Can Arch Supports Boost Performance on the Trail?
    What you need to know to make a decision.

By Howard E. Friedman DPM

A few years ago, an official providing foot care for hikers on the Appalachian Trail at a comfort station in Damascus, Virginia was shocked to see that one backpacker’s feet were both swollen, and painful. Not only had the thru-hiker been carrying his own 40-50 pound pack, but for the last several miles he had also been carrying his partner’s gear as well since his companion was badly injured, all while wearing badly fitting boots. The swollen painful feet were a clue to a significant foot injury. The extent of the injuries, however, became clear only after the hiker’s trip to the emergency room: stress fractures in multiple metatarsals in both feet!

It’s not clear that any type of arch support would have prevented all of the foot injuries that overburdened hiker developed. However, some mechanical support under the overloaded arch of the foot may have decreased the extent of the injuries and provided some relief. Expert opinions vary, however, about what advice long-distance backpackers, going “light” or otherwise, should follow when it comes to adding arch support to their sturdy boots or trail shoes.

Ask three long-distance backpackers for advice about avoiding foot pain while on the trail for many months and you will get a variety of suggestions. In recent conversations, one hiker admitted using no arch support of any kind, while another used a customized version of a popular product and yet a third hiker, having recently completed criss-crossing the country, alternated a prescription custom-made foot orthotic with a pre-fabricated arch support.

What is the Arch of the Foot?

Someone who is on their feet many hours at one time may have considered the prospect of “fallen arches”, or, in other words, flat feet. This common problem could sideline anyone who depends on his or her feet for work or recreation. While an “arch” is the image of a strong and stable structure, “fallen arches” can be considered a biomechanical breakdown of the feet. A flat foot, however, need not be a reason to stop long distance hiking, since, in many cases, the weakened arch of the foot can be effectively, if artificially, supported.

The arch structure of the human foot is the most developed of all mammals. While the ligaments in the primate foot help create an arch, the human foot bones, however, create an actual arch just by their shape. In fact, the human foot has a pronounced arch along the inside, or, medial, border of the foot, a much less developed arch along the outside, or, lateral, side of the foot and an arch has also been described near the ball of the forefoot.

Although the human arch is based partly on the skeletal structure, when a supporting tendon or ligament fails, the entire arch can nonetheless be affected, lowering the arch height and lengthening and widening the foot. In cases of a complete tear of a supporting tendon, a bulge can emerge on the inside border of the foot. Over years, this change in shape can go from being a flat but flexible foot that can be propped up with an arch support, to being stiff, painful and arthritic.

Is a Flatfoot a Painful Foot?

The mere presence of flat feet does not automatically mean treatment is required. Some health care providers may recommend treatment in the absence of symptoms, but some practitioners will delay intervention until symptoms appear. Symptoms frequently include foot pain, but sometimes are only felt in the knee or back.

An otherwise healthy foot with an appropriate arch can also develop ‘arch’ pain if it is stressed or subjected to overuse beyond its ability to provide support. A sudden increase in weight over a long distance, for example, could precipitate foot or arch pain, for example, a hiker with a heavy backpack traveling over a long distance. Unfortunately, no formula exists to determine how much weight is too much or how many miles are too many.

An orthotic, arch support or footbed?

An arch support is a term, used to describe a product that fits inside of a shoe or boot to support the arch of the foot.  Other terms used when discussing ‘arch supports’ may include ‘footbed’ or custom fabricated foot orthotic. Different terms are used by manufacturers when marketing products, serving to confuse consumers.

A ‘footbed’ is generally not customized for the individual and will provide minimal support to the arch of the foot and may not significantly alter, or, improve the foot’s biomechanics. They are frequently made of a molded foam or other material with no physical ability to support the arch of a foot while standing.

Some footbeds can be enhanced with molded plastic to give them more support.
Pre-molded arch supports with a more rigid plastic exterior shell provide more mechanical arch support than soft footbeds. They are significantly less expensive than a custom foot orthotic. Several commercial products, including some new designs specifically for the hiking and backpacking community, are available.

