A stress fracture is a small incomplete crack in a bone that is due to repeated stress in an area in the body. 95% of stress fractures develop in the lower extremity and account for 10% of all running injuries. Stress fractures are a common injury in runners because of the repeated motion that runners go through over thousands of steps. Stress fractures commonly occur in runners when they have too many miles on their shoes, change the surface they run on, or change the intensity level of their workout.

The symptoms of a stress fracture are tenderness over a localized area, pain when you put weight on the affected limb, and slight swelling around the area. 

It's important as a runner to make sure that you are getting the proper nutrients to keep your bones strong in order to avoid developing stress fractures. It is recommended that you get 1000 mg of Calcium per day and 200 IU of Vitamin D per day, as well as maintaining a Body Mass Index (BMI) of at least 18.5 or higher and a body fat level of at least 14%. All of these factors will help insure that your bones have the right nutrients to sustain themselves even through daily running stresses.

If you think that you may have a stress fracture then the first thing to do is to decrease the amount of exercise you are doing. It is also important to come see Foot and Ankle Specialists of Utah so we can take an x-ray. X-rays aren't always able to detect a stress fracture and a bone scan or ultrasound may be required. Although stress fractures can be frustrating to an athlete who is in training, it is important to listen to your doctor’s instructions to modify your workout routine or you may create a more severe injury that may require surgery and more time away from your sport.   

The foot is a very complex structure which when functioning optimally supports and balances the weight of the entire body. Walking alone puts up to 1.5 times one's body weight on the foot. Running has been seen to put 3 times your body weight through every inch of your foot.

Foot pain is not normal and should not be ignored. It can lead to serious problems that can affect the functioning of other parts of the body, including the hips, knees, and back. Foot-related problems are often treated very successfully with orthotic shoe inserts.

Orthotics are prescribed to:

1) Reduce pain
2) Provide support
3) Prevent or slow down the development of a foot deformity
4) Provide better positioning of the foot, knee and hips
5) Improve the overall biomechanical function of the body

Orthotics allows the muscles, tendons and bones of the feet and lower legs to function at their highest potential. When correctly fabricated, orthotics can decrease pain, not only in the foot, but in other parts of the body such as the knee, hip and lower back. By eliminating the need for one's muscles to compensate for imbalances, orthotics can reduce fatigue and promote efficient muscle function to enhance performance. They can also increase stability in an unstable joint and prevent an early foot deformity from developing additional problems.

What you should know about orthotics:

The use of orthotics adds a new dimension in the treatment and prevention of overuse injuries of not only the lower extremity but also of the hip and back. However, there is still confusion as to what orthotics are, what they can and cannot do, along with who really needs them.

What is a functional orthotic?

An orthotic is a device that fits into running shoes to accomplish two things:

(1) To ensure that the foot moves correctly through the various phases of running which includes heel contact, whole foot contact and toe off, the orthotic functions like a rudder to help the foot function efficiently biomechanically.

(2) To support the foot, the orthotic assists the foot and enables it to communicate and align with the rest of the body. The body is then balanced above the foot in midstride as well as when the foot is on the ground.

A true foot orthotic is a custom-made device prescribed by a podiatrist. 

BIOMECHANICAL BASICS

To fully appreciate why some runners need orthotics and others do not, an insight into basic biomechanics will go a long way towards explaining the need for orthotics.

Our feet go through a very complex series of movements to help propel us forward. One of the most important functions of the foot is to help the body absorb shock when it hits the ground. Every time we strike the ground in running, our lower extremities experience a force between one and a half and three times our body weight.

Pronation

The foot normally strikes the ground on the outside (lateral) part of the heel. As soon as this occurs, the heel should roll in. This motion, called pronation, which absorbs shock, gives the appearance that the arch is flattening out. This mechanism of pronation reduces forces to the ankle, knee, hip and back and helps prevent impact related injuries such as stress fractures.

Once this 'pronation phase' is complete, the foot begins to roll-out or supinate slightly, creating a more stable foot position and allowing the lower extremity to achieve maximum efficiency when pushing off.

Pronation then, is a normal, necessary biomechanical motion in foot function. However, if the foot pronates too much or for too long it will remain unstable, making the lower extremity less supportive of body weight. This can result in a multitude of overuse injuries from heel or arch pain, stress fractures, knee, hip and back pain and injuries.

