Question
Dear Dr,

I need an unbiased opinion even though you are a chiropractor.  I am seeing a chiropractor %26 things are moving along nicely.  My one leg is somewhat shorter than the other due to a crushed ankle injury some 20+ years ago, thereby causing pain on my right side.  We have discussed orthotics.  Now the chiropractor utilizes the digital foot scans to determine where exactly I'm off balance.  I also have a Podiatrist who doesn't utilize digital foot scans & does a manual examination instead.  The Podiatrist said that they haven't had much success with these foot scans.

Here is the issue:  I know the Chiropractor will say his method is best whereas the podiatrist will say his method is best.  Please provide me with an unbiased opinion as to which is better - the digital foot scan or the manual exam.

John

Answer
John,

I am a Diplomate in Chiropractic Sports Medicine and I do have notable experience in evaluating and issuing foot orthotics, enough to have some level of authority on the topic.  There is no research I'm aware of to prove that the digital scanning devices provide any better "outcome" than an orthotic fabricated by some other method.  I've seen some orthotics produced by digital scan devices that, while meeting the criteria of the scanner protocol, don't feel good under the patient's foot, don't match the footwear well, and don't change the patient's condition.   The science of foot orthotic prescription has not yet caught up with the art of it.   Personally, I have several different pairs of custom orthotics as well as several pre-fab (off-the-shelf) versions.   They are all different.  Even the custom orthotics feel and function differently depending on how I need to use them, e.g. snowboard boot verses cycling shoe, or dress shoe I stand around in verses my gym shoes.   In your case, what is the goal?    Back to your question... there is no substitute for a manual examination.   There also should be a kinetic exam, e.g. looking at foot and leg function during your gait (walking) and 1-leg balancing (for example).   Manual examination provides information about how stiff or loose your joints are, how much range of motion you have, etc.   Some of the scanning devices are simply marketing tools to help the practitioner sell more goods to the public.   So far, I'm not sold on it.   If the chiropractor has no advanced training in sports medicine, no additional coursework in how to address lower extremity conditions that include orthotic use, and only uses the scanning device because that's all they know, then you can guess what you can expect.   If the podiatrist only sees you as a pair of feet and ankles, and fails to appreciate the uniqueness of you anatomy, kinematics, activities, and footwear, you can also guess that your orthotic will look like everyone elses.   And what's the cost??   Don't be afraid to challenge your providers with questions.  If you get a giant wad of defensiveness instead of logical answers and explanations, then you problably are dealing with a salesman more than a clinician.    I hope this was helpful.

Dr. G