Adapting to no orthotics after 15 years

Triathlon Forum
1

OK, very brief summary of 20 years is about to follow, but the headline is has anyone else been long term orthotics users who have moved out of them? Not wanting a debate about if orthotics are evil or not, but accepting I’ve had them for a long time can I go back and how long will it take to adapt.

****skip this unless you like detail (ok, this is slowtwitch, I should have saved my fingers)
I got my first orthotics around 2000 after repeatedly going over on my ankle and spraining the ATFL and CFL ligaments. Were presecribed for use in all shoes, this was when I was 25 and didn’t really do much running - cricket and MTBing. Worked fine for several years. Then got new orthotics, slightly lighter, in 2004 when I started running more, and doing triathlons. Was a ‘solid’ unit back then 90kg and 6ft4" Running pace was about 1:50 for Half marathons, heel striking.
2008 I tore my ligaments on my left in a 10km race - went over on a dropped water bottle. Reconstruction surgery and new orthotics after that to take account of new gait.
2015 - tore ligaments in right ankle in trail running race. Reconstruction 2015. Tore tendon just at end of rehab in late 2016, surgery to repair 2017. New orthotics to follow.
Ok, then wierd shit happened. Over the years my weight had crept up to about 100kg, and whilst still reasonably in shape was still at that 1:50-2hr half marathon time. After my last surgery my running suddenly lept forward. I’m now 44, have dropped to 85kg, and did a 1h36 half a month after my last IM. Regular Sunday long runs of up to 33km at 4:45/km pace, easyish 44min 10k, 21:15 5km etc.

So to 1 month ago I pulled my left hamstring. Had been suffering from plantar fasciitis for last 6 months in right foot. No sudden increases in run volume (I’m well coached). A month on and the ham is healing well, but my right heel is almost unbearable pain the night of a run and the morning after.

So go to a new podiatrist (old one moved) and she checks it out and thinks it’s post tibial tendon dysfunction. Tells me that this is being made worse by my orthotics and the Saucony Omnis I’ve been running in. So has taped my feet and told me not to use the orthotics in any shoes. Get a pair of Hokas (bondis) to train in and we’ll go from there. The hamstring is actually a symptom of overstriding with the left to compensate for the right foot.

Now 24 hours later and just walking, then things are better. The PTTD is consistent with several other observations related to my run style (splayed feet), pilates positions and also the over developed outside shin muscles.

So on one side I’ll be elated if I can get to running without orthotics as the weight is not insignificant. And now I’m running quicker, and midfoot then this seems logical. My worry is that the reason I started with the orthotics is that all that ligament damage has knackered teh nerves and I tend to go over on the outside of my foot. Not when running particularly, but just walking down the street as I have no awareness of what angle my feet are at.

So back to the question, anyone else tried this. Did you end up going back to orthotics? If not how long before you were running again at the same level and without pain/injury risk. Thanks in advance to anyone that has experience and takes the time to share.

2

I don’t think I really have anything useful to advise. I’ve been running in prescription orthotics since 2003. I started in rigid orthotics from a podiatrist, and changed to flexible ones several years later from a Foot&Ankle Orthopedist. My issues have been many, and not entirely well understood by the medical community. Also, I’m considerably smaller. So, I don’t really think that anything I might say, has much relevance for you. Nevertheless…

I haven’t tried to run without orthotics. For a long time, I couldn’t stand or walk without them—the pain was debilitating. I can now easily walk barefoot through the house or outside, for indeterminant lengths of time. Its become something that I no longer really think about, though habits die hard. And, I will usually put on something if I’m standing for more than 15 minutes or so.

My own expectation for myself is that it would likely not be successful, and I’d probably end up more injured. I have no intention of ever trying it. But, I’d be thinking in timescales of many months, if I ever contemplated it for me.

3

Thanks Tom.

More similar than you’d think, with that same bare foot around the house, but insoles in and shoes on for any degree of standing. I even struggled a bit with the T1 run at IMNZ which is pretty long.

However, the odd thing is that I’m actually finding walking around much lass ‘odd’ than I expected after just one day. I think being injured actually is helping that adaption. Having said that, it’s one thing walking 5 mins at a time - most I’ve done so far, and doing a 42km run. What I’m hoping for though is that the running is actually a lot more neutral than teh walking as my orthotics stopped just behind the ball of my foot, and so a lot of my running mechanics may not have changed a huge amount, or at least a lot less than if I’d still been a heel striker.

I certainly wouldn’t have deliberately made a move out of the orthotics if I’d not had my had forced.

4

I got custom molded orthotics way back in high school (~1989) due to severe shin splints. Which the orthotics magically fixed.

I ran on them extensively for maybe 20 years. College track/XC. Marathons. Ultras. Triathlon. During the minimalist fad years I ran several years without them with no issue. No recurrence of shin splints, no new issues.

