Monday Shakeout: Do I Need Insoles? What Shoes Should I Use With Them?

The Monday Shakeout: Do I Need Insoles and What Shoes Should I Use With Them?
By Matt Klein

In this week's Monday Shakeout, Matt discusses a common question we get about the general use of insoles. We offer our thoughts on them and best practice tips.

A common question asked of us is whether someone needs insoles or whether a shoe can handle them. The obvious answer is it depends but some definitions may help us clarify this. The term "insole" is a catch-all term that can refer to the additional piece of material inside the shoe under the foot, sometimes called a footbed, an external piece of material that can be added or used to replace the "stock" insole (the one that comes with the shoe) or an orthotic. An orthotic is an insole with additional stiffening agents or pieces that may provide support or rigidity to the shoe and foot. 

Most footwear companies now put a great deal of effort into the insoles that come with the shoes. The shoes are developed and tested with these in mind. A shoe is a sum of all its parts and the final product that is debuted to market is put there with the stock insole as an important part of that. People typically judge the midsole comfort of a shoe to a great degree by the initial perception provided by the insole, so changing it out can change how the shoe feels and potentially how it functions. Shoes that are already stiff may be made stiffer with an added stiff insole. Shoes with arch support may push someone too far (more is not better, the right amount is best) if an additional arch support insole is added. Shoes that are already soft may become too soft if a more cushioned insole is added. In fact, adding a foot orthoses and insoles have been shown to worsen running economy, potentially due to many shoes not being designed with those pieces (Crago et al., 2019)

For those without any kind of pathology, we do NOT suggest replacing insole especially with an arch support insole. The exception is if the stock insole is defective, folding or creasing in a way that causes problems. For those with acute pathology, such as plantar fasciitis or a posterior tibialis issue, some people respond well to an arch support insole, which may help relieve symptoms while the tissue heals. Long term, arch support insoles do not work well, people should wean their way out of them and address whatever influenced the development of the issue. If the issue persists, it is a far better idea to get a shoe that already has arch support, stability or guidance in it. Stability shoes are better than they ever have been, so there are plenty of options on the market. If arch support is needed, choose a shoe that has that aspect designed into already. That will allow you to be more confident that the shoe is working as it is designed. Adding an additional piece long term into a shoe may change the shoe for the worse. This comes from years of personal experience dealing with people who had been unnecessarily sold an arch support as an add-on sale (which many running stores do) and their symptoms were relieved simply by removing it. 

There are a group of people that do need some additional stability not provided by over-the-counter arch supports. Custom orthotics are helpful for those with unique and specific pathologies when developed and prescribed by a legitimate healthcare professional.

What about footwear if you are using a special insole? Shoes like the Brooks Ghost Max 2 (best for walking) and the Saucony Echelon 9 (best for running and walking) were developed to take external insoles thanks to their generous volume inside the shoe to accommodate one and are the best choices if you need a custom orthotic. If those do not fit you, finding a standard neutral shoe from companies like New Balance, Saucony and Brooks are also good options. My personal experience has been their standard neutral trainers typically do okay with custom orthotics but I also suggest to patients that they test them out first and compare them instead of assuming things will work. Editor's note: We discuss further in this video why we don't recommend stability shoes with insoles.

So to finally answer the question, most people do not need an extra insole. The exception is for BRIEF relief of symptoms from certain pathologies or unique support/stability for issues diagnosed by a legitimate healthcare professional. For those two, short-term use of an arch support may be helpful (NOT long-term) and a custom orthotic may be helpful for those with specific ongoing needs that are not provided by traditional footwear. Long-term use should not be necessary for the over-the-counter orthotics, rather it should be a test to see whether a stability shoe may be a better option. Given how many great stability shoes are on the market, most people will find something that will work for them. 

References:

Crago, D., Bishop, C., & Arnold, J. B. (2019). The effect of foot orthoses and insoles on running economy and performance in distance runners: A systematic review and meta-analysis. Journal of Sports Sciences, 37(22), 2613-2624.

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