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Which kind of running shoes with orthotics?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Paulo Silva, Oct 27, 2007.

  1. Paulo Silva

    Paulo Silva Active Member


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    Hi

    This is something that occours me every once:

    Some times comes a costumer sent with prescribed orthotics to limit pronation and instructions to look for a "neutral" running shoe..

    Wile I'm not to disagree with the prescriber I always wonder if a solution with the orthotic and stability shoe would be a better solution.
    (assuming that stability/anti-pronation does makes any difference).

    It's not rare to attend costumers referred that say:

    "My podiatrist told me that the shoe it's not important, watt really matters its the orthotics"

    So my question:

    Which is a better solution?

    Neutral shoe and orthotics

    Stability shoe and orthotics


    (assuming the patient/Costumer needs stability)

    Tank you for you input on this.

    For the record: I always respect the prescriber instructions.
     
  2. brevis

    brevis Active Member

    Re: Which kind of shoes with Orthotics?

    you have to take into consideration sporting activity, frequency and body type etc....its amazing how different footwear can influence the desired effect of an orthotic
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Re: Which kind of shoes with Orthotics?

    The problem with a stability shoe and orthotics, is that there may be too much 'control' (whatever that is) and then excessive lateral heel compression in the shoe, so a neutral shoe may be more appropriate (it happen to me!).
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. Admin2

    Admin2 Administrator Staff Member

  6. markjohconley

    markjohconley Well-Known Member

    Re: Which kind of shoes with Orthotics?

    A few good slaps across the face to these podiatrists is strongly indicated!!
    Appropriate footwear is EQUALLY important, no argument!
     
  7. Paulo Silva

    Paulo Silva Active Member

    Re: Which kind of shoes with Orthotics?

    If you pass trough this small country please be my guest :D (but please leave Romeu alone)
     
  8. Bruce Williams

    Bruce Williams Well-Known Member

    Paulo;

    from my standpoint it depends very much on the material used for your orthotic. Also, it greatly depends on the characteristics of the shoe / orthotic combination.

    The AAPSM, American Academy of Podiatric Sports Medicine, has a 3 step process for patients and the public to test shoes for stability / motion control. Go to http://www.aapsm.org/crishoe.html to see this testing process.

    So, in a neutral shoe that most often will flex at the middle of the shoe, you can overcome this with a relatively stiff or non-flexible foot orthosis.

    If you utilize an EVA or leather type of device you will need a shoe that does not flex in the middle.

    I make this statement because I find a loss of AJ rom in shoes that flex in the middle. There are some neutral shoes with no midfoot flexibility issues, but you really have to look hard for them.
    cheers
    Bruce
     
  9. CraigT

    CraigT Well-Known Member

    It is a question which needs to be addressed on a case by case basis.
    I will pick up on one point-
    This is something that varies greatly amongst so called motion control shoes. I generally do not like shoes with what I have dubbed a 'sharp support gradient'. This is where the difference between the medial higher density and the softer lateral density is too great. In other words the inside is too hard or the outside is too soft. A firm medial midsole is very useful, but if the lateral heel is too soft you may find other problems occurring.
    I found this to be a real problem with some asics shoes in the late 90's- I had quite a few patients through the clinic who had started to have peroneal problems, ITB problems and lower back issues- the issue was apparent when you examined their footwear- they had compressed the shoe laterally and blown out the upper. The previous model of the same shoe had not worn as dramatically.
    This is not a problem now though Simon B :p
    This issue will be exaggerated in an orthosis which is not well balanced or over-corrected.
     
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Craig - funny you should mention that! We just tested 10 shoes using a force gauge to measure the medial and lateral differences in the heel seat! There were huge differences between the shoes. Not sure what do do with the data yet as we have also looked at force/time curve data in different runners in the 10 shoes .... if it wasn't for those two little Arena'ettes keeping life so busy, I might get the data out there ....

    I do agree, that just becasue we need a higher density medially for 'control' dosen't mean the lateral has to be softer.
     
  11. markjohconley

    markjohconley Well-Known Member

    Re: Which kind of shoes with Orthotics?

    Tudo bem Paulo
    thankyou for the invite, would love to. I have been a fan of 'SPORTING LISBON' for many years, and will watch PORTO AND BENFICA matches as much as i'm able, and at the recent rugby world cup, República Portuguesa were a revelation, their captain Vasco Uva was in my world cup best 15.
    As for leaving Romeu alone, I have been through his posts in this forum and have not seen any reason for me upsetting him/her? If I have the good fortune to visit the República Portuguesa I promise I will leave Romeu alone, I won't even think of him/her, in fact, what are we talking about?
     
  12. GarethNZ

    GarethNZ Active Member

    CraigT - from memory it might have been the Asics 2040? and very similar, but not quite as bad but still compressing alot laterally was the Brooks Adrenaline from 2 season ago.
     
