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Highlights and frequently asked questions from our Health & Injury forum


Posted: 27 June 2003

Foot | Achilles | Ankle Area | Lower leg | Knee | Hip Area / Upper leg | Upper-body | Chest | Digestion/diarrhoea | Women's issues | Credits

These are highlights and frequently asked questions from our injury & health forums. They were created by members of Runner's World just like you. If you want to bring a discussion back to life, don't be shy: just add a new message at the end of it. Alternatively, start a new thread on the injury & health forum.

HEALTH: BEATING INJURY
Foot
Blisters - for an underpronator
Blisters - I've tried all socks
Blisters - on toes
Blisters - What to do when they appear on a run - and how to avoid them
Foot pain - under ball of foot - 2 solutions
Laces - pain on bridge and toes - simple solutions
Numbness - whole foot goes numb randomly - laces, stretching solution, and wiggling fingers
plantar fasciitis - 2 success stories
Plantar fasciitis - should I have a hydrocortisone injection; and taping
Plantar fasciitis - taping links, and golf ball treatment
Tendinitis? - Pain on outside of foot after a track session
Tibialis Posterior Syndrome - around bony part of arch - caution against self-diagnosis
Toenail loss - disguising lost ones!
Toenail loss - shoes, solutions, and downhill technique
Achilles
Achilles tendinitis - how long should I wait before running?
Achilles tendinitis - how to cut heel tabs to reduce friction
Achilles tendinitis - lots of experiences, including cortisone and glucosamine
Achilles tendinitis - supplements, stretching, accupuncture
Achilles tendonitis - how much longer? - inc friction massage and splints
Achillies rupture - partial - help!
Achillies tendinitis - stretching and self-massage
Ankle Area
Mystery ankle pain - linked to Asics 2070?
Sprain - how soon can I run afterwards?
Sprain - rehab strategies
Lower Leg
Broken leg - how best to rehabilitate?
Calf pain - when to continue, when to stop?
Calf tightness - is ibuprofen the solution?
Inside lower-leg pain - between ankle and knee - lots of experiences
Inside lower-leg pain - part 2
Shin splints
Shin splints - gym work, and benefit of orthotics
Shin splints - new shoes worked!
Shin splints - part 2
Shin splints - part 3
Knee
Cartilage operation - is it too early to run?
General - various knee problems and solutions
Inner-knee pain - doctors converse…
ITBS - High heels to blame?
ITBS - how much rest?
ITBS - pain on side of knee
ITBS - roads to recovery
Kneecaps - they feel as if they're popping out of their joints…
Kneecaps - they feel as if they're popping out of their joints…
Lateral plica…
Osteoarthritis - can I continue to run with it?
Patellar tendinitis - a cheap fix, stretches and strengthening
Patellar tendinitis - treatment, and maintaining fitness
Runner's knee - beating that dull ache
Runner's knee/tracking imbalance - a dose of realism
Shoes - is too much shoe stability causing knee pain?
Weight training - how to balance quads and hamstrings to protect the knees
Hip Area / Upper leg
Hernia - time for surgery?
Hip pain - diagnosis discussion - and discussion of advice-giving!
Hip pain - feels right on the socket
Hip pain - ibuprofen or treatment?
Hip pain - right on bony part
Hip pain for a year - what now?
Piriformis (buttock) pain - much advice
Piriformis (buttock) pain - stretches 2
Piriformus (buttock) pain - link and stretches
Top of leg, under buttocks - tightness after run
Upper-body
Lower back pain - over last few weeks - any advice?
Lower back pain - possible causes
Neck pain - checks to make
Nipples - chafing - fixes
Nipples - chafing - part 2
Nipples - chafing - part 3
Red face - am I normal?!
Shoulder pain - broom handle solution…
Sprained wrist - can I run with it?
Stitch - solutions part 2
Stitch - solutions!
Swollen hands
Throbbing head after running - why?
Chest
Asthma - Exercise-induced - just diagnosed - can I continue running?
Asthma / wheezing - Exercise-induced - part 2
Asthma / allergies - part 3
Chest pain - muscles or worse?
Heart palpitations - part 1
Heart palpitations - part 2
Digestion/diarrhoea
Runner's trots (diarrhoea) - part 1
Runner's trots (diarrhoea) - part 2
Runner's trots (diarrhoea) - part 4
Runner's trots / cramps - part 3
Pregnancy/breastfeeding/menstruation/stress incontinence
Breastfeeding and running - advice, and bras
Postnatal running - breastfeeding and more
Pregnancy - can I run while pregnant?
Skipping periods - is this bad? (Inc osteporosis risk)
Stress incontinence - lots of advice

