UKC

A bit of background...

I'm 32 and played a lot of sports until I was 19 (went to uni and got more into climbing) and was really fit. I just ran when I felt like it after this - generally a few runs a month. When I was 23 I injured myself on a run (possible meniscus tear) but was working in London and always busy so just hobbled around for a while and never got it checked out. Just climbed more instead of running. 

A few years later I wanted to run again but found I couldn't without pain. So for around the last 6-7 years I've done the Couch 2 5km countless times and never made it to the end due to causing some issue/pain.

Since then I've seen loads of physios, had ultrasounds, done lots of strengthening, stretching, made significant changes to my run style etc. Always taken care building up again with loads of walk running. But it always ends up back at the same problems.

I can generally get to the point where I can enjoy 5-10km walk-runs but as soon as I push it too much, have a few too many days off, or even think about running for 10 minutes without a walk in there, something goes wrong. 

Now, after 2 months of rest to try and heal a tear found on an ultrasound I was in pain within 5 mins of a reeeeeallllllyyyy slow HR zone 2 run. 

So.....

Back to a physio today (another £70 on top of the easy £2-3000 over the last 5 years) and he thinks that my arches are falling in a bit which is making my roll my ankle a little when landing, which also means I'm not landing with a straight (when viewed from the back) leg and he thinks this will be exasperating the problems on the outside of my calf/knee. 

He said the next thing he would advise would be to go to a local guy who makes bespoke insoles to put my foot back in the proper position to try and reduce the pressure caused by my alignment/form. But these cost £450, plus the probably new shoes he would recommend.

This physio wants all his clients to run in the "perfect" style. Another two physios I've seen don't think there is a perfect style and everyone is different and don't like the other guys approach.

My instinct says that there's also no correct style, but with both approaches I'm still stuck not being able to run.

So, has anyone tried having proper insoles made for their running? Has it made a difference?

How much better are expensive, bespoke ones versus those you can buy online?

Do the running shoes for flat-footed runners make much of a difference as an alternative to insoles?

 

Any thoughts, advice or experiences would be hugely welcomed. I'd love to run again, but I also want it to be enjoyable and don't want to be ever reliant on physios - I'd rather just do something else!

In reply to James Malloch:

I certainly can't help, but will say that when I've struggled with old injuries stretching and changing style didn't help, but strength training did.

It must be frustrating it's not working for you but it sounds like you've made a hell of an effort.

Could it be that your issue is beyond the skill of a physio and you need a surgeon. You would have to be very demanding to your GP to not get fobbed off.

I've got some horrifically expensive custom inserts for my work (office) shoes. They are made from a very stiff foam and wouldn't work in my flexible running shoes. Assume they are advising a different product for you.

Sorry can't help but best of luck. Hopefully others can come along soon.

In reply to James Malloch:

You might get good results from the custom insoles but I did not. A waste of money for me.

Best thing for me (entirely different problem to yours though!) was strength training. Loads of foot strengthening, ankle, calf, spiky ball etc.

I'm going to recommend a book but not because I think you should run barefoot or in minimalist footwear. I'm only recommending it to you for the running form and strengthening elements which I thought were excellent.

https://olderyetfaster.com/

There are similarities in terms of how they explain running form with Shane Benzie's book "The Lost Art of Running", which is also a fascinating read if you're interested in that kind of thing.

Just so you know I'm not some sort of barefoot running evangelist, I actually run in cushioned running shoes like most people. I just found these books really helpful in explaining running form etc. and good strengthening exercises. Videoing yourself running is also very useful so you can see for yourself.

In reply to James Malloch:

Sounds like straw clutching

yes, but for me, they weren't any better than sticking the metatarsal pads in the right place on standard inner soles.

Depends what the problem is and you won't know until you have an accurate diagnosis.For me, foot and ankle strengthening exercises, plus more stretching help as much as inner soles.

I'd find a different physio, there are loads in north west, many very running specific. I'd spend the money that would have gone on inner soles on a second opinion. 

These for example https://www.sportandexercisemedicine.co.uk/services/manchester-running-clin...

