Q: I was told recently that I need orthotics. I am concerned because I know some runners that have tried orthotics and found them to be painful. How do I know if orthotics are right for me?
A: It is true that some runners find orthotics uncomfortable, and even painful to wear. Two broad issues need to be addressed. First, the 'break in' period is extremely important. If new orthotics are worn too much, and too soon, the feet can become painful as they adjust to the new forces and pressures under the feet. Similar discomfort can be noted in the leg muscles. This soreness can further decrease your tolerance to orthotics.
The second broad issue in relation to orthotic tolerance is that muscle and joint inflexibilities actually contraindicate wearing these devices. One reason not to wear rigid orthotics is a lack of movement in the ankle joint caused by either tight calf muscles and/or bony blocks at the front of the ankle joint. Tight calf muscles can be stretched, but when this is not possible rigid orthotics are contraindicated. Bony blocks, small protrusions of bone, at the front of the ankle joint can usually be noted on x-rays and can occur after trauma to the ankle such as ankle sprains. Even if the calf muscles have enough flexibility, the block to movement in the ankle joint contraindicates wearing orthotics. Some other issues for runners who may be considering orthotics include instability in the knee joint and limited motion of the first metatarsophalangeal joint, the joint at the ball of the foot. A podiatrist can and should assess, among others, these factors that test your suitability for orthotics. All this noted, in some cases, a podiatrist might actually prescribe orthotics to correct some of the limitations mentioned above.
Another important point on orthotics is that orthotics can be flexible or rigid and inflexible. The type of material from which orthotics are made should be based on your running needs, foot type, biomechanics, … and the list goes on. If your feet and legs are suitable for rigid orthotics, they can be very comfortable and help correct abnormal biomechanics, which in turn can treat injuries. If for example, you have limitations in joint motion but still need some improvement to your biomechanics, more flexible orthotics may work well for you.
Finally, shoes make a difference to orthotic comfort. Typically, orthotics are prescribed based on the shoes you normally run in and if orthotics get uncomfortable with new shoes, you should get the orthotics checked and modified (or try different shoes).
Dr. Nick Brown
Dr. Brown is a postdoctoral researcher in the Department of Biomedical Engineering at The University of Texas.