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I have recently been advised to invest in some orthotics after persistent lower leg problems. As I understand it, there are a number of ones to choose from, for instance, permanent or semi-permanent etc. Does anyone have any experience as to which might be the best option. For example, I have been advised that permanent orthotics, as they are more inflexible than semi-permanent, long term, may be offsetting the problem to another part of the lower body (e.g. Knee or Hip)? Whilst semi-permanent orthotics won't last as long, they may offer more shock absorbancy. Any thoughts would be greatfully received.
Posted: 03/10/2003 at 10:00

You dont say what your lower leg problem is, have you looked at your running gait shoes etc
Posted: 04/10/2003 at 00:17

I have seen a podiatrist, and he has told me I have rear foot variance in both heels(more so in the right foot, and it is the right lower leg that has been giving me the problem), and also forefoot pronation in my right foot.
I have been wearing Asics trainers (1070 and 1080), which I believe have structured cushioning.
Assuming I need orthotics to correct this feet problem, do you have any experience as to which type is the better option or what factors (cost aside), should be considered when making the decision on which orthotic to go for.
Posted: 04/10/2003 at 11:09

rear-foot variance...?! thats a new one on me, but I assume he means that your heels turn inwards or outwards (less common) upon landing?
What is your podiatrists advice?
I would probably see if you could go for the cheaper option, and invest in permanent orthotics, if the problem is corrected successfully with the semi permanent orthotics.

If you want my honest opinion on a slightly different matter, it sounds like your podiatrist is blasting you with various jargon terminology without making sure you know exactly what he/she is talking about. You are questioning what type of orthotics to go for when the questions should really be-what is your running gait? do your current shoes help/hinder your running gait? if not, do you have to get orthotics to fix it or is there a cheaper shoe-only option? then start thinking about what type of orthotics to go for.

I hope that the podiatrist isn't saying that your pronation/'variance' is the problem with your lower legs, it is actually less common not to overpronate in some way or another.

what are the problems that you have been having with your lower legs, and when you got your current running shoes, did you go to a specialist running shop who analysed your gait before recommending you trainers (i.e. they watched you run and brought out the 1080s and similar trainers with heel support, on the basis of what they observed?)

sorry 20 questions, but I'm not convinced from your post that you have been given all the correct guidance. I'm certainly not questioning your podiatrist's competence in any way, but just wondering whether you have been given all the information that you need, in an understandable way, to make your decisions on.
Posted: 08/10/2003 at 09:44

I certainly don't have the same problem as you, but did used to be flat footed and knock kneed.

Was advised by podiatrist to get permanent orthotics. Wans't happy about paying so much for a solution I would always have to use, even in my everyday shoes.

I sorted out my knees by doing yoga and used off the shelf orthotics in my shoes.
Now use a neutral shoe, again on advice from specialist shoe shop.

Funnily enough have paid more for yoga holidays than I would have for the orthotics, but I find it more enjoyable and gives me more benefit that just sticking inserts in my shoes.

Agree that I don't understand what your podiatrist is talking about.
Posted: 08/10/2003 at 15:48

Hmmm

I would suggest to go for the most cost-effective option to "prove" the ability of an orthotic to improve your symptoms but bear in mind that this sort of temporary trial orthotic is never as good as the real thing.

When happy go for the permanent orthotics with the materials chosen by your Podiatrist - most typically a moulded plastic.

Always produces a smile to my face when people make out orthotics are sooooo expensive, this happens a lot with my patients too.. but 99% dont regard them as expensive once they've got them and are wearing them and back to being pain free.