In reply to James Malloch:

I would try and find a good sports podiatrist who has been trained relatively recently. I've worn custom orthotics for about 20 years. I was first prescribed them with a very similar rationale to the one you've been given. I had achilles and knee pain. For years orthotics seemed to help me (went from being unable to walk for more than 30 mins without severe pain to running, mountain marathoning, long mountaineering days out etc). Until recently.

Over the last 5ish years I've developed forefoot problems that almost ground me to a halt again. The person that has made my orthotics in recent years didn't seem to want to diagnose or treat other than by modifying the orthotics. So I decided to get a second opinion a few years ago. Went to a podiatrist near where I live. They offered more in the way of diagnosis, exercises and shoe advice that helped up to a point. But also sold me some incredibly expensive orthotics that I felt made things worse (after months of pain and trying to get used to them). They refunded me for the orthotics but I'd lost  faith (and a lot of time) by then so haven't been back there. Tried NHS podiatry who were very helpful but needed to refer me to the msk service, which has a long wait list.

Eventually found a different private sports podiatrist and things are getting a lot better. Climbing with less pain now and back to running. I have changed from orthotics that cost hundreds every 3ish years to some £30 off the peg ones that have been modified a bit by the podiatrist. Most interestingly (and finally perhaps the most relevant point to the OP), the podiatrist tells me that much of the relevant theory has changed radically since I first had orthotics. I think what she's saying is that what was done for me is outdated and that, although orthotics helped, they didn't solve the root cause and led to other problems in the forefoot.

This is all very difficult because opinions seem to have changed but also I think there are different views on this. Maybe some people are using outdated and less effective approaches. Maybe they have sound reasons to stick with older approaches. I expect it also varies depending on precisely why you are having problems. I'm glad that I've persevered because I went through a(nother) period earlier this year of seriously thinking I'd have to give up many activities and/or accept constant pain forever. Some of my issues will never get fixed (one thing they all agree on!) but am now way more optimistic that they can be managed to a greater degree. So I'd say don't give up and, given the apparent variety of professional opinions in this area, don't accept the first (or second or third) thing you're told if it doesn't seem right for you.

Good luck.

Thank you for all of the responses. 

I think part of the problem is that I don’t have a definite diagnosis. There are some things which have persisted but nothing seems to have helped in the long term. The current thought is that a build up of pressure (from some big arteries and veins found on an ultrasound) is potentially pressing on a group of nerves where the pain is. And that the collapsing arches mean I’m rolling in and it is exasperating the problem/pressure.

So as I’ve got fitter the I can do a bit more, but the pressure will always build when I push myself more (or don’t have walk sections which reduces my HR) and maybe correcting my style will alleviate the issue a bit. 

But in general my knees feel a bit weak which could also be to do with the arches. But it’s all theory really given there’s not been anything definitive. 



I’ve kickstarted my strengthening exercised again and will have a look at the book you recommended, Mountainbagger. 


I’m also thinking along the same lines, ExciledScott. Though time is against me as we’ve a baby due in 2 months so I’m trying to get things done asap whilst I’ve still got a bit of spare time! There’s also a recommended physio in Leeds - The Coach House - who would have been my next port of call. 

I think I need somewhere where I can just go on a treadmill until it’s painful. As it’s hard to pinpoint and describe what’s happening after the event - no matter how much sharpie I put on myself…



I have booked in for an initial consultation after speaking with the recommended clinic. I came across this thread in which the guy came highly recommended:
https://www.ukclimbing.com/forums/running/rebound_clinic_or_andy_horwood_fo...

After speaking with them the initial consultation is £75. IF they decide you would benefit from something (they say they send a large percentage of people away) they will charge £200 for some temporary insoles which can be tested and adjusted over a 4-6 week period.

Only after this would they make a proper pair which then raises the total price to £450. So in the absence of making a decision I’ve gone for the initial consultation to get the ball rolling. 

In reply to cathsullivan:

Thank you, Cath. Who do you use? 

I notice you say you’re listed in Cumbria which isn’t far from me (and I travel across to visit my family there fairly frequently). Thanks

In reply to James Malloch:

Walk, walk and walk a bit more, (3 weeks)

Walk, walk and then run a bit. (3 weeks)

Walk and a little bit of running. (2 weeks)

With plenty of stretching,  touching of toes, calf stretch and pushing off your toes ect.

Try to run off your midfoot and check your running gait when possible, plus don't run in over cushioned shoes.

