I began researching foot orthotics 15 years ago when I was the trainer for the University of Western Ontario Cross Country running team. I noticed inserts that some of the competitors were placing in their training shoes. When asked, they would often indicate that they could not train without them, as they would develop debilitating foot or lower limb pains without the orthotics. Unfortunately, most of the racing shoes would not accommodate the orthotics, so I always had lots of work to do after an event!

Since my days as a trainer, I have become fully convinced of the benefits custom foot orthotics offer.

Custom foot orthotics help the body deal with biomechanical faults commonly found in feet. “Flat footedness” or “fallen arches” are the most easily visible cues of these faults. The problems are usually due to an issue called Plastic Deformation. Plastic Deformation occurs over time, when connective tissue (ligaments and such) are placed under constant or repetitive stress. The tissue will stretch a bit when stressed, and will almost return to its pre-stretched state afterwards, but not quite. Over time, the “almost returns” accumulate, and these fractions of millimeters become millimeters. The increase in the length of the tissue allows the bones to move with more freedom, which can lead to instability and “fallen arches.”

“Fallen Arches” are a big problem. They signify a condition known as overpronation, which is a fairly complicated syndrome. Suffice it to say that overpronation can and does cause foot, leg, knee, thigh, hip and low back complaints.

Custom foot orthotics reduce the effects of overpronation. Orthotics are comfortable inserts that fit into your shoe or boot. Orthotics do not generally work well in sandals, so the orthotic companies have all developed customized sandals to deal with this problem.

The process is fairly simple. If orthotics are indicated, I will take a foam mold of your foot, then send that mold with my clinical impressions to the orthotic lab in Toronto. A little more than a week later the finished, custom-made-for-you foot orthotics are in your shoes. Customized shoes, boots and sandals are available, but they take a bit longer to ship.

The fees associated with custom foot orthotics and custom footwear are usually covered entirely or in part by your work health benefits. If you are not covered, rest assured that Napanee Chiropractic Care Centre offers the most competitive pricing in the area for custom foot orthotics.

Antidepressant medications offer significant benefit in the treatment of the severest depressive symptoms, but the current standard of treatment may have little or no therapeutic benefit over and above placebo in patients with mild to moderate depression — a population which accounts for most cases.

An analysis of 6 randomized, placebo-controlled trials conducted by investigators at the University of Pennsylvania, Philadelphia, and published in the January edition of the Journal of the American Medical Association indicates that compared with placebo, the magnitude of benefit of antidepressants varies with the severity of depressive symptoms.

“True drug effects (an advantage of antidepressants over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms,” the investigators, with first author Jay C. Fournier, MA, write.

“I think the most surprising part of the findings was how severe depression has to be in order to see this clinically meaningful difference emerge between medication and placebo and that the majority of depressed patients presenting for treatment do not fall into that very severe category”

According to the authors, although antidepressants are the best established treatment for major depression, there is little evidence demonstrating their efficacy in patients with less severe symptoms because most major clinical trials tend to exclude patients in the mild to moderate range.

In the meantime, he said, it is premature and potentially hazardous to suggest patients with mild to moderate depressive symptoms discontinue use of their antidepressants.

“Treatment decisions need to be made on an individual basis between patients and their doctors,” said Mr. Fournier.  He also pointed out that it is important for depressed patients to take an active role in their own care, regardless of the severity of their symptoms.  “One additional point that may be getting overlooked in the broader messages about this paper is that even placebo treatment helps a great many people, and although we don’t fully understand why that is, part of it likely comes from patients taking their symptoms seriously, acting on their concerns, and speaking with mental health professionals.

“Rather than walking away with the impression that nothing works for mild or moderate depression, I hope patients understand that treating their illness seriously and actively engaging in treatment can be quite beneficial,” he said.