This is a topic that I’ve been dreading, but I feel that it’s still very important to discuss, because opinions on this one are all over the place. As usual, before I post anything myself, I like to look around the internet at other articles about the subject and forums where people have given their own testimonials. In doing so, this post became much more difficult than I expected. There are hundreds of users out there who swear by orthotics in their running shoes, or else just plain hate them and talk about their terrible experiences. Then there are those in between who tolerate their orthotics but eventually remove them from their running shoes completely.
Additionally, there are arguments about the types of orthotics and which shoes are best made for them, since clearly the orthotics still need to sit within the structure of a shoe. The hard part for me is that I can’t always know what these online individuals are wearing their orthotics for, or what kinds of orthotics they are. I also don’t know what types of runners they are either, and what their goals are from running. These all play a huge factor in what I recommend in my own practice, but I still wanted to come up with something that might be helpful for people on the fence. After all, if you love your orthotics or hate them, then I probably can’t sway you one way or the other, and I don’t really care to try since both sides can be quite right.
In case you didn’t know already, an orthotic is an insert that is placed in the shoe bed to provide support or change pressure distribution in order to enhance the function of the shoe, whether that be to protect, support, or alter the gait. They can be made of various materials and come in multiple thicknesses and lengths depending on the patient's needs. They can also be pre-fabricated, also called over the counter (OTC), or custom. The OTC orthotic comes in different arch heights, heel heights, depth and flexibilities, but they are not molded to someone’s specific foot and are instead one size fits many. These can certainly be modified by a podiatrist to fit your foot better, but again, they are not an exact fit for your foot. Despite this, they can work very well off the shelf or modified for patients, and in my experience this is the only orthotic that most people will need, if any.
Some patients do require custom orthotics. These are orthotics that are made after molding one specific foot with plaster or foam or using images to create a custom 3d printed model. In my experience these are reserved for people with “custom” feet, such as post surgical patients, specific deformities, or specific work/recreational demands. They can work very well, but they do come at a premium cost and require that the maker understands the patient’s deformity and needs.
So where do these fit in with running? For the vast majority of patients, I do not recommend wearing orthotics while running, especially at first. I believe that most problems that runners are told to wear orthotics for can be fixed over time with physical therapy, training adjustments, the right pair of shoes, and sometimes wearing orthotics in their walking shoes. Many overuse running injuries are due to training error, the wrong or worn out shoes, or muscular and tendon imbalances that result from foot type or gait. I like to completely examine the patient, their shoes, and ask them everything about their running, from their mileage to cross training. By doing so, a proper plan can be laid out for how to fix said problems, whether this be simple such as a shoe gear change, or more in depth such as stretching and strengthening to help prevent future injuries once the current symptoms improve.
It’s fairly common that my treatment includes orthotics, but I recommend wearing them primarily in their work shoes or walking shoes, especially at first. Most people are standing at work or walking around far more often than they are running. Even if the injury was caused by running, supporting the foot during other activities can therefore be more beneficial. For running, I instead focus on the shoe that they run in, as a good shoe can be much better for the patient than a good orthotic in a bad shoe. In this way I attempt to prevent reliance on an orthotic in their running shoes, because inevitably some patients will return saying that the orthotic causes blisters, sloshes around in the shoe, or compresses the sole of the shoe rendering it a hazard more than a help. These issues can all be addressed, but it's a huge hassle to the patient.
Now there are certainly some instances where orthotics are needed for running as well, be it because the patient is unresponsive to the initial plan, has a unique foot type, or just likes wearing them running. In these cases, the issue becomes what shoes to wear them in. I’ve heard running shoe clerks telling customers that they should only buy a neutral shoe for their orthotics because a stability shoe already has arch support and serves the same function as the orthotic. This may be true in some instances, but really isn’t a good guideline overall. There are some neutral shoes that are very good at holding orthotics, such as the Brooks Dyad or Saucony Echelon, which are designed to hold orthotics well and are fairly stable neutral shoes. Other neutral shoes might be fine for shorter runs, but for longer runs the single density foam may compress under the hard material of the orthotic and change it’s function. This is especially true if arch support is the main function of your orthotic and the hard material compresses into the foam arch.
Make sure you remove the shoe insert before placing the orthotic in the shoe
Stability shoes can actually be very good at holding orthotics. In individuals with orthotics specifically for arch support, these are often the best choice, as the dense foam under the arch prevents the orthotic from compressing or falling into the arch. The key is finding a shoe that your specific orthotic fits into. some orthotics are completely flat on the bottom of the shoe and require that the foot bed is also flat. If it has a large arch then this won't work because the orthotic will rock back and forth on the shoe's arch. Other orthotics have a concavity under the arch and can therefore be used on footbeds that have arches. This should actually prevent the orthotic from moving.
The best thing to do is to bring your orthotic to a running shoe store and try several shoes. Make sure you pull out the insert that’s in the current shoe and place the orthotic in the foot bed. See how the arch lines up with the arch of the shoe. They should ideally lock in like a puzzle. The more surface area in contact with the orthotic the better, but in the case of a flatter shoe bed it’s most important that the heel of the orthotic sits on the heel of the shoe without rocking. Try to rock the orthotic back and forth with your fingers to check the fit, and then actually try the shoe on and go for a small walk or run. As always, if there is a treadmill in the store, try that out for a couple of minutes. If it doesn’t feel right, try another shoe. They great thing about having so many different shoe companies is that there is likely a model out there with a foot bed that will pair well with your orthotic. If you still can’t find a shoe that fits the orthotic, remember that a podiatrist may be able to add padding etc to customize the fit better.
I know I don’t usually do this, but I thought I’d mention a couple of specific shoes that are good at holding orthotics. For maximum control, the Asics Gel Foundation is great and is designed specifically to hold an orthotic. For stability shoes, the Asics Gel Kayano, Brooks Ravena, New Balance 870, and Mizuno Wave Catalyst may all fit inserts well. As always, this list is nowhere near all inclusive, but may offer a helpful starting point.
I know this post was a lot longer than expected, but I really hope it helps with this tough question. Please comment below if you have any questions or information that might be helpful to others looking for shoe models etc.