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<p>We all know the marketing poster in shoe stores. It shows a person standing still while highlighting their poor foot posture. Then, a side-by-side comparison of the whole body magically aligned when provided with orthotics to wear. This is marketing brilliance and sells the concept very well&nbsp;<strong style="color: rgb(16, 94, 162);">but does the claim for orthotics for running hold true?</strong></p><h3>Why do Runners buy Orthotics?</h3><p>Speaking from experience, runners that are wearing orthotics would most commonly have a past injury which orthotics helped overcome, therefore they continue to wear them for injury prevention. On the other hand, other runners have been told they have pronated or ‘flat feet’ &amp; require orthotics, even though they have never experienced an injury. In my opinion, orthotics have been over-prescribed with a poor narrative attached.&nbsp;<strong style="color: rgb(16, 94, 162);">Unfortunately, marketing ploys have created promises of ‘correcting’, ‘realigning’, ‘protecting’ and ‘helping your posture’&nbsp;</strong>which don’t hold true when factoring our current understanding.&nbsp;<strong style="color: rgb(16, 94, 162);">So, as much as this false narrative may help runners create a positive placebo effect, it may also create a false dis-empowering narrative that leads them to think they NEED orthotics.</strong>&nbsp;So hopefully this blog clears the air.</p><h3>How does orthotics for running work?</h3><p>I follow the work of&nbsp;<a href="https://twitter.com/sports_pod?lang=en" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Ian Griffiths</a>&nbsp;who is a world leading sports podiatrist &amp; researcher and his colleagues and they have helped shed some light on our current understanding of the mechanics created when wearing orthotics. He cleverly shared a statement in a recent presentation:</p><blockquote>Ian Griffiths: Do orthotics work?….</blockquote><blockquote><strong style="color: rgb(16, 94, 162);">“Yes only for some of the people, some of the time</strong>,</blockquote><blockquote><strong style="color: rgb(16, 94, 162);">And never for all of the people all of the time”.</strong></blockquote><p>In other words, we currently cannot predict who will respond well to orthotics, even based on foot posture, foot function or type of pain.<strong style="color: rgb(16, 94, 162);">&nbsp;Some people respond very well, while others don’t.</strong>&nbsp;Here are a few different components to how orthotics might work.</p><h4>Kinematics (changing posture angles)</h4><p>Literature sways about 50/50 whether orthotics ‘align’ posture. There is work by Zammit et al in 2007 who concluded that the changes in foot posture are too small and probably insufficient to account for the extent of symptom reduction found. In fact,&nbsp;<strong style="color: rgb(16, 94, 162);">some people actually INCREASE their pronation when wearing orthotics</strong>. This is on the contrary to what orthotics are meant to do based on marketing posters. So if some people are getting better, and their foot pronation angles aren’t changing, what else is happening?</p><h4>Kinetics (changing the work of the muscles)</h4><p>This probably has the biggest influence but is also the hardest to study. If an orthotic is placed within your shoe and you are asked to walk or run, the load going through your joints and the demand of the muscles will change. Exactly HOW they will change is hard to predict from person to person. Sometimes is will have a beneficial response, other times not. Hence why Ian Griffiths states the quote mentioned above.</p><h4>Neuro-motor (changing how the nerves respond)</h4><p>Similar to the effects on kinetics, the research shows zero correlation between symptom relief and posture change. It seems like pure guess work if someone will have a positive experience. So, another theory proposed was the changes in neuro-motor control which will vary from person to person. Your foot receptors will be relaying information differently if your foot is interacting with a different sensation. Once again, this is hard to prove scientifically.</p><h4>Psycho-social (associated beliefs &amp; narratives)</h4><p>Lastly, we need to consider beliefs and narrative associated with the experience of buying and wearing orthotics. This is particularly my favorite because it goes hand-in-hand with what we know about other passive treatments. If someone is&nbsp;<strong style="color: rgb(16, 94, 162);">convinced&nbsp;</strong>this solution will work, based on what they have been told and based on their past experiences, it’ll be more likely to work.</p><h3>What about for injury prevention?</h3><p>There is no evidence to show a link between orthotics and injury prevention.&nbsp;<strong style="color: rgb(16, 94, 162);">The body will adapt as long as the applied load is not greater than the body’s capacity to adapt.</strong>&nbsp;In other words, if you carefully apply load with a sensible running program and strengthening then the body will adapt to any mild pronation, internal rotation or shock absorption applied to the joints.</p><h3>What about for treatment?