From February through May we are featuring articles by BMA's own orthotist and prosthetist Chelsea Luttrall.   

Future Newsletter Articles:
Problem 1: Over-pronation (February)
Problem 2:  Plantar Fasciitis (March)
Problem 3: High Pressure Points Resultant of High Arches (April)
Problem 4: Chronic Forefoot Striker vs. Heel Striker (May)

As an orthotist, I see a lot of folks with foot problems.  Some can be helped with foot orthoses (FOs), and some can’t.  However, I also see tons of people spending $300-$400 on custom foot orthoses that may or may not help their condition.  And, no, most insurances do not help with costs of foot orthoses. 

With cars, shoes, clothes--almost everything, you get to test drive before you shell out the cash.  But with custom FOs, you have to pay and trust that you’re in the 50% of people who can be helped by custom FOs. 

Endurance athletes are interesting.  If, we put in as much daily mileage as the average American, we’d likely have very healthy feet.  But because of the repetition and duration of endurance sports, subtle problems can surface, magnify, and wreak havoc on our training and racing. .

I’m of a different camp than most.  I believe, first, that many of these conditions prescribed custom FOs can be helped by non-custom, over-the-counter FOs if used correctly.  And second, that many patients (excluding diabetics and folks with true foot deformity), should first pursue cheaper, non-custom options to see if they see marked improvement in their condition.  Then, once you know your feet can be helped by FOs, you can either stay with the over-the-counter option, or invest in the custom, slightly more durable FOs. 

SOLE FOs are some of the best over-the-counter options on the market today.  They are heat-moldable to accommodate the needs of the wearer.  They are affordable relative to custom FOs --usually around $45.  And, they are still flexible enough to allow healthy amounts of pronation, which is necessary for runners and endurance athletes to avoid stress fractures and unnecessary joint trauma.  What’s more, SOLE stands behind their product, and has a money-back guarantee if you don’t see results within 90 days. 

Problem 2:  Plantar Fasciitis
Plantar fasciitis often occurs in runners and endurance athletes. I see it more often in people with medium to high arches. The plantar fascia is a broad tape of connective tissue that runs along the bottom of your foot and connects to the heel of your foot and to the base of your toes. If this tissue is excessively tight, or you over-pronate and the plantar fascia is one of the last things putting up a fight to prevent foot collapse, this fascia can develop excessive tension. The excess tension can result in inflammation of the tissue itself, or it can pull at the connection point of the heel, triggering the bone to grow (Wolf’s Law), causing painful heel spurs to develop.

Possible Cheap Solution to Plantar Fasciitis:
(1) If your plantar fasciitis is caused by an excessively tight plantar fascia, you need to stretch it. You should stretch it during the day using active stretching techniques, and you should also try to passively stretch it using sleeping devices such as the Strassburg Sock. If you live in the Front Range, Colorado Running Company carries these and SOLE FOs at their store.

(2) If the fascia is inflamed, you should also try to take some of the tension off of it during walking and running by using a SOLE FO to supplement the fascia and give it some rest while it heals. If it was an acute flare-up, you may only need the FOs for a little while, and then never need it again.

(3) But if the fasciitis is resultant of chronic over-pronation, a SOLE FO molded to your natural arch height (heat molded while sitting, not standing) will resist the over-pronation, thus requiring less work from the plantar fascia, keeping it from being chronically over-worked.

(4) If the heel spurs are not severe, sometimes having a heel cup in an over-the-counter FO is enough to redistribute pressures more evenly and keep those spurs from hurting. Other times, an over-the-counter gel heel pad can help relieve these pressures.

Beware of Something Under the Surface
Now, these are problems I often see in athletes, but if you’re having foot pain, I definitely do recommend seeing a doctor first to get a diagnosis using an XRay or MRI to ensure that nothing else more complicated is going on under the surface.  But if your problem fits into one of these categories, and you’re not into the idea of possibly being out of $400 if it doesn’t work for you, give these ideas a try and see if they work for you.  Good luck!  And I hope you get to enjoy a foot-pain-free race season!