Why Orthotics are Gifts from the Running Gods (and how I almost went mad)

Hey there runner, this week's blog is a little different.

It's a real-life,

behind-the-scenes,

hot-take

on a runner under life's stresses with MIA orthoses.

Meaning, I can't run all the stress away (ok…at least not run "comfortably" without some foot pain by mile 2).

That foot pain part: you *might* understand! (maybe even say, "hey, me too!")

So if you'd like to come along for this week's ride you'll:

• find out more about orthoses (orthotics)

• how they help #teampancakefeet (flat feet)

• What if feels like to actually need custom orthotics vs just new shoes/foot exercises

• Why you're not crazy when you feel that the off-the-shelf orthotics aren't helping

• And some wild stories along the way

Ready for the most fun way to learn about feet and orthotics ever? ;)

Let's go, running fit fam.

DAY 1

Dropped off my badly-needing-refurbishment orthotics with the athletic trainer who set me up with custom ones at the VERY beginning of baby-running-marie's journey (and here we are now).

The original prototype he gave me 13 years ago was a hard plastic form molded to my foot that I had in my running shoes for so long they eventually cracked from all the miles on them.

I eventually went back to get fitted for correct, actual orthotic instead of a (rather robust) prototype.

Signs & Symptoms YOU might Need Orthotics:

• No real pain/issues first starting your run, even a few miles in

• Gradual "burning" sensation. The key here: you can identify it as a muscle-fatigue burn rather than a sharp, stabbing, burning sensation. (it can be a tricky differential diagnosis between muscle symptom vs nerve)

• You continue to experience this muscle fatigue burn (maybe to greater or lesser degrees) regardless of rotating shoes or getting new shoes

• Foot strengthening exercise *may* help and decrease your symptoms, but they don't fully go away.

• Please know, this is NOT a comprehensive list. (this is based off of my personal experience and observations as a practicing physical therapist)

The coolest thing however might be HOW this athletic trainer (AT) made and formed the original prototype.

Because this is where you'll start to see an engineering difference between the off-the-shelf versions and the beauty of custom made. (yea, we're getting pretty nerdy here…)

Off-the-Shelf Orthotic Versions:

• You buy the option that best describes your feet (high arch, flat foot, normal, etc).

• Most instructions say pop it in the microwave & warm up the material so it's moldable

• You stand on it (in your shoe or outside of your shoe, it all depends) so it forms to your foot. Great in theory, right?

My Custom Ortho Experience:

• The AT had me lie prone (on my stomach) with feet hanging off the edge of the training table.

• He positioned my feet in what's called a talar neutral position (where the talus bone in the ankle is placed in a central position, meaning you can actually feel with your fingers that the amount bone is equal on both sides-the talas isn't off to one side more than the other)

• From there, he warmed a square sheet of moldable plastic, draping it over the back of my heel and along the entire bottom of my foot

• Very clear instructions to NOT move followed until the plastic cooled.

• Afterwards, he trimmed the mold of my foot down to size so it ran roughly half of my foot-from heel to about midfoot (but it still allowed natural supination/pronation forefoot movement)

Did you spot the biggest difference yet? ;)

The reason the off the shelf orthotic might not be working for you: your mold of your feet is created in a weight bearing position (aka standing).

Compare that to to my orthotics experience where I was lying down and the mold was taken with my feet in a neutral position, rather than a flattened out, pancake position.

By creating a mold in a non-weight bearing position, the AT was able to capture my naturally occurring arch (which gets flattened out into pancake oblivion when I stand and walk).

Can you start to see how you're NOT crazy?

Those off the shelf versions *can* provide some support, but they aren't truly enhancing or complementing the natural engineering that is your unique arch and foot, nor are they providing any minute corrections you may need.

DAY 2

Day 2 of no running because the orthoses are MIA.

So I decide to double down on strength work. It's full body strength day-let's go!

Did I mentioned I'm moving? If you didn't know that, you do now. And we are in the throws of house showings. Which for us, means we need an home inspection.

We knew this part was coming.

But we didn't know when he was coming.

What day

What time

Nothing.

Story time.

I'm working out upstairs with earbuds in.

Crazy bed head.

Sweat dripping down my face.

Ugly workout faces (it happens.)

Maybe I put deoderant on? (maybe I didn't. But it doesn't matter…because it's just the husband working downstairs and me upstairs).

And I threw my warmup sweatshirt to the side, fully embracing the sweat-tastrophy of workout sports bra and shorts.

Then…the husband taps my shoulder and says the home inspector is here.

And actively coming up the stairs.

