We spend so long focusing on the knees and the hips when it comes to treating runner’s knee. However, it’s important to look at the foot. Often a simple change in footwear, or in this case custom insoles (orthotics) can help to ease your knee pain.
Foot orthotics have been proven to be effective in helping to improve symptoms in runners with patellofemoral pain (runner’s knee) and help make their rehabilitation more successful.
Foot orthotics, more accurately referred to as ‘orthoses’, are perhaps the most misunderstood treatment available to people with patellofemoral pain, often known as runner’s knee.
However, in running circles there often seems to be a degree of resistance when it comes to the prescription of orthotics.
As a physiotherapist and runner, I regularly hear concerns such as:
- Will I need to wear orthotics forever?
- Will orthotics make my feet weaker?
- But I can’t use them with my current trainers
- My running coach says orthotics will slow me down
I find misconceptions such as these particularly frustrating, especially as there is great evidence to suggest that orthotics can make a real difference to runners with knee pain.
Foot orthoses are recommended by the International Patellofemoral Pain Research Network (read: a group of scientists who meet up every two years to talk about kneecap pain) as a front line treatment for people with runner’s knee.
My colleague Ian Griffiths addresses these common misconceptions directly in this interview.
There is absolutely no evidence to suggest that orthotics are a life sentence.
Much like other treatments, such as medication, for example, you may only need to use your orthotics for a period of time until your runner’s knee symptoms settle.
Once again, there is no evidence to suggest that orthotics weaken feet. The research community’s current understanding of how orthotics work, it that they change the way your foot interacts with the ground dynamically (as do your running shoes!), rather than by holding your foot rigidly in place (like a cast would, for example).
I would go as far as to say that orthotics could, in fact, make your feet stronger, especially if they allow you to keep running and exercising pain-free!
There is every chance that your orthotics will be able to go into your current footwear. No podiatrist I have ever worked with has ever suggested a runner we are helping buy a new pair of trainers just to accommodate their orthotics.
Finally, whilst your orthotics will make your shoes weigh slightly more, this will not be to the degree where the added mass starts to affect your running economy.
In short, the positives can significantly outweigh the negatives, which are usually make-believe anyway!
How do you know if you need orthotics for runner’s knee?
In an ideal world, this decision would be made by a qualified medical professional, such as a physiotherapist or podiatrist.
However, the current understanding is this: the more flexible your foot, the more likely you are to benefit from orthotics. This means it is not as straightforward as having a “flat” or pronated foot.
If you are a runner with a foot that looks much flatter when you are standing on one leg versus two, this indicates that orthotics are worth exploring. Another clue is if you are a runner with very stiff ankles.
Try doing a squat: if you cannot get your hip below your knee without your heels coming off the ground, then orthotics may be for you.
What type of orthotics are best for runner’s knee?
This is where the question can get tricky – There is no one size fits all approach with orthotics. The best advice I can give you is to see a specialist musculoskeletal podiatrist, who takes a keen interest in running.
However, if you do choose a pair of off-the-shelf orthotics (sometimes described as a prefabricated device), it is important that you find the orthotic comfortable.
If you have a flexible foot, you are likely to benefit from an orthotic with a significant medial arch support, similar to a stability shoe.
If you have stiff ankles, you are likely to benefit from an orthotic with a ‘heel raise’, which will increase the heel-to-toe drop of your running shoes. You can learn more about heel-to-toe drop in this article (and video) about running shoe seleciton.
I do hope this article helps you decide whether or not you wish to try orthotics as a treatment option for your patellofemoral pain. If so, I’d suggest speaking to your physio about it. Good luck!