Where their running shoes are concerned, runners may need to think beyond the blinding myriad of colored stripes and swooshes. It's no longer just a question of shock absorbent gel or strategically placed air pockets.
When you're considering premium footwear to prevent injuries, sports medicine physicians say that orthotic insoles, or "orthotics" -- custom-made to support your particular feet -- may be the way to go, especially if your problems are connected to the type of foot with which you were born.
"There are foot structure issues that seem to have a relationship with lower extremity injuries," said Commander Richard Shaffer, Ph.D., of the Naval Health Research Center in San Diego, Calif. Shaffer and his colleagues have studied how foot structure is related to overuse injuries in Navy SEAL recruits during training. Their results were published recently in the American Journal for Sports Medicine.
Shaffer's team found that recruits with flat feet or high arches were more likely to suffer a stress fracture -- one of the most common injuries among runners -- than those whose arches have an average curve. His study could have bearing on the estimated 10 million runners in the United States, up to half of whom will experience some kind of foot injury.
But while orthotics may be the solution to the woes of some runners, the specialized insoles aren't a necessity for everyone.
Identify the Cause
Physicians first need to go beyond foot structure and hone in on the source of the problem, says sports podiatrist William Olson, D.P.M. Olson is President of the American Academy of Podiatric Sports Medicine and Podiatrist for the University of California, Berkeley athletic teams.
Identifying training errors -- which can compound the effects of an athlete's body structure -- is the first step in evaluating fitness injuries, Olson says. The most common training mistakes are cranking up the intensity, duration, or frequency of training too quickly; not properly rehabilitating old injuries; and failing to warm up and stretch adequately before working out.
The next thing to look at is the athlete's particular body structure and motion -- or "biomechanics" -- and how they may have contributed to the injury. Podiatrists use a simple examination technique: They watch their patients walk, both barefoot and in the shoes they use while training.
Even if the patient's foot has some biomechanical abnormalities, it could be the ground surface or the patient's shoes that are actually causing the problem.
"One fellow ran a marathon on a crowned highway, so one foot was turning in for 26 miles," Olson says. "To make orthotics for that person would be a mistake. I told him why he was injured and to avoid circumstances like that."
Worn-out shoes can cause similar trouble. Most people don't wear down their shoes perfectly evenly. As times goes on, the uneven wear causes the whole foot to tilt, and could lead to an injury.
Once podiatrists rule out other causes, they can then focus on correcting the athlete's biomechanical makeup. To do that, they often suggest specific shoes that can help control some of the causes of the abnormal biomechanical function.
A committee of the American Academy of Podiatric Sports Medicine evaluates shoes and maintains an online list of the best ones for different sports at www.aapsm.org.
Over-the-counter arch supports can also help. But when the standard sizes don't work, Olson prescribes custom orthotics to correct the athlete's specific biomechanical deficits.
To design an orthotic insole, the podiatrist takes an impression of a person's feet and makes models of them, which the podiatrist then alters to counteract any problems the person is having.
Orthotics can be made from a hard material such as graphite or a softer, rubber-like material. The choice of materials is an economic decision, not a medical decision, Olson says. Harder orthotics last longer, but are more expensive. The total cost can range from $300 to $500.
Spending the money could make a big difference in the game, says orthopedic surgeon James Garrick, M.D., Orthopedic Consultant for the San Francisco Giants and Director of the Center for Sports Medicine at Saint Francis Memorial Hospital in San Francisco.
"There's no question in my mind that in some cases, custom-made orthotics can make a big difference and even cure some problems," Garrick says.
But only if you really need it, says sports podiatrist Perry Julien, D.P.M. -- the Atlanta sports podiatrist who coordinated the podiatry services for the 1996 Summer Olympics. "It's the single most promising treatment I can offer patients," Julien says. But he adds, "I don't need to offer it to every patient."