Are Insoles (Orthotics) The New Saviours For Your Feet & Running?
This is an ultra-long version of my Hindustan Times column ‘Re-Solution: Solution to move optimally well lies within you’ published on 5th January 2019.
My shoe collection from a decade back
Just a couple of days back multiple running mates shared an article with the headline, ‘This Indian startup wants you to stop buying expensive running shoes’.
I was keen to know more about the underdogs who like David had just openly announced their duel with Goliath, the sports shoe industry with the market size bigger than GDP of more than a hundred countries on planet earth.
“I wondered if we had new set of vigilantes in town? Or was it simply a marketing gimmick where this start-up’s business model was simply focused on a piece of this massive pie, more like a cake actually?”
Before delving deeper, a disclaimer — from 2014 to 2017, I was Principal Technical Consultant and Head Coach for running for adidas India. Before taking on the role, my only condition was that I would not promote running shoes but running itself. That, yet again, is my intent here.
The world's oldest known leather shoe (pictured) has been found in an Armenian cave date back to 5,500 years, archaeologists say. (source: National Geographic)
Sagebrush bark sandals, in 1938 were excavated by archaeologist Luther Cressman ( University of Oregon) at Fort Rock Cave, a volcanic crater in central Oregon. They radiocarbon dated from 10,500-9,300 years old. (source: University of Oregon)
Let us start from the very beginning. The oldest footwear ever found were woven from twine made of sagebrush bark. They date back to over 10,000 years, when our ancestors were gatherer-hunters. Back then it would take an enormous amount of time and effort to make those sandal like shoes. As soon as we had the know-how, we were busy making them, with the emphasis on protecting the feet from cold and rough ground. Looking at the effort that went in, I would imagine them to be more a necessity, than a luxury, unless of course, it was our forefathers and foremothers favourite pass-time.
Below is a video of mine from a decade ago demonstrating how to wear Tarahumara Huarache Running sandals.
Imagine your body being a state-of-the-art car and the best feature being what your bumpers are like. So when you do hit the other cars or they hit you, how much impact will those bumpers be able to absorb and reduce the injury to you. Even in the eccentric car designs, we don’t see crazy amount of cushioning or stiffness in the super large bumpers. You can have the best car, but if you don’t know how to drive, you are better off driving the cheapest car to start with.
For that reason, first learn to drive that car, or in this case, your one and only very precious body. As soon as your driving skills start getting better, running in this case, almost like transformers, your car, i.e. your body will start upgrading to better specs. And you’ll be able to do justice to all the tech in your amazing body. In this whole story, bumpers aka running shoes play almost no role. As was the case 10,000 years ago, the running shoes’ role is to reduce injuries from cold or thorns.
Running shoe prescription is a newer phenomenon in India. The problem is that current research has shown that when it comes to injuries, shoes don’t make much of a difference.
I too prescribe shoes, but slightly differently. I, like a matchmaker, look at the horoscope of your feet and running, and then I match it to the shoes that are available in the market. If you over-pronate, i.e. your foot arches collapse while walking or running, then you are looking for stability shoes to start with. If not, you are looking for neutral shoes. Across all decent brands like Asics, New Balance, Adidas and Nike, you will find these kind of shoes.
“You then need to go on a date with the shortlisted pairs of shoes in each brand. It might surprise you but the ‘feel factor’ is far more important than all the science that has gone into those high-tech expensive shoes. It pretty much is marriage of arranged and love shoe selection. ”
In last 5 years, Gazelle Adidas have been my favourite shoes. When they were on, the way a good shoe should be, I wouldn’t even feel them. They were just an extension of he feet.
“The price of the shoes should not be a consideration whatsoever, nor should their appearance be. Like choosing your partner, how they are to you should be the most important thing to go by. ”
For over 40 years now, these over-cushioned and stability shoes have been promoted by the running footwear industry but the incident of running injuries hasn’t got any better. That itself should make you wonder what is going on here.
