Stepping Into Better Health: What You Should Know About Orthotics

As your train­ing efforts work toward meet­ing upcom­ing goals, take an hon­est self-assess­ment of strengths, weak­ness­es, and past per­for­mances. With increased demands on your body, you may begin to notice weak areas in your feet, ankles, knees, legs, hips, and/​or back that are trig­gered by increased mileage, speed, or aer­o­bic impact. Remark­ably, on long runs, I’ve even encoun­tered neck and shoul­der pain. Too often, the cul­prit to these aches and pains is poor align­ment from the low­er extrem­i­ties. For­tu­nate­ly, there are prod­ucts — or modal­i­ties — avail­able that will relieve your pain and keep you run­ning with­out fur­ther chron­ic injury.

The art of the step: Prop­er Biomechanics

Much hap­pens when you take a step. Dur­ing rough­ly 60 per­cent of your time walk­ing or run­ning, your body’s mass resides on one foot. Depend­ing on your speed, this can trans­late three to nine times your body weight on each low­er extrem­i­ty with each step. At heel strike, your foot should con­tact the ground just lat­er­al to the cen­ter of your heel. As your body moves for­ward, your slight­ly supinat­ed (rolled out­ward) foot will pronate (roll inward) to accom­mo­date the sur­face on which you’re wak­ing and serve to absorb shock. Just before heel left and toe push-off, your foot will re-supinate, lock­ing it into a rigid lever to pro­pel you forward.

Where things go wrong

In the prona­tion phase, if you hyper-pronate (roll inward too much), your tib­ia rotates inward, tak­ing along your hip as it goes. In this sit­u­a­tion, your foot can­not prop­er­ly re-supinate to gain a prop­er mechan­i­cal advan­tage in propul­sion. Reper­cus­sions can be let in the feet, ankles, shins, knees, hips, and back. Like­wise, if you over-supinate, you can­not accom­mo­date prop­er shock absorp­tion and are more vul­ner­a­ble to lat­er­al stress frac­tures in the feet, ankle sprains, and exces­sive com­pres­sion in the knees, hips, and back.

Know your sup­port systems

Each in their way, orthotics and arch sup­ports are designed to sup­port and cor­rect the feet dur­ing the stance phase of gait. While both are intend­ed to replace the insoles in your shoes and sup­port your feet, an orthot­ic is cus­tom-made for you. Once acquired, orthotics should be used in each shoe for at least 85% of your over­all activ­i­ty. Your body will adjust to the new cor­rect­ed align­ment, but inter­mit­tent use — such as wear­ing them only when you run – will per­pet­u­ate local­ized irri­ta­tion and dis­com­fort, much like inter­mit­tent use of read­ing glass­es. There are two kinds of orthotics: func­tion­al and accom­moda­tive orthoses.

Func­tion­al Orthot­ics are designed to cor­rect malalign­ment and can influ­ence your body all the way through your hips and spine. They keep your rear­foot in its neu­tral posi­tion and coor­di­nate this align­ment with your fore­foot and low­er extrem­i­ty so your stride stays with­in the nor­mal para­me­ters of motion. This will de-rotate your tib­ias, align your knees, and reduce the abnor­mal ten­sion in your hips and low­er back. Func­tion­al orthotics are typ­i­cal­ly made by cast­ing a 3‑D repli­ca of your feet while the foot is held in its cor­rect­ed posi­tion. This is usu­al­ly done with plater or in foam. Once in use, func­tion­al orthotics can help an ath­lete per­form at max­i­mum poten­tial longer, with­out fatigue. They can also help every­one ambu­late longer, more com­fort­ably and reduce the harm­ful sequela asso­ci­at­ed with malalign­ment such as bunions, ham­mer­toes, neu­ro­mas, plan­tar fasci­itis, etc.

Accom­moda­tive Orthotics sup­port your feet in their cur­rent posi­tion. These are often made by stand­ing on a mechan­i­cal device or walk­ing across a plate. Accom­moda­tive or ​“soft” orthotics offload promi­nences and offer sup­port in an inflex­i­ble foot. In less active indi­vid­u­als, they accom­mo­date bio­me­chan­i­cal dys­func­tion and seek to relieve pain. These are out­stand­ing old­er patients, those with lim­it­ed mobil­i­ty or feet that have very min­i­mal bio­me­chan­i­cal dys­func­tion. These are typ­i­cal­ly not used in ath­letes or indi­vid­u­als with jobs that require exten­sive weight bearing.

Arch Sup­ports are sim­ply what the name implies. They add a lit­tle extra sup­port in a shoe to allow bet­ter func­tion in high­er-stress sit­u­a­tions. Peo­ple with min­i­mal dis­com­fort or bio­me­chan­i­cal irreg­u­lar­i­ties can ben­e­fit from these over-the-counter devices. Typ­i­cal­ly, peo­ple who see an ini­tial ben­e­fit from arch sup­ports but need more sup­port lat­er will usu­al­ly do quite well with cus­tom orthotics. While I don’t favor any par­tic­u­lar brand of OTC devices, I’ve seen many qual­i­ty arch sup­ports com­ing from local shoe retail stores. Look for a firm device (to con­trol motion), com­bined with a soft pli­able top-cov­er to pro­vide cush­ion from impact.

Oth­er over-the-counter options

Metatarsal pads are to be worn under the fore­foot just behind the metatarsal heads. They not only offload the metatarsal heads from impact but also func­tion­al­ly spread them, reliev­ing painful com­pres­sion against a devel­op­ing neu­ro­ma. Be care­ful to place them prop­er­ly in the shoes and not too far for­ward to be promi­nent against the metatarsal heads.

Toe caps or gel sleeves are devices that may be ben­e­fi­cial for an area of your toes that is sub­ject to chron­ic pres­sure. They can be used to pro­tect a vul­ner­a­ble toe­nail, a toe in mal­po­si­tion, or an area of fric­tion between two toes.

Two Day Rule

Take two days off if a body part hurts for two straight days while exer­cis­ing. Two con­sec­u­tive days of pain may sig­nal the begin­ning of an injury. If some­thing hurts for two weeks, even after rest­ing prop­er­ly, it’s time to see your doctor.