To read Part I of “Foot orthoses – what do you need to know?” click here.
What to expect from a practitioner?
When you see a practitioner regarding your running injuries and/or efficiency expect that the practitioner has some understanding of running and activities themselves. Managing distance runners can be tricky. Your practitioner should understand running and that orthoses and footwear are only one small part of managing running injuries.
They should also understand that, above all, running efficiency and good postural form, along with appropriate training, are more important. Expect that there is an understanding of running and what it is like to be subject to significant stresses and that small differences have a large effect.
Observation of your running is useful and in some cases essential. This is preferably done over-ground, compared to treadmill running.
Types of orthoses
As in many industries over many years, materials used for orthoses have changed rapidly. There is no need for runners to have orthoses that are rigid, thick ,and heavy. Ideal orthoses for distance runners are flexible, lightweight and of minimal bulk.
Some ideal ‘running’ orthoses are even pre-formed and can be easily modified to suit individual needs. Preformed orthoses can be made from materials of different stiffness depending on what is required for the individual, ranging from extremely flexible to flexible/semi-rigid. More recent materials surpass older materials and are often lighter, more easily modified, and less bulky.
Although some flexible orthoses provide small ranges of control of excessive motions of the foot and usually have poor durability, they provide an excellent way to assess an individual’s suitability and tolerance to wearing orthoses.
‘Off-the-shelf’ orthoses are available commercially though they are often foam moulded devices, offering little support for the runner and are often bulkier than needed. Orthoses of this style are difficult to modify for the individual to achieve an ideal fit and level of support.
Casted rigid orthoses are manufactured from a plaster impression of the feet and enable large ranges of control to be achieved. Casted orthoses may be made from a variety of materials ranging from semi-rigid to rigid. In my opinion, there is no place for rigid orthoses to be used for distance runners.
There is a large variation among individuals to what type of device is most suitable and how much control is required. Runners adapt to their own individual running and are subject to significant forces so many times that the aim is to control only a percentage of excessive motion.
The initial wearing of orthoses. What to do and what to expect.
The first few days of wearing orthoses should involve only daily walking activities. There may be some pressure in the heel and/or arch area but this should only be temporary. To begin, orthoses should be worn for a short time only such for a few hours. If there is excessive pressure from the device, remove the orthoses for a short time. Wearing time should be gradually increased over the first five to seven days until you can wear the orthoses all day during daily activities and walking.
Running or participating in any activities should begin when the orthoses are comfortable and can be worn all day. Gradually introduce the wearing of the orthoses into running and other activities. This should take no longer than seven to ten days at most. If it takes more than this time or even several weeks to be comfortable the orthoses are more than likely too high.
Most people should be able to run in their orthoses after approximately one week, but there is variation between individuals. Orthoses should not impose any pressure to the feet and should be extremely comfortable with excellent fitting in footwear.
If there are fitting problems, blisters, or excessive heel or arch pressures, orthoses should be easily adjusted. Feedback to the practitioner is most important! Approximately one-third of runners issued orthoses require adjustments. Orthoses should be worn with complete comfort! Modifying orthoses should be quick and easy when using excellent and appropriate materials.
Jason Agosta is a Podiatrist of 25 years and is also a former Australian representative at the World Cross Country Championships. His pb’s are 13.48 5000m, 29m for 10km. He still runs approximately 50-60kms per week. The above is very much his opinion in managing distance runners.
References and additional reading:
Cavanagh PR, La Fortune MA, (1980), Ground reaction forces in distance running. Journal of Biomechanics 13, 397-406
Clarke T E, Frederick EC, Cooper LB, (1983) Effects of shoe cushioning upon ground reaction forces in running. Int J Sports Medicine 4, 247-251
Feehery RV, (1986), The biomechanics of running on different surfaces. Clinics in Podiatric Medicine Surgery 3, 649-659
MacLean C, McClay Davis I, Hamill J, (2006), Influence of a custom foot orthotic intervention on lower extremity dynamics in healthy runners. Clinical Biomechanics 21, 623-630
McMillan A, Payne C, (2008), Effect of foot orthoses on lower extremity kinetics during running: a systematic literature review. Journal of Foot and Ankle Research 1:13
McMillan A, Payne C, (2011), Immediate effect of foot orthoses on plantar force timing during running: A repeated measures study. The Foot 21 26-30
Nigg BM, Bahlsen HA, (1988), Influence of heel flare and midsole construction on pronation, supination, and impact forces for heel toe running, Int J Sport Biomechanics 4, 205-219
Payne C, Chuter V, (2001), The clash between theory and science on the kinematic effectiveness of foot orthoses. Clinical Podiatric Medicine and Surgery 18 (4), 705-713
Robbins SE, and Hanna AM, (1987) Running-related injury prevention through barefoot adaptations. Medicine Science in Sports and Exercise, 19, 2
Robbins SE, Gouw GJ, (1991) Athletic footwear: unsafe due to perceptual illusions. Medicine Science in Sports and Exercise, 23, 2
Shorten MR, Winslow DS, (1992), Spectral analysis of impact shock during running. Int J Sport Biomechanics