  13. CraigT

    CraigT Well-Known Member

    Racking my brain makes me think it may have been the GT2060, but the Kayano of the same era was also a problem. I think they particularly showed problems with DC wedge orthoses that were over corrected (common in Melbourne!!!) Agree that the Brooks Adrenaline has had similar problems. They had a triple density midsole which I alway thought would have been better if they had used the middle density for most of the midsole as the low density was far too soft.
     
  14. Paulo Silva

    Paulo Silva Active Member

    Hi

    Thank you all for the replies, very helpful and interesting thoughts.

    As I imagined the problem is not that simple...

    markjohconley, I see you are well informed

    PS: I'm a Sporting Lisbon (locally known as Sporting Portugal) fan
     
  15. Paulo Silva

    Paulo Silva Active Member

    I found this form in the AAPSM site
     
  16. Bruce Williams

    Bruce Williams Well-Known Member

    Paulo;
    This is the current 10 point athletic shoe assessment form for the AAPSM. We base this on visual and touch evaluations. In other words we bend the shoes and visually gauge them.

    We do not have instrumentation for mechanically gauging the durometer of the lateral to medial EVA in the shoes. If this is something that is affordable please let me know and I’d be happy to purchase that.

    We also do not do wear testing. At this point we find that much too subjective.

    If anyone has comments or suggestions on the form, please feel free to let me know publicly or privately. I welcome the opportunity to make it better and better.
    Sincerely;
    Bruce Williams, D.P.M.
    President- Elect, AAPSM
    Chairperson of the Shoe Recommendation Committee
     
  17. We all do the squeezy, squeezy tests but I should be interested to know how the validity of the 3 point test has been examined and how the two shoes used in the demonstration influenced the observed kinetics of subjects.
     
  18. Bruce Williams

    Bruce Williams Well-Known Member

    Simon;

    I would as well! Let me know when you get a grant for the squeezy, squeezy tests so we will know whether it really makes a difference or not!

    Seriously though, this is something that I'm currently looking into. I will have to test the kinematics with just in-shoe initially. After that, I hope to do both the in-shoe and hopefully 3D kinetic data.

    If anyone does want to take this on, the AAPSM does have applications for grant money to do this actual testing. I cannot gauruntee that you will get the grant, but it is something we'd like to see proven, we hope!
    :drinks
    Bruce
     
  19. Paulo Silva

    Paulo Silva Active Member

    Hi Bruce

    I do like the squeeze, squeeze tests, after all I'm using 1920's low tech in a daily basis.

    I know "testing" shoes this way it's not scientific but this low tech approach works just fine for shoe fitters with low income:eek:

    Some times big technologies and gadgets can make one lost the main focus, in this case it's all about fitting shoes, and my goal is to communicate as simple as possible with the final consumer, (thats why I like this kind low tech approaches).

    I will try do make some tests using the "athletic shoe assessment form for the AAPSM" next week or so, I will let you know.

    But I still don't have any clue if its viable or not to create some kind of guidelines to shoe selection with orthotics.

    any ideas?

    Tanks
     
  20. Bruce Williams

    Bruce Williams Well-Known Member


    Paulo;
    please let me know what you find when testing an athletic shoe that flexes easily in the midfoot as opposed to one that does not and instead flexes easily at the MPJ's.

    Regarding the orthotic / shoe suggestions: That is a tough one considering that most CFO's are made specifically for the patient. OTC devices are made for the general public at large.

    When I talk to colleagues about this, I just tell them that you can cheat with a more rigid orthotic and a more midfoot flexible shoe. I'd like to see what kinemaitc or kinetic data might show on that, but time will tell.
    Thanks.
    Bruce
     
  21. Paulo Silva

    Paulo Silva Active Member

    Hi Bruce and all

    As promised here I am "reporting" the running shoe tests according with the AAPSM Guidelines and form:
    It took us a wile to get it right we had to repeat several times to have enough experience to be capable of make the test with confidence and repeatable results.

    I must say that usually we already use some but not all of the "squeeze" tests on a daily basis but never this way.

    The final results wore fairy accurate and (important) also fairy repeatable, and in a few days I saw one fitter teaching his costumer how to "evaluate" one shoe for her needs (not to choose the lightest more flexible but to look for balanced features).

    I like the fact of the results (although not scientifically accurate) are fairy repeatable but most of all are able to report different kinds of stability (or as it is in the AAPSM site: "pronation control")

    Also this was a conversation theme for a few days in the store and made everyone think by them selfs rather than just eat some of the athletic brands exaggerated Marketing

    Finally I also was able to tell everyone that I was able to discuss these matters with the "Gurus" of Podiatry at Podiatry Arena
     
  22. Bruce Williams

    Bruce Williams Well-Known Member

    Paulo;
    thanks for the update. I'm very pleased that the tests are seeming to prove repeatable and reliable.
    What exactly did you do in your testing, what measures did you use. If you have any other data, I would love to see it, feel free to email me privately.

    Have a great holiday season.
    Bruce
     
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