FREQUENTLY ASKED QUESTIONS
The running store told me I have wear on the outside of the soles of my running shoes. They told me I am a supinator and that I should be in a neutral shoe. Why do I need to see a pedorthist for a shoe recommendation?
You can be a severe pronator with wear on the outside sole of your shoes. A view of your gait while barefoot and in shoes, along with a complete historical intake re: training and injury will be required before a determination can be made. Keep in mind that shoes, while easily classified as neutral, stability and motion control are more complex than such classification implies. Each shoe is created from a last that varies in shape, vamp length and girth even within the same category from the same manufacturer. At FootMechanics, we consider the structure of the foot as well as the biomechanics of the foot as it relates to the biomechanics of the entire body when recommending a shoe for the athlete. Conditions such as genu valgum, tibial varum among other conditions may dictate the recommendation of a shoe that might not typically be considered for the pronator or supinator.
The running store watched me run on the treadmill and told me I needed a stability shoe because I pronate. Why do I need a gait analysis by a pedorthist?
The running stores that take the time to watch runners on the treadmill are typically the best source for your running shoes. Such efforts demonstrate a desire to fit the runner and work with the runner until a shoe is located. They have usually tried on most of the shoes and are daily determining which foot type works best with which shoe. Additionally, they are intimately familiar with the idiosyncrasies of each shoe since most have attempted running in them and are the first people to discuss problems with the shoe with the customer.
That said, input from a pedorthist who specializes in the feet of athletes and is an athlete as well is invaluable. First, it is impossible for the human eye to pick up on all of the biomechanical issues of an athlete without the benefit of a video taped session that can be slowed down and replayed many times. And, of course it goes without saying that the video is only as valuable as the practitioner evaluating it! Second, most individuals do not possess optimal biomechanics; and as such, are not always helped by the shoe alone. Most athletes, and especially endurance athletes, will benefit from an interface between the foot and the shoe. Many patients I see have been put in the best shoe for their type of foot; but for various biomechanical reasons, the shoe alone did not prevent injury. An assessment as to whether one pronates or supinates, in many cases, is insufficient information to properly outfit the endurance athlete with the correct platform for their sport.
What is an orthotic? Are there different types? Aren’t they just an arch?
Technically, an “orthotic” is a word used to describe a device (orthotic device) and is often used when actually referring to a foot orthoses.
An orthoses can be any device that interfaces between the foot and the shoe. It can be accommodative (adaptive to the foot and it’s biomechanics as is) or functional (corrective). At Foot Mechanics, we create functional orthoses for our athletes. Functional orthoses address the high level of forces and biomechanical issues of the athlete to prevent injury. Every sport uses the foot and body in a different and unique way. We believe that orthoses should reflect that and accordingly, we recommend different orthoses for different sports. A common example is the difference between the use of the foot as a cyclist vs. a runner. An orthosis for a cyclist would be inadequate for a runner and vice versa.
I would like to start running longer distances and my doctor has told me that I would benefit from custom orthotics. Running is a natural state, isn’t it?
Custom orthotics are so expensive/why should I invest in something like this for an activity that I was designed to do,
The body and the foot, working together is an amazing phenomenon. We were designed for running and it is a good thing to do. However, just like everything else …….few of us were blessed with optimal biomechanics: and even if we were, we age and things change. An orthosis can be specifically tailored to address those biomechanical issues and changes. Orthoses can be the difference between being able to run long and not being able to do it at all. Some people need to experience injury before they opt for orthoses. At FootMechanics, we believe they can be a wonderful preventative tool. When you consider that the feet and the body are the “equipment” that you cannot take back or exchange for a new set, custom orthoses are a wise investment. Custom orthoses will allow you to do all that you want to do with much greater comfort and allow you to enjoy a lifetime of activity.
I can buy orthotics at the running store. Why do I need to see a pedorthist to obtain an orthotic for my running shoes?
OTC orthoses (over the counter orthoses) are much different from the custom orthoses that a pedorthist would provide. Did you know that each step a runner takes represents full body weight X 7? A runner is one who is basically jumping from leg to leg in reality. That’s a lot of force and if it’s provided in a less than optimal biomechanical state, that’s a lot of force that is destined to create an injury. The OTC is not always equipped to 1) handle that level of force and 2) handle such force in the optimal state for any particular athlete for an extended period of time. At FootMechanics, we provide athletes with custom, functional orthoses. If a foot has a biomechanical issue and it creates stress on soft tissue, joints, and/or bones, then a functional orthoses must be made to improve the biomechanics. A functional orthoses improves the biomechanics of the foot by applying a post or wedge in the shoe or orthoses to counteract undesirable forces generated by ground reaction forces at the time the foot contacts the ground. The forces act on wedges or posting to change the moments that produce movements in the joints of the foot and elsewhere. The OTC cannot address undesirable forces responsible for injury because they are not typically posted; and other than providing some arch support, cannot address the specific biomechanical issues of the individual athlete. That said, the OTC is sometimes sufficient if 1) your biomechanical issues are very minor and 2) use will not be heavy in terms of distance and weight. If you are an endurance athlete committed to optimal performance and care for your feet, a functional custom orthoses is the way to go.
I’ve heard that pedorthists put everyone in orthotics…is this true?
No. This is why we take a thorough intake of the athlete’s training and injury history. Sometimes, we discover that the injury has arisen from training error or is due to an unrelated medical condition. In such cases, we speak with the personal trainer or physician and with some rest or treatment, the athlete is ready to continue the activity without orthoses. If the injury has not arisen from the biomechanics of the foot or body, we believe the patient should continue activity, once restored, without orthoses.
