Differences in Orthotics for Runners

This month’s guest blogger, Dr. Noushin Shoaee, DPM, is here to explain the differences in orthotics for runners.

What are Orthotics?
Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely “arch supports,” although some people use those words to describe them. They perform functions that make standing, walking and running more comfortable and efficient, by slightly altering the angles at which the foot strikes a walking or running surface. Orthotics take many forms and are constructed of various materials. All are concerned with improving foot function, and minimizing stress forces that could ultimately lead to foot deformity and pain.

Orthotic Materials:
Rigid Orthotics – These orthotics are chiefly designed to control motion in two major foot joints. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function. This material is best for motion control, but it gives the least amount of shock absorption.

Soft Orthotics – the second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials. The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished. It is particularly effective for arthritic and grossly deformed feet. This material gives the greatest shock absorption however it has the least control of muscles and tendons.

Semirigid Orthotics – the third main type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This is the ideal material for runners. This orthotic is not a crutch, but an aid to the athlete. Each sport has its own demands and each sport orthotic needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. This material gives dynamic control with efficient and moderate control of muscles and tendons. It has greater shock absorption as compared with rigid materials.

Research has shown that back problems frequently can be traced to a foot imbalance. It’s important for your podiatric physician and physical therapist to evaluate you as a whole to provide for appropriate orthotic control for your individual needs.

Importance of how orthotics are made:
It doesn’t end at just getting the right material, how an orthotic is made is just as, if not more, important than the material.

Casting your feet (with plaster) in a non-weight bearing position captures your joints in a 3 dimensional model/mold which is much more accurate than any other technique. The second technique, the use of computer gait scanners only gets a 2 dimensional image of the feet and does not capture the subtalar joint which shows how much your foot is pronating or supinating (3 dimensional gait scanners exist however they are too expensive and most places do not have them yet). The third technique is the use of a foam box which captures the subtalar joint in a semi-weightbearing position. The problem with this technique is that it captures the “abnormal” image of your foot, the position which has caused pain in the first place. With casting, the foot and its joints are placed into an “ideal” neutral position and this is the gold standard technique that we use.

Next, the 3 dimensional ideal molds are sent to a laboratory to produce your custom orthotics. Not all labs are created equal. It is very important for your mold to be sent to a lab with experience in biomechanics and has podiatrists on staff. The lab we use is run by podiatrists and continues to do research to come up with innovative techniques to solve patient concerns and eliminate pain and help prevent injury.

Importance of shoes: There are three common foot types: Flat feet, medium arches, and high arches.

  • For individuals with flat feet (low arches, over pronators), we recommend motion control shoes with straight lasts.
  • For individuals with medium to low arches, we recommend stability shoes with a slight curve last.
  • For individuals with high arches (over supinators), we recommend neutral shoes with curved lasts.

If, for example, you have high arches and you place orthotics into a motion control shoe, you may end up with more pain. It is therefore very important that the right type of shoe is combined with the right type of orthotic for YOUR individual needs. That is why it is important as a runner to have a consultation with your podiatrist to evaluate and recommend the best types and materials for you. Then follow up with your physical therapist to reduce symptoms associated with previous injuries. Together this can solve current symptoms and prevent future injury.

Also consider the soles of your shoes for traction needs of different running surfaces. The heel height is also important. Too much heel height on a running shoe may be good for people with a tight calf or people who have Achilles tendinitis, however if too high, it can cause back, knee or hip pain.

For all foot types, the soles of the shoes should not be too flexible or the orthotics will not function at their maximum capacity. For example, if you place rigid graphite orthotics into ballet flats (which have VERY flexible soles), you may only get 50% function out of your orthotics. However if you place them in a more rigid sole dress or athletic shoe, it will function at its optimum and give you ideal support to help prevent injury.

What about the whole “barefoot running” phenomena?
Barefoot running is an ancient practice widely popularized by one man’s experience with a tribe in Mexico. Products marketed to devotees now reportedly sell more than five times what they did two years ago. “Barefoot running and the use of minimalist footwear are very controversial topics. They are movements within the running community that many are incredibly passionate about,” said Paul Langer, DPM, APMA member, book author, and avid marathoner. While anecdotal evidence and testimonials proliferate on the Internet and in the media about the possible health benefits of barefoot running, research has not yet adequately shed light on the immediate and long term effects of this practice. Dr. Jenkins, a professor at Midwestern University’s Arizona Podiatric Medicine Program, recently compiled extensive research from more than 120 external sources—including Christopher McDougall’s “barefoot bible,” Born to Run. “There has been a lot of focus on the biomechanics of barefoot running, and not as much on the perceived hazards that can cause injury,” he said. Barefoot running may be a possible alternative or training adjunct to running with shoes. Barefoot running has been touted as improving strength and balance, while promoting a more natural running style. However, risks of barefoot running include a lack of protection–which may lead to injuries such as puncture wounds–and increased stress on the lower extremities including causing stress fractures and tendon injury (tendinitis or tendon tears).

