Running In Orthotics: What Does The Science Actually Say?

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Have you started to notice pain in the foot or lower extremities?

Has a running buddy from the local running club recommended getting insoles? Running in orthotics worked for them, so it’ll work for you. You’re about to order some until another friend says they made their injury worse! Now what?

Orthotics have been a widely used method of injury treatment and prevention for decades. They come in different shapes and sizes, including off-the-shelf and custom-made options.

Runners tend to use orthotics to prevent lower limb injuries such as plantar fasciopathy, shin splints,” or posterior tibialis pain.

Nevertheless, the question of whether running in orthotics can actually improve performance and prevent injuries remains a subject of debate.

In this article, we will delve into the existing scientific literature to provide a comprehensive overview of the evidence behind the use of orthotics and their role in running injury prevention and performance.

We’ll look at:

  • What Are Orthotics?
  • Biomechanical Effects Of Orthotics
  • Role Of Orthotics On Performance And Efficiency
  • Role Of Orthotics In Injury And Pain Prevention
  • How Do You Know If A Custom Orthotic Is Right For You?
  • Final Thoughts On Running In Orthotics

Let’s get into it!

A person holding an insole.

What are Orthotics?

Orthotics are usually prefabricated or custom-made insoles that go within the shoe. They are designed with the intent to modify foot and lower limb mechanics and have become a ubiquitous component of the running scene.

Generally, over-the-counter inserts are built to offer comfort but don’t aim to directly correct foot issues.

Orthotics are prescribed by professionals with the purpose of addressing biomechanical problems and relieving foot pain.

Some orthotics will be classed as “functional orthotics.” They aim to address biomechanical discrepancies and are made from materials like plastic or carbon fiber.

On the other hand, soft orthotics, or “accommodative orthotics,” are crafted from soft, compressible materials. They offer cushioning to relieve pressure on sensitive or painful areas.

As a general guideline, prefabricated orthotics can range from $20 to $100 or more, while custom-made orthotics typically range from $300 to $600 or higher.

Molds to make custom orthotics.

Biomechanical Effects Of Orthotics

One of the major claims in favor of orthotics for runners revolves around the alteration of running biomechanics to correct gait abnormalities and improve overall running efficiency.

In particular, overpronation, which is the excessive inward rolling of the foot during the stance phase, is often a biomechanical issue that is treated with orthotic use.

It should be noted that a degree of pronation is normal and necessary.

By providing support to the arch of the foot, custom-made orthotics support the foot and reduce the degree of inward rolling, potentially reducing the risk of overuse injuries.

There are a plethora of studies that look to inspect the biomechanical effects of orthotics on running gait. A comprehensive review by Mills et al. (2018) aimed to corroborate previously fragmented findings.

The study analyzed 22 papers, considering different orthotic design features, including posting, molding, and density.

People running in orthotics.

Key findings include:

  1. Use of orthotics in non-injured individuals reduced rearfoot eversion and tibial internal rotation.
  2. In terms of impact force, molded and posted orthosis demonstrated statistically significant reductions in loading rate and impact.

The finding of this study supports the notion that orthotics can indeed modify biomechanics.

Conversely, some studies have cast doubt on the degree to which orthotics can have a biomechanical effect. Although they found that while orthotics did reduce pronation, the effects were relatively modest, calling into question whether these alterations were clinically significant.

It is also unclear as to the degree of change expected to the biomechanics of someone’s foot during the running gait when foot orthosis has been applied.

In summary, the current scientific literature suggests that orthotics can influence running biomechanics, especially in cases of significant overpronation.

A person trying on an insole.

Role Of Orthotics On Performance and Efficiency

By improving the biomechanical stride, the thought is that orthotics may indeed contribute to more efficient performance by reducing the energy cost of running.

On the performance front, one randomized control trial suggests that orthotics may enhance running economy and, in turn, lead to improved performance. By using orthotics in running shoes, runners reported increased comfort levels and speed during running, with a small reduction in injury.

The relationship between orthotics use and improved comfort showed the largest effect size, whilst the reduction in injury however was largely insignificant.

That said, a key constraint arises from the inability to implement blinding among participants after group assignment, a result of the study’s inherent design.

The enhancements in comfort and performance that participants who received an orthotic reported might be attributed to the placebo effect if these individuals had preconceived expectations regarding the orthotic’s potential to improve these aspects.

Let’s throw another spanner in the works!

A 2019 meta-analysis, looking at “The effect of foot orthoses and insoles on running economy and performance in distance runners”: A systematic review and meta-analysis” found that foot orthoses and shock absorbing insoles may, in fact, adversely affect running economy in distance runners.