Despite the husband trying to tell him: WAIT! LET HER GET A SHIRT ON!

….

Oh lordy.

A couple awkward moments pass.

During which, all I could think was "if I'd had my running orthotics, I would have been out on a run instead of being shirtless and surprised by a strange man in my own home!"

But we survived, running fit fam.

He got a stink eye.

I finished my workout.

And the world did not implode.

But it was made painfully obvious- I need to get back to running ASAP.

What can we learn from this?

Why Some Flat-Footed Runners Might Need Orthoses:

Orthoses (the technically correct name for the things you put in your shoes; orthotics is the study of said things you put in your shoes) are usually prescribed because of foot pain

However, orthoses should NEVER hurt your flat feet.

They should complement and support them, encouraging more efficient foot biomechanics.

• Just because you have flat feet does NOT mean you *always* need orthoses

• But signs you *might* need them despite NOT having foot pain include biomechanical compensations such as:

  • medial heel whip

  • knee valgus

  • and excessive hip internal rotation

  • all of which are documented indicators in the literature that you might be predisposed some sort of running injury somehow, sometime down the line

• Orthoses that are developed for YOU to correct any of these biomechanical issues should create near-immediate improvements

  • (aka someone can watch you run with the orthoses in and observe that your heel isn't hitting the inside of your calf, your knees aren't knocking together anymore, and your hip doesn't dipping down and in like it did before).

But just to cover all the basis, sometimes the correct stability shoe can create these positive changes too, without the use of supplemental orthoses.

• It all depends on your body and how much help it needs. (mine needs a lot; you might not!)

DAY 3

Missed my alarm. Slept in…oops.

Frantic shower.

Coaching call from relocation career helper person while simultaneously trying to make breakfast.

Dropped an egg which cracked all over the was-clean kitchen floor.

2 house showings in 30mins after half hour coaching.

Shovel food in face.

Chaos cleaning.

All the while thinking: "If I had my orthotics, I'd just be out on the trails in my running trail shoes for the entire duration of the house showings."

Send help, running fit fam.

Send positive running vibes, please.

DAY 4

Set a different alarm...which worked.

In the middle of working with an amazing shin splint runner-client who is making phenomenal progress!….

I get a text saying a contractor will be over in 15mins to look at things we need fixed up around the house.

...

The theme this week: people come over to look at the house when I am not non-runner appropriate.

(Meaning, you, running fit fam, understand the "I live in my workout/running clothes look". Other people call this staying in your lazy comfy clothes all day…)

We survived regardless, but only after another full body strength workout to burn off the angsty jitters.

Let's see what madness tomorrow brings.

DAY 5

I'm going to have bite the bullet this weekend and run a couple miles without my orthoses.

*dramatic music!*

The trick will be paying attention to how my feet feel

...and respecting their complaints.

I know; not fun.

However, I'm in the same boat as some of you all who are currently dealing with foot pain. Here are the symptoms I pay attention to that tell me it's time to call it.

Signs &Symptoms It's Time to Wrap Up My Orthoses-less Run:

• when the muscle burning symptoms in my forefoot persist

• I'm constantly changing how my foot falls, rolling through supination to pronation because I'm trying to get comfortable...and I can't

• When my right knee starts getting cranky and achey which happens from having a pancake right foot which results in right knee valgus up the chain (meaning, my right knee will start to cave in with fatigue and due to poor biomechanics)

That's a wrap for now, running fit fam!

Here's to hoping you can learn from my experience and if nothing else, walk away knowing PT's are NOT untouchable, especially runner physical therapists.

I'm right there in the trenches with you.

Exploring how my body responds.

Experimenting with exercises.

And trying really hard to respect it when it says it doesn't like running at the moment.

(and of course, trying to cheat and run a little bit)

Until next time, Dare to Train Differently,

Marie Whitt, PT, DPT //@dr.whitt.fit

P.S. Hey there! If you're like me and trying to NOT lose your mind because you can't run as much as you'd like at the moment, grab a copy of my FREE running guide! Do helpful cross training running things along with me and before you know it, we'll both be strong enough to run again!

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REFERENCES

Jimenez-Perez, I., Gil-Calvo, M., Quesada, J. P., Aparicio, I., Sanchis-Sanchis, R., & Pérez-Soriano, P. (2019). Foot Orthosis in Running. Materials in Sports Equipment, 451.

Souza, R.B. (2016) “An evidence-based videotaped running biomechanics analysis,” Physical Medicine and Rehabilitation Clinics of North America, 27(1), pp. 217–236. Available at: https://doi.org/10.1016/j.pmr.2015.08.006.