Insoles that walk the walk

GET a group of athletes, especially runners, together and conversation will eventually turn to orthotics -- what kind, for what injury, how are they working, are they prescription?

The molded devices, usually made of plastic such as polyurethane, slip into the bottom of shoes to help support and align the feet and alleviate pressure or pain. Thousands of pro and elite athletes (runners, skiers, skaters and basketball players) and weekend warriors now swear by them.

“Orthotics are huge,” says Los Angeles podiatrist Noreen Oswell, who estimates that 90% of her patients who have orthotics have been helped by them.

Many people simply plunk down $20 for over-the-counter insoles with simple features such as arch supports. Others pay $500 or more for specially fitted custom jobs.

But more expense doesn’t always translate into safer movement.

The little pieces of plastic have a fairly straightforward job. They can be used to prevent excessive pronation, in which the foot rolls too far inward, putting the ankle and leg out of alignment and increasing the risk of problems such as Achilles tendinitis, shin splints and plantar fasciitis (the over-stretching of tissue at the bottom of the foot). They can also correct supination, in which the foot rolls to the outside, and treat collapsed arches and Morton’s neuroma, in which excessive pressure inflames a nerve in the ball of the foot.

Some orthopedists and podiatrists who routinely fit patients for custom devices say that athletes can sometimes safely start with over-the-counter inserts.

A study published three years ago in Medicine & Science in Sports & Exercise compared custom and semi-custom orthotics among 11 runners with high, medium and low arches to see which type fared better in rear foot motion and comfort.

Both fared the same.

Though the less-expensive devices (which offer different types of support or changeable parts) are mass-marketed and don’t take into account every foot deformity, “they’re not bad,” says Dr. Timothy Charlton, associate professor of orthopedic surgery at the Keck School of Medicine of USC. “They’re certainly an inexpensive start to see if an orthotic would be helpful.”

Even asking advice at an athletic-shoe store that offers assessments of running and walking gaits “is a good start,” he adds.

And as orthotic choices grow, these stores and others are offering a middle option for people who want more than the basics but are reluctant to pay hundreds of dollars.

This spring, New Balance will roll out its X-Sole line of semi-customizable polyurethane insoles for supinators, mild over-pronators, severe over-pronators and those with neutral gaits who might suffer from other foot-related problems.

Some footwear stores now feature kiosks that analyze customers’ feet and gait. A computerized foot plate assesses pressure points and features such as flat feet, then suggests one of four types of athletic inserts, selling for about $60 per pair.

The company behind the kiosks, Aetrex Worldwide, used to make custom orthotics until switching over to the more moderately priced category several years ago. “About 80% of the casts we’d get in were for very common foot problems,” says chief executive Larry Schwartz. “Clearly there’s a place for custom, but in some cases over-the-counter ones can help.”

Prescription orthotics, on the other hand, usually require a biomechanical evaluation to assess how a patient walks. Oswell, chief of podiatric surgery at Cedars-Sinai Medical Center, says she analyzes such things as gait, joint motion and foot flexibility. A plaster cast is made of the foot, which is sent to a lab that makes the orthotic. Computers are sometimes used to further assess gait and pressure points.

This medically supervised process is usually paid for by insurance, but some plans don’t cover the cost, leaving patients to pick up the entire tab.

Athletes may need this custom approach -- or at least a doctor’s opinion -- if their pain is severe, doesn’t abate or gets worse, Charlton says. The cause of such pain can sometimes be serious, such as a fracture.

Many elite athletes, like Joanna Hayes, the 2004 Olympic gold medalist in the 100-meter hurdles, now rely on orthotics during intense training periods and competitions. The 29-year-old Angeleno first started using them about three years ago when she began suffering sharp foot pain -- “like my foot was going to break.” A podiatrist diagnosed a probable stress fracture and designed an orthotic that allowed her to run without pain.

“I got better pretty quickly. It took the pressure off the top of my foot,” she explains. After that, “I competed fine. I know they definitely helped relieve the pain in my feet, but also my knees and shins.”

Greg Kimmell lived his entire life with flat feet and never had a problem, through basketball games, soccer and running. About three years ago he developed sharp pain in his arches that he endured for two months before seeing a podiatrist, who fitted him for custom orthotics that alleviated the pain. Changes can occur in feet over time -- arches can flatten out even more, for example. That, plus continuous exercise and worn shoes can lead to problems.

“They’ve made a huge difference,” says Kimmell, a 30-year-old Los Angeles sales account executive who’s training for the San Diego Rock ‘n’ Roll Marathon in June. “I couldn’t [train] without them on these long runs. Without them I’d be lost.”

Checking shoes for specific types of wear is one way to see if an orthotic may be needed.

Wear in the middle of the outside edge of the heel is an indication of pronation, says Dr. Dan Altchuler, a Santa Monica-based podiatrist and spokesman for the California Podiatric Medical Assn. Wear should be slightly to the left of the middle on the left shoe and slightly to the right on the right shoe. There should also be some wear on the forefoot, just below the second toe.

Foot specialists know that any kind of pain can put an end to an exercise program, kicking off a downward spiral of inactivity and weight gain. “The most important thing we can do,” says Altchuler, “is keep people walking.”