A custom foot orthotic is frequently a rigid or semi-rigid material manufactured from a mold of the feet. The mold, or cast, of the feet is taken with the foot in its ideal position, neither pronated nor supinated. In addition, corrective ‘postings’ can be added to the rear or front portion of the orthotic to actually correct biomechanical problems of the foot. The orthotic can be made from a strong plastic such as polypropylene, or to reduce weight, from carbon graphite. Posting materials can be made from many materials, including various strengths of the chemical EVA, or a modified cork or crepe material. The orthotic can be further modified with fabric coverings that can include cushioned material to provide shock absorption in a specific location.

Some research study results.

Studies on the role of orthotics in sports and in military recruits may likely come the closest to approximating the demands hikers put on their feet. A study published in the American Journal of Sports Medicine in which the authors surgically implanted a measuring device onto the tibial bone of soldiers determined that a soft or semi-rigid foot orthotic can reduce the stress and strain while walking at about 3 mph in boots weighing 3.5 lbs. A rigid foot orthotic, however, increased the strain and, they concluded, may increase the risk of injuries, while neither type of device was effective during running. A study of several hundred soldiers published in Foot and Ankle International recommended a pre-fabricated soft arch support over a custom rigid and semi-rigid arch supports in preventing overuse injuries, when considering comfort and cost. Yet a third study published in the Journal of Manipulative Physical Therapy concluded that a custom fabricated foot orthotic reduces the incidence of low back injuries and shin splints in military recruits. The study did not compare results against the use of a pre-fabricated arch support or footbed, however.

Who Needs an Arch Support?

Andrew Skurka, 25, who completed a North American cost-to-coast 7,800 mile traverse, wore only his Montrail trail running shoes, with no additional arch supports. He was “concerned that an arch support would change the biomechanics of the shoes.” Skurka traveled with little foot pain on his trip, carrying between 6.5-30 pounds including food and water, with the exception of some irritation of a small bunion deformity. He subsequently developed a likely metatarsal stress fracture while trail running after completing his trip.

Brian Robinson, 45, a member of the Go-Lite Adventure team, completed the Appalachian Trail, the Pacific Crest Trail and the Continental Divide trail, a total of 7,371 miles in 2001. He supplemented his Vasque Clarion trail running shoes with a SuperFeet green pre-molded arch support. Previously he hiked in a leather boot and “ felt like the little bones in my forefoot were bruised.”

His foot pain subsided after he added a SuperFeet insole, Robinson said. He even used a customized SuperFeet product and said the improved custom fit, especially in the heel area, kept his foot from sliding in the shoe. While Robinson is now more focused on ultra long-distance running, he is still using a customized foot bed, molded to the foot after being heated, made by SofSole, in his LaSportiva trail running shoes.

Justin Lichter, 26, who completed a 10,000 mile backpacking trip of the Pacific Crest, Continental Divide and Eastern Continental trails this past October, had the most involved system for keeping his feet pain-free.  Averaging 28-31 miles a day carrying 25-40 lbs, including food and water, Lichter would begin each day hiking in a Garmont trail running shoe in the summer and a Garmont boot in the winter. Inside his footwear he would use a SuperFeet Orange pre-fabricated arch support. In fact, Lichter helped field-test the newest SuperFeet product, which was introduced this past summer.

As the day progressed, however, Lichter would exchange his pre-molded arch supports for a pair of custom molded foot orthotics he had made by a podiatrist before his expedition began. He had the orthotics fabricated in the hope they would prevent overuse injuries. When he resumed walking with his custom made orthotics, “it felt like I hadn’t walked all that day,” he said. Lichter finished his trip without any foot injuries.

What the Experts Say

Podiatry and biomechanical experts differ about what advice to give hikers and backpackers who have no foot complaints while on the trail. Steven Levitz DPM, a professor at the New York College of Podiatric Medicine and a vice-president of STJ Orthotics, a laboratory specializing in the manufacture of custom foot orthotic devices, says that a high quality trail shoe or boot may be sufficient. However, a significantly flat or high-arch foot will likely develop symptoms. Some people will get relief of their symptoms from a pre-molded device, like a Spenco Corp. cushioned support with a plastic shell, he said. Those who do not get relief should seek out the help of a podiatrist to be evaluated for a custom foot orthotic, Levitz added.

