5 replies to this topic

[Sunder]

Guys,

I went to see a physio today, because I'm about to start training again after a 9 month break. Actually, we started a couple weeks ago, but my wife got knee problems so we stopped - and I wanted to see a physio to make sure I didn't get injured too.

Anyway, the physio gave me about 6 stretches to do, but referred me to a podiatrist because she was concerned about my feet.

I have been using off the shelf orthotics for about 5 years now. They turned chalk into cheese. Previously, I would get shin splints around the 5km mark. Last year, I ran a half with no shin splints, though I do have a lot of blisters and corns when doing high km running, so clearly it's not a perfect solution.

The podiatrist recommends a $300 pair of shoes to be replaced every year, and a $500 pair of custom orthotics good until they crack, which is generally about 5 years. This seems like a lot of money for a "cheap" sport. The other thing though, was she concluded the appointment, by recommending I see several other people, including an "Active Release Technique" Chiropracter, a massage therapist, an acupunturist, and a nutritionist. Sure she wants to make more money for her clinic, but it left a sour taste in my mouth where I felt like I had gone from a professional consultation to a sales pitch, and it made me wonder about the value of her podiatric advice as well.

I do want to push to a full marathon as my next goal, but now I'm skeptical. Anyone else have experience with custom orthotics, or advice on what I should do?

[Gordo31]

I think you'll find a lot of people wear orthotics (myself included). I payed about $250 (plus consultations) for my first pair and got a second pair for my work boots. They've helped me a great deal with everything from lower back pain to knee pain. Would never run without them again.

Price for shoes sounds about right too, but you'll probably need to replace them more often than that, depending on your distances. I replace mine every 800-1000k's, so about every three months. If I could afford it I'd replace every couple of months. A good pair can set you back that much, but you'll find them cheaper if you let your fingers do the international walking. I would spend about $150 per pair (a good $100 cheaper than retail).

Running may be a 'cheap' sport, but with all the time on your feet and the pounding you do to your body, do you really want to skimp on your health. Especially something that could be compounded over time and really do some damage long term.

Not too sure on all the other 'extras', but others maybe in a better position to contribute.

[Steve 'The Footman']

Have I read it right that you went to see a physio because you were worried that you might get injured not because you had any problems?  Firstly stretching has some recent evidence to show increased injury risk if done without warming up.  It is certainly no panacea for injury prevention.

Why do you need all of those treatments if you do not even have a problem?  While you might be able to make a case for preventative orthotics if you have had a recent history of frequent injuries - I would want to find some solid proof that your poor structure or biomechanics was a contributing variable.  If your off the shelf orthotics are working then why change?  I doubt new rigid orthotics would be as comfortable.  You perhaps need to find out why you are getting your blisters and corns and it is often just as much to do with your footwear and socks as it is the orthotic.  If you are blistering in the arch then orthotics moulded to your feet may very well help.  It is less likely that a 3/4 rigid orthotic will help with corns and blisters on your toes.  There are a lot of different types of custom orthotics and they are not all $500.

Any medical practitioner who recommends a particular model of shoes without seeing you running in them is talking rubbish.  Paying more is no guarantee of getting the best shoe to suit you.  There are not many $300 pairs of runners and most of them are really fashion shoes for posers.  A specialist shoe store will be able to find you the best shoe for you without forcing you into the most expensive pair.  You would be better off paying less and replacing your shoes more often.  As Gordo31 said you need to replace your shoes every 800 to 1000Km.  If you are doing 20km a week then that is about a year.  If you start training for a marathon you will need to do more than 20km a week and will need to replace them accordingly.

The right pair of running shoes and custom orthotics help many people to achieve their running goals.  It is always good to be a skeptical consumer.  Make sure your podiatrist understands running and more importantly watches you running before taking their advice.

Just because your wife got knee problems does not mean you will.  Sometimes "if it ain't broke don't fix it" is a good adage to follow.

[BEN-HUR]

Sunder, on 21 February 2011 - 04:17 PM, said:

The podiatrist recommends a $300 pair of shoes to be replaced every year, and a $500 pair of custom orthotics good until they crack, which is generally about 5 years. This seems like a lot of money for a "cheap" sport.

Hi 'Sunder'.
- What shoes did the Podiatrist recommend? I personally feel $300 is too expensive considering you have also been advised to wear orthotics as well. There are many factors to consider i.e. your weight, intended weakly mileage, biomechanics, gait type etc... but despite this, I still personally feel that $300 is too expensive for running shoes. I feel the majority of running shoes anyway (including high range expensive shoes) have adverse issues which can potentially cause/initiate injury in many runners (that's another big topic in itself).  

- Was the $500 for the orthotics including the initial assessment, casting/moulding/scanning of feet (for custom orthotics) & fitting of orthotics (thus all up $500), or was it just for the orthotics alone? $500 for the orthotics alone is too expensive (personal opinion). Orthotics are a valuable asset for some runners as they reduce the degree of particular adverse forces which are liable to cause an array of running/sports related injuries.

Also, orthotics shouldn't normally "crack" either (depends on the definition of the term & the materials used).

Sunder, on 21 February 2011 - 04:17 PM, said:

The other thing though, was she concluded the appointment, by recommending I see several other people, including an "Active Release Technique" Chiropracter, a massage therapist, an acupunturist, and a nutritionist. Sure she wants to make more money for her clinic, but it left a sour taste in my mouth where I felt like I had gone from a professional consultation to a sales pitch, and it made me wonder about the value of her podiatric advice as well.