“We need to go back to what we are trying to cater to, the human feet. In a set of human feet, there are 66 joints in between the 52 bones held together and moved by more than 100 muscles, tendons and ligaments. And the smart evolved human-beings wear a shoe and use the foot to work like a single unit.”
As if not enough damage had already been done, here is yet again an industry talking about all the science that in its eagerness to provide more stability to the foot, is dumbing down this masterpiece of engineering.
They are trying to correct flat weak foot arches that actually don’t need static support but dynamic. No amount of stability whether in-built in running shoes or insoles (orthotics) are going to give you a long term solution. Only when you move and load those foot arches, similar to rest of the human body and even mind, will they become strong. Besides starting to walk and eventually graduate to running, you also need to focus on strength training.
“My favourite running drill is simply walking barefoot for 5 minutes on grass and on pebbles. ”
In Lodhi Garden. Pic courtesy Mint from my article Relearn Running
One muscle that we all have massively abused, besides the brain, are the ones we have been sitting on forever, gluteus maximum, also known as the butt muscles. It’ll surprise you that exercising that muscle helps your foot arches, which seem miles away.
After reading the NDTV Gadget 360 article that got me started in this, I had a few questions for the Nitin Gandhi, the co-founder of Shapecrunch who was quoted in that article. Below are his responses to my queries.
Question 1: Measuring two feet differently is a great idea. But again the feet will be in same set of shoes with identical size. Thoughts?
Nitin Gandhi: They are measured differently and insoles are also different in many cases. There are also cases, where feet length is different where we provide filler in front. There are also cases of leg length discrepancy in that case we increase height of insoles of one insole by the difference. Also, there are cases in which case one feet is highly pronated and other isn’t so wedging angle is provided different.
“Background to the question: At Shapecrunch the protocol is to separately measure both feet. That makes sense as none of us have both feet that are identical. There is some difference in width and or length. The problem is that no shoe brands sell you customised shoes whether it be for size, stability or cushioning. At the end of the day, the insoles need to go in to those shoes. ”
“Comments on response: That’s barely a unique selling point then as even non-customised shoes can be cut to whatever size your feet are. To the point on leg length discrepancy, that can be a whole ultra-long article. As different pronation in the two legs, customised orthotics are meant to do exactly that, measure the two feet differently. Score 3/5”
Question 2: Your assessment is static for a dynamic activity. Thoughts?
NG: Dynamic assessment is done by physio there. They provide their observations in the prescription.
“How do I start responding to this without using an emoji. :) I love how everyone in this society is busy outsourcing their problems. Walking and running are dynamic but assessment is done while you stand. We are not trying to make orthotics for a piece of furniture like chair or table. It’s for a human being. If you are a company that does customised orthotics, you better give me an end to end solution, because if there is a problem, you’ll even outsource that fault. Score: 1/5”
Question 3: Whether stability shoes or insoles haven’t been shown to make a difference, at least not in the long run, so why then?
NG: Because there are several studies which show how feet affect biomechanics of body. Just to give one example - One of the most common problem – Flat Feet. People with Flat feet are 50% more likely to have osteoarthritishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403611/
Knee OA is a costly surgical intervention.
“The problem I find with companies that claim that they bank their work on science is that they are selective. Whatever suits them, they pick. Flat feet in majority of cases are a factor of weak muscles and poor posture, that can be changed by pro-actively working on it rather than expecting magical shoes or insoles to fix them for you for long term. I’ll be putting down lots of research articles to support everything I have said. Score: 1/5”
Question 4: You start off by standing up against shoe companies making expensive shoes but then your own insoles can be as or more expensive than those shoes themselves.
NG: We are medical service provider- where insoles are part of the treatment, what we charge includes this-
Assessment by physio
Measurement and Scan by our tech and generation of report.
Design and different corrections provided by sole which are described in (e).
