Inserts, Orthotics and barefoot running

By Dr. Michael Cerami

I get questions almost every day about this month’s topic.  Some people are totally confused and some are rigidly certain about what runners should use. I can only relay my personal and professional experience with the hope it may help you choose what’s best for you.

In my 26 years of practice I’ve seen a lot of different kinds of feet and in my opinion, no one product is going to work for everyone. Like a personal diet, not one diet will work everyone or there would only be one diet book not thousands of new ones every year.

First, let’s talk about shoes. The most inexpensive part of a running shoe is the insole. This part of the shoe is usually removable and it’s where the bottom of your foot contacts when you put the shoe on. This is also the part that’s most overlooked by runners as it’s isn’t designed for your foot. Look at it this way; Nike can research and engineer the outside bottom of the shoe for runners of all weights and styles. Year after year they improve their shoes and provide many options across their whole line of shoes (trails, racing, and simple or complex). What they can’t do very effectively is make an insole that matches up to your specific need. The arch of everyone foot varies widely so they and other manufacturers put an insole in the shoe that feels comfortable but provides little or no support.

For this reason, I believe that most runners will benefit from an “over the counter” insert. The insert will provide minimal but flexible support for the interface between the bottom of your foot and the top inside of the shoe. Inserts are usually made with about 4 degrees of correction so they will not over or under correct most runners.

Let’s dig a little deeper into shoes. In my opinion the new trend toward a minimalist shoe is a good progression. The over engineering of shoes that was occurring up until recently was creating shoes that got too heavy because they tried to do too many things. A good shoe should provide effective contact with the ground and allow us to move though our running with ease and some support. It should also give us proprioceptive feedback so our joints, ligaments, tendons, muscles and nervous system can be active in the run and accommodate as necessary. Overbuilt shoes removed us from the “feel” of running like some automobile manufactures try to make us so comfortable with driving we can’t feel the road anymore.

It’s important to remember though that we don’t go too far in the other direction and think we don’t need shoes at all. Since we didn’t grow up running barefoot on trails and most of the surfaces we run and walk on are concrete, blacktop and wood, we do need cushioning and support to avoid damaging our feet and legs. Walking and running increases the pressure on the foot 5-10 times above non-weight bearing activity. Overall, I like a balance of “feel” for the runner with proper support and I recommend my patients/runners spend no more than 15-20% of their total weekly mileage in a “barefoot” type shoe (your experience may vary).

Personally I made the switch out of 25 years of Asics a few months back. I now use a minimal, soft and flexible custom orthotic with a K-Swiss shoe and love the new feel. I recommend a low ramp angle simple shoe with some support to my clients and along with a few re-alignment office visits we’ve had phenomenal success.

I’d like to hear your experiences and opinions and will respond when possible.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online at www.utahsportsandwellness.com



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