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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>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>

Do I need to transition to a minimalist shoe?

<p>Firstly, I must knowledge&nbsp;<a href="https://bjsm.bmj.com/content/52/24/1552" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">the work published by Chris Napier &amp; Richard Willy</a>&nbsp;as their article has inspired most on the content within this blog. It is a confusing time to be a runner when buying running shoes because over recent decades, new paradigms continue to surface. Minimalist footwear is one of the most popular fads on the market, with motion-control, carbon plate &amp; maximalist trends working their way into the running community. While researchers try to catch up to this advertising frenzy, how can we choose the best running shoe?</p><h3>Avoiding the shoe buying trap!</h3><p>When we buy running shoes, we are mainly asking ourselves three things. Firstly, are they comfortable. Secondly, will they reduce the likelihood of injury and lastly, will it help with running performance. However, trying to get to these answers is often misleading. This is because shoe stores want you to buy more, and they are not regulated by research-backed industries. This will give them permission to circulate misguided fads and catchy advertisement ploys. While conclusive literature takes a long time to emerge, here is what we do know.</p><blockquote>“There remains a lack of conclusive evidence to support traditional shoe prescription to prevent running-related injuries”.</blockquote><p>There is also no evidence to support one shoe type based on your foot shape. This is an important topic because a common experience when buying shoes in a shoe store is walking on a treadmill or a pressure-pad, placing you into flat, neutral or high arch category and then selecting an allocated shoe. Not only is there no evidence to support this process, but several publications actually contradict these belief.</p><h3>Why change shoes?</h3><p><strong style="color: rgb(16, 94, 162);">There should be 3 reasons to buy new shoes:</strong></p><ol><li>Your current shoes are getting old: I believe you shouldn’t base this decision on mileage. Instead, ask yourself a few questions. Are your shoes starting to become uncomfortable? Is there significant deterioration of the sole? And are the old shoes starting to change my running bio-mechanics? Marketing ploys to change your shoes every 6 months or every 500km is a gross estimation without factoring in key information like strike pattern, ground reaction force and running surface.</li><li>To increase performance:&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/28483557/#:~:text=Minimalist%20shoes%20caused%20large%20reductions,changed%20to%20a%20forefoot%20footfall.&amp;text=Conclusions%3A%20Gradually%20introducing%20minimalist%20shoes,and%20performance%20in%20trained%20runners." rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Research has shown that lighter shoes improve running economy</a>. This will generally (but not always) sacrifice stability and shoe support, so a careful transition into different types of shoes requires professional guidance.</li><li>To change running bio-mechanics: For instance, minimalist shoes are suggested to increase running cadence, alter strike pattern and reduce vertical loading rates. On the other hand, a larger heel drop and support will off-load the calf complex. This adjustment and shoe selection requires professional guidance.</li></ol><h3>Buying running shoes: Conclusion</h3><p>When it comes to reducing running injuries, choosing one shoe over another is just as reliable as choosing a red shoe over a blue shoe. If you would like to reduce your risk of running injury, then gait retraining and a well-planned running program from a professional is the best option. If you are still deciding on which shoe to buy, then choose the shoe that feels the most comfortable.</p><h4>Relevant Blogs:</h4><ul><li><a href="https://runsmarter.online/transition-into-a-minimalist-shoe/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Do I need to transition into a minimalist shoe?</a></li><li><a href="https://runsmarter.online/running-shoe-assessment/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Learn how to Conduct a running shoe assessment</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/using-shoes-as-tools-to-overcome-injury-with-matt-klein/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Using shoes as tools to overcome injury? Matt Klein</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://bjsm.bmj.com/content/52/24/1552" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Chris Napier &amp; Rich Willy. Logical fallacies in the running shoe debate, 2018</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/28483557/#:~:text=Minimalist%20shoes%20caused%20large%20reductions,changed%20to%20a%20forefoot%20footfall.&amp;text=Conclusions%3A%20Gradually%20introducing%20minimalist%20shoes,and%20performance%20in%20trained%20runners." rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Lighter shoes improve running economy</a></li></ul><p><br></p>

The dangers when buying new running shoes

<p>Has someone told you your injuries are due to a leg length discrepancy? It can be a concerning, dis-empowering thought for any runner. But do athletes need to be concerned? Let’s look at the research to find the answers.</p><h3>Assessing leg length for runners</h3><p>A paper titled ‘Methods for Assessing Leg Length Discrepancy’ found that without scans, the most reliable method to determine leg length is to measure the distance between the hip bone (ASIS) &amp; ankle bone (medial malleolus). However, a CT scanogram is reported as a sensible alternative when considering accuracy, cost and radiation exposure.</p><h3>Leg length relevance:</h3><p>If a runner is found to have a leg length difference with accurate testing, then they share this finding with 90% of the population. That’s right,&nbsp;<strong style="color: rgb(16, 94, 162);">90% of humans (with studies including 2.68 million people) will have some form of leg length difference.</strong>&nbsp;Additionally, research then found the average difference was 5.2mm and deemed insignificant.</p><h3>Link to running injury</h3><p>A<strong style="color: rgb(16, 94, 162);">&nbsp;leg length difference under 20mm is not likely to cause symptoms that require treatment</strong>&nbsp;and reviewing these massive population studies, only 1 in 1000 show a difference greater than 20mm. Then reviewing the research findings above, this would fit our current understanding of running injuries, because our body does an amazing job at adapting to a wide range of running styles. As a result, we should focus on load management and avoiding rapid changes so our body can adapt and stay healthy, rather than handing our control over to a false, dis-empowering narrative.</p><h4>Relevant Blogs:</h4><ul><li><a href="https://runsmarter.online/treat-running-injuries/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How to treat your running injuries</a></li><li><a href="https://runsmarter.online/am-i-strong-enough-to-run/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Am I strong enough to run?</a></li><li><a href="https://runsmarter.online/the-new-running-injury-index/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The new running injury index</a></li></ul><h4>Relevant Podcast episodes:</h4><ul><li><a href="https://runsmarter.online/podcasts/addressing-common-running-misconceptions-part-2-running-form/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Addressing common running misconceptions 2: Running Form</a></li><li><a href="https://runsmarter.online/podcasts/running-technique-insight-for-injury-prevention-performance-with-chris-bramah/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Running Technique insight Chris Bramah</a></li></ul><h4>References:</h4><ul><li><a href="https://pubmed.ncbi.nlm.nih.gov/11869914/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Burke Gurney: Leg length discrepancy</a></li><li><a href="https://www.researchgate.net/publication/21684513_Leg_Length_Inequality_Implications_for_running_injury_prevention" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">S, McCaw. Leg Length Inequality Implications for Running Injury Prevention.</a></li><li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628227/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">S, Sabharwal et al. Methods for Assessing Leg Length Discrepancy, 2008.</a></li></ul>

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