Orthotics

Experience From - Mary Gorski , Dale Perry , Dave Cameron#1 , John Liebeskind , Jim O'Neil , Norm Yarger , Byron Chikinda#1 , Rock Cogar , Tim Jantz , Tim Neckar , Rock Cogar , Tim Jantz#2, Deb Vomhof , Craig Waters , Charlie Vincent , Eileen Clark , Dave Cameron#2 , Byron Chikinda#2 ,

Andy wrote:

"So before purchasing expensive orthotics, I thought I'd find out what other people use in their shoes."

I have very flat feet and was surprised that an arch support would help so much. I ignorantly thought that only people with high arches needed arch support. Wrongo!

Andy Holak wrote:

"I remember a thread a while back regarding orthotics and over the counter inserts that some people found worked very well for them in lieu of orthotics. My question for those of you who use these over the counter inserts/orthotics, what do you use, how do you like it, do they take time to break in, and what would you recommend?

I went to the chiropractor last week for some major lower back pain I've been having since backpacking in Montana two weeks ago. I told her about my problem with plantar fasciitis and she looked at my feet and stance, and recommended I try orthotics. As I've been have knee and hip pain (ITB) in the same leg as my plantar fasciitis (right side), she suggested that perhaps it all starts at my foot. So before purchasing expensive orthotics, I thought I'd find out what other people use in their shoes. "

I'm a moderate to severe over-pronator. I need orthotics to counter my bio-mechanical inefficiencies. The result of this was causing me severe knee pain, as well as a mild case of Plantar. All that is basically gone now. I've had several bouts of knee pain in the interim, but that was based on worn out shoes, or needing the orthotics tweaked a bit.

I guess it all depends on how bad your foot placement is. If it is relatively mild, you might get by on the cheap insoles. My guess is, based on what you said above, you're more than that. Orthotics may be expensive in the initial outlay, but they last for a very long time (6-10 years) vs. who knows how long for the insoles.

It took me about a day to get used to the orthotics. Mine are a little stiff (rigid plastic to support the arch) with some cushioning in the forefoot. The effects of the orthotics were immediate. I couldn't believe they worked so fast!

To supplement the orthotics, I run in motion control shoes to overcome my over-pronating style of running. For trail shoes, it doesn't seem to matter (at least for me) what kind of shoe I wear. I've used both the Adidas Response Trail and the Adidas Alfresco (a motion control trail shoe).

If it was me, I would go see a podiatrist, get his opinion and go from there.

I second the arch supports. I have high arches (opposite of Mary Gorski) so my feet turn in a lot creating lower back pain. Arch supports have not eliminated the pain, but have cut the intensity significantly.

I have had problems with inflammations of my metatarsal heads (the distal ends of the long bones in the foot). The only podiatrist that my health plan would pay for was worthless (I live in a small town). So I did a fair amount of research and tried every over the counter orthotic I could find including Hapad and Superfeet. I have had the most success with Birkenstock 3/4 length inserts. They come in urethane or cork in a variety of styles from any Birkenstock store or the great shoe repair shop in Boulder, CO. Some places carry fewer styles. Cost is $35 to $45 and varies from store to store. I use them in all my shoes.

It also may be worth calling Hapad. They have an 800 number and person who answers the phone is the founder's sister who is extremely knowledgable.

In my last post I explained how I am dealing with my heel spur and ankle sprain problems. Although I am running well now, my podiatrist has suggested that orthotics might be a more permanent solution over the ankle strap that I am now wearing. The orthotics would also relieve the pressure on the neuroma's that I have in both feet. I have heard about runners who have orthotics and don't wear them for one reason or another. Can some of you who are wearing or who have worn orthotics share your experiences with these devices. Thanks. Another source for foot care products:

Foot Express
6714 North 64th Place
Paradise Valley, AZ 85253
1.888.922.4529
http://www.footweb.com

Jim, The one down side I had with my orthotics was that they elevated me a little too much and I didn't feel as stable on the trails. But they did work and cured my P.F. Then Nike re-did my cushion shoes so I could go back to them and I didn't need as much arch support. Now the neuroma's are another thing. I am currently living with one on each foot.

Jim, both my wife and my self wear orthotics and have run Ultras for two years now. Joy had very bad knee problems. She started with the hard orthotics but they hurt her feet to much when running and switched to the soft orthotics. They are great but don't last as long as the hard ones. Her knees have been great ever since! She has had the same orthotics for two years.

I started wearing orthotics because I had a bad case of Plantar Fasciitis that would not respond to other forms of treatment. For the last year they were great. Just recently I started to have problems with my other foot. I guess over time your feet can change I had to get refitted for another pair. The old ones were worn out.

