Orthotics and Flat Feet - Member Case Study

author : AMSSM

comments : 0

My right foot is killing me (flat feet, wearing orthotics). I can no longer run on it and am forced to walk. After walking 10k, my foot felt like it was squeezed really hard.

Question from paulieman:

My right foot is killing me (flat feet, wearing orthotics). I can no longer run on it and am forced to walk. After walking 10k, my foot felt like it was squeezed really hard. Now the pain is also in my shin on the outer part of the leg. Any ideas? My first triathlon is on April 24th, and I have put in too much suffering to quit.

Answer:

I'm not sure if we can help you in time for your event on the 24th, but I'll try my best to point you in the right direction. How long have you had your orthotics and running shoes? Being a triathlete, I am assuming that you change shoes around every 300 miles. In addition, evaluation by someone knowledgeable in footwear can confirm that you are in the right type of shoe. Are your orthotics custom made, or were they purchased off the rack? There have been great advancements made in over-the-counter orthotics, and many people, even runners or triathletes with fairly severe foot abnormalities, can do well in over-the-counter orthotics. However, they tend to wear out more quickly. I would advise you to see your doctor regarding this if you have not already.

While flat feet can certainly contribute to foot and lower leg pain in high mileage athletes, it likely is not the only cause. More and more studies are looking into core stability as it relates to overuse injuries. Specifically, the hip abductors, such as gluteus medius, have been implicated in a variety of conditions ranging from patellofemoral syndrome (kneecap pain) to shin splints and stress fractures. Although it is difficult for elite athletes to believe they have some significant weakness when they work out all of the time, these particular muscles seldom get adequate strengthening unless supervised by a good physical therapist or a sports medicine physician. Elite athletes simply need more muscle than their less active counterparts.

With the limited history given, it is difficult to tell for sure what is causing your problem. There is a possibility that you are showing signs of an early stress fracture. I would suggest that you have your physician and/or a physical therapist (who works with runners/triathletes) evaluate your gait and core strength. As the competition is rapidly approaching, I would suggest a switch to aqua jogging, and/or elliptical training to decrease the pounding on your lower leg and foot. With a proper assessment and backing off a little, you may be able to get through your event and continue rehab when you're done.

Good luck!

Mark Alexander, M.D.
Minneapolis, MN
 

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date: May 3, 2005