Physical Therapists Using Clinical Analysis To Discuss The Art And Science Behind Running and The Stuff We Put On Our Feet

Thursday, May 19, 2022

Footwear Science: Should I Buy Orthotics For My Running Shoes?


Should I Buy Orthotics For My Running Shoes?
By Nathan Brown, Senior Contributor & Chief Editor Matthew Klein

A question we are frequently asked is "what is the value of orthotics, custom inserts, or 'upgraded' insoles?" The root of this question may come from various experiences. Some are due to having custom fabricated insoles created by a podiatrist or physical therapist after a specific injury or for a specific condition. Some may be from people who have been to running shoe stores and have been told to pair their new pair of shoes with a nicer insole to maximize the shoe. Some are from those looking to prevent injury and fend off things like plantar fasciopathy, "shin splints", or posterior tibialis pain. Regardless of the reasoning, the literature does provide some insight into these questions. As you may expect, it isn't crystal clear and will depend on the circumstances. However, the large majority of people do not have a need for custom (created specifically for the runner) or prefabricated (mass-produced without specific individual model) inserts to pair with their running shoes. Let's talk about why.


To start, let's look at what some of the research says about the impact of insoles and orthotics on injury prevention and rehabilitation. Little research within the world of orthotics/inserts is done with healthy runners but typically is related to specific conditions or people who already have pain. Even less research is performed on the actual sock liners. But what has been found? In non-runners who have heel pain, the use of either custom or pre-fabricated orthoses have been shown to help with short-term pain relief, particularly for those who have responded well to taping techniques to support the medial arch (Hawke et al, 2008; Lee et al, 2009; Landorf et al, 2008). Some also have had benefits up to 1 year for pain relief, with no evidence for benefits of orthotic use beyond that time for plantar fascia pain. So even if you temporarily use orthotics or inserts for the sake of pain relief, it's not something you likely will need for life, but just a tool for short-term use.



For people with medial tibial stress syndrome ("shin splints"), a systematic review looked at studies geared toward pain prevention in people participating in various sports (Thacker et al., 2002). Ultimately the methodology was limited in most of these studies, but no connection between various inserts and injury prevention were found. There are many more examples, but you can see from these two scenarios that the literature is consistent that custom or prefabricated orthotics have limited utility for the masses and should be reserved for special cases. Even in those special cases, most people won't need these orthotics for any period over one year. How do you know if you're a special case or not? It should come from a full-body evaluation by a trained medical professional such as a physical therapist.

Then comes the application of these concepts to running shoes and why you may or may not want to swap out your inserts for some other ones you've bought at a store. The development of a running shoe is very intricate and spans from creating a concept, testing materials, testing biomechanical response to these designs, and ultimately producing a product. The shoes you purchase in a store are tested with the insole that exists within the shoe. These particular insoles often have a specific purpose and design unique to that shoe. This is particularly true in a shoe like the Saucony Ride 15, where the goal was to alter the running experience through a sock liner with PWRUN+ that sits well within an EVA cradle created by the side walls. So most times, no, a new insert is not needed for your shoe. If you try on a shoe that you may think you need an insert to make it structured enough for you, we encourage you to get a true stability shoe (see our Stability Shoe Guide). The variety of shoes on the market these days allows for people to select a shoe that has the appropriate support for their needs instead of needing to buy something in addition to the already expensive shoe. 

When it comes to inserts that also include support for the medial arch (in the special cases where it is needed), we recommend pairing that insert with a neutral shoe versus a stability shoe. Inserts that are designed to interact in a certain way with the foot don't do well placed on a platform also trying to act upon the foot (i.e. a "stability shoe"). Pair a custom orthotic with a neutral shoe that has appropriate volume to allow for the orthotic to perform its intended role. A few shoes that are known to work well in these scenarios are the Brooks Dyad and various New Balance shoes. Adding an orthotic to a stability shoe can lead to "overcorrection" and sometimes creates new issues.

The literature supporting the necessity of "upgraded" inserts for runners simply isn't present. If you are in a running store and the idea is being pushed that you need inserts, I would be hesitant to purchase a pair. Find the shoe that is comfortable for you without needing to buy external inserts. That said, there are viable reasons to purchase inserts such as personal preference and comfort, but this has to be person dependent and driven by your own desires.

Sources

Hawke, F., Burns, J., Radford, J., & du Toit, V. (2008). Custom foot orthoses for the treatment of foot pain: a systematic review. Journal of Foot and Ankle Research1(1), 1-2.

Landorf, B., & Menz, B. (2008). Plantar heel pain and fasciitis. BMJ Clinical Evidence2008.

Lee, S. Y., McKeon, P., & Hertel, J. (2009). Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Physical Therapy in Sport10(1), 12-18.

Thacker, S. B., Gilchrist, J., Stroup, D. F., & Kimsey, C. D. (2002). The prevention of shin splints in sports: a systematic review of literature. Medicine & Science in Sports & Exercise34(1), 32-40.


VIDEO



We broke down the subject a bit further in this clip from a recent podcast.


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