If you have been a runner for some time, odds are you have heard of, know someone that has, or have orthotics yourself. Some runners have custom orthotics prescribed by their chiropractor, podiatrist, orthopedist or physical therapist. These devices are constructed to limit excessive range of motion, usually pronation.
It is very common in the running community for athletes, regardless of how long they have been a runner, to head to their nearest running specialty store anytime they need advice about the Anything from shoe/clothing selection advice (acceptable) to questions about medical concerns stemming from running related injuries (not a good idea). At most, shoe store employees have no formal education about orthotic devices and related medical conditions. They are unaware what the orthotic is actually trying to achieve. They usually will put the individual in a stability or motion control shoe which is designed to limit normal range of motion and when combined with and orthotic can become a severe detriment to the runner.
Another trend that has become popular these days is for shoe stores to have an individual in their store making custom orthotics. Most of these people are self proclaimed experts with little if any training in the art of podiatry, medicine, anatomy or biomechanics. They are not health care practioners and should not be diagnosing medical conditions or prescribing orthotics. This practice is illegal and should be viewed with skepticism. Having a shoe store employee diagnose your injury and then try to solve it with a shoe is ridiculous and they are guilty of practicing medicine without a license. It’s important to find a doctor or expert you can trust when it comes to making decisions related to your everyday health. The same applies when ensuring you can continue, injury free, with your athletic lifestyle.
Another way orthotics are often made is by having the customer walk across a padded mat. That person’s center of pressure is transposed into the computer and sent to a laboratory where a custom orthotic is constructed. The basic flaw with this system is obvious. There is a radical difference between walking and running (Mann: Biomechanics of walking, running and sprinting, The American Journal of Sports Medicine, 1980). As the speed of gait increases the length of stance phase progressively decreases from 62% for walking to 31% for running to 22% for sprinting. The body lowers its center of gravity with the increased speed by increasing flexion of the hips and knees and magnifying dorsiflexion (flexion toward the rear) at the ankle. Both quadriceps and hamstring activity increase as speed increases and as speed increases so does the amount of toe running. To custom create an orthotic for a runner based on walking gait is unscientific and irresponsible and usually does not help or improve the persons running any more than a much less expensive over the counter insole would have. These orthotics are generally much too rigid to flex in the way a foot needs to during a running stride.
In a more recent study (Nigg: Orthotic Comfort Is Related to Kinematics, Kinetics, and EMG in Recreational Runners, Med & Sci in Sport & Exer, 2003), it was found that 50% of the time a subject would respond the exact opposite as expected when fitted with an orthotic prescribed in the above manner. Runners would actually supinate more if a lateral wedge was given or pronate more if a medial wedge was prescribed! In effect they would continue to shift their center of pressure even more into the direction that the orthotic was trying to prevent.
In conclusion, orthotics are a very helpful device when properly prescribed and made with the intended activity in mind. If you think you might need orthotics be sure to trust the person who you have making them for you and remember, if you are running pain free, then there should be no reason to change the equipment you are using.
Written by Dr. Victor J Runco, DC