Orthotics - do they last forever?

I have had orthotics for about 7 years and they did resolve my major problems with calf strains from being almost continuous to having a couple of issues a year at most.

However in the last 2 years or more the frequent injuries are re-occurring to often for comfort and if I try running quickly then they occur almost straight away. Therefore I am going to get a new gait analysis done and accept I will likely be prescribed a different fitting (so that will be £300+).

I can accept all that if it fixes the problem but I am bit dubious about how much my leg physiology will have changed over time and whether a change of orthotics will be of any real benefit.

Any experience in this area  anyone?

Depends on the material the orthotics.  It's more likely your trainers have worn....  When was the last time they were changed? 

Personally not a fan of permanently wearing orthotics, I believe they are from the same school of thought as plaster casts and bed rest - immobilisation/support should only be used for as minimal time as possible. 

They are good quality orthotics and show no sign of wear and I have not run that excessively in the last few ~800 miles at best. I change my trainers regularly an do not do more than 450-500 miles in them.

So what other options do I have to resolve constant calf strain problems?

did you ever discover the cause of the calf strain.........i can see that  the orthotics seem to be working for you.

but i didn't think orthotics actually addressed the reason.....just an adjustment

If nothing else has changed in your training regime (milage etc.) then could be running style.  Have your hips become stiffer over the years?  Worth checking.   Reduced hip extension and rotation will effect gait and foot strike thereby making calves work differently/harder.  As will weak gluts, tight hamstring, forefoot running...

FYI  there is NO quality evidence to suggest that running with insoles prevents injury or that customised orthotics are any better at preventing injuries than prefab off-the-shelf insoles.  There is evidence they can treat existing dysfunction in the foot, but from what you've said I'm guessing problem is elsewhere.  

Get my orthotics refurbished each year, they do wear out, just like the trainers. But I am quite hard on mine. I think I do about 800 miles a year, maybe 1000 

@ Sir Brent :  Thanks for making that clear!  

Wasn't trying to infer they immbolise - they do provide external support, which for your average runner shouldn't be needed on a permanent basis. 

Sir David of Brent wrote (see)

Thinking of orthoses as "providing external support" is a little outdated and not quite as scientific as it should be. They actually have far more profound kinetic effects. They can manipulate the magnitudes, vectors and temporal patterns of plantar reaction forces and when used in the right hands with the right understanding of their mechanical effects they can be the difference between the ability to be able to run pain and injury free and not.

I would think that that would exclude all over the counter orthotics and any of the cheaper orthotics on sale.to have someone who can assess you and then develop the corect onesand train the runner how to use them correctly I think wouyld be rare..........The majority of people wearing orthotics seem to use them as some kind of miracle cure when they are not willing or able  finacialy etc to find the cause of the probblems........

a bit like keeping a bandage on to stop the blood from getting on your clothes.instead of finding out why your arm is constantly bleeding

Hi seren nos,

Cheaper/over the counter orthoses are not necessarily excluded by any means.  They 'work' in exactly the same way as all other orthoses do.  Whether they achieve the desired outcome in a particular individual will of course vary.  Some people find them incredibly useful (whether by luck or judgement).  It should be remembered that there is seldom just one orthosis "prescription" which will work for a given problem in a given runner - it should be thought of more as an envelope of success.  The wider the envelope, the more different types of devices which may all potentially bring benefit.  Hence why some individuals have great results from off the shelf devices, and other will inevitably require more specialist advise and guidance.

I agree with you completely that they are far from a miracle cure.  I would go as far to say they should never be issued/purchased in isolation, and should always instead be thought of as just one part of a structured rehabiliation/management plan.  However there are of course cases where the cause of the problem has been indentified and orthoses do form part of the solution.

Sir David of Brent wrote (see)

I guess I assumed you were inferring that orthoses immobilised feet given you mentioned both these things in the same sentence and likened them to a plaster cast which of course does immobilise... ?

Thinking of orthoses as "providing external support" is a little outdated and not quite as scientific as it should be. They actually have far more profound kinetic effects. They can manipulate the magnitudes, vectors and temporal patterns of plantar reaction forces and when used in the right hands with the right understanding of their mechanical effects they can be the difference between the ability to be able to run pain and injury free and not.

I'm not sure how you define an "average runner" but I assure you that whilst orthoses are certainly not appropriate for everyone, there are many runners who will need them on a permanent basis and could not run without them.

Ok, plaster cast was a bad example to give - that will fully immobilise a joint, and of course orthotics won't do that.  It would have been better to have likened them to a pair of crutches - they can have a profound effect on kinetics and manipulate the magnitudes, vectors and temporal patterns of plantar reaction forces of someone who is partial weight bearing as well.

I'd agree orthoses design & production and gait analysis has come a long way since the simple 2-D "upside-down pendulum model" I was taught as an undergraduate and rightly so.  It does make orthoses more fit for purpose - but doesn't change their purpose.   

I'd still be inclined to try and wean the average runner off them after symptoms have eased if I can.  I'd define the average runner as anyone who does not have arthritic or ossified joints, major abnormal foot anatomy or any form of muscle wastage disease, MS etc...  I'd refer them in this case.  

Orhthoics do not last forever. Depending on the material used, some will last longer than others, but if you have had them for 7 or more years, your feet may have changed and even if the orthotics still look good, they may not fit perfectly any more. Re "providing external support" being outdated - Orthotics work for many people, not everyone, but if your orthotics worked originally, then go back and see an Orthotist either through the NHS or look for one privately, and get some new ones. Do go to an Orthotist though as they are fully trained to supply orthotics of all kinds and will assess your feet in relation to the rest of your body. Not everyone selling foot orthotics is fully qualified to do so. Make sure your clinician is registered with HPCC and is a menber od BAPO. 

Thanks for the input. The orthotist who prescribed mine is well recognised and I am happy to trust his advice. I am going for the 2 pronged approach. Visit him for a re-analysis of my gait and see what he says and visit some physios  who may be able to help me loosen off my hamstrings which have definitely gotten tighter over the years and I think are more the cause of my problems. Saying that I do have quite obvious flat feel/low arch problems so I suspect that long-term orthotics will still be required.