Bottom line is we didn't think these would work but found they great. I have noticed we have had less injuries since wearing them.

Over the last few weeks I have read several statements that suggest that the long term use of orthotics might cause running injuries due to atrophy of foot muscles.

This worries me because I have been wearing hard orthotics for the last 6 years of 40 miles a week running. I have serious arch problems. While it looks like I have arches, my feet flatten almost totally when I put (160 lbs & I am 5'11" tall) my weight on a foot. Before I got orthotics, my knees would hurt greatly after every run. Since then, except for some off and on inflamed achilles, I have been injury free. I do know that tight calve muscles are causing the achilles problems.

This is not to say that orthotics are perfect for me. I seems that by wearing hard orthotics, I suffer much more shock damage from running 50 and 100 mile trail races (really bad after OD100) than my non-orthotic wearing ultra runner friends.

QUESTION: Should I consider not wearing orthotics or changing to a softer type ?

If you have had success running with your orthotics, then now is no time to change, no matter what anyone says about the intrinsic musculature of the foot. you have bio mechanical problems that have been corrected enough for you to run with minimal pain as compared to running without orthotics. if you want to continue to run without pain I suggest you keep those orthotics in your shoes and continue with what works for you.

As for shock damage, try getting spenco(neoprene) insoles(the ones without the arch) and layer 1 or 2 of them in your shoe instead of the usual sock liner that comes with the shoe. most spenco is only 1/8" thick so 2=1/4". that will add some good cushioning to your shoe. of course this works best if your orthotic is a metatarsal length shell and not a full length device.

I also use orthotics to run with. The one thing I do to keep the foot from being atrophied is that once a week I do 10 to 12 --100 yard strides at a football stadium ( the stadium has artificial turf). I believes this strengthens the whole foot from heel to toe. It gives the foot a chance to expand and contract without the use of a running shoe to support it. You'll be amazed how good it feels.

I have worn orthotics for the last 8 years for all running and hiking. I now think that you can get 2-5 years out of a pair. Here are some things that I have learned.

1. Most Orthotics are not really made for runners
   • They are too hard (need some cushion)
   • Heels are too low (stresses calves/achilles)
   • Soft coverings are useless (hard to clean/dry)
   • Soft coverings are too short (gives toe blisters)

   I have to guess that most of the patients that DPMs and PTs treat are not athletes of any kind (much less ultra-runners/triathetes,..) but are obese people with totally flat feet. I would love to find a DPM who specializes in treating 100 mile trail runners!

2. Beware of copied orthotics.

   Because the labs that make orthotics do not like to keep molds or casts, you might have to pay (maybe $100) a lab to copy your only pair of usable orthotics. The ones I just got have heels that are too low (achilles killers) and arches that are too high and might result in arch blisters.

3. Rip off those soft coverings.

   I always remove those sweaty soft covering from orthotics and use running shoe insoles on top of them. That way water and mud problems do not matter, just replace the insole.

4. Pay extra for fiber reinforced orthotics.

   These resist cracking - well worth the extra $8-$20.

5. Modify your own orthotics.

   You can modify your own orthotics. If you are in a town or city with nobody who can make/modify your orthotics, you can heat your orthotics in the oven at very low temperatures (like 180-220 F) and bend them to fit better (like when the arches are too high). However do this only as a last resort because you can ruin them ! You can also glue rubber pads or cork on the heels to ease calf/achilles stresses.

The lifespan of orthotics does depend on the material they are made of. if it is polyethylene (beige) they will sag over the years. polypropylene (white) is much stronger if it's the 3/8" variety and may last indefinitely if no adjustments are needed(adjustments are difficult and may need to be done by the lab)

My preference is the carbon fiber devices. the lab i use has come out with the next generation carbon fiber (light blue) it is light, thin, easy to heat adjust, comes in 3 types of firmness. the lab i use also guaranties them against breakage under normal use for the lifetime of the individual(they will replace them for free if you break or crack them, prescription changes aren't included) they also have gone to computerization so no more casts to send back or store, it's all in the computer. I've worn mine for 10 years with no problems.

