Are Orthotics Worth It

Audio Transcript

Michael: Welcome to another episode of the podcast. Today, I’ll be answering a question from Wendy about orthotics.

Wendy: Hi! I’m coming out of a boot that I’ve been in for 12 weeks. I had a second metatarsal stress fracture, right near the lease frank region, so it was the upper part of my bone. I would like to return to running.

The doctor’s recommended that I get an orthotic to put my foot in the try hard position where the first metatarsal, fifth metatarsal in the back of my foot are getting more of the impact than the middle metatarsals.

There’re mixed reviews about running with an orthotic, and I was wondering if you had any thoughts about them.

Thank you very much.

Michael: That’s a great question Wendy, and there’s lots of different opinions on orthotics. For listeners who may not be familiar, orthotics typically referred to custom made orthotics, which are typically made by a podiatrist or something of that nature.

They’ll essentially take a mold of your feet, and get you custom made insoles based on that mold. This is why they are believed to help alleviate running injuries, and basically just better set a shoe to fit your feet.

There’s also other brands that make what we would call somewhat customized insoles and orthotics; those are brands like Superfeet.

What these brands will do is, they’ll essentially have like different levels of the orthotic based on your arch height and stuff like that.

They’re not 100% custom, but at the same time, they’re pretty good. They’ve had some decent results, but they’re still along the same lines of orthotics, which we’ll talk about here today.

To begin, we’re admittedly a little bit skeptical of stuff like gait analysis and custom orthotics. Mostly because a lot of times, this stuff can make your running form worse.

We’re talking about the kind of gait analysis where you end up in a specific running shoe.

Sometimes this can make your running form worse, which is kind of contrary to popular belief, but if you’re getting your running gait analyzed and getting in a specific kind of shoe, like a motion controlled type shoe, it can actually make your running form worse.

That’s why, just to begin, we are definitely a little bit skeptical and especially with the amount of runners that are told they need custom orthotics, if you have flat feet, high arches, they can tell you, you need orthotics for anything.

Your foot can look any way and if you’re having any sort of pain then, a podiatrist can easily tell you that you need a custom pair of orthotics.

Not to mention, custom orthotics are close to $400 or $500 in some cases, if they’re not covered by insurance.

If there’s a way to solve your problems without them, then that’s obviously going to be best, but there are cases where it can be very beneficial.

The idea of orthotics mostly centers around the pronation paradigm.

Basically, what pronation means is the inward rolling of your ankle while you impact with the ground, where your foot impacts with the ground.

If it over pronates, that means your foot kind of, ever so slightly or even a lot rolls to the inside of your foot, to the medial side of your body a little bit too much, kind of towards the end side.

Over pronation is commonly thought to cause many of the common running injuries: IT band syndrome, shin splints, hip issues, knees, all that stuff is commonly attributed to over pronation and in some cases, under pronation.

Typical conical trials of orthotics have gone really well. Doctors and podiatrists have found success in helping running injuries through custom orthotics.

Runners come in injured, get a custom orthotic, and the next thing you know, you’re better.

Biomechanics labs have attempted to quantify the degree to which a particular feature of an orthotics’ impact it has on a runner’s gait has. It’s been negligible, very difficult to find an actual effect.

Perhaps there is a way that it definitely helps, but it’s not necessarily exactly the way it’s explained, in terms of altering your gait to produce a better running stride.

While some studies have made us a bit more skeptical of custom orthotics, there is one study. In 1991 a survey of 347 runners using custom orthotics after suffering an injury, found that 75% of them reported complete or near complete recovery, and 90% of those continued to use their orthotics, even after their recovery.

That’s obviously a pretty good marker there that sounds pretty good. It could be coincidence; we don’t necessarily know that the orthotics are exactly what caused the recovery.

Maybe they were doing some strength exercises, stretching, just being more diligent with everything overall, we don’t really know.

Nonetheless, those numbers look pretty good, and make a pretty good case for using orthotics post injury.

In terms of people who absolutely should consider using orthotics, and this gets back to Wendy’s question, any runner with chronic pain under the first metatarsal head, which is a pretty common thing, will almost certainly benefit from the orthotics.

Basically, this is going to relieve pressure in the area; obviously it’s going to be specifically designed to help with the specific area for that individual.

That’s a case where it can definitely help, but podiatry is going to be one issue.

That’s one reason that we’re a bit skeptical overall.

If you’re going to talk about pronation, and talk about archs, and molding this orthotics in a specific way, that will be assuming that you have a specific foot; like a perfect foot.

We don’t really know what the perfect foot looks like, because that would assume that somebody has the perfect foot.

We don’t necessarily know what the perfect foot is, and thus you can’t necessarily say that every person needs to stride for this exact perfect foot strike, or gait or whatever it is.

Different things are going to work for different people.

Different people have different gaits, and body dimensions and all of that, so it’s going to cause some differences to where you can’t necessarily just say, “This is the perfect foot. We’re going to absolutely make sure that these orthotics get you closer to that perfect gait and basically mimic that perfect foot.”

Yet again, it’s definitely been shown to help; there’s a correlation there, to help with post injury, getting back from injury, getting to the point where you’re running consistently healthy.

If your doctor does recommend an orthotic, then that’s something that we’re never going to go against the will of a doctor, that’s for sure.

If your doctor says, “This is what you need,” then they’ve seen your foot, they know what’s going on, then we’re going to go along with that.

At the same time, don’t be afraid to try a high quality orthotic. I’m a big fan of Superfeet myself and I’ve found people had a lot of good results with those; it’s more like $50 rather than $500.

Could be a good alternative to try, if your doctor says you need a little bit more support on the inside of your arch, or whatever it may be.

That could be something to try.

Otherwise, it’s typically something that, if you’re just thinking of a way to prevent some injuries or just a way to make your shoes more comfortable, that’s typically the case where we’re not going to recommend looking at orthotics.

There’s other things you can do, like strengthening exercises and core work.

All of that is going to be tremendously more beneficial than throwing an orthotic into your shoe.

One thing I will add is that I wore custom orthotics back in college, but I never ran in them.

What my doctor recommended was, to wear them walking around. I was on a big college campus, walked around a whole lot and I would in a sense just walk to class and walk between my classes in these orthotics.

I was having some planta fasciitis problems, so that’s why I had had the orthotic made.

It seemed to help, though I’m not going to necessarily say it made a huge difference, but that could be a good alternative for people.

People who are on their feet a lot, especially if you work a job where you’re standing up a lot or you walk a lot or whatever it is, you could use them as you’re walking.

That’s not going to necessarily affect your gait in the same way that wearing them, while running is.

That was a great question.

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Thanks for tuning in Runners Connect fans. Have a great run today.