A Few Myths About Orthotics

Due to mild pronation, I've run in a stability shoe for as long as I've been getting my shoes professionally fitted. That was towards the beginning of college; before that I honestly can't say what type of shoe I was running in, because my basic approach was to try on a bunch of running shoes until I found ones that felt comfortable. Then there was the one year we couldn't afford shoes and my coach gave me a pair to wear for the season, which I think were actually used and already worn out. Given all that, it's probably not surprising that I suffered from horrendous shin splints for years that all manner of leg and foot exercises did nothing to fix. Around the same time that I started wearing a stability shoe, I also started trying to switch to a forefoot strike; between these two things, my shin splints all but disappeared in a few months.

Earlier this year, I got really curious about racing flats and started looking into getting a pair for shorter races. At the time, flats weren't something I knew much about. In high school I wore spikes for time trials and races 1600 m or shorter or regular trainers for workouts and two mile races; it never occurred to me that there was any other option. (Mostly I wanted them for 5Ks & 10Ks - it's hard for me to imagine running farther than that with that little cushioning.) In an effort not to walk into a running store completely clueless on the topic, I tried to at least do some research on how flats are fitted compared to trainers and what different types exist. Alas, there wasn't as much detailed information out there (at least that I was able to find) as I'd hoped. So, armed with precious little knowledge beyond the basics, I put myself in the hands of the shoe people at Roadrunner Sports.

And I learned a few things right away. First, that there are two types of racing flats: performance neutral or "true" flats (very little in the way of cushion and support), and performance stability shoes (slightly more support, mostly aimed at preventing overpronation). After video-taping a few seconds of me running barefoot, they confirmed what I already knew: high arches + flexible ankles = not insignificant overpronation. Which, one of the salespeople explained to me, meant that running in a true racing flat was probably out of the question.

On the off chance that it might help, they did a quick custom orthotic for me and we did a few more videos of me running in the neutrals with the orthotics. It made some difference, but not really enough. Next, we tried a few different performance stability shoes. In those videos, my pronation looked similar to when I was wearing the neutrals with orthotics. When we added the orthotics to the stability shoes, the pronation was almost gone. So I left that day with my Mizuno Musha Wave 3's and a pair of molded inserts.

In the last couple of months before this, the shin splints I thought I had banished back in college had been sneaking back up on me. They weren't as bad as they had been; just noticeable enough to be annoying (and worry me a little). On the off chance that it might do some good, I started switching the molded inserts into my trainers when I wore them. (It didn't.) As I've mentioned lately, I think they've been getting better in the last few weeks; I'm now running in my new Brooks and the molded inserts in an effort to add every little bit of stability I can.

It's been a while since I discussed all this with someone with an actual medical degree, though, so recently, I made an appointment with a sports medicine podiatrist, just to see what he thinks. Then today, I ran across another Gina Kolata article regarding orthotics and running.

That was kind of a bummer.

Well; sort of. It turns out that yes, orthotics really do work in a lot of cases in that they often do let people run or walk more or less pain-free when they weren't able to before. On the other hand, there's apparently a lot of bad information out there about orthotics as well. The article goes into a lot of detail, but here's what I took away from it in terms of myth-busting:

Myth#1: Doctors understand how orthotics work. Apparently they don't, really. It's more a process of trial and error than anything else.

Myth #2: Doctors can predict what effect a given orthotic will have on a given patient's biomechanics. Unfortunately, ten patients with the same biomechanical problem may react to the same orthotic in ten different ways. Depending on how a certain patient responds, the issue may get better, worse, or stay the same.

Myth #3: Orthotics change a person's running form & kinematics (how the skeleton moves during running). Even when a patient reports that orthotics are working, there is rarely evidence that s/he is actually moving differently as a result of the orthotics. (On the other hand, there is evidence that wearing orthotics can reduce muscle strength.)

Myth #4: There is good scientific / medical evidence that orthotics prevent injury. There isn't. There are lots of studies, but most of them are not scientific or lack rigor. That doesn't mean that orthotics don't prevent injury in certain cases, just that there is no real evidence that they do. (The article does site one well-controlled scientific study where orthotics did appear to reduce injury in a group of soldiers; but again, even in the soldiers who suffered fewer injuries, the researchers did not see evidence that the orthotics changed anything about their biomechanics. Also, the soldiers chose their own orthotics based purely on what they thought was comfortable, without any input from a doctor at all.)

The article wraps up with some advice from a professor of biomechanics: Instead of turning to orthotics right away, he says, most athletes would do better to instead work on strengthening the muscles in the affected parts of their legs.

So really, who knows whether those custom inserts are really doing anything for me or not? I'll definitely be very interested to see what the podiatrist has to say about all this next week.