"Benno M. Nigg has become a leading researcher on orthotics  those shoe inserts that many athletes use to try to prevent injuries. And what he has found is not very reassuring. For more than  years Dr. Nigg a professor of biomechanics and codirector of the Human Performance Lab at the University of Calgary in Alberta has asked how orthotics affect motion stress on joints and muscle activity. Do they help or harm athletes who use them And is the huge orthotics industry  from customized shoe inserts costing hundreds of dollars to overthecounter ones sold at every drugstore  based on science or on wishful thinking His overall conclusion Shoe inserts or orthotics may be helpful as a shortterm solution preventing injuries in some athletes. But it is not clear how to make inserts that work. The idea that they are supposed to correct mechanicalalignment problems does not hold up. Joseph Hamill who studies lowerlimb biomechanics at the University of Massachusetts in Amherst agrees.  We have found many of the same results said Dr. Hamill professor of kinesiology and the director of the universitys biomechanics laboratory. I guess the main thing to note is that as biomechanists we really do not know how orthotics work. Orthotists say Dr. Niggs sweeping statement does not take into account the benefits their patients perceive. The key measure of success said Jeffrey P. Wensman director of clinical and technical services at the Orthotics and Prosthetics Center at the University of Michigan is that patients feel better. The vast majority of our patients are happier having them than not he said about orthotics that are inserted in shoes. Seamus Kennedy president and coowner of Hersco Ortho Labs in New York said there was an abundance of evidence  hundreds of published papers  that orthotics can treat and prevent mechanically induced foot problems leading to common injuries like knee pain httphealth.nytimes.comhealthguidessymptomskneepainoverview.htmlinlinenytclassifier shinsplints and pain along the bottom of the foot. Orthotics do work Mr. Kennedy said. But choosing the right one requires a great deal of care. Yet Scott D. Cummings president of the American Academy of Orthotists and Prosthetists says the trade is only now moving toward becoming a science. So far most of the focus in that direction has been on rigorously assessing orthotics and prosthetics for other conditions like scoliosis httphealth.nytimes.comhealthguidesdiseasescoliosisoverview.htmlinlinenytclassifier with less work on shoe orthotics for otherwise healthy athletes. Anecdotally we know what designs work and what designs dont work for foot orthotics said Mr. Cummings who is an orthotist and prosthetist at Next Step in Manchester N.H. But when it comes to science and rigorous studies he added comparatively there isnt a whole lot of evidence out there. Dr. Nigg would agree. In his studies he found there was no way to predict the effect of a given orthotic httpjournals.lww.comacsmmsseFulltextEffect_of_Shoe_Inserts_on_Kinematics_Center_of..aspx. Consider for example an insert that pushes the foot away from a pronated position or rotated excessively outward. You might think it would have the same effect on everyone who pronates but it does not. One person might respond by increasing the stress on the outside of the foot another on the inside. Another might not respond at all unconsciously correcting the orthotics correction. Thats the first problem we have Dr. Nigg said. If you do something to a shoe different people will react differently. The next problem is that there may be little agreement among orthotics makers about what sort of insert to prescribe. In one study discussed in his new book Biomechanics of Sport Shoes Dr. Nigg sent a talented distance runner to five certified orthotics makers. Each made a different type of insert to correct his pronation. The athlete wore each set of orthotics for three days and then ran  kilometers about  miles. He liked two of the orthotics and ran faster with them than with the other three. But the construction of the two he liked was completely different. Then what Dr. Nigg asked in series of studies do orthotics actually do They turn out to have little effect on kinematics http_obArticleURL_udiBTYTRN_user_coverDateFF_rdoc_fmthigh_origbrowse_originbrowse_zonerslt_list_item_srchdocinfotocFLAdisplayVolume_cdi_sortd_docanchor_ct_acctC_version_urlVersion_useridmdcaacbacabdfasearchtypea  the actual movement of the skeleton during a run. But they can have large effects on muscles and joints httpjournals.lww.comacsmmsseFulltextEffect_of_Shoe_Inserts_on_Kinematics_Center_of..aspx often making muscles work as much as  percent harder httpjournals.humankinetics.comjabbackissuesJABVolumeIssueFebruaryConsistentImmediateEffectsofFootOrthosesonComfortandLowerExtremityKinematicsKineticsandMuscleActivity for the same movement and increasing stress on joints by a similar amount. As for corrective orthotics he says they do not correct so much as lead to a reduction in muscle strength. In one recent review of published papers httpadisonline.comsportsmedicineAbstractEffectiveness_of_Foot_Orthoses_for_Treatment_and..aspx Dr. Nigg and his colleagues analyzed studies on orthotics and injury prevention. Nearly all published studies they report lacked scientific rigor. For example they did not include groups that for comparison did not receive orthotics. Or they discounted people who dropped out of the study even though dropouts are often those who are not benefiting from a treatment. Being generous about studies with design flaws that could overstate effects Dr. Nigg and his colleagues concluded that custommade orthotics could help prevent and treat plantar fasciitis a common injury to a tendon at the bottom of the foot and stress fractures of the tibia along the shin. They added though that the research was inadequate for them to have confidence in those conclusions. Dr. Nigg also did his own study with  Canadian soldiers. Half of them got inserts and the others for comparison did not. Those who got inserts had a choice of six different types that did different things to foot positioning. Each man chose the insert he found most comfortable and wore it for four months. The men selected five of the six inserts with equal frequency. The findings were somewhat puzzling While the group that used inserts had about half as many injuries  defined as pain that kept them from exercising for at least half a day  there was no obvious relation between the insert a soldier chose and his biomechanics without it. Thats why Dr. Nigg says for now it is difficult to figure out which orthotic will help an individual. The only indication seems to be that a comfortable orthotic might be better than none at all at least for the activities of people in the military. So where does this leave people like Jason Stallman my friend and colleague at The New York Times Jason has perfectly flat feet httphealth.nytimes.comhealthguidesdiseasepesplanusoverview.htmlinlinenytclassifier  no arch. He got his first pair of orthotics at  or  and has worn orthotics all the time for walking and running ever since. About a year ago he decided to try going without them in his everyday life he still wears them when he runs. Every medical specialist Jason has seen tried to correct his flat feet but with little agreement on how to do it. Every new podiatrist or orthopedist he told me would invariably look at his orthotics and say Oh these arent any good. The lab I use makes much better ones. Your injury is probably linked to these poorfitting orthotics. So he tried different orthotic styles different materials different orthotics labs with every new doctor. That is a typical story Dr. Nigg says. In fact he adds there is no need to correct a flat foot. All Jason needs to do is strengthen his foot and ankle muscles and then try running without orthotics. Dr. Nigg says he always wondered what was wrong with having flat feet. Arches he explains are an evolutionary remnant needed by primates that gripped trees with their feet. Since we dont do that anymore we dont really need an arch he wrote in an email. Why would we For landing  no need. For the stance phase  no need. For the takeoff phase  no need. Thus a flat foot is not something that is bad per se. So why shouldnt Jason  or anyone for that matter  just go to a store and buy whatever shoe feels good without worrying about correcting a perceived biomechanical defect That is exactly what you should do Dr. Nigg replied."