Feet First: Why Orthotics are a Game-Changer for Runners

What are Orthotics?

I think it would be best if we went ahead and defined just exactly what orthotics are as well as look into what they do. Orthotics are prescription medical devices.

They are custom orthopedic devices that are designed and developed with the aim of relieving or supporting movable parts of your body. They can be used for almost any extremity but are most commonly used for lower leg and foot ailments. Orthotics can brace, align or prevent conditions that would otherwise hinder someone or cause them significant pain or discomfort.

Who Makes Orthotics and Where Can I Get Them?

Prosthetic specialists or orthotics as some may call them are professionals that design custom orthotic devices based on a patients’ individual need. However, podiatrists also known as foot doctors are usually the professionals behind foot orthotic devices. Either way, orthotic devices are not any run of the mill “in sole” you can find at your local sporting goods store. You will need professional assistance in obtaining an orthotic device.

Are insoles and Orthotics the Same Thing?

Short answer? No they are not the same thing. Insoles are generic, mass produced inserts designed to replace the standard inserts that come in your favorite pair of running shoes. They do not take into consideration your foot posture during stance or during gait. They don’t compensate for any specific size, length or structural considerations.

However, they can prove to be helpful in a few different ways. Namely, they can provide arch support or help with treating plantar fasciitis by reinforcing the heel area of the foot. And even more importantly they tend to be way more cost effective than your custom orthotic device.

The simplest way to look at orthotics vs insoles is that orthotics are made for function and insoles are designed with comfort in mind.

And now that you know the difference, let’s dive into the question at hand:

Can Custom Orthotics Help Alleviate Joint Pain?

In order for this to make sense we’re going to go ahead and look at this from a micro perspective as well as a larger macro scale. When we say joint pain we are referring to back, lower back, lumbosacral, hip, knee and ankle conditions. Individually, each of these joints can benefit from an orthotic device whether directly (micro perspective) or indirectly (macro perspective).

The Micro Perspective on How Orthotics Can Help With Joint Pain

Let’s take the foot and ankle joint as an example, since this is probably the most affected joint when it comes to this entire conversation. Orthotics can be used to address a collapsed arch in one foot that might not be present in the other. This difference could be because of a previous injury, traumatic accident or even just a developmental discrepancy. Regardless, the orthotic will provide much needed support and stability during gait. This is a prime example of how these devices can directly help you with joint pain. I.e The micro perspective.

And What About the Macro Perspective?

Well let’s stick with the hypothetical example we discussed in the previous paragraph. If we zoom out and take a look at the body as a whole, a few tell-tale signs might become a lot more apparent. Let’s say this discrepancy in the patient's feet was due to a significant ankle injury he or she experienced as a pre-adolescent. Because this injury occurred during a significant stage of this child's developmental years, it had a more significant impact than what everyone thought it did.

As years went by the child’s arch collapsed and stayed that way until the day he was referred to an orthopedic specialist. The specialist found that due to the overpronation of the affected foot, the child's vastus medialis oblique muscle (VMO) at the knee joint never properly developed. In turn, this led to a valgus knee posture (knock knee) that caused a leg length discrepancy, iliotibial band friction syndrome and underdeveloped glute muscles. Now yes this may sound excessive but the truth is this happens more often and not. And we start to realize the importance of these devices.

In this case, the specialist would (in a perfect world) refer the patient to a podiatrist for a full evaluation. The podiatrist would use 3D imaging to get a sense of the foot's condition and design an appropriate orthotic for this patient.

This orthotic device would in theory, correct the collapsed arch which in turn should help activate the VMO and correct the maligned knee and ultimately assist in treating any other underlying conditions caused by this injury.

Yes, this is a very specific example. But it was the easiest and most practical way to demonstrate how these devices can help you with various joint pains and injuries. They provide functional and structural support which could help you become pain free for the first time in a while.

The Downside of Orthotic Devices, the Part They Don’t Tell You

Just like most things in this world there are both positives and negatives to wearing orthotics.

Our bodies have this innate disposition to maintain homeostasis, to keep the status quo the main thing at all times. This is because, 9 times out of 10 our body adapts to discrepancies in our posture or our gait. Thus leading to our bodies to develop in a very unique way based on the situation it finds itself in. Our bodies want to maintain balance.

Now introducing an orthotic device is quite intrusive and will ultimately disrupt that balance. So much so that it could make your condition worse or even cause you to develop a different set of problems.

Case in point, I had a client preparing for the Comrades marathon. It was her first time attempting an ultra marathon. During her training she realized that as soon as she passed the 60km mark she had extreme hip pain.

After a consultation process with all the relevant medical personnel we found out that she had a leg length discrepancy probably stemming from her developmental years. And the problem only really presented in the extremes of her training and performance. Her body could withstand the discrepancy but only up to a specific point.

Anyway, we had her evaluated and she got a custom orthotic and she was off. Three weeks later she ruptured her achilles and was sidelined for almost 12 months. You see, the introduction of the orthotic resulted in increased pressure to an achilles tendon that developed in a specific way to balance out her discrepancy. It disrupted the homeostasis and resulted in a potentially career-ending injury.
 
In the end none of us knew this would happen. In hindsight, we should have progressively introduced the orthotic in order to give her body time to readjust and adapt to her new biomechanics. This is a mistake I will never make again and hopefully you will heed my advice when I say take it slow and don’t make the decision of getting an orthotic, lightly.

Our final thoughts…

What I discovered during this process is that orthotics and insoles can in fact help with your joint pain. If it is a well thought out process with multiple opinions from different medical perspectives that ensures all your bases are covered. Because just as fast as these devices can help you it could cause more problems. So proceed with caution.