</h3><p>How about orthotics for runners who have an injury and in pain? Unfortunately, evidence hasn’t shown any definitive results. An orthotic can change running biomechanics very slightly and most tend to believe this as insignificant. There were some studies to show orthotics helping foot pain such as pes cavus, rheumatoid arthritis and hallux valgus. But when it make to conditions like plantar fasciitis, science is unclear.</p><h3>When is the best time to wear orthotics for running?</h3><ul><li><strong style="color: rgb(16, 94, 162);">If it is more comfortable then not wearing orthotics</strong></li><li class="ql-indent-1">But keep in mind that you are only wearing them for comfort, not for injury prevention.</li><li><strong style="color: rgb(16, 94, 162);">If you have been wearing them for a long time</strong></li><li class="ql-indent-1">Your body has adapted to using orthotics and if you choose to remove them, do so gradually.</li><li><strong style="color: rgb(16, 94, 162);">If you have an acute injury such as plantar fasciits, shin splints or medial knee pain</strong></li><li class="ql-indent-1">It is still worth trying out and rolling the dice to see if you have a positive response. Like Ian Griffiths said, they work for some people some of the time. In my opinion, I would start with a less expensive off the shelf orthotics.</li></ul><p><br></p><h4>Relevant Blogs</h4><ul><li><a href="https://runsmarter.online/leg-length-discrepancy-running/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Does Leg length discrepancy effect my running?</a></li><li><a href="https://runsmarter.online/how-to-transition-to-a-lesser-shoe/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How to transition to a lesser shoe</a></li></ul><h4>Relevant Podcast Episodes:</h4><ul><li><a href="https://runsmarter.online/podcasts/is-there-a-right-wrong-running-shoe-with-jf-esculier/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Is there a right &amp; wrong running shoe? With JF Esculier</a></li><li><a href="https://runsmarter.online/podcasts/is-a-carbon-fibre-shoe-right-for-me-with-simon-bartold/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Is a carbon fibre shoe right for me? With Simon Bartold</a></li></ul><h4>References:</h4><ul><li><a href="https://pubmed.ncbi.nlm.nih.gov/27789429/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Ian Griffiths &amp; Simon Spooner. Foot orthoses research: identifying limitations to improve translation to clinical knowledge and practice (2016).</a></li></ul>

Do I need orthotics to help my running?

<p>As a runner, learning the pros &amp; cons of each running surface type is a huge advantage because it allows you to adapt in different circumstances. For example, throughout your career you may encounter different injuries and prepare for different races. Therefore, we should dive into the different terrains a runner encounters and learn from each one.</p><h3>Running Surface #1: Pavement</h3><p>The most common surface, pavement offers the best energy return due to it’s tough nature. It might surprise you but&nbsp;<strong style="color: rgb(16, 94, 162);">a hard surface can have a lot of advantages</strong>. For example, pushing off a firm surface ‘returns’ a lot of energy which equals greater ‘efficiency’. The downside is a very repetitive running action which I will discuss later. However, a runner might require a softer landing which pavement does not offer. So, let’s discuss grass.</p><h3>Grass Running</h3><p>Grass is more forgiving when impacting the ground and there are individual circumstances will aid a runner. For example, returning from a stress fracture, managing a sensitive arthritic knee or any other injury that directly relates to ground reaction force. However, it is not recommended to spend the entire training week running on grass and a combination with other surfaces can be a good option.&nbsp;<strong style="color: rgb(16, 94, 162);">Keep in mind you are sacrificing efficiency when choosing grass running which may increase the demand in the achilles, calf and other structures responsible for propulsion</strong>.</p><h3>What about Sand?</h3><p>For runners,&nbsp;<strong style="color: rgb(16, 94, 162);">soft sand running is rarely recommended</strong>. Firstly, the surface is too unstable and unpredictable, leaving too much demand for the foot and ankle to control. Secondly, it offers no firm ‘push-off’ and will spike the load required for the achilles and calf as they work hard to keep you moving forward.&nbsp;<strong style="color: rgb(16, 94, 162);">This fosters an environment for injury.</strong></p><h3>Hitting the trails</h3><p>Lastly, we have trails. In most cases this offers a firm, uneven surface which fosters the healthy ‘variability’ foot placement.&nbsp;<strong style="color: rgb(16, 94, 162);">This is actually my favorite surface and highly recommended for all runners.</strong>&nbsp;The downside of running on pavement is the lack of variability, leaving the body prone to injuries from ‘repetition’ for example ITB friction syndrome. However, trauma-based injuries may occur so care is needed. The pros and cons of up-hill and down-hill running is outside the scope of this blog but I will attach references below.