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An orthotic is a specially made shoe insert designed to increase the mechanical efficiency of the foot. It allows your foot to adapt to a hard, flat surface. An orthotic compensates for any structural or postural instability in the foot, thereby relieving abnormal stresses on the foot, particularly in distance running. How does an orthotic differ from an arch support you can buy at the drugstore? The arch support does just that-it helps the arch support your full weight. In many instance, this may be all the runner needs. The orthotic, on the other hand, maintains the foot in the normal position through the entire footstrike, from heel contact through mid-stance to toe-off. Why is this overall control of footstrike necessary? Because errors in footstrike cause most overuse injuries, contributing to injuries in the foot, leg, knee, and lower back. Depending on the individual foot, the origin of injury may arise in the rearfoot, midfoot, or a combination. Does every runner need an orthodic? No, not if the runner is running pain-free. Anything you put in your shoe to make you better can make things worse if it's unnecessary. Orthotics are tricky, and so are feet. If things are going well, don't rock the boat. By the way: You're more likely to need an orthotic if you have a history of repeated overuse injuries. This almost always indicates a problem foot that needs help. Delayed pain is also a sign of a basic biomechanical difficulty. Dr. Richard Schuster has pointed out that distance runners who are helped by orthotics frequently experience pain only after covering a certain number of miles in their daily run or at a specific level of weekly mileage. Well, then, does every injured runner need an orthotic? I think there are a number of things an injured runner can do before trying orthotics. A podiatrist who immediately prescribes an orthotic is much like the physician who always treats the same problem with the anti-inflammatory drug. He hasn't taken the time to evaluate the runner and the injury. Over the years, I referred a number of injured runners to one excellent sports podiatrist, and only about 10 percent ended up wearing orthotics. Another fine sports podiatrist has told me that he prescribes orthotics for only one out of six injured runners. In general, I would say that about 60 percent of injuries are due to training errors and can be helped by relatively simple changes in shoes, surface, weekly mileage, running form, and exercise. How do you know if you need an orthotic if you're injured? First, review your training habits. Have you done something different lately? Have you changed shoes, for instance, or increased mileage, or started running on a hard surface, or added a lot of hill-and speedwork? Be flexible enough to make adjustments in these factors: Reduce your mileage. Wear a shoe you know agrees with you. Exercise regularly. Stretch, then stretch, and then stretch some more. Finally, add an over-the-counter arch support. Then, if all this fails, see an experienced sports podiatrist and let him decide whether you need an orthotic. Some runners have told me they spent hundreds of dollars for orthotics and are still in trouble. Why is that? Orthotics do fail. Sometimes it's the podiatrist's fault, sometimes it's the runner's. There may be a limit to the mileage a highly arched foot can handle running on a hard concrete surface, orthotic or no. In general, the reasons an orthotic fails are as follows: *The "neutral position" of the foot is difficult to find and mold, leading to either under or over-correction of the problem. When over-corrected, the initial complaint is frequently cured, but the runner develops a new pain, usually on the outside of the foot, leg, or knee. *No correction is made for abnormalities in the leg, thigh, or hip. The foot is the only place the lower extremity can adapt to these biomechanical errors. Therefore, the orthotic must be designed in such a way to compensate for any misalignments higher up. For this reason, an orthotic may help where the foot is actually normal, but the rest of the leg is not. *The runner's leg muscles are too tight tot handle the orthotic. The leg is a foot-to-hip continuum. Short thigh muscles, inflexible calf muscles, and tight hamstring muscles put additional stress on the foot and arch. Unless these muscles are stretched to full range of normal motion, the orthotic can't do the job. *The runner is wearing the wrong shoes. In a surprising number of cases, orthotics don't work until the runner changes to a particular type of shoe. The best shoe may be a standard running shoe with some modification - the side flanges removed, or a new crepe sole added. But tennis shoes, basketball sneakers, or Army boots might also work. Only an experienced sports podiatrist would know for sure. *The orthotic may need further correction, so that you and the orthotic work as a unit. *You may need a heel lift to compensate for a leg that's shorter than the other. As for me, I can't do without orthotics. Of course, all the orthotics in the world won't protect you from injuries if you don't stretch.