Q I visited a sports doctor a while back with an achilles tendon injury and he prescribed custom orthotics. I have high arches, which he said were collapsing in. He was able to tell this just by looking at the back of my ankles; folks in running stores had analysed my gait several times and told me that I was a neutral runner.
Eventually the achilles injury healed and then I developed severe shin splints. I hadn’t been using the orthotics so much because I found them uncomfortable.
Despite successfully transitioning to a midfoot strike, I’ve since had shin splints several times and am starting to finally believe I need to stick with the orthotics. I still don’t like wearing them though, mainly because they are so heavy, and am wondering whether I can get some lightweight racing shoes to wear (without the orthotics) in races. In other words, based on the above, can I race without orthotics? – SHANE
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A This is a great question but a bit difficult to answer without examining you personally. If you run on a consistently flat surface and your pain is in both legs, you may be someone who needs the added support of an orthotic. If the injury is one sided, the rest of your kinetic chain mechanics should be investigated. The shin pain is likely the victim; but is the culprit your foot collapsing in, or some other dysfunction in the knee, hip, pelvis or low back?
In studies of injury to runners, the high arch foot usually has more associated injuries than the pronated foot, but over-pronation can cause pain in the shins if the posterior tibialis muscle is not strong enough to support your foot as it pronates to help absorb shock. An orthotic is the usual intervention to splint the foot until the muscle heals and the pain resolves. If the muscles supporting the arch and ankle can be strengthened adequately to control the foot and ankle, you should be able to run without an orthotic.
An orthotic should be comfortable when it is in your shoe and when you are running. If not, and it is a custom made orthotic, it is either “miss fit” or the material is too hard to be comfortable. As a simple test, you might try an “off the shelf” running insert. Make sure it feels perfect in the store before you purchase it. Try running with it to see if it is comfortable and keeps you pain free. If you become used to running with an insert, I would continue to use them for racing, but be sure to fit them into your racing flats. You might also consider seeing a physical therapist who treats runners regularly for a kinetic chain evaluation, manual therapy if needed, and a strengthening program tailored to your mechanics. – BILL