In reply to robert-hutton:

Several things:

try Sorbothane double strike insoles.

Join a gym and use the leg press machine with single leg presses.

use the leg press machine for toe raises at least 30 reps on these

do lots of bridges and flutters

stretch stretch and stretch some more.

good luck

edit: oh and shove lots of kt tape around the knee , dunno if it actually does anything but it feels good. I’ve had a few custom insoles over the years and they were definitely not worth the money for me. If you try mid foot or front foot strike you’ll need to strengthen calf’s. Barefoot style is overrated for people with injuries, I keep minimalist shoes for races but train / recreation run with as much cushioning as I can.

In reply to James Malloch:

Hello, sorry to hear about your running, sounds very frustrating

I had a knee issue about a year ago and went to three physios. They all suggested strength training which I did in a slightly haphazard way. Eventually two of the physios suggested gait analysis which I was a bit cynical of but had reached the point where was desperate to get back running - and walking - pain free. So I went along and had loads of info thrown at me - it's pretty amazing what info the tech kicked out. The guy was able to pinpoint a few issues that were causing the problem and gave me a strength training regime which I stuck to religiously... and it worked! I am back running and am forever grateful to this guy! He was very much of the view that everyone is different but if your legs are strong enough then your body should be able to cope with whatever weird and wonderful running style you have. To make me feel better he showed me a video of this famous female runner (I forget her name but proper hardcore runner) who had a frankly hideous run but because her legs were mega strong managed to run (and run exceedingly well!) all these races. He suggested insoles as a last resort as they don't correct the issue.

Possibly food for thought? Best of luck. 

In reply to James Malloch: I haven't had custom insoles, but the people I know who have over the year have not generally stayed injury free.  I am struggling to see also how adding a bit of sorbothane into a shoe is better than getting a better shoe in the first place.

You're still in London? Where do you normally run? Current shoes are? If all the insoles will do is stop you rolling in, why not an antipronation shoe?  What sort of injuries are you getting as well?

In reply to James Malloch:

Possibly it's a bit late if you've already started things going with the podiatrist, but it may be worth giving some Superfeet a go. They seem to do a good job of aligning minor issues, and - in the past at least (I've not actually bought any new ones for years) - gave a 60 day money-back trial period. Might save you a few hundred in custom soles if there's nothing too drastic causing problems.

In reply to James Malloch:

If you see a good sports physio who knows running you definitely shouldn't need to run until in pain for a diagnosis. The old school wet feet on tiled floor, or the modern sensors for foot plant analysis is all they'll need. 

In reply to James Malloch:

I've been being treated by Sally Wilson https://www.lakelandsportspodiatry.com/

So far, I'm very impressed. She was very clear at the outset that some of the problems I have are unlikely to be entirely fixed without surgery (and even that might not work and might not be worth it). But over the last few months of doing the daily exercises and gradually getting used to the new non-custom orthotics, I have seen massive improvement.

In reply to FranC:

What kid of things did you cover in your gait analysis? The physio I see is also a running coach and he videoed me lots on a treadmill. He looked at how I land, how high my knee goes, how I’m landing (crossover etc), what angles I am landing with (which is where he saw that I was rolling in a bit and recommended orthotics) etc. 

In reply to wbo2:

I’m up in Skipton now. I’m mainly running off road in some inov-8 trail roc shoes.

This is also why I’m sceptical of orthotics as I’m rarely on an even trail - and the fact that there doesn’t seem to be supportive trail shoes for sale suggests that it’s not how things would normally be solved…

The injury is where my calf joins the Fibula. When I was walk-running lots I could do 60-90 mins doing 4/5 run, 1 walk and it would feel fine. 

Going downhill could sometimes set it off, but anytime I did 10-15 mins running (with no walk) I’d get intense pain in that area and would end up hobbling home… Apparently I have a “stonking” vein and artery there (from an ultrasound). The latest theory was that there is a build up of pressure there (maybe when reaching certain HR/blood pressure) which is then pressing on some nerves…

In reply to James Malloch:

I can send you the report if you like? A lot of the findings were incidental but it threw up a few big things. 

In reply to FranC:

Hi Fran - that would be interesting, thank you. I’ll drop you a message/email