These corrections are provided based on recommendation of Physio and Orthotist.
There are cases where insoles can’t solve the problem, and surgery is required. So we can’t provide them the insoles.
“If you are a medical service provider, you are open to scrutiny like this and more from the medical fraternity, specially folks like me from Sports-Exercise and Musculo-Skeletal Medicine background who move a little. Your claims are not backed sufficiently by current medical evidence. ”
“Why would you charge for the physio assessment if you are merely the insole provider? The problem I have is that in your Gadget360 interview you openly want to go after expensive shoes but then you yourself are not any cheaper. Score: 2/5”
Question 5: Feet are state of the art engineering. How are you helping them get smarter or are your solution is just doing more of the same as a stability shoes?
NG: Most of the people we have seen have multiple problems. Even in case of over or underpronation angle is different in both feet
These are some of the modifications we do:
Custom Arch support based on calculated foot parameters
Medial Heel wedging – different angular calculations are done and medial wedging is
provided by calculating pronation angle in each foot. It can be different.
Lateral Heel Wedging
Metatarsal pad or metatarsal bar depending on problem
Offloading for corn or ulcer
Customizable density of insole based on BMI and other parameters
Heel cup or extra heel cushion if required
Different thickness of insoles for each foot in case of cases where there’s difference
limb length
Toe filler in cases where there is discrepancy in foot length.
There can be one modification or combination or multiple modifications
“That’s all good but the problem comes when you take that holier-than-thou stand and comment on how doctors should have spoken up about high-heels, how shoe brands want to fleece the runners or whatever else, you are putting yourself in a very tricky situation. As far the as the masses go, if at all, these insoles can have a temporary role. It’s not a bad business model, but claims are too tall. Score: 2/5”
What I’ve done above is addressed the responses I had from that new start up making customised orthotics.
“My overall score for Shapecrunch based on the article in NDTV Gadget360 and responses to my queries: 2.5/5 (3.5/5 for the idea and efforts)”
Studies have shown that there is large amount of differences in how runners respond to orthotics whether it be for performance or injuries, from no response to helping to some extent. If at all, non-customised orthotics have been shown to have better motion control of the foot. Customised orthotics have shown to reduce loading rate & vertical impact force, which are attributed to running injuries.
“For that reason the only thing I want you to focus on while running is to start landing softly. For that you can get started with skipping gently for a minute or two at a time. Once you get the hang of that, soft landing while running will slowly but surely start creeping into you running too. ”
So far we have been trying to fit into shoes, or at best getting orthotics to stand on. We moved to be born, we need to keep moving and running. We just need to figure what works for us rather than being told by others what to do.
Below is an interview of mine with Rajiv Makhni on the show ‘Contrarian’. People want things to be black and white, when it all is shades of grey.
Below are links to a few of my running articles on running form and shoes.
Running: Losing My Religion: Running without a good technique or a good pair of shoes is like driving a car without a bumper
Focus on running form: Running is probably the best hobby you could have ever picked: It’s poor running form, not running, that is going to hurt you. And improving your form and focusing on exercise can greatly reduce those injuries
The science of selecting shoes: Most people assume that any shoe from the top brands will work for them. But you need to understand what would be a good match for you and your feet
Run better, reduce injuries, with strength training: Some exercises that can be done anywhere for strength training, will help runners of all levels to run better and avoid injuries
To run effortlessly, don’t resist: Remember some basics and run daily to stop resisting
The shoe that fits: Buying the right pair is a decision that needs to be dictated not just by your wallet, but also the kind of runner you are
Relearn Running: Shoes are simply a tool—they don’t do a thing unless you start moving in them. If you know how to run well, you’ll do amazing things, but if you don’t, you’ll get injured
Also, all the experts are trying to change your running form to get it to that ideal gait. Like your finger prints, you have a unique way of moving. Your best running form is the way you moved as a 2-3 year old when no one had yet told you how you need to be running. That is your goal. To move without a care for the world or time or distance.