Perry Julien DPM, a podiatrist in Atlanta, Georgia, past president of the American Academy of Podiatric Sports Medicine and himself a mountaineer, says that arch supports can “absolutely prevent injuries”. He will not recommend that an experienced hiker or mountaineer abruptly change what works for him, he said. But, he would recommend that someone training, especially in light-weight shoes, consider adding a pre-fabricated arch support. If a hiker’s foot symptoms are significant, however, he would recommend a custom foot orthotic as an initial treatment.

Another biomechanical expert who feels arch supports can prevent injury is Jeff Gray, an education and training specialist for Superfeet and a pedorthist, a specialist in foot biomechanics, shoe fitting and modifications. “Arch supports are the missing link that does not come with the shoe,” he said, explaining that walking in a shoe or boot that does not fit well is like “driving a care with loose lug nuts”.  He would especially recommend an arch support if someone is sporting a 30-pound pack. A more pronated foot, however, would likely benefit from a custom foot orthotic.

Ray Fredericksen, a pedorthist and president of Sport Biomechanics, Inc., a laboratory that performs product testing for the shoe industry, agrees that an over-the-counter product is a good first place to start when considering biomechanical foot support. Mr. Fredericksen helped design two new products for the Spenco Corp. called the Backpacker and Day-Hiker footbeds. The arch supports were designed in part based on information gained from collecting pressure data from hikers who walked on a groomed trail, wearing 40-50 pound frameless back-packs at a speed of 3.5 miles per hour.

The Backpacker foot bed is designed for pack weights of over 25 pounds on a multi-day trip while the Day Hiker product is designed for less heavy loads. These pre-fabricated arch supports have a sophisticated system of shock absorbers strategically placed under the heel and mid-sole. The arch of both models of hiking foot beds have a supportive plastic shell that extends high enough to encompass most of the medial arch of the foot. The covering of both models is cushioned and extends to the tips of the toes. Either model in the series weighs less than 3 ounces.

SuperFeet also manufactures a variety of popular well designed pre-molded arch supports, identified by color, and also weighing less than 3 ounces. The green model has an extra-deep heel cup as well as a cushioned arch support to provide some rear foot and mid-foot control. The SuperFeet blue product has a moderately deep heel cup and a slimmer profile medial arch. The new orange and berry products blend a deep heel cup with a slimmer profile along with a new feature, a forefoot pad under the metatarsal heads. A customized foot bed is available at select retail outlets. A fitting, using a proprietary system, could take about a half-hour and may cost about two to three times the price of an off-the-shelf product.

The Sole Custom Footbed company also offers a moldable foot bed that can be form fitted to the foot, inside the shoe or boot, after heating in a home. The moldable EVA material is covered by up to several millimeters of cushioning. Sole custom footbeds include notable endorsements by mountaineer Ed Vieusters, who wore the footbeds to the summits of Mt. Everest and Annapurna and ultra-marathon runner Dean Karnazes.

When to Consider a Custom Orthotic?


Orthotics can offer a level or arch support not available with a pre-molded or even custom molded footbed. The expertise of the prescribing doctor will determine which material is best suited for the patient. Some patients with rigid, arthritic feet may be more comfortable with an orthotic made primarily of leather, while someone with a very flexible foot may require the rigidity of carbon fiber.

Many hikers and long-distance back packers, however, will probably function well with a semi-flexible plastic, such as polypropylene. These plastics can offer significant support at thicknesses of 1/8 to ¼ inch. They are durable and the orthotic itself can last for many years, if the shape of the foot or patient’s weight has not increased significantly. When the additional top covers and cushioning material wears out, the orthotic device can be recovered and the corrective posting materials can even be replaced.

Orthotics can be used to treat many different