- So were all these people associated with the same clinic? If so, I too would acquire a "sour taste in my mouth". Sure general health/wellbeing & getting the most out of one's body is potentially a holistic endeavour but one (i.e. the practitioner) needs to keep in mind that draining of one's finances also affects one's general health & wellbeing. I am not saying that any of the recommended referrals are of no use (probably wouldn't state such on a public forum anyway - except if it was beyond the boundaries of logic/science i.e. some new age Reiki nonsense). However, my guess is that you didn't present with the signs & symptoms whilst in consultation with the Podiatrist that warranted to be referred to another 4 specialists. Hence, one thing at a time to start off with. Allow the Physio & Podiatry treatment to work, listen to your body & if needed seek out the appropriate practitioner in your time.

Remember to eat healthy, warm-up/warm-down appropriately, gradually adapt to the training load, throw in some plyometrics & some core muscle work & you will safe guard yourself from most overuse type injuries (which is a large percentage of running related injuries). There really shouldn't be such a fine line between a "professional consultation to a sales pitch" ... it would seem however this Podiatrist may have come pretty close to that line (probably unintentionally - I hope).

All the best.

[Sunder]

Steve, on 21 February 2011 - 08:09 PM, said:

Have I read it right that you went to see a physio because you were worried that you might get injured not because you had any problems?  Firstly stretching has some recent evidence to show increased injury risk if done without warming up.  It is certainly no panacea for injury prevention.

Why do you need all of those treatments if you do not even have a problem?  While you might be able to make a case for preventative orthotics if you have had a recent history of frequent injuries - I would want to find some solid proof that your poor structure or biomechanics was a contributing variable.  

Just because your wife got knee problems does not mean you will.  Sometimes "if it ain't broke don't fix it" is a good adage to follow.

When I trained for for the City 2 Surf in 2007, I had pretty severe shin splints, and thats when my first physio (Who was fixing a sprained wrist from catching a falling 180kg motorcycle!) casually recommended trying off the shelf orthotics, and to come see a proper podiatrist if I had problems.

When I trained for the half in 2009 (ran in 2010), I had 6 weeks off for an inflamed ITB.

This time, I wanted to get things right before I started running. So yes, I guess you could say that I do have some history of injury. But also, my PT commented in 2009 that I was inflexible, even considering my gender and height. I can't touch my toes (I know many of my age can't) but even grabbing my ankle is - pardon the pun. A stretch.

BEN-HUR, on 21 February 2011 - 08:15 PM, said:

Hi 'Sunder'.
- What shoes did the Podiatrist recommend? I personally feel $300 is too expensive considering you have also been advised to wear orthotics as well.

- Was the $500 for the orthotics including the initial assessment, casting/moulding/scanning of feet (for custom orthotics) & fitting of orthotics (thus all up $500), or was it just for the orthotics alone? $500 for the orthotics alone is too expensive (personal opinion).

- So were all these people associated with the same clinic? If so, I too would acquire a "sour taste in my mouth".

Remember to eat healthy, warm-up/warm-down appropriately, gradually adapt to the training load, throw in some plyometrics & some core muscle work & you will safe guard yourself from most overuse type injuries (which is a large percentage of running related injuries). There really shouldn't be such a fine line between a "professional consultation to a sales pitch" ... it would seem however this Podiatrist may have come pretty close to that line (probably unintentionally - I hope).

The Podiatrist listed three which should be fine, and recommended that I go for a short run in each of them before deciding. Referred me to a specific store who would let customers do that, which could explain the price tag.

That was orthotics alone. If I wanted a second pair, it was no cheaper, so none of the $500 was from consultation or casting.

Yes, they were all from the same clinic which is what made me so skeptical.

Gordo:

Sorry I didn't quote your message. the 1 year was actually calculated by my dodgy maths. A little scary since I work in computing science and do maths all day. She said 1000km to 1200 per pair if you rotate between shoes (I.e. give them at least 48 hours to regain their shape rather than run in them every day). Somehow I did the maths for me and ended at 1 year for a pair... No idea how now.

I think after all these replies, I'm going to get a second opinion, even though my health fund doesn't cover it. (Funny, physio is 100%, chiro is 100%, even massage is 25% covered... But podiatry gets nothing). For $80, it's worth keeping her honest.

[BEN-HUR]

Sunder, on 22 February 2011 - 07:31 AM, said:

The Podiatrist listed three which should be fine, and recommended that I go for a short run in each of them before deciding. Referred me to a specific store who would let customers do that, which could explain the price tag.

I see, still a bit expensive but the decision is ultimately up to you. As Stevo The Foot Dude said...

Steve, on 21 February 2011 - 08:09 PM, said:

Paying more is no guarantee of getting the best shoe to suit you.  There are not many $300 pairs of runners and most of them are really fashion shoes for posers.  A specialist shoe store will be able to find you the best shoe for you without forcing you into the most expensive pair.

I'll take a guess & say one of the listed three was the Asics Kayano.

Sunder, on 22 February 2011 - 07:31 AM, said:

That was orthotics alone. If I wanted a second pair, it was no cheaper, so none of the $500 was from consultation or casting.

I too feel this is a bit expensive. Also if one requires a second pair, then the second pair should again be even cheaper as part of the processing/manufacturing has already been done. However, this will vary somewhat according to the manufacturing techniques/technology used i.e. 10, 15, 20% cheaper than the first pair.

Sunder, on 22 February 2011 - 07:31 AM, said:

Yes, they were all from the same clinic which is what made me so skeptical.

I see, I don't blame you... I would likely be also.

Just out of curiosity & only if you feel comfortable... could you PM the clinic details to me (I'll understand if you don't & I have no intention using any of the above info.).