. It looks impressive enough, with colorful images of your feet that show the different pressures. After standing on the machine for a few seconds it spits out a number and that is the pair of foot supports that you are supposed to use. Simple right? Wrong.
Custom foot supports, or orthotics as they are called by foot doctors, are a complicated science. The science of how living things move is called biomechanics. This is the science that one must you to properly diagnose and treat conditions with a pair of orthotics. The machine has none of this training. The foot is a very dynamic structure with 28 bones, 33 joints and over a hundred ligaments in each foot. Placing the foot in the proper position is crucial in obtaining a good representation of this moving target.
As an example, we have all heard of someone having 20/20 vision. What that means is that at a standard of 20 feet a person can see a size of type that has been designated as the standard font. This system breaks down if you measure people at 10 feet or with a different font size. When molding someone for an orthotic in my office I have similar standards that I have to abide by. The foot, ankle and knee must be in the standardized position. If not taken in this very specific way the mold is useless. This is exactly what happens with these machines. There is no uniformity. There is no standardizing.
As someone who has prescribed hundreds of orthotics in my career I can tell you that there is an art as well as a science involved. You have to know the activity level of the patient and the types of shoes they most often wear. There are some sport specific adjustments that can be taken into account and let us not forget the follow up. When you get a pair of orthotics from me or my colleagues you are sure to have the devices evaluated and any adjustments made in order to get the results you want. Every year thousands of people buy a 1/4 inch drill bit. None of these people want a 1/4 inch drill bit...they want a hole that is 1/4 inch around. The same can said for orthotics. No one really wants a piece of custom molded plastic in their shoe...they want pain free walking, running, golfing etc.
People often ask why orthotics are so expensive. The answer is because they are time consuming if you are going to do them correctly. You can get a piece of padded plastic out of a machine in a grocery store all day if you want to, just don't call that an orthotic. The ghost in the machine is not going to follow up with you. The ghost does not care if the device works. The ghost is not going to adjust the device and improve your comfort and quality of life.
You do get what you pay for in life and this is just another example of cutting corners and you will suffer for it. Remember that when you do end up with a inferior device you only have yourself to blame...the ghost in the machine doesn't care.

Committed to your health,

Dr. Craig Conti
Sarasota Foot Care Center

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