Fitness Fridays - podiatry, gait analysis, orthotics, and new running shoes

I've been meaning to write this post for a while now. Unusually for me, I have struggled with how to start it. Do I tell you about my experiences with orthotics from age 12 to age 18, when my tendencies towards over-prontation were identified? Do I tell you about the running seminar I went to where I heard about gait analysis? How much detail do you really want on orthotics anyway?

I decided to just start with why I went to see a podiatrist this year. Back in April, just after my first half marathon, I went to a distance running seminar organised by the Western Australian Marathon Club (WAMC). The WAMC is the main running body in Western Australia and organises various runs and events over the year (not just marathons as the name would suggest). The seminar was great and I do intend to write up my notes on it at some stage.

One of the speakers at the seminar was a sports podiatrist. He wasn't the most useful speaker of the afternoon for me, but he did show video footage of people undertaking gait analysis, where they're filmed as they walk and then run on a treadmill, both bare foot and in shoes. I was amazed at the number of things that could go 'wrong' (in a misaligned, rolling in or out, injury-inclination kind of way). I knew my feet rolled inwards, but I had no idea how I actually looked when I ran. Given I was nearly due for new running shoes, I thought I might arrange a podiatry visit for myself.

New running shoes - Brooks Trance. They're bright!

I spoke with my physiotherapist to check that the place I planned to visit was respectable, booked an appointment, and looked forward to finding out what my legs actually did when I ran. I didn't make the session thinking I would need orthotics, rather hoping for some extra guidance with shoe choice.

I wish I could show you images from my gait analysis. The expected part was that my feet rolled in when I walked and ran, a lot when I was bare foot and very much less (but still a bit) when I was in my running shoes. The unexpected part was that my right hip dropped whenever I landed on that side. If you can imagine the drawing below being me, and please forgive my terrible computer drawing skills!, that was the scenario.

Laugh away. Just note the red sloping arrow too. That's my hip position on landing on my right side!

I had no idea I was doing this. I did get a new appreciation for why I get hip / ITB pain, and sometimes knee pain, and was really glad that I'd bothered to get the gait analysis done.

An evolution in running shoes (oldest from the right - Mizuno Wave Renegade, Brooks Ariel, Brooks Adrenaline, and Brooks Trance).

From the gait analysis, the podiatrist kindly explained that we had two issues. The first was the over-pronation (rolling in), which was quite well managed with my supportive running shoes, but was still going to leave me slightly injury prone. Her phrasing was that if I wanted to keep running at my current level / frequency, I would probably be fine without orthotics; however, if I ever wanted to increase my distance or mileage, I would be vulnerable to injuries without extra support.

The second issue was my dropping hip, which was quite separate to my feet and stemmed from weak gluteal muscles on my right side. She suggested I work with my physiotherapist to identify exercises to strengthen these.

(Lest you wonder why my physiotherapist has never noticed these weak muscles himself, I see him mostly for my back, which is prone to quirks that result in headaches unless regularly addressed.)

Given that I would like to be able to run more than I currently do without fearing injury, I decided to tackle both aspects: feet and hips. Thus, we took moulds of my feet at the end of that first appointment and they were sent off in order for orthotics to be made.

The result of my feet moulds. These blocks carry a hefty price tag.

If I had known that my health fund didn't cover podiatry at all (I really should have checked) I may have thought harder about orthotics and whether I needed them. The price tag for these customised shoe inserts is quite horrifying. I have since justified it in terms of injury prevention; the fact that the moulds above will last for years, possibly forever (and the orthotics themselves will last for at least 3 years); and possible shoe savings brought on by a greater range of shoes to choose from now that I don't need as much support in the shoes themselves.

Still. I will say, if you're thinking about getting orthotics yourself, be prepared to part with the some money. You can buy 'over the counter' non-customised ones that work fine if you don't need much support, but the variety built from moulds require a bit of input.

The actual orthotics. I know, so small!

Orthotics ordered, I visited my physiotherapist for advice on how to address my errant right side muscles. His verdict, phrased nicely but nonetheless cutting in its accuracy!, was that it wasn't so much that my left side was strong and my right side weak...instead, both sides were weak, but the right side was weaker. Excellent.

I am now doing leg extensions, side leg raises, one-legged squats, and one-legged standing dutifully, and have noticed after my recent long runs that my gluteal muscles are actually sore. This has never happened before (goodness knows what muscles I was running with!) so I am taking it as progress - clearly the muscles are being used in a way they weren't before.

As for the orthotics? It's too soon to say whether they will make a huge difference in injury prevention. They feel good in my shoes, and I have fully adjusted to the feel of them when I run. I have found I get less pain immediately after running on hard surfaces like concrete or brick (which I do try to avoid but sometimes are unavoidable). And, I have got new shoes, a supportive but slightly less supportive Brooks model than my last pair.

Spot the chunky soles on the right...

The pictures above show changes across my last four pairs of running shoes. The oldest, on the far right above, are the Mizuno Wave Renegade, which I actually went through two pairs of before they were discontinued in 2010. They were a 'control' shoe, and my first Brooks pair, the Ariel (second from right), were in that same category. You can see above how their bases are a lot thicker and more built up than my newer shoes.

Last year, I transitioned to the Brooks Adrenaline, a progression that took me from 'control' to 'support' (in other words, a step down in how rigid my shoes were). I'm not sure how my feet managed that, but I'm pleased about the shift. I could have stayed in the Adrenaline model even with my orthotics, but also had the option of a slightly less structured shoe, and on running around in both in the shoe shop, I went for the Brooks Trance instead. They're still in the 'support' range but have a few subtle differences to the Adrenaline.

One other thing I learnt in my podiatry visits is that I am, supposedly, slightly 'hypermobile' in my joints. This means that my joints stretch slightly further than usual. I found this diagnosis hilarious because I have terrible flexibility, and initially I thought the podiatrist had things completely wrong. As it turns out, hypermobility does tend to be associated with poor flexibility (the joints may be over-mobile but the muscles are not) and injury vulnerability. Fortunately in my case it is quite mild, so I don't think it plays much of a role in my functioning. It may, however, explain why I find it so hard to balance. If I stand on one leg, my ankle joints are liable to wobble all over the place! If you want to know if you are hypermobile, an easy test is whether you can get bend your thumb down to touch the inside of your arm. I thought everyone could do this,  but apparently not.

In all, my first podiatry visit sparked a chain of events that has left me more educated about my gait and running style, more aware of my muscle weaknesses and joint quirks, and better able to (I hope) minimise my injury risks. I am really glad I went through the process, and if you run regularly, I would recommend a gait analysis for interest if nothing else.

Have you ever watched yourself walk or run on video? Or do you have any muscular limitations you've learnt to manage?

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