Today on the Doc On The Run Podcast we’re talking about whether or not you really need custom orthotics for running.
Do you really need custom orthotics if you’re a runner?
Well, that depends. This episode really comes from a question that was sent in from Charlie in Dubai. And so Charlie, thanks for sending this question in. I really appreciate it. It is a great question.
He wrote in and said, “A foot and ankle doctor here suggested custom orthotics due to my extremely high arch. Anyway, I have them, they’ve been made with computer tomography and I’m wearing them but I feel like they’re not quite right. Close, but not right. Anyway with 50 plus years of not having them, are they really needed?”
Well that is a great question. And that is really what you have to think about. If you’re a runner and a doctor suggests custom orthotics for you. Now the basic premise behind custom orthotics is that you need custom orthotic therapy or this device that is custom molded to fit your foot and change the positioning and functioning of your foot as it hits the ground as you run. So, there is basically an underlying premise that you are, in some way, bio mechanically flawed. You’re somehow anatomically defective or permanently broken.
So, Charlie brings up a good point here. If he’s had 50 years with no trouble why does he all of sudden need custom orthotics. How long have you been running without trouble. That’s one thing I often ask people who I see and they say, “Well some doctor said I have to have custom orthotics, because of my foot, the way it is, I need to have custom orthotics to in order to support my foot to protect me from trouble.” Now most cases, those are people that either have really have really high arches like Charlie, or people with really low arches or flat feet.
We know that people at the far ends of the spectrum, people with really high arches and people with really low arches or really flat feet are prone to certain problems. But, they are different problems.
If you have really high arches your foot is pretty ridged so you may be more prone to stress fractures. You may be more prone to peroneal tendon injuries or ankle sprains but when your foot is really flat you get different problems. You have too much flexibility and not enough rigidity in your foot and we think you’re more prone to getting plantar fasciitis and posterior tibial tendinitis and some other conditions.
But, the question I always have, assuming that you have been running for a long time, if you’ve never gotten any problems because your foot is that type of foot, why do we just assume that you’re going to get problems down the road?
If you don’t have problems I don’t really see why you need custom orthotics, at least not for most people. Maybe something happened, maybe you got an issue with tendonitis or you got a stress fracture or something happened. But, it’s just one thing happening right? And that can happen to anybody. I’ve had over-training injuries because I’ve done something stupid. I went and ran 16 miles on a hilly course when I wasn’t really fit, in shoes that I shouldn’t have been running in for that particular run. Well, that was a dumb thing to do. And I’ve run in shoes on trails where they’re not rigid enough and I’ve basically hammering down the stairs I’ve gotten and issue. That doesn’t mean I need custom orthotics to protect me. Maybe I need a coach to protect me from doing stupid things to myself. But I don’t need custom orthotics, necessarily, to support my foot and hold it in a corrected position to protect me from foolish behavior.
All over training injuries result from some error in judgment. If you do the training plan yourself and you put the wrong kind of workouts back-to-back, you can get into trouble. If you do the right kind of workouts with the right spread of time between them you can recover in between and don’t get injured. But, if something happens, you know, you change directions, unpredictably because of a dog or the way you land on a trail or some obstacle on the road that you hit, then you could get an injury because you’re already about to get injured. And most runners as they train, they’re always about to get injured.
Let’s face it, if you’re at your maximum physiologic capacity for absorbing those workouts you’re maximizing your capacity to build fitness and get stronger for your next event. However, if you cross-over that line because you run a little too far or you run on a surface that’s a little too irregular or it just happens to be a lot muddier than normal and you have to exert more force as you do that particular run it then translates into too much force that pushes you over that line when you cross through threshold for injury and you get an over training injury. But, it may have just happened once so if it works that you back off your training and you do the stuff that you need to do and you heal it are you really still broken in terms of your underlying mechanics?
There’s an interesting quote I saw one time from a guy who wrote a book on barefoot running. Now, he runs barefoot. If you run barefoot, custom orthotics don’t really help you, they go in your shoes, they don’t work if you’re running barefoot. But he said, “Don’t trust the man behind the curtain who is selling custom orthotics.” And there’s a lot of truth to that, right?
So you need to think about people’s underlying motivation and granted every doctor wants you to get better but at the same time doctors are selling products and services that they make a profit from.
And so, you have to ask the doctor many times, say, “Okay well look, if I have custom orthotics because I got injured can’t I use orthotic therapy for a period of time the same way you’d use a fracture walking boot or a cast or crutches for a period of time? To help you get some additional stability to protect you so that injury can heal faster for a sort of determined period of time, not forever?” And your doctor may just say, “Well yeah that makes sense. You can use these for a period of time. It will get you back to running soon, or it will help you train more now. It will protect you a little bit more now but then you may not need them forever.”
It’s really important. You really have to just decide whether or not you do need them long-term because your foot is prone to getting the same kind of injury over and over and over or if it’s a thing that can help you just by protecting you a little bit to keep your activity level up while you continue to heal so that you can then get back to running and training without any issues.
But, remember, once you’re healed, in all likelihood you’re back to your actual baseline where there isn’t really that much issue of applying excessive forces that are going to predispose you to another one of those injuries. So, the truth is that I don’t think most runners need custom orthotics. I do not make orthotics for most of the runners I see. And I see runners all day long. I talk to runners all day long and most of them, in my opinion, do not need custom orthotics.
So, the thing you can think about is that if you’ve been training, running, you’ve been active for 50 years, you’ve never had any problems then you get one over-training injury, that’s a mistake in training. That’s something that happened. That doesn’t mean that your bio mechanically faulty or you would have had problems for years. If you’re getting posterior tibial tendinitis over and over and over and over, yeah you might need custom orthotics. If you’re getting stress fractures over and over and over, you need to think about what you’re doing in training and see if there’s something you can modify.
You may think about your shoe type first and if those things aren’t sufficient to address it and you’re still getting stress fractures then yeah, you might need custom orthotics. But, everyone does not need custom orthotics.
So, ask your doctor the right questions and you’ll be sure that you can get back to running sooner and hopefully get back to running without custom orthotics.
If you have a question that you would like answered as a future edition the Doc On The Run Podcast, send it to me, and then make sure you join me in the next edition of the Doc On The Run Podcast. Thanks again for listening!