Wednesday, 1 March 2017

Do You Need Insoles? (Part 1)

Not long ago, runners seeking to correct imbalances in their feet had to buy custom-made orthotics insoles at prices as high as $400 to $600. Today, however, a host of manufacturers offer over-the-counter inserts designed to do the job of orthotics at a fraction of the cost. The insole market is a multi-million dollar industry and with more options available than ever. The two questions many runners ask themselves are: 

1) What type of insoles are right for me?

2) Do I even need insoles at all?

What is an insole?

When you purchase running shoes, they come with a sock liner designed to enhance the comfort of that pair of shoes. While some insoles intend to address pronation, the latest insoles designed upon current research, are built to enhance comfort, which according to the latest studies, is the key (and only proven) method for preventing running injuries. 

Available over the counter or prescribed by podiatrists, orthotics insole properly align your feet to avoid and treat injuries. About 25 percent of people have a normal running pattern. The rest of the running population overpronates or underpronates, meaning their foot turns too much or not enough at heel-strike. Orthotics insole can correct these imbalances by adjusting the angles at which the foot strikes the ground.

Orthotics insole are often considered the cure-all for just about any kind of lower-body, running-related injury, says sports podiatrist Richard Braver, D.P.M. They are used to treat plantar fasciitis (heel pain), chronic blisters, shinsplints, and leg-length discrepancies. "Orthotics insole can prevent and cure a problem by reducing and eliminating the stress that caused it," Braver says.

You'd think with all the technology that goes into making today's running shoes, runners wouldn't need additional support. But Ray Fredericksen, president of Sports Biomechanics Inc. and Runner's World technical editor, says companies skimp on the sock liner (the thin insole that comes with the shoe). "Sock liners are designed to break down and conform to the foot to enhance the fit," he says. "They're not designed to add extra cushion or act as an orthotic or a stabilizer." That's why so many runners are replacing them with over-the-counter or prescription alternatives. In fact, about $375 million was spent on over-the-counter orthotics in 2003, up 14 percent from the previous year.

But orthotics, especially prescription ones, should be one of your last options, Braver says. Custom orthotics cost between $375 and $450, and only about half of all insurance companies cover the cost. They aren't an overnight solution either. A podiatrist makes a plaster cast of your foot, and then a lab creates the insole from the cast. It can be about a month before you get them, and then when you do, they're still not race-ready. You need to break them in for one to two weeks, and you could feel some discomfort until you get accustomed to them.

If you're experiencing some kind of lower-body or foot pain, Braver recommends this course of action: 

Get Fitted
Problems can occur when you're in the wrong shoes. People with low arches as well as heavier runners need more stable, motion-control shoes, and those with high arches need more cushioning. Visit a specialty running store to make sure you're wearing what's right for you.

Alternate Shoes
"Most runners get injured because they run the same pace on the same surface on the same shoe, day in and day out," says Fredericksen. By alternating the shoes you're running in, the slight modification will give you relief from a high-stress area. If you like one particular brand and style, you can just rotate a slightly worn shoe with a new pair, Fredericksen says. 

See a Pro
Orthotics insoles are often the solution for structural deficiencies. But if your pain is caused by tight or weak muscles, Braver says, a physical therapist or massage therapist could solve the problem--and make orthotics unnecessary. See a sports podiatrist for a proper diagnosis.

Useful as they may be, such arch supports aren't without controversy. One voice of caution is Benno Nigg, co-director of the Human Performance Laboratory at the University of Calgary in Canada. Such inserts, he says, can be useful in recovering from injury but may not be something you should wear indefinitely. That's because, by reducing the range of motion of your feet, they allow some of the small muscles of the foot and ankle to get lazy. "It seems preferable to have strong muscles," he says. "Strong small muscles around the ankle joint and foot solve the majority of lower-extremity problems."

Portland, Ore., podiatrist Ray McClanahan agrees. "It shouldn't be a permanent, lifelong thing," he says. In addition to Nigg's concerns, he warns that anti-pronation arch supports can heighten the risk of sprained ankles, particularly for trail runners or people who run on slanted surfaces. There are times, he says, when you want your foot to be able to roll inward, "So don't use it on all routes," McClanahan says.

McClanahan is a minimalism advocate, favoring shoes with wide toe boxes, a small heel-to-toe drop and limited "toe spring" (the upward curve that most shoes have in their toes) as an alternative way to stabilize the arch. "We have the same goal but go about it in a different fashion," he says. He adds, however, that he's not adamantly opposed to foot supports. To begin with, they can be useful to take the pressure off a recent injury. "Maybe you strained a plantar fascia ligament," he says. "That might be a good time to temporarily put in a device to let it heal." In addition, McClanahan says that 4 or 5 percent of his patients do need permanent arch supports. "These are people who have structural problems," he says. 

To be continued...


Run On!

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