A lot is said about orthotics and sports insoles and how they can either prevent injury or improve sports performance.
This article is going to briefly describe how orthotics can possibly help prevent injuries and potentially improve running performance. One of the most common errors with orthotics or insoles is that there is a poor diagnosis of the problem and more importantly the cause of the problem. There are many causes of injuries such as those listed below.
Poor Foot Biomechanics
Loss of Muscle Control
Training Volume & Intensity
Malalignment of the Pelvis and Lower Limb
Muscle Weakness and Muscle Imbalance
Without the correct diagnosis and the cause which can be multi-factorial you will be unable to fully treat a long term problem like Runners Knee, Achilles Tendonopathy, Knee Pain, Hip Bursitis and Shin Splints. Often injuries like those above become reoccurring problems or you get a range of different injuries due to the same fundamental cause which has not been addressed.
An orthotic is “a device for the foot that is issued by medical professional following an examination for the treatment of an injury in order to help restore optimal foot biomechanics to prevent injury and improve gait”. This is very different to an insole which may look like an orthotic and can be purchased from a shop or running shop. Here, no examination of the foot or biomechanics is looked at in depth. However they do have their place with regards to shoe comfort and may help provide some proprioceptive feedback, though there is little evidence for this and what research is available is of poor quality.
One bit advice I would give to runners, having worked in the industry now for over 15 years, is that rigid orthotics can cause problems and I would strongly suggest that if you use rigid orthotics for running to look for an alternative.
When you see a professional with regards to foot biomechanics and running technique you need to find someone who can first assess your body and screen you for abnormalities and then assess your functional stability.
Without all this information it is difficult to say whether orthotics will be of significant benefit to the runner. Orthotics are an aid in helping injury prevention and should not be seen the answer to all your problems but they can help significantly in certain individuals.
How can orthotics be of benefit?
Reduce tissue loading: If the tissues in the foot are suffering undue stress by supporting these structures it will help reduce direct loading to these tissues. E.g. plantar fasciitis.
Abnormal Biomechanics of the foot: If, as a result of poor genetics, your foot has abnormal biomechanics, the most common being forefoot or rearfoot varus; these can be reduced by postings added to the orthotic to try and reduce the abnormality. The posting which is wedge shaped, allows the foot to align more correctly, there by helping prevent tissue loading and an abnormal amount of pronation at the forefoot, rearfoot or both.
Proprioception: Depending upon the materials used, correct posting etc the foot may benefit from the orthotic by a complicated mechanism of neural feedback. This will enhance motor control and give the body better feedback of joint position allowing more rapid control of the foot motion. This will help with fatigue and motor control on landing and reduce the speed of pronation rather than the amount of pronation to prevent injury.
Increase motor control and shock absorption: The muscles in the lower limb absorb the majority of the shock on landing and throughout mid-stance (not your trainers). It is the repetitive strain on the muscles and increase shock through the lower limbs that can lead to injury. Orthotics using the above 1-3 reasons will help some people improve motor control and ability to absorb shock. This will reduce risk of injury, muscle fatigue enabling the runner to recover quicker between runs and improve performance.
Poor Lower Limb Alignment: If you have poor lower limb alignment when running then this can lead to injury. Lower limb alignment is generally believed to be governed by the pelvic control or the foot posture. Deciding which one is driving the misalignment needs full assessment and quite often it is a combination of them both.
These are just some of the suggestions as to why orthotics may prevent injuries and improve performance. If you have pelvic or thoracic misalignment, poor motor control or poor technique you may find orthotics do not help as much as you would like. All of the above can increase pronation at the foot (foot rolling in) and this is what you may see when someone analyses you on the running machine. The orthotic may be ineffective in cases where muscle retraining and running technique need to be concentrated on with modification in training program. Orthotics may later enhance your training by allowing you to increase mileage or intensity.
Another factor greatly overlooked with orthotics is how we land on the rear, mid and fore foot. Orthotics may help all types of foot strikes but some may benefit more than other when it comes to orthotics.
This is just the tip of the iceberg when it comes to orthotics; at Physio4Life we will spend up to an hour assessing your biomechanics and muscle control along with a full video analysis and gait scan. The orthotics we use are made from a Thermo Memory Plastic which is a dynamic material with a life time guarantee. It is excellent for runners who want to improve their foot biomechanics, proprioception and muscle control. At Physio4Life we offer a full follow up service and you will be sure of getting the best advice based on the current evidence available.
Mark Saunders
Clinic Director