Orthotics

Question
QUESTION: Hello: I am getting back into running at age 62 (I ran 15 miles a week for 10 years starting in my mid 30s),and need a new pair of running shoes,as the ones I have are 5+ years old.I visited the Consumer Reports website looking for advise on the best running shoes.One thing they did say caught my eye.They said orthotics may not always be good as they might cause a loss of impact protection.I have been wearing rigid plastic prescription orthotics in my street shoes for years now,as I have severe over-pronation.My question to you is whether the stability control built into modern running shoes would enable me to run without my prescription orthotics(I would save them for my street shoes),or should I buy a pair of shoes with a removable insole and continue to use my orthotics?
Thanks!

ANSWER: Great question Michael and great job starting to run again!!!  I have 2 suggestions that you can either combine or just take one of them.  

First, I would use the shoes without the orthotics.  If running causes pain without the orthotics then use the orthotics.  It is impossible to know without trial and error.  While the orthotics may not have as much impact protection, the impact protection is only beneficial for the comfort of your foot.  Studies show that great impact protection/cushioning in a shoe offers no benefit to forces in the ankle, knee, and hip.  Forces in those joints is what causes pain.  

Now for my second piece of advice.  I strongly suggest you consider incorporating forefoot running into your running routine.  This is commonly called barefoot, midfoot, or chi running.  While this can be done barefoot this is not practical because of rocks, stickers, glass, etc. that you could step on!  This can be done with shoes as well.  The benefit of this style of running is that it more naturally absorbs the impact of each step.  This is how people ran until the 1960s or 1970s when modern running shoes became popular.  A huge warning with this though is to start slow! It causes your calves and ankles to be sore until the strength is built up in them.  The benefit of this pain, however, is that it is muscle, ligament, and tendon pain.  These can become stronger.  The pain that often occurs from traditional heel strike running is not alleviated by getting stronger and only becomes worse.  I recommend starting one day with 5 minutes of striking with the midfoot and seeing how you feel the next day.  Slowly build from there.  Start with no more than 5 minutes the first day. The Barefoot Running Professor is an excellent youtube video with a doctor from Harvard discussing more of the technique and the benefit of forefoot running.

You can use solely the first piece of advice.  If you use the second piece of advice then switch in the first piece of advice as well while you continue to build the strength in your calves and ankles.  

---------- FOLLOW-UP ----------

QUESTION: Thanks,Nick,very interesting answer!When you refer to barefoot, midfoot, or chi running,does that include forefoot running? I am asking because that is how I started running in the 80s,and loved it.I think I am predisposed to developing really meaty calves and quadriceps,and would have little difficulty getting strong in those muscle groups. The only problem was I got heel bruise in one,then the other foot back in the 80s.In your opinion,would that be related to toe running? Thanks again,Michael

Answer
Yes, it is also called forefoot running.  And yes, it likely is related if your heel pain is what I think it is.  Your achilles tendon attaches at your heel and then is continuous with the plantar fascia that runs along the bottom of your foot.  Often plantar fasciitis is felt near the heel in forefoot runners.  Plantar fasciitis is when the fascia on the plantar (bottom) of your foot becomes tight and painful.  Here are 2 crucial things to help you not have this happen again.

1) Start slow!  I said this in my initial response to you and will reiterate it because I can't emphasize it enough.  The first time I ran barefoot I only ran for 5 minutes and was sore for a few days and was young, healthy, and exercised often.  If you run forefoot in shoes it will take away some of the stress (and some of the benefit to other foot muscles) on your plantar fascia.  You are a 62 year old man.  It is much better to build up more slowly than is possible than build up too fast and be hurt.  You can run the rest of your life if you do it correctly.  Further, while you're building up your strength to be a forefoot striker you can switch off with running heel first.  

2) Massage and stretch the bottom of your foot. An easy way to massage it is to roll your foot around over a golf ball for 5 minutes each day.  An easy way to stretch the achilles tendon and  is any calf stretch that you like to do.  

Good luck with this and don't hesitate to ask any other questions.