The Orthotics Question

My favorite column in the New York Times posted a new article yesterday. The Personal Best column is updated inconsistently at best, rarely at worst, but never fails to interest me and pique my curiosity. This post is no different. You can read it here.

I myself have worn orthotics for most of my life. It started when I came back from England at the age of 6 with horrible heel pain. My doctor took one look at me and said "You've got flat feet!"

So started the regimen. For the next six years or so I had to get special shoes, regularly making the trip down to the "Stride Rite" store where a very helpful and friendly old man would patiently fit us in the "correct" shoes to support our admittedly awful feet. Years later, the same man would help me pick out my first suit, a task for which he was eminently, if you'll pardon the pun, suited. Then, when we were old enough that we would not go through shoe sizes quite so quickly, we were fitted with custom orthotics, made possible by my mother's discretionary health fund.

I started with soft orthotics, as it was deemed that hard orthotics would injure my feet and inhibit development. When the time was right, I went to see our family orthopaedist (if that's the right term) Sharie. She took one look at my leg alignment and said "that's the worst case I've ever seen."

Sharie was never much for bedside manner.

Soon enough, my plaster casts were made, and my orthotics duly ordered.

I might point out that this was also the first year I started distance running. It arose, unlikely though it may seem, out of a knee problem. My orthopedic surgeon looked at me and decided I had a condition called tendonopathy, in which the achilles tendon is gradually replaced by scar tissue. Along with a regimen of strengthening exercises, he suggested I run. As my girlfriend at the time was an avid and quite talented distance runner, I took to this quite quickly. That is still the only instance I have heard of in which a doctor suggested running to help fix a knee problem.

In due course, my orthotics arrived, and I joined the distance group on the track team. From the position of captain of the sprinting team the year before, I now took a demotion to a low rung on the distance totem pole. I mentioned my orthotics to my coach, and in the first statement I had heard disparaging orthotics he said "I don't believe in them. We'll get to the why of that later." This would not last long, as my orthotics initially resulted in significant arch pain, and then hip problems took me out for the rest of my senior season.

Nonetheless, I continued to run, with my orthotics, and for many years this worked. I ran and walked in those same orthotics for almost eight years. I set every single PR wearing those orthotics, from the 800 (1:58) up to the 10k(36 flat). Inevitably, they reached the point where there was more duct tape than insole remaining, and I decided to have new ones made at the University of Colorado.

As I might have expected given prior experience, the arrival of my new orthotics was accompanied by a host of new leg problems. I figured these were temporary and just tried to trudge through them. I tried for a year, and never got back into the kind of shape I had been in prior to the new inserts.

Then the FiveFingers started becoming popular, and after many nudges, with great trepidation, I bought a pair and started training myself to run, for all intents and purposes, barefoot. To my great surprise, my alignment-related joint pain disappeared immediately! It was replaced by a far more familiar and friendly pain: muscle-building pain.

Now, after six months of the FiveFingers, I have returned to using shoes for most of my training. I switched back not for the support shoes provide, as I am now a big proponent of strengthening feet and ankles rather than further weakening them with overly-supportive shoes, but for the cushioning. Running barefoot is all well and good on softer surfaces: tracks, trails, and grass fields are all excellent places for that. But for bike paths and roads, the cushioning shoes provide is well worth it.

So thank you, NYT, for confirming, or at least supporting, my suspicion that orthotics are not science after all, but still, so many years on, speculation. I, for one, will keep working on my foot and ankle strength, and keep running minimally all the time, and barefoot whenever possible.