Custom Orthotics Why, How and When

By Dr. Tim Maggs
© 2002

Many runners currently have one or more pairs of orthotics. Custom made orthotics are typically an investment made during some desperate phase of life that usually involves a chronic injury. This desperation is oftentimes met with less than successful results. In spite of this fact, most runners would benefit from orthotics, but the success comes when they are purchased before being injured. And here’s why.

First of all, custom orthotics are not just for runners with foot problems. The feet are the foundation of our entire structural system and are the sole or contributing cause of many structural problems. So, if you’re suffering with low back, hip, hamstring, calf, sciatic or other problems, even upper body, your feet will usually be involved. If we don’t balance and stabilize the feet as our primary goal, we limit the potential benefits when attempting to correct and balance our structures.

Generic orthotics that can be purchased “off the shelf” have limited benefits. Just as you would never think of wearing some generic running shoe from “off the shelf”, don’t be cheap when it comes to one of the more important decisions you’ll make involving your running life. Your foot is made up of 26 bones, 33 joints plus 126 ligaments, muscles and tendons. Your running longevity will be greatly impacted by keeping your feet happy.

So many patients of mine resort to buying orthotics only after injured. With a pro-active, instead of reactive, management of the structure, many of their debilitating injuries could have been prevented. Keep in mind, my goal is to help runners stay running, and if injured, to get back to running. Again, paying now is always less than paying later.

Foot Exam

The examination of the foot is a great place to start when concerned about the structure. With the athlete in the standing position, a simple “fingers under the mid-arch” test can be done. Both feet should have a similarly high arch, so that a good chunk of fingers can make it under the arch. If the feet are flat, different in arch height or have excessively high arches, custom orthotics are imperative.

A study of shoe wear should be done next. Keeping life simple, just look for different wear patterns on the base of the two shoes. If they exist, orthotics will help. Third, look at the runner from behind with no shoes on. If the achilles tendons bow or bend due to pronation of either foot, this adds to the urgency for orthotics. If either toe points in or out when standing, think orthotics. Finally, upon standing, note the center point of the knee cap, and then the bump on the bone (tibia) just below the knee cap. They should be almost in line with each other. If the alignment between the two points is more than a ¼” off, make sure you note this.

When deciding what type of orthotics to buy, here are a few guidelines. Some doctors recommend rigid orthotics instead of softer orthotics. A rigid orthotic has limited value, as it is designed to treat the foot as an independent part of the body. With running, this type of orthotic has no give, which is necessary for normal foot motion. There’s also no shock absorption in the orthotic, so the foot, leg and low back must absorb all shock. (Bad idea!) The foot is unable to move in a complete and normal manner due to the restriction of the orthotic, altering the normal motion relationship between the foot and the rest of the body.

A softer orthotic will allow the foot to move in it’s full range of motion while providing shock absorption in the heel with each foot strike. Some orthotics have better shock absorption than others, and this is an important feature to look at when deciding on which orthotics to buy.

The method used to get fitted for your orthotic is important too. Many doctors use the neutral casting method, which casts the foot in a non-weight-bearing position. The preferred method is to have the foot evaluated and casted in a weight-bearing position so the influence of gravity can be considered.

Conclusion

Custom orthotics are the very beginning of learning more about your biomechanical system. The foot is the foundation of your entire structure, and imbalances in the low back, neck, hips and entire muscle system can certainly originate from the feet. If attempts are made at correcting any structural condition without first considering the feet, the benefits will be limited.

So ask you doctors for a complete structural foot exam in the standing position with an evaluation of the wear patterns of your shoes. This should be done at least once a year on all athletes. Finally, if we could ever get all sports docs to include standing x-rays of the low back and neck and make specific structural recommendations, we'd be well on our way to a national network of help for all injured athletes. Ah, to dream.