I just got new glasses - £230 & I spent 20 mins with the Optician! I charge less for custom orthotics plus it takes a 3-4 times as long, Im in the wrong job!!

Lawrence
Posted: 08/10/2003 at 19:40

Thats interesting LB

My podiatrist wanted to charge me in excess of £400 for one pair (if memory serves) and he also suggested he would do a 2nd 'everyday' pair for a further £200.

And was it £40 or £60 for the consultation. Can't remember now.

Bad experience. Put it out of my mind.

But he was based in Harley Street which may explain it.
Posted: 08/10/2003 at 22:19

I was hoping you'd show up, Lawrence-this is your area of expertise!


Posted: 10/10/2003 at 15:03

Thanks for all the replies and comments.
Apologies for not replying sooner (have been away on holiday), and apologies if my explanation is inaccurate / misleading.
Let me take another stab at explaining my predicament.

Since running the London Marathon earlier this year, I have had a soreness in the lower right shin (on the inside of the leg and mid-way between the ankle and the knee), which was subsequently also aching at rest. This area also felt bruised and there was a 'lumpy-like' feel, for lack of a more medically sound term. These symptoms were made worse with speed work and a lot of this seemed to improve gradually, as I cut my running right back after the marathon. However, the symptoms never cleared up completely and returned as I increased the amount of running again.

I have had an ultrasound scan and a bone isotope scan and both came back clear. The consultant did say, however, that if I kept hitting a speed / distance ceiling, I should consider orthotics. As the condition did not clear up completely, I saw a physiotherapist for a second opinion. That person looked at my feet and legs and concluded the lower leg problem was probably scar tissue that had built up in the fascia as a result of a problem with my feet (and continuing to run was just aggravating this problem). Looking at my feet, in particular the heels and the achilles tendons, as I understand it, the tendons should be perpendicular to the ground, however, neither of mine are. I forget the exact degrees of deviation, but the right tendon was substantially more deviated than the amount at which associated problems are likely to occur (when standing with my legs together, the tendons slant inwards). The feeling was this deviation was probably causing the shins, in particular the inner lower shins, to be under more stress than they should be when my feet land, as the feet are having to pronate more (?), which in turn has caused the problem with the fascia (running predominantly on concrete probably did not help either!).

Ultra sound treatment was suggested to break up some of the scar tissue (and seems to be helping), and orthotics to correct the problem and prevent the lower shin problem returning. On seeing the podiatrist I was referred to, he confirmed as much from the examination and also told me my right foot was twisted which was also causing a forefoot pronation.

Do you think a gait analysis will highlight anything further? As an aside, I have done a couple of foot scans and purchased the Asics and also a pair of Adidas as a result of the outcome of the foot scans.
If I do get orthotics, it does seem to make sense to get semi-permanent orthotics and go from there. I would be interested to hear people's thoughts on any possible side effects of permanent orthotics.

Sorry to ramble on and any further advice would be gratefully received.
Posted: 12/10/2003 at 23:21

Side effects of orthotics - sounds like a chance for Pantman to jump in ;-)

Its about risk versus benefit. Problems that may be caused by orthotics are usually minor but would be highlighted by a trial orthotic. Gait analysis would be a part of having this done.

Studies conducted on shin pain in Army recruits suggest orthotics are a safe and effective treatment
Posted: 14/10/2003 at 00:04

Thanks for replying Lawrence.

Have you come across similar cases, where problems with the biomechanics of the foot are causing this sort of problem? If so, have orthotics been used to help solve this problem and have they helped? Also, do you know of any long term side-effects of orthotics, e.g. hip or knees problems and would they be obvious early on?

In another thread relating to orthotics, I believe Pantman mentioned that they used to have orthotics, but no longer use them and feel they only made the condition worse / let the weakness get weaker. Do you agree with this? Also, are there exercises / procedures that can help to correct the biomechanical problem, e.g. in my case, by strengthening the ankle or calf muscles etc?