I’m using them again, though starting around the time of the Hoka mountainous padding fad. Just because I “feel” a little more solid with them. Though shoe-wise I’m back to mainstream non-fad shoes.

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I wore rigid custom orthotics for 20 years - training staff in college set me up with a podiatrist due to multiple injuries. I wore them for all runs for those 20 years then finally gave them up and went to rotating shoes and have been relatively injury free since (about 4 years ago).

I’m not sure they did much as I look back and realize I have overtrained my entire life before coming to triathlon - now I overtrain in three sports combined and reduce my injury risk in running alone!

Anyway, I would say it took me 3-4 weeks to fully adjust to not wearing the orthotics. My unscientific theory is that by rotating different running shoes (all different models) that I am working more stabilization muscles and not over working the same ones and decreasing my risk for injury - that and being smarter/wiser in my training.

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My unscientific theory is that by rotating different running shoes (all different models) that I am working more stabilization muscles and not over working the same ones and decreasing my risk for injury …

That’s also my approach, but I wouldn’t call it unscientific.

Regarding the OP, my sports medicine doctor told me, when I sheepishly showed him my $400 custom orthotics, that there is good evidence that orthotics are effective, “but there’s no evidence that custom orthotics are more effective than the kind you buy off the shelf.”

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Regarding the OP, my sports medicine doctor told me, when I sheepishly showed him my $400 custom orthotics, that there is good evidence that orthotics are effective, “but there’s no evidence that custom orthotics are more effective than the kind you buy off the shelf.”

I but I have 2 pairs of custom orthotics so they must be twice as good… Even have a carbon weave. Sadly not painted red…

Just struggling to get some hokas that fit at the moment. They are a bit narrow, especially the cliftons. And the Bondis are out of stock to next week. However did have a little run in the store in them to see how it felt. As I said to the fitter when he asked if they felt good. - “No, f’king wierd as hell. However as I’ve come out of orthotics in support shoes and have jsut tried to run in neutral Hokas you’d think I was crazy if I said it was natural” A point he accepted. Having said that, a mini-run in the Saucony Omnis with no orthotics didn’t feel too different to normal, probably back to that midfoot land where there is no orthotic, just the flat sole.

But good response so far. No “I tried it and broke my ankle 3rd run” posts as I feated. True, I may be selecting a biased sample here, as those people are all now on gaming or contract bridge society forums after leaving sports behind, but there we go.

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i have been in orthotics for several decades. i’m very particular about the kind of orthotics, the prescription, the weight, etc. i can’t see myself ever not running in orthotics, tho if a semi-custom came along that did what my customs do i’d be fine.

having established that, i don’t know why you were ever in orthotics. you’re in them because you kept turning your ankle? that doesn’t seem right.

i used to turn my ankle a lot when i was younger. very frustrating. out for days or weeks. at some point along the way i unconsciously began to immediately unweight the leg where my ankle was about to tip over. i haven’t had a turned ankle in a couple of decades i don’t think.

orthotics were never a cause or a solution to that for me. i’m an overpronater pure and simple. if you’re like that, then an orthotic makes perfect sense. otherwise, if there’s no good reason for an orthotic i don’t see why one would want to have it.

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I started wearing orthotics round about 2000 after getting really bad foot pain when I increased my running volume training for a marathon. Like you, I used to go over on my ankles quite a bit as well, off road running was always a bit scary for me and I have had numerous sprained ankles.
I got standard orthotics at first, and then moved on to custom orthotics (nice shiny carbon fibre ones as well) and used them 100% of the time when running and about 90% of the time in normal shoes. I used to be paranoid about not wearing them, and wore them round the house in my slippers as anything but the plushest carpet used to hurt like hell when barefoot, like walking on hot coals. I had very high arches so could only fit the widest shoes, plus this meant lots of knee pain due to an inflexible foot arch with extra pressure being put on the ball and heels of my feet.

Fast forward to 2017 and I fractured two metartasals in the run up to an IM. The specialist at the hospital took one look at my feet with my high arches and diagnosed pes cavus and suggested that I have foot reconstruction. 12 months later I had both feet “re-shaped”, basically re-setting and aligning the heel bones, and cutting the plantar fascia.

To get back to your original point - since the surgery I threw my orthotics away and since starting running in March of this year I do not have the foot pain that I once had. I’m not running long distances yet (1 hour max) , but a side benefit appears to be that I no longer have any knee issues.
I have definitely changed my running style to adapt to my new feet, but so far so good. Lots of prehab and foam roller, golf ball under the foot etc is helping too.
I never thought I’d be able to walk barefoot round the house on wooden floors again but seem to manage OK so far.

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I dropped orthotics after about 15 years of wearing them.

Went to a good neutral shoe without too much padding, dropped mileage and speed to ‘beginner’ levels and spent a lot of time working on my mechanics. It took about six months of shorter runs at lower intensity to get my mechanics to where I was comfortable. Be very, very patient.

