Orthotics

Orthotics - which type to choose

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03/10/2003 at 10:00
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.
04/10/2003 at 00:17
You dont say what your lower leg problem is, have you looked at your running gait shoes etc
04/10/2003 at 11:09
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.
08/10/2003 at 09:44
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.
08/10/2003 at 15:48
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.
08/10/2003 at 19:40
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
08/10/2003 at 22:19
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.
10/10/2003 at 15:03
I was hoping you'd show up, Lawrence-this is your area of expertise!

12/10/2003 at 23:21
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.
14/10/2003 at 00:04
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
15/10/2003 at 13:17
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?
15/10/2003 at 16:30
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.
15/10/2003 at 17:04
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!
16/11/2007 at 11:48

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  

Nam
16/11/2007 at 12:00

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.

16/11/2007 at 12:26

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

Nam
16/11/2007 at 13:04

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.

16/11/2007 at 13:35
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?
Nam
16/11/2007 at 13:57
Just for running... 
20/11/2007 at 11:31

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.

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