“TO SUM UP, WHETHER INSOLES (CUSTOMISED OR GENERIC) OR STABILITY SHOES, BOTH ONLY PLAY A TEMPORARY ROLE. THEY MIGHT PLAY AN IMPORTANT ROLE WHEN YOU ARE JUST GETTING OFF. IN THE LONG RUN, WHETHER YOU HAVE AN INJURY, A MEDICAL CONDITION OR NOT, YOU NEED TO WORK ON YOUR BODY FOR A LONG TERM PERMANENT CHANGE. SO GET MOVING. ”
British Journal of Sports Medicine
BJSM is a multimedia portal for authoritative original research, systematic reviews, consensus statements and timely debate in sport and exercise medicine (SEM) as well as clinical education and implementation success stories.
AlI that I mention above and also in last 11 years of writing isn’t about my way, but what scientific evidence, esp. research published in BJSM, today suggests.
My intent is always to reach out to masses by simplifying the message as I personally have always struggled with complex explanations.
Thanks a million miles BJSM for bearing with my eccentric ways.
Keep miling and smiling.
REFERENCES
Glasgow P. Simplicity: the ultimate sophistication. Br J Sports Med 2014;48:345.
McKeon PO, Hertel J, Bramble D, et al. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med 2015;49:290.
Napier C, Willy RW. Logical fallacies in the running shoe debate: let the evidence guide prescription. Br J Sports Med 2018;52:1552–1553.
Napier C, Cochrane CK, Taunton JE,et al. Gait modifications to change lower extremity gait biomechanics in runners: a systematic review. Br J Sports Med 2015;49:1382–1388.
Clinghan R, Arnold GP, Drew TS, Cochrane LA, Abboud RJ. Do you get value for money when you buy an expensive pair of running shoes? Br. J. Sports Med. 2008;42;189-193
Nigg BM, Baltich J, Hoerzer S, et al. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Br J Sports Med 2015;49:1290–1294.
Davis IS, Bowser BJ, Mullineaux DR. Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation. Br J Sports Med 2016, 50 (14) 887-892.
Smoliga JM. What is running economy? A clinician’s guide to key concepts, applications and myths. Br J Sports Med 2017;51:831–832.
Malisoux L, Chambon N, Delattre N, et al. Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding. Br J Sports Med 2016;50:481–487.
Nielsen RO, Buist I, Parner ET, et al. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study. Br J Sports Med 2014;48:440–447.
Franklyn-Miller A, Roberts A, Hulse D, et al. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med 2014;48: 415–416.
Ryan M, Elashi M, Newsham-West R, et al. Examining injury risk and pain perception in runners using minimalist footwear. Br J Sports Med 2014;48: 1257–1262.
James AM, Williams CM, Haines TP. Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. Br J Sports Med 2016;50:1268–1275.
Bonacci J, Saunders PU, Hicks A, et al.Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study. Br J Sports Med 2013;47: 387–392.
Kong PW, Candelaria NG, Smith DR. Running in new and worn shoes: a comparison of three types of cushioning footwear. Br J Sports Med 2009 43: 745-749
Barton CJ, Bonanno DR, Carr J, et al.Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion. Br J Sports Med 2016;50:513–526.
Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence-based? Br. J. Sports Med. 2009;43;159-162
Altman AR, Davis IS. Prospective comparison of running injuries between shod and barefoot runners. Br J Sports Med 2016;50:476–480.
Bonacci J, Vicenzino B, Spratford W,et al. Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med 2014;48:425–428.
Theisen D, Malisoux L, Genin J, et al. Influence of midsole hardness of standard cushioned shoes on running-related injury risk. Br J Sports Med 2014;48:371–376.
Tam N, Astephen Wilson JL, Noakes TD, et al. Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med 2014;48:349–355.
The Foot Collective on Instagram :)
