ORTHOTICS—LOVE ‘EM OR HATE ‘EM

“PHIEDIPPIDES DIDN’T HAVE TO DIE”

WHO SHOULD WEAR ORTHOTICS?

If Pheidippides had worn orthotics, he might have fared better. Why? Because an orthotic minimizes the work it takes to move forward. It reduces stress and strain of the working muscles, which minimizes oxygen need and reduces the production of lactic acid, through efficiency. Of course, we’ll never know for sure, but his body had to work much harder to run that distance, because we all have some inherent poor alignment characteristics in our biomechanics.

PRONATION

What is not well understood is that the arch stretches as far as it has to, to absorb incoming shock; this active motion is called pronation. When the arch spreads like this unless it has been limited beyond its neutral (I prefer to call this optimal) position, is called overpronation.

That moment in time between the optimal position and beyond is the injurious force that accumulates over a lifetime until the injury comes to the surface and you feel it as pain.

This includes walking as well as running; the difference is like a car, adding mileage at 25 mph or 65 mph. For every step you take, is like a mile in your car. For every decade of your life, your biomechanical injury (comparatively) level is approximately 100,000 miles.

ORTHOTICS AND PREVENTION

Am I saying that everyone will face biomechanical injury? The answer is that very few individuals in their lifetime will not experience some kind of foot, knee, hip or low back pain. Am I saying that everyone should wear orthotics, YES. The real issue is prevention, not cure. Just like brushing your teeth to prevent cavities, not cure them.

All runners who do as little as 3-5 miles/week will eventually develop some kind of lower extremity injury.  In addition to various physical therapies such as: rest, ice, heat, cross training and stretching, the single most important adjunct to recovery (and prevention) is proper fitting orthotic.

Over-the-counter orthotics are usually helpful, because they minimize the repetitive motion of the arch, and are good if you choose not to go with a custom fit.

The bottom line is that while custom orthotic are made to fit your foot they  “must” also fit the way your foot walks by meeting all four criteria of the fit.

ORTHOTICS FIT: FOUR CRITERIA

There are four criteria that you must look for when being fit for or wearing orthotics.

  • the orthotic must be supportive, you should feel the support such that it is full or snug fitting
  •  it “must” be comfortable
  •  it cannot overcorrect your alignment position on the ground, you “must” be stable (by overcorrect I mean that your foot should not be tilted too much on the outside edge-this would be overcorrection/supinated)
  •  It “must” fit the way your muscles and feet are working and not necessarily the architectural fit of just the foot.

All too often, custom orthotics fail because they are either too uncomfortable to wear or they work slowly and the wearer does not realize this, and gives up too soon.

Consider that even if wearing an orthotic that fits, if you continue to run or just walk, every step is still antagonistic to the healing process. The best way to heal yourself quickly is to go to bed and stay there for the next 3-6 months… Can’t do that? Then deal with the fact that the healing process at best is two steps forward and one back.

This happens because the orthotic is trying to “precisely” control the action and position of the foot through the gait cycle, and the foot does not or is not ready to function in that position.

For maximum results and comfort, there can be no compromise in these criteria.  Anything less may help, but will not achieve maximum results and more than likely be uncomfortable.

If you find that your orthotics do meet all the criteria, then they are working. The healing process can take a long time and for most runners, always does, considering that running on the injury is like taking two steps forward and one back.