It’s been almost eight years since then and none of the issues the orthotics were purported to correct have come back. Caveat that I’m about 70ish kg, but guessing by your username that we’re the same age.YMMV.

Going from a supported shoe with orthotics to a Hoka sounds like a lot of variables at play, but hoping this works out for you.

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This is a cool topic and one that I used to deal with a lot as the owner of a shoe store with a medical clinic/orthotic lab next door. Here’s my thoughts after reading your post.

Sounds like you were initially over posted with your Saucony Omni’s and the orthotic. The shoe and orthotic need to work well together. The omni would have had a firmer medial post in it and that would cause the orthotic to rock to the lateral side of the shoe. So it just wasn’t a great match up.

If you want to go without orthotics have at it. Go slow with your mileage and ease into it.

As far as shoes go, really drill down on knowing the heel to toe drop of shoes, understand the last of a shoe, and how the shoe offers support. Heel to toe drop could really impact your new found orthotic-less running. Going from the Omni, which is an 8mm drop shoe with an orthotic (most of these add a few mm’s of pitch) to a 4-5mm drop shoe like a Bondi could be a big change. The last of the shoe can play a factor. A curved last shoe might not be for you, something that is a straighter last that has some midsole under your foot might feel like you still have some substance in your arch even without the orthotic. Lastly, there’s a trend to having support come from guiderails, strapping, and “walls” around the foot rather than the older “posting” that came as a stability feature in shoes for many years. It’s just a new way of thinking and you may find shoes with these help too. Go somewhere where you can run in shoes and get some experienced eyeballs on you to help. There are sooooo many good options out there!

You won’t know until you try! Oh, and one more thing. My shoe closet is full of metatarsal pads, heel wedges, heel lifts, and all kinds of weird shoe cobbler kind of stuff. You might want to play around a bit with some of this stuff to find the recipe that works for you!

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So, I have had orthotics but mostly Superfeet, Powersteps, or Aetrex insoles since 1996. I have had ankle issues and really needed them. BUT, I wanted to try a pair of Nike Next % - to my suprise, they seem fine with just their non-removable insole. So, then I tried my Hoka Carbon X with just their standard insole, and to my surprise they seem fine too. Perhaps it is the carbon plate. Or, maybe it is just time for me to migrate away from the supportive devices. I would love to hear any insight on whether the carbon plate may be what is helping.

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orthotics were never a cause or a solution to that for me. i’m an overpronater pure and simple. if you’re like that, then an orthotic makes perfect sense. otherwise, if there’s no good reason for an orthotic i don’t see why one would want to have it.

I was/am an overpronator, but mixed with other stuff too. Key was that all the ‘going over’ on the ankle has damaged the nerves and so I don’t have the feedback to the brain as to what my feet are doing - I have no proprioception at all. And so what happes is as my foot comes down then combined with the loose outside ligaments (from sequential minor tears) then I’d land on the outside edge of my foot. In a shoe then that meant most of the time it would then let the foot roll flat as the sole became parallel with the ground. But sometimes it would land at that 45 degree angle and then go the other way with the sole perpendicular to the ground. That hurt. So the idea was with orthotics that added height to the inside, then the shoe sole would land parallel to the ground all the time, and I wouldn’t roll over, even if inside the shoe my foot was landing on the outside edge.

Moving on a few years and post surgery / reconstruction then the orthotics are there to provide support to the high arches and to help the (much lesser, but still present) over pronation. So different prescription, but also to try to address that mechanically despite three different ankle reconstructions (1xleft 2xright) then they aren’t exactly the same. In shoes then with the orthotics ideally I needed Saucony echelons for the right and Omnis for the left…

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Dah,

Wow, that’s more like the duration I feared / expected for the transition. However, good to hear that you are going well on your rehab journey, so fingers crossed for you.

Duncan

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I’m 44y/o now. Hmm, that 6 months puts me bang on IMNZ. Having said that I’ve been through a big journey with the rehab after surgery, so have learnt patience, even if that’s not come naturally to me.

Thanks for sharing.

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i have been in orthotics for several decades. ** i’m very particular about the kind of orthotics, the prescription, the weight, etc. i can’t see myself ever not running in orthotics, tho if a semi-custom came along that did what my customs do i’d be fine.**

I’m in that same boat. I have unusually high arches, and have always been an over-pronator. I’ve tried every non-prescription orthotic insert, I could find. I’ve even experimented with combining differerent inserts that had complimentary features. I’ve just never found anything that works quite as well*** as my prescription full-custom ones.

***By “well” I mean was comfortable for standing, walking, and/or running for hours at a time.

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Thanks

Rehab going well so far - I’m being very cautious and if I feel any strain in my achilles (which is my weak point as it has effectively been repositioned) then I back off the running and stick to a walk/jog routine. Cycling and swimming are fine however.

Good luck with whatever you go for!