Pronation, therefore, is a problem only when it becomes excessive. Excessive pronation can result from several causes. Hereditary congenital bone structure refers to our foot type, which to a great extent, is genetically predetermined. The position of the joints can cause the foot to assume a pronated position.

Excessive pronation can also result from biomechanical abnormalities. If a certain part of the foot or leg is unable to go through the motion necessary in normal walking and running, another nearby joint may be required to make up or compensate for this lack of motion. For example, one of the most common biomechanical problems causing the foot to over pronate is a tight calf muscle also known as an equinus. The foot needs to bend (dorsiflex) upwards five to ten degrees at the ankle for normal lower extremity motion to occur.

If this motion is unavailable, the foot will overpronate to make up for the limitation. By stretching the calf muscle properly, these forces acting on the foot can be reduced and can help to prevent lower extremity injuries.

Finally, improper shoe gear is another cause of overpronation. Running shoes that have a curved last or shape will tend to increase the amount of pronation that occurs in the foot. Many shoes are categorized as 'motion control shoes', usually made from a straight last, have more supportive materials on the inner (medial) side of the shoe to limit the amount of inward roll (pronation). They are not included to stop pronation but to let this motion occur in normal limits.

Many runners almost literally run their shoes into the ground and discard them only when they have the shoes reduced to little more than a pulp. Shoes are meant to only last 6 months or 500 miles; whichever comes first. Remember that if the shoe is worn-out or broken down it cannot function in the way it was designed.

Supination

Is the opposite motion of pronation. It occurs normally right after heel strike to help the foot become a 'rigid lever' to propel toe-off. 

A foot that underpronates is not able to absorb ground shock very well and can be prone to stress fractures. A foot that underpronates needs a shoe capable of absorbing shock well. Motion control is usually not very important in this type of foot; however, in some cases foot orthotics can help in supporting and redistributing pressure in the foot when a neutral cushioned shoe is just not enough.

How do you know if you need orthotics?

Most serious runners who have biomechanical imperfections end up with orthotics out of necessity. The runner who runs fewer than 20 miles per week will not likely need orthotics unless they have a serious biomechanical weakness, but for the serious runner any biomechanical weakness will be magnified, with the result being injury.

When a runner gets a series of nagging injuries one after the other, they are probably caused by a biomechanical flaw and can be corrected by orthotics. Runners who suffer from chronic knee pain, arch pain, plantar fasciitis, heel spurs, hip and lower back pain and certain types of muscular fatigue very often benefit from orthotics.
 

The top three questions runners ask about custom foot orthotics are:

1. Should they use orthotics in their shoes while running if they don’t have an injury?

2. If they have fatigue in their legs while running they often wonder if orthotics will help?

3. Should they wear orthotics forever even after  healing from an injury?

The answers are yes, yes and yes!! A new study showed that orthotics have a significant benefit in reducing running injuries as prophylaxis. It makes common sense, that if you have an underlying biomechanical deficit, orthotics give you better alignment so therefore should reduce overall abnormal stressors and subsequently injuries. Now there is a new study that shows just that! Piggy-back that on years of biomechanics research and the answers get much more clear.

This study demonstrated that the subjects who wore orthotics had "a significantly reduced rate of exercise-related lower limb injury across the training period". The authors emphasized that participants were not treated for an injury with orthotics, but were prescribed orthotics to prospectively reduce the risk of injury. In addition, they believe that these "preventative results can be cautiously extrapolated to a recreational running setting and should be considered by sports and exercise medicine professionals."

We generally prescribe foot orthotics to treat specific injuries. This study indicates that orthotics can be a valuable prophylactic tool for injury prevention, supporting orthotic use in at-risk populations (e.g. runners). Considering the results of this study and the results of a previous study on the use of orthotics in runners by Mundermann, it is recommended to use at least a pre-fabricated Powerstep orthotic which incorporate a medial heel skive and rearfoot post, as a cost-effective means of providing prophylaxis with corrections proven effective in runners. Runners with a previous history of these injuries and/or those that develop symptoms would be good candidates for custom orthotics based on the results of these two studies.

We offer only the most cutting edge treatment in Custom foot orthotics. Come see us to get scanned for your pair! 
    

Franklyn-Miller A, Wilson C, Bilzon J, et al. Foot orthoses in the prevention of injury in initial military training: a randomized controlled trial. Am J Sports Med 39(1):30-37, 2011

Mundermann A, Nigg BM, Humble RN, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech 18(3):254-262, 2003