I already own orthotics…..they’re in my closet……they didn’t help at all and they were uncomfortable. Why should I see a pedorthist for more of the same
Good question. As runners, we have personally used custom orthoses made by chiropractors, podiatrists, sports podiatrists and pedorthists. Due to personal frustration with these devices and a considerable number of injuries before and after use of same, we decided to form FootMechanics for athletes. Simply stated, as long as orthotics are made by human hands, no two will be alike and many will not be the answer to your biomechanical issues. We believe that you cannot simply look at the foot and design orthoses for it. We also believe that you cannot look at the strength of various muscles and not look at the platform (or feet) for the muscles in the body. Likewise, the alignment of the skeletal structure, while important, cannot be viewed apart from the platform for the body----the feet. Often a very narrow view of the issue is responsible for ineffective orthoses.
Orthoses are casted in many different ways. Casting is an extremely important part of the orthotic fabrication process and is often the difference between a good and bad pair of orthoses. Feet must be maintained in the subtalar joint neutral position while casting, which is impossible to do when using foam or inadequate computer programs to take an impression of the foot. Even with the technique used by Foot Mechanics; i.e., plaster casting, a good cast can be difficult to achieve if left in the wrong hands.
It is FootMechanics’ philosophy that functional orthoses for the athlete cannot be made without a good exam and video-taped gait analysis. It is through these two avenues that the biomechanical issues responsible for injury are often discovered. Both are used to determine forefoot abnormalities, an often overlooked area that if addressed can mean the difference between the ability to continue an activity with or without injury. An exam to assess the athlete’s range of motion in the foot will also determine the extent an orthosis can or will need to be posted.
Finally, specifying and fabricating orthoses is an art rather than a science. It’s been said that an artist with depth is one who has experienced a good deal of life. Likewise, over 30 years’ experience in running and 10 years’ as a cyclist and several injuries and different types of orthoses lends depth and unique understanding to the orthotic therapy FootMechanics can provide. Additionally, our experience working with athletes and orthoses on a daily basis…….along with a deep desire to help the athlete perform and keep on performing often identifies Foot Mechanics as the practioners who finally address the athlete’s issues.
Will orthotics make me a better runner? Will I be faster?
Custom orthoses designed to address your individual biomechanics will allow you to be a more efficient runner. If you become more efficient as a runner, you should experience less fatigue and that may allow you to better your time in the race. At a minimum, an orthosis will certainly provide you with more comfort and support in any athletic endeavor.
What does a hip, knee or back issue have to do with my feet?
All muscles work together. All muscles operate from a platform. That platform is your feet. If that platform is unstable, your strong and hard earned musculature will not be able to perform optimally. If that platform is unstable, your muscles will help stave off injury but in the end, after any extended period of repetitive activity, injury will occur. The foot must be held in subtalar joint neutral position to become stable: orthoses designed to maintain that position will contribute to optimal propulsive gait.
I have orthotics and I wear them while running. I like to wear flip flops in the summer. I can’t figure out why I’m experiencing plantar fascitis again? I thought the orthotics were supposed to take care of that?
Very good question. Most athletes come to recognize, usually after a long trial and error period, however, that one hour of correction on the trails is insufficient when pronation continues for the remaining 16 hours of the day. At a certain point in the athlete’s career, and especially during time of injury, it becomes imperative to remain in correction most of the time. Sandals can be made with orthoses! Shoes can also be modified. FootMechanics assists the patient in finding a shoe that will allow correction with style. (At some point, however, remaining injury free may even trump fashion!)
I have been a runner all of my life. Why am I starting to have injuries now? How can something in my shoe alter biomechanics that have been around for more than 40 years?
The bulk of my patients are in their 40’s. It’s the time, especially if your odometer is high, when we all must hit some kind of age bump and things are either breaking down a little or at a minimum---changing. Biomechanics do change over the years as our bodies adapt to things like scoliosis, leg length discrepancies, old unaddressed injuries, etc. Tendons get stretched with repetitive ankle sprains and joints begin to develop arthritis. Orthoses can work with those changes and make them bearable and even unnoticeable! If you put a rock in your shoe------do you think your biomechanics would change? Of course! Likewise, when we sustain an injury and it goes on and on unaddressed, our biomechanics can change, setting us up for an additional injury. Orthoses do change your biomechanics; however, it is not completely known why. Some research states that the brain senses the footbed and changes the foot plant accordingly even before it hits the ground. Other research states the foot plant is directed by the physical properties of the orthosis. Either way, orthoses have been determined to alter the biomechanics of the athlete, old or young and that’s a good thing----especially for runners who hope the trail never ends.
I repeatedly sprain my ankle. A pedorthist told me that custom orthoses could help prevent these injuries. Won’t the high arch push my feet to the outside, creating a greater opportunity for sprained ankles?
The foot has a unique locking mechanism on the lateral side that is responsible for maintaining a stable midstance position. If the athlete pronates, this mechanism cannot be engaged and the foot becomes unstable. If unstable, ankle sprains can occur. Custom orthoses can place the foot in a stable position, reducing the likelihood of sprains. The arch will support the foot and push the foot to the outside slightly during gait to engage that lateral locking mechanism. Casting the foot in a subtalar position, along with other specifications dictated by the athlete’s biomechanics, is crucial.