As far as what i found works best for distance running is a metatarsal length shell with no extensions, and a vinyl top cover. it requires no maintenance, and is easily transferred from shoe to shoe. either put the orthotic right on top of the sock liner or replace it with flat spenco 1/4" if possible

Kirk Apt wrote:

I'm a recent convert to the joys of orthotics-my chiropractor tried for a long time to get me to try them. I finally relented in Oct., and I've been amazed. They were completely comfortable right away, and my pesky sub-acute plantar fasciitis disappeared immediately. Anyway, re: your question, I've got about 2100 miles on them at this point, and the soft material under the forefoot, and also under the hard part of the arch, is beginning to breakdown/crack a bit. They still seem to be working well, and I've just used athletic tape to cover the cracks. Mine are from a company called ComfortFit, and they're still under warrantee. I just hate to send them back and go without for a month or so. To any of you more experienced orthotics wearers: As long as the rigid supportive part is fine, should I worry about the soft part breaking down a bit?

I got these new type of orthotics, made from solid plastic, very strong, very inflexible. SInce wearing them the shock of impact on my leg joints and back has been tremendous. I saw a different podiatrist, who said i needed a different type of orthotic, more flexible. The impact is less but it still is killing me.

I have tried running without the orthotics, no pain just aching in my lower legs probably from pronation and using my stabilizer muscles (I am a flat footer with severe pronation).

So what is the answer, run without the orthotics and wait for another pronating related injury, or persist with the orthotics, strengthen my back and lose some weight. I have had one good run since wearing these orthotics, and i have no idea why it was successful.

Are there other people who have thrown away their orthotics and been fine? I originally only got orthotics for plantar fasciitis. Any help would be great thanks.

I wear orthotics primarily for Plantar Facia problems. I don't have the luxury of not wearing my orthotics for more then a few days to a week. Semi-rigid ones do take a bit of getting used to. I'm sure I could not wear rigid orthotics to run in. A hard piece of plastic under my arch is a sure route to severe pain and problems.

I'd agree with the guy who recommended another style of orthotic. My experience with Plantar Fasciitis injuries suggests: Loosing weight never hurts, but is hard if your feet hurt. Motion control shoes are a must. Calf and foot flexibility both help. Taping your foot works for acute injuries, but orthotics are pretty key. Once you have injured the area, it takes like 4-8 weeks for the facia to heal itself. Any excessive stress during this time and you are back to square one.

I have worn orthotics for ~15 years. The first several pair were whats called a semi-rigid--a plastic arch that had some give to them. They worked ok, but concentrated the load on a relatively small heal platform and they tended to breakdown shoes quickly.

A step in the right direction was a rubber/leather composite orthotic made by Foot Levelers (http://www.footlevelers.com/). I went to a local chiropractor, who made foot molds, and sent them off some place. They didn't last too long, were fairly heavy, and cost $150 a pair, but worked ok.

For the past couple years, I've worn "soft" orthotics made by the trainer at the local university (~$150 per pair and last 1500-2000 miles). They are a composite of cork, foam, and a cloth top covering. He buys the kit and assembles them. I think the name on them is FootTech (it is worn off). They are outstanding, have helped my plantar facia pain go away for the first time since I can remember, although it still flares up sometimes. The beauty of the whole approach is that they are built while I wait, I can walkout with orthotics 45 min after I walk in. During the appointment, based on my feedback, he adjusts then to modify the correction or pressure points.

I would like to hear the experiences--good and bad-- of folks with narrow, high-arched, under-pronating feet who tried custom orthotics (and why they tried them in the first place.) The background--today a sports med doctor recommended that I get them. He said that it amazes him that I have run for so long without foot problems. He feels they may be of help for some (as yet) minor lower leg tendonitis I am getting. No agenda here--he doesn't make them himself. I am skeptical, being of the "if it ain't broke..." frame of mind, but I am willing to try them. Unfortunately, the only people I know with orthotics have flat feet.

Eileen, I fit your bill. I wear a 9B in dress shoes - which is OK for a woman, but narrow for a man. I also have high arches, and the so-called arch supports on most shoes do nothing for me. Finally, I've been using orthotics for the last 10 years.

I think it depends on the reason for using. If you can find shoes that work w/o injury, why bother. I lost 6 mos. due to achilles problems - then when I compensated, I lost 6 mos. due to hamstring problems. I went to see a renown podiatrist (who has worked with Olympians Jim Spivey and Sebastian Coe). He fit me with orthotics (which weren't cheap) - and I haven't missed more than a few days to injury since (in ten years!).

I have problems finding shoes which fit - but the orthotics ensure that even if the shoes aren't a great fit, the molding of the orthotics offsets it. I've been able to buy cheaper running shoes.

But, everyone is individual, and what works for me may not be necessary for you.

Eileen, I have the 'semi-soft orthotics', rather than the hard plastic orthotics. Yes I have high arches. I got them to help resolve Plantar Fasciitis problems in both feet. It took about 3 - 4 months but it finally resolved this problem. My wife has orthotics to help with knee problems from over pronation.