Orthotics / Insoles
Orthotics (also known as orthoses) are custom made foot supports. An impression is taken of your foot from a cast or by standing in a foam box (static impression with the foot held in its “neutral” position. The theory is that there is a neutral position where your foot functions optimally. Most feet, when observed in a standing position, deviate from this position to some degree. An orthosis is designed to position your foot so that it is held closer to its “neutral” position. Podiatrists, orthotists, chiropractors, physical therapists, athletic trainers and kinisiologists can prescribe orthotics.
After the impression is taken it is sent to a lab where the orthotic is fabricated. Labs vary in the way they produce the orthotic. Most labs will digitally scan the impression and match the impression with their closest mold. There are a few labs that make a truly custom orthotic. A company from Germany has recently begun taking a dynamic foot impression with the use of a computer monitored force plate that you run across, based on contact pressures and timing an orthotic is created.
Orthotics are fabricated from a variety of materials. Some orthotics are rigid - to provide maximal control of the foot position, others are made from material designed to maximize cushioning. The type of orthotic prescribed should be based on several factors (foot type, weight, running style, etc). Generally, a higher ached foot is stiffer and responds better to a cushioning type orthotic. A flatter foot may respond better to a more rigid orthotic. Orthotics are most commonly prescribed for heel pain or plantar fasciitis; however, they are also used to treat IT band pain, knee pain, shin splints and a variety of foot injuries.
Unfortunately, there is not enough research to confidently predict which orthotic is “best” or who or what responds to using an orthotic. This is where the art of medicine dominates science. Testimonials cover both sides of the spectrum. I know people who have been “cured” by orthotics and I know others who finally threw them away and swear they are better for it. This could also reflect the artistry (or lack thereof) of the person prescribing and creating the orthotic.
Insoles are typically purchased “over the counter”. Companies such as Sorbothane, Sof Sole, and Spenco research what the most common foot shapes are and create an insole to provide a full contact support made from materials designed to offer support and shock attenuation. Some insoles can be custom molded by standing on the insole, while (or after) it is heated.
At this time, to the best of my knowledge, there isn’t enough research to conclude that an orthotic improves symptoms any better than a “full contact insole”. Since insoles are much cheaper, it may be worth starting with an insole that is recommended by an experienced running specialist. My preference are the sorbothane insoles at RoadRunnerSports because they provide good arch support as well as cushioning and will last through several pairs of running shoes.
In my opinion, orthotics or insoles can be helpful to support the foot and allow the injured tissue to recover. However, I think most people are best off in the long term by strengthening the musculature of the foot through balance training exercises and ensuring good strength of the trunk and hip musculature. The routine presented in The Injured Runner – A Balanced Solution, will guide you through a comprehensive program with emphasis on balance training and core conditioning.