Not all foot types are compatible with barefoot running, so it is important to consult a podiatrist to better determine if this type of running is ideal for you.

For more information, or to read about the “Top Five Running Injuries”, click on the link below:

Dr. Noushin Shoaee, DPM
Carmel Valley Foot & Ankle Surgery
4765 Carmel Mountain Road, Suite 104
San Diego, CA 92130

NeuroCom SMART EquiTest® system is here!

…and the response is astounding!

We have already analyzed multiple patients of various ages and medical diagnoses on NeuroCom’s SMART EquiTest®, and we’ve been able to reveal the underlying vestibular, visual, and upper motor neuron pathologies that contribute to their feelings of unsteadiness.

This computerized dynamic posturography system was developed by balance research funded by NASA, and is used by NASA itself to treat astronauts to prepare them for space travel and reacclimatize them to earth. What such a precise balance analysis system has offered us, in the physical therapy world, is the ability to design personalized, and extremely specific, treatment plans that actually work.

Balance Assessment San Diego

If we discover that you rely primarily on your eyes for balance, the EquiTest® can help us determine whether you compensate visually for poor proprioception, poor vestibular function, or both. If you have poor proprioception, which is your joints’ awareness of their position in space, we can improve this by
1. Determining the true source of proprioception decline
This could be anything from a compressed nerve in your lumbar spine weakening your muscles and depressing your sensation, to joint stiffness and/or swelling limiting the function of joint receptors
2. Designing a tailored plan to improve your proprioception
This could involve postural exercises, improving your joint function by stretching and strengthening, and training comprehensively on challenging surfaces.

If you have poor vestibular function, which is your body’s own system to assess rotational motions and linear accelerations, we will assess your vestibulo-ocular reflex and screen you for various brain dysfunctions, and provide you with exercises to challenge your vestibular system in the areas that are impaired.

Most importantly, though, we will help you understand your dysfunction. This is, we feel, the area where physical therapy fails the most often. If you understand why your balance is impaired, you will be able to make the adjustments in your own life to live as safely and independently as possible.

Clearly, we are only scraping the surface, though. Our team is planning to attend a comprehensive three day training course in the next two months, so we can truly take advantage of the many ways this system can help us help you to regain your balance.

Keith Mahler Physical Therapy is, to our knowledge, the only private physical therapy clinic in San Diego County that offers this comprehensive technology.

New Balance Master System!

Welcome to Keith Mahler Physical Therapy! Thank you for visiting our site. For our very first blog post, we are excited to announce that we are upgrading our NeuroCom Basic Balance Master system to the NeuroCom SMART EquiTest® system.
balance master smart equitest

We are excited by the opportunities this new system will afford us, as we maintain our reputation as San Diego’s premier provider of balance assessment and training.

To accurately assess balance impairments, a physical therapist must consider a patient’s activities of daily living that are challenged by various dynamic postures. The Computerized Dynamic Posturography (CDP) uses stable and unstable visual and support input to both assess and retrain patients to safely return to their daily activities.

For patients who have been to many “balance specialist” clinics and walked away without any improvement in symptoms, this system can finally help shed life on their conditions. Many different factors play into balance impairments, such as sensory system impairments, motor use impairments, adaptation impairments and diminished limits of stability.

Proprioception is the body’s ability to process incoming physical stimuli and move itself accordingly to maintain balance. The SMART EquiTest® system allows our therapists to adjust both the support surface and the visual stimuli to respond to patients’ movements and create random movements, to which the patient must respond, mimicking real life conditions where patients can retrain their balance in a safe and controlled environment.

Additional features include the Head Shake-Sensory Organization Test (HS-SOT), which assesses patients’ use of vestibular input during active head movements. A patient’s central nervous system and motor function can be analyzed, using the EMG option, which utilizes additional stimuli during support surface rotational movements.

We are thrilled to offer exceptional balance assessment and intervention to our patients, starting in January 2012!