“Once acquired, orthotics should be used in each shoe for at least 85 percent of your overall activity.”
By Dr. Randall Kline, podiatrist, Allied Bone and Joint
It’s March, two-plus months into the still fairly new year. You have been working to stick with your resolutions and directing training efforts to meet upcoming goals. This may be the prime time to 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 not only relieve your pain, but keep you running without further 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 is residing 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 (turn in) to accommodate the surface on which you’re walking—shock absorption. Just prior to heel lift 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 pronate phase, if you hyperpronate too much, your tibia rotates inside as well, talking along your hip as it goes. In this case, your foot is not able to re-supinate properly to gain a mechanical advantage in propulsion. Repercussions can be felt in the 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 own way, orthotics and arch supports are designed to support and correct the feet during the stance phase of gait during weight bearing activity. While both are designed to replace the insole in your shoe and support your foot, an orthotic is custom made for you. Once acquired, orthotics should be used in each shoe for at least 85 percent 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 rear foot 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. Yes, these can be made with your feet placed in foam, but I have found casting in the office is the most reliable. The result is an orthotic that balances the entire kinetic chain of the lower extremities.
Once in use, an athlete can perform at maximum potential longer, without fatigue and significantly reducing the harmful sequela associated with malalignment—such as bunions, hammer toes, 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 in older patients, those with limited mobility or feet that have very minimal biomechanical dysfunction. They 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 irregularity 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 will 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. These will usually come in different thicknesses. Only trial and error will determine the best size for you.
Toe caps or gel sleeves are devices that may be beneficial for an area of your toes that are subject to chronic pressure. These can be used to protect a vulnerable toenail, a toe in malposition or an area of friction between two toes. Caution should be used as a silicon sleeve could retain moisture and cause maceration and skin breakdown on longer runs, particularly if your feet sweat significantly. Nylon caps reduce this risk, but irritation could develop if the seam creates pressure against the adjacent toe. Other alternatives would include other foam devices or even a strategically placed piece of cotton between two toes that rub together.
The Two Day Rule
If you haven’t heard of The Two-Day Rule, here it is: “If something hurts for two straight days while exercising, take two days off. Two straight days of pain may signal the beginning of an injury.” This can translate to any of your favorite activities. If something hurts for two weeks, even after resting properly, it’s time to see your doctor.
Exercise smartly this season! As many of us have learned (perhaps painfully), starting slowly and increasing steadily is always preferable to overtraining in the first weeks only to be interrupted with an injury that needs recovery time.
If you’re like me, you’re now a year older and expectations should be tempered with the patience and wisdom that you’ve accumulated over your many years. May you continue to have a blessed 2018.