Running Shoes and Orthotic Choices for Stability vs Shock Absorption Issues

     Many runners present with an interesting dilemma. Their biomechanics demand orthotic devices to control excessive pronation, yet their running on pavement, and present with symptoms which may be related to poor or inadequate shock absorption. Shock Absorption and Stability seem to be on opposite ends of the insert or shoe spectrum. Yet, I believe I can sum up the problem, and the dilemma of treatment. Running shoes are either cushion (good shock absorption/minimal stability), stability (moderate shock absorption/moderate stability), or motion control (poor to fair shock absorption/excellent stability). And, there are always in between shoes. Functional foot orthotic devices are either cushion/some stability, stability with some cushion, and maximal stability with minimal cushion. Health care providers who recognize this dilemma in prescribing tend to split the difference by ordering a stability shoe with a stability orthotic device. But if I understand statistics alittle, I really only have a 1 in 9 chance at hitting the nail on the head with this approach.

     So, the prescribing doctor/therapist has nine combinations with these to choose from based on what is the cause of the pain--poor shock absorption, poor stability, or a combination. Because it is easier at times to change shoes than change orthotic devices, I will make my orthotic device on either extreme (maximal stability or maximal shock absorption) based on my best guestimate of cause. Then, I can start with the shoe type I think is the best, but vary based on how the symptoms respond. For example, if I believe I need maximal stability, with little to no shock absorption, I will order a maximal stability orthotic devices with a motion control running shoe. If the patient returns complaining of shock related symptoms (new or old), I can have the patient switch shoes to a more stability or cushion shoe. If I believe initially that they need all Shock Absorption (a runner with knee joint pain with history of knee arthritis), I may start with the Hannaford Device (see previous post) for maximal shock absorption good stability with cushioned shoes. If they need more stability based on their subjective complaints and/or gait evaluation, I can recommend a stability or even motion control shoe.

     Here are the possible 9 starting points based on shoes and orthotic types:

1. Cushion Shoe--Cushion Orthotic Device
2. Cushion Shoe--Stability Orthotic Device
3. Cushion Shoe--Maximal Stability Orthotic Device
4. Stability Shoe--Cushion Orthotic Device
5. Stability Shoe--Stability Orthotic Device (most common combination seen)
6. Stability Shoe--Maximal Stability Orthotic Device
7. Motion Control Shoe--Cushion Orthotic Device
8. Motion Control Shoe--Stability Orthotic Device
9. Motion Control Shoe--Maximal Stability Orthotic Device