</p><p><strong style="color: rgb(16, 94, 162);">In conclusion, to become a well-rounded runner to should probably spend time running on different, firm surfaces.</strong>&nbsp;If you require a softer landing temporarily due to injury, a slightly softer surface may provide relief.</p><h4>Relevant Blogs</h4><ul><li><a href="https://runsmarter.online/can-i-train-for-a-race-just-using-my-treadmill/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Can I train for a race just using my treadmill?</a></li><li><a href="https://runsmarter.online/the-top-5-must-haves-in-your-training-program/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The top 5 MUST HAVES in your training program</a></li></ul><h4>Relevant Podcast episodes</h4><ul><li><a href="https://runsmarter.online/podcasts/the-benefits-of-trail-running-with-daniel-farrugia/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The benefits of trial running with Daniel Farrugia</a></li><li><a href="https://runsmarter.online/podcasts/how-can-i-boost-my-running-program-with-jason-fitzgerald/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How can I boost my running program with Jason Fitzgerald</a></li></ul><h4>References</h4><ul><li><a href="https://www.researchgate.net/publication/306009034_Biomechanics_and_Physiology_of_Uphill_and_Downhill_Running" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Biomechanics and Physiology of Uphill and Downhill Running</a></li></ul><p><br></p>

What is the best running surface?

<p>Feet are often a neglected piece of the running puzzle. That is because they often hide away and are compensated by footwear. But how important is it to have strong feet for running? Does it reduce risk of injury? Let’s see what the evidence says.</p><h3>The Foot Core System</h3><p><a href="https://bjsm.bmj.com/content/bjsports/49/5/290.full.pdf" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">An article published in 2014</a>&nbsp;introduced the concept of the ‘foot core system’ and argued that the foot core behaves such like the ‘core muscles’ in your back and stomach. They went on to say, that the foot core system is influenced by 3 sub-systems all interacting together to achieve strength &amp; function. The active system includes the muscles, the passive system relies on the bones, and the neural system focuses on nerve receptors sending feedback to the rest of the body.</p><h3>Foot strength &amp; running injury</h3><p>Surprisingly,&nbsp;<strong style="color: rgb(16, 94, 162);">no evidence has shown a link between flat feet and injury</strong>. Additionally, evidence has struggled to link foot strength &amp; function with injury. I believe this is the case because we are missing one key piece. Individual running loads!&nbsp;<strong style="color: rgb(16, 94, 162);">Increasing foot function will help raise foot capacity</strong>&nbsp;and help the function of the entire kinetic chain, but we need to combine this with a well-structures training plan. Therefore, it can be very useful for runners to increase foot function, while training within their adaptation zone.</p><h3>Exercises to develop strong feet for running:</h3><p>It is important to note, if your foot is weak to start with the basics. Try some co-ordination exercises like toe yoga and built a foundation. Once this is built, progress to strength exercises in standing, single leg standing and jumping. Alternatively,&nbsp;<strong style="color: rgb(16, 94, 162);">one of the most effective ways to strengthen the feet is to walk barefoot</strong>. If you are able to tolerate these loads, wear minimalist footwear throughout the day, do your gym workouts in bare feet &amp;&nbsp;<strong style="color: rgb(16, 94, 162);">utilize every moment you spend on your feet as an opportunity to build strength!</strong></p><h4>Beginner foot strength examples:&nbsp;</h4><ol><li><a href="https://www.youtube.com/watch?v=wfYSEFwJMDA" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Toe yoga</a></li><li><a href="https://www.youtube.com/watch?v=f9OsUCzXqZg" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Foot doming</a>&nbsp;</li><li>Calf raises with toe extension (photo 1 below)</li><li>Intrinsic calf raises (photo 2 below)</li><li>Isometric big toe flexion (photo 3 below)</li></ol><p><br></p><h4>Relevant Blogs:</h4><ul><li><a href="https://runsmarter.online/do-i-need-to-run-with-orthotics/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Do I need to run with orthotics?</a></li><li><a href="https://runsmarter.online/how-to-transition-to-a-lesser-shoe/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How to transition to a lesser shoe</a></li></ul><h4>Relevant Podcast episodes:</h4><ul><li><a href="https://runsmarter.online/podcasts/strength-training-5-keep-your-feet-strong-with-podiatrist-tim-bransdon/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Strength training 5: Keep your feet strong with Tim Bransdon</a></li></ul><h4>References:</h4><ul><li><a href="https://bjsm.bmj.com/content/bjsports/49/5/290.full.pdf" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">McKeon et al. The foot core system: a new paradigm for understanding intrinsic foot muscle function.</a></li></ul>

Do you need strong feet for running?

<p>Firstly, what is a minimalist shoe? Well, this is a shoe that attempts to mimic barefoot function as closely as possible. This usually means it is accompanied by light material and offering less support. Because this leads to confusion, the ‘minimalist index scale’ was created. I want to give a big thanks to the team at The Running Clinic, because they created this spectrum, the rating scores and do a fantastic job at explaining it’s function.&nbsp;<a href="https://therunningclinic.com/minimalist-index/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">You can visit their website here.</a></p><p>There has been plenty of debate around barefoot running over the past few years and there are strong believers in both camps. I have heard runners ask,&nbsp;<strong style="color: rgb(16, 94, 162);">should I run in comfortable, supporting, protective shoes?</strong>&nbsp;Or&nbsp;<strong style="color: rgb(16, 94, 162);">do I run in light minimalist shoes and let my feet do all the work?</strong>&nbsp;Well, the answer to these questions will depend on several factors, including your your strength and your current running goals. However I like to simplify this dilemma and ask you two questions.</p><p>1.) Do you want to improve my running performance?</p><p>2.) Are you currently injured?</p><h3><strong style="color: inherit;">Minimalist shoes on running Performance</strong></h3><p>If you answered yes to performance then you might consider carefully transitioning to minimalist shoes, or at least have a pair to rotate with your traditional shoes. Because we are discussing performance, we need to consider your running economy. Practically speaking, your running economy means you are spending less energy to achieve the same running speed.&nbsp;<strong style="color: rgb(16, 94, 162);">This is a huge advantage!</strong></p><p>To support the theory that minimalist shoes help performance. Studies like Hoogkamer, 2016 conducted tests, measuring runners in different shoes at a 5k time-trial speed. Surprisingly, the study found that&nbsp;<strong style="color: rgb(16, 94, 162);">for every 100g that was added to the shoe weight, the athlete decreased their running economy by 1.11%</strong>. Just think about the difference in your running economy if your shoes are 200-300 grams heavier!&nbsp;</p><p>There are other research examples that support this claim. Fuller and colleagues allocated 61 runners into 2 groups. A minimalist shoe group and a traditional shoe group. This meant that both groups would follow the same 6-week training program, but one would group slowly transitioned to minimalist shoes. As a result, they concluded that the&nbsp;<strong style="color: rgb(16, 94, 162);">minimalist shoe group improved their running economy more than the conventional shoe group during a 5km time trial (on treadmill).&nbsp;</strong>These claims are supported by several other studies which show a correlation between shoe weight and running economy.</p><h3><strong style="color: inherit;">Minimalist shoes on running injuries</strong></h3><p>A nice systematic review conducted by Warne &amp; Gruber in 2017 titled:&nbsp;<strong style="color: rgb(16, 94, 162);">Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations</strong>&nbsp;found out of 10 studies that fit their criteria, five observed more injuries in a minimalist footwear group, one observed more injuries in the traditional shoe group and four did not observe any difference in injuries between groups. Puzzling right? The minimalist shoe group did have greater risk of injury development if body mass was above 71.4 kg. And from my understanding of load management, that seems to make sense.</p><p>Clinically, it seems that&nbsp;<strong style="color: rgb(16, 94, 162);">transitioning to minimalist running shoe will increase the demand on the muscles, joints, tendons located below the knee</strong>.</p><p>This could be a good thing, because if you transition gradually, these structures will actually become stronger and more resilient. It also seems that these shoes reduce joint forces at the knee, the most common location for running injuries. This is in part due to adjustments in foot contact and cadence when adopting a lighter shoe.&nbsp;</p><h3><strong style="color: inherit;">Methods to transition into a minimalist shoe</strong></h3><p>The method and timeframe to transition shoes is open to debate. As I mentioned earlier, shoes fall on a minimalist index spectrum, so it will depend on the leap you take from one side to the other. Other factors include your history of injuries, your strength, running style, the list goes on!&nbsp;I will try my best to provide some generic guidelines.</p><ol><li>I suggest that a transition period of&nbsp;<strong style="color: rgb(16, 94, 162);">no less than 4–8 weeks</strong>&nbsp;should be used because of general muscular adaptation to training, taking this period of time.</li><li>Given the dramatic change in the demand of the foot structure and musculature with minimalist shoes,&nbsp;<strong style="color: rgb(16, 94, 162);">a period of preparation could include some light walking and every day, non-uniform loading whilst wearing minimalist footwear or going barefoot may be of benefit before any running activity has begun.</strong></li><li>I suggest that the initial overall&nbsp;<strong style="color: rgb(16, 94, 162);">running volume is decreased</strong>&nbsp;in the region of 10–20% in the first 2 weeks, in order to reduce the risk of this bony injury from unfamiliar repetitive loading.</li><li>I suggest a hybrid approach—e.g. “10% of your daily running volume, up to a maximum of 10 minutes”—that is increased by 5–10% per week.&nbsp;</li><li><strong style="color: rgb(16, 94, 162);">Females and heavy males &gt;85kgs should perhaps consider a more conservative programme.</strong>&nbsp;Using a screening protocol to determine high-, moderate-, or low-risk participants, clinicians may be able to individually prescribe the exposure to minimalist footwear.</li><li>It is suggested that some&nbsp;<strong style="color: rgb(16, 94, 162);">proportion of running takes place in different footwear, and on numerous different surfaces</strong>&nbsp;to help develop the ability to deal with multiple stressors in a variety of environments. This way we may be able to develop more resilient runners and combat the dramatic injury rates seen today.</li></ol><h4>Relevant Blogs:</h4><p><a href="https://runsmarter.online/should-i-listen-to-running-shoe-fads/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Should I listen to running&nbsp;<strong>shoe fads?</strong></a></p><p><a href="https://runsmarter.online/shoe-prescription-misconceptions/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);"><strong>Shoe prescription</strong>&nbsp;misconceptions</a></p><h4>Relevant Podcasts:</h4><p><a href="https://runsmarter.online/podcasts/is-a-carbon-fibre-shoe-right-for-me-with-simon-bartold/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Is a&nbsp;<strong>carbon fibre shoe</strong>&nbsp;right for me? With Simon Bartold</a></p><p><a href="https://runsmarter.online/podcasts/using-shoes-as-tools-to-overcome-injury-with-matt-klein/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Using<strong>&nbsp;shoes as tools&nbsp;</strong>to overcome injury? Matt Klein</a></p><p><a href="https://runsmarter.online/podcasts/is-there-a-right-wrong-running-shoe-with-jf-esculier/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Is there a&nbsp;<strong>right &amp; wrong running shoe?</strong>&nbsp;With JF Esculier</a></p><h4>References:</h4><p><a href="https://therunningclinic.com/en/minimalist-index/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The Running Clinic Minimal Index</a></p><p>Joel T Fuller et al. Six-week transition to minimalist shoes improves running economy and time-trial performance (2017)</p><p>Matthew J Salzler et al. Injuries observed in a prospective transition from traditional to minimalist footwear: correlation of high impact transient forces and lower injury severity (2016).</p><p>Warne &amp; Gruber. Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations (2017).</p><p>Hoogkamer et al. Altered Running Economy Directly Translates to Altered Distance-Running Performance (2016).</p>

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