Pantman - did you have a similar problem to mine? Are there exercises / procedures that you have come across that may help my particular problem?
Posted: 15/10/2003 at 13:17

Rajan

I have treated many, many cases sucessfully with orthotics. Long-term side effects like you mention are not known, however a study conducted in approx 500 runners at a 6 year follow up folowing prescription of orthotics found 70% still wearing them after their symptoms resolved with no new probs attributable to the orthotics. So not bad.

I think what should be taken from Pantmans case is that they are not a cure all. They are not for everyone however if you have sport related shin pain that is unresponsive to standard Physio treatment, rest etc and initial exam has confirmed in you evidence of biomechanical abnormalities then you are a prime candidate. Exercises should be used in conjunction with othotics but these will be specific to your problems.

I think you should perhaps be careful of over analysing yourself. Knowledge is power but there is only so much you can do and ultimately you need to find someone your comfortable with and let them make some decisions.
Posted: 15/10/2003 at 16:30

Thanks for your advice Lawrence - I completely agree with the last sentence.

Fingers crossed I can solve this problem with the orthotics / exercises and get back to what I enjoy doing - running!
Posted: 15/10/2003 at 17:04

Rajan

I was just wondering if you have had any luck with curing you injury. I have been searching the internet for information on running injuries and orthotics as I have exactly the same problem as you have. It started in my right leg with pain on the inside half way between knee and ankle. Its very close to the shin bone and is lumpy, this in turns causes pain in my calf especially on the inside of my calf. I've been to see a physio who said that it was inflammation of the tendon so I rested for 6 weeks. I then went to have a bio mechanics check where they said my right leg was shorter than my  left and I over pronate on my right side with the left being neutral. I wear Nimbus 9 neutral shoes so they added a heel pad and 5 degree angle to stop the overpronation. This caused me to have headaches because of the difference in balance but I persisted. I have now taken the heel pad out but kept the angle in. In the last two weeks I have had the problem in both legs! Exactly the same on both sides.

 If you have any advice on orthotics or getting rid of this injury I would be very grateful as its horrible not to be able to run. 

Or if anyone else could help me I would be very grateful  


Posted: 16/11/2007 at 11:48


Nam

I have, like you, both rear-foot as well as forefoot problems (pronation, rotation etc) as well as a functional leglength difference of 11mm (not hip alignment).  I tried seemingly every shoe in the universe, some alleviated some problems but caused others.  My feet are just too different to be happy on one pair of shoes and off the shelf orthotics didn't cut the mustard for me.  I have CAD/CAM bespoke orthotics which will last me years and years and £150 are cheaper than all the money I wasted previously on the wrong shoes and subsequent physio.


Posted: 16/11/2007 at 12:00

Thankyou for the advice. Have the orthotics solved the problem completely? Also where do I go to get them, will any podiatrist be able to help or do they need to be running specific? thanks again


Posted: 16/11/2007 at 12:26


Nam

I would ask around (maybe start a specific thread) on a podiatrist recommended by other runners in your area, or have a look in the back of Runnersworld magazine where various specialists advertise.  Or have a look in your yellow pages to see if any of them say they are sports podiatrists.

I was very unlucky with my first (generic) podiatrist but found a fab sports podiatrist who sorted me out. 

Running again after almost 3 months off and so far everything's fine!!  It feels weird at first as the orthotics modify my gait considerably and I'm now using all of my leg muscles as opposed to before where the majority of my strength came from my quads.  Initially they were quite literally a pain in the 'rse as due to my rearfoot problems I never engaged my glutes properly and they were complaining!!  LOL... all is well though and developed much stronger hamstrings now too.


Posted: 16/11/2007 at 13:04

I've just started a new thread so hopefully someone will be able to recommend a good one. Just out of interest, do you wear your orthotics all the time or just for running?
Posted: 16/11/2007 at 13:35


Nam
Just for running... 
Posted: 16/11/2007 at 13:57

this is a question for Lawrence, with your inside knowledge can you tell me a good way to find a sports podiatrist in Bristol, I suffer with shin splints and have tried motion control shoes and off the shelf orthotics but the problem always returns.

I feel the only way to go now is custom made orthotics but don't want to get ripped off or buy the wrong type. Is there a list off good podiatrists around or do I just take the gamble on one I find on the internet.

Need it sorted soon because I have a place in next years FLM that I deferred from this year.


Posted: 20/11/2007 at 11:31

Hi Swarf,

Havent seen Lawrence post on here for a good few years - so you may be waiting a while for his reply!

A good starting place is either your yellow pages or here

Is there a list of 'good' podiatrists around? Sadly no. If you dont have the fortune of a recommendation or word of mouth then it may be a gamble.

Things to look for:

  • HPC registered
  • Sports interest; sportsman/woman themselves; postgraduate sports/biomechnics qualifications

Hope this helps

SDoB


Posted: 20/11/2007 at 13:18

thanks for the reply SDoB, didn't look at the date of Lawrence' post, '2003'. had a look on your link and 37 popped up for Bristol, so seems to be a bit of a gamble. I'm going to ask at a local running shop hopefully they would have had some feed back from other runners.

Swarf.


Posted: 20/11/2007 at 23:56

Hi Rajan

 Firstly as I am a Podiatrist and interested in mechanics of the lower limb, I can offer you my perspective and hopefully clear up a few misconceptions for you.

Permanent Orthoses- that's also a new one on me- I isuue off the shelf, semi custom and custom orthotics, so I think that your Podiatrist is referring to custom-the question for the prescribing podiatrist should be whether you are a long distance or sprinter- this will determine the type of custom orthotics you need. And yes you don't have to get orthotics actually. the advice given to you about going to a specialed running shop to assess your running gait is a good one. The staff there will be able to determine whether you need a running shoe with or without correction. If you go for one with correction then you may not need orthotics-it depends on how much correction is in the shoe. However from personal experience of corrective footwear and being quite a severe abnormal pronator ( and no over or abnormal pronation is not normal, but it is common- pronation is normal- too much is abnormal, and can definitely lead to torsion on the knees and stress on ligaments and cartilage-hence knee pain), I didn't find the correction enough to support my running style, but a pari of neutral shoes with orthotics I have found much more comfortable.

Also if you are using orthotics in your shoes only take out the inner sock if they are full length and in a neutral pair.

As to variance- in fact this is varus - it means that your feet are in an inverted position just prior to heel strike so that they have enough pronation available in your joints to get down to the ground. 

Off the shel orthotics can be ok for a short period of time but remember they are stock orthotics not specifically designed to your feet where as custom ones are and are always going to be better and give you better correction and last longer.

Hope that helps, please feel free to ask me any advice.

Martin

martin@head2toeuk.com

www.head2toeuk.com


Posted: 22/12/2011 at 13:43

Hi Martin Vine,

Found your post very interesting, I only just started to get in to running and have suffered tendonitis in my knee (Patella). I am recieveing physio at the moment, ultra sound treatment. My Physio has recommended me getting a pair of custom orthotics made, he says that my problem comes from having one leg shorter from the other and I run on the out side of my heels (became obvious from the wear on my trainers). £250 is the price for the orthotics, my only concern is that 5 years ago i suffered trauma to both knees that left some knee damage, if the custom orthotics do not sort my problems out i'm left with a very expensive pair of insole.

Any advice would be greatfull.

 

Thank you


Posted: 11/05/2012 at 13:45

I have used orthotics for a few years and they sorted out the problems I had at the time. £120 all in. Probably a little more expensive now but not much


Posted: 11/05/2012 at 21:16


UFO

I just cut up some cardboard to shape and put it under the insole. Worked for me and saved a fortune.


Posted: 12/05/2012 at 12:47

just come across this thread and wanted to add my bit .... I have orthotics that Norbert Cauvas (Foot Factor) made for me and I haven't looked back. They're expensive but worth every penny and still cost less than many podiatrists charge.

He makes them while you wait so you can use them straight away and as you're there with him they are fitted perfectly. Give him a call as he also offers a 1/2hr free appt if you want to find out more before booking in. Different to UK podiatrists and brilliant.


Posted: 11/02/2013 at 20:22

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