It would appear that the extent to which the performance benefits vary among individuals may depend on factors such as the type of orthotic, the runner’s experience level, individual differences, and the specific biomechanical issues addressed.

A doctor presenting a pair of orthotics.

Role Of Orthotics In Injury and Pain Prevention

Injury prevention in runners is complex. The question of whether orthotics can effectively prevent injuries in runners is even more complex, as it involves numerous variables and factors.

The underlying mechanism through which orthotics promote comfort and mitigate the risk of injury is grounded in their capacity to distribute pressure across the soles of the feet and mitigate overpronation or other excessive biomechanical errors.

The resultant theory is that mitigating these biomechanical factors lowers the likelihood of injuries that are associated with pressure and overpronation in the lower limbs.

Although there is good evidence to suggest that orthotics can reduce pain and increase comfort, the mechanism by which orthotics reduce injury is unclear, with many studies showing little to no reduction in injury risk.

When it comes to running injuries, the number one cause is overuse.

A doctor fitting an orthotic.

This is where we subject excessive and repetitive stress on the muscles, tendons, bones, and joints without adequate time for recovery.

In my clinic, I see runners daily, and one theme that is consistent throughout is a strong temptation to push too hard, too fast, or increase mileage too rapidly. It’s critical to understand that your body needs time to adapt gradually to increased training loads.

Inadequate sleep, insufficient nutrition, and the absence of cross-training or strength training can contribute to this issue. It’s vital to prioritize proper recovery strategies to ensure your body remains resilient and injury-free in your running journey.

Rushing the process is a recipe for injury. Over time, however, you can achieve great things.

Future research aimed at exploring orthotics and injury prevention should consider asking the following important questions:

  1. Effectiveness Across Various Injury Types: Does the utilization of orthotics lower the likelihood of particular running-related injuries, like stress fractures, plantar fasciitis, or shin splints?
  2. Short-Term vs. Long-Term Efficacy: Are orthotics more efficient at preventing sudden injuries or long-term overuse injuries over an extended period?
  3. Runner Diversity: Do orthotics offer consistent injury prevention advantages across different runner categories, including beginners, recreational runners, and elite athletes?
  4. Custom vs. Off-the-Shelf Orthotics: Is there a notable disparity in injury prevention between individually crafted orthotics and mass-produced orthotic inserts?
  5. Biomechanical Influences: Can specific biomechanical aspects, such as pronation, supination, or foot strike patterns, serve as predictors for the runners who may benefit most from orthotics?
A person taking a step.

How do you know if a custom Orthotic is right for you?

Here are four things to consider to know if a custom orthotic is right for you:

  1. Trust your instincts: Prioritize comfort as your primary indicator of orthotic effectiveness.
  2. Gauge improvement: If you’re dealing with a foot or lower leg injury, using an orthotic should result in a more comfortable experience compared to running without one.
  3. Pay attention to how it feels: If the orthotic feels uncomfortable or “wonky” while walking or running, it’s unlikely to be beneficial for injury prevention.
  4. Consider an alternative approach: If the orthotic isn’t working for you, invest your time and resources in strengthening your hips. Strong hips and glutes are your best defense against future injuries.
A person inserting an insole into a running shoe.

Final Thoughts On Running In Orthotics

Running in orthotics is a subject that has stirred considerable interest and debate among scientists, athletes, and healthcare practitioners.

The scientific basis of orthotics indicates that these devices can influence biomechanics, potentially enhancing comfort and reducing the risk of injuries.

While orthotics may offer short-term injury prevention benefits for some athletes, the development of effective inserts remains an ongoing challenge.

This is partly due to the lack of consensus on the ideal running form, as individual variations in biomechanics make a one-size-fits-all solution challenging.

Our bodies are unique, and our natural movement patterns differ. This raises questions about how orthotics can effectively correct alignment issues when individual preferences for alignment may vary.

When it comes to injury prevention, the most crucial factors include gradual training progression, incorporating strength training, and ensuring adequate rest.

A pair of orthotics.

While studies investigating the science of running in orthotics provide valuable insights into their biomechanical effects, injury prevention potential, and possible performance enhancements, the topic remains intricate and multifaceted.

Future research should focus on determining the best use of orthotics for various types of runners and exploring potential synergies between biomechanical improvements and performance enhancements.

Ultimately, making the decision of whether or not running in orthotics is right for you should hinge on a thoughtful evaluation of individual needs and objectives, weighing scientific evidence alongside practical and individual considerations.

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A front squat.
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Ben is a qualified Personal Trainer and Sports Massage Therapist with a particular interest in running performance and injury. He has spent the last 9 years working with runners at his clinic in Brighton. Ben is a keen runner and avid cyclist. Evenly splitting his time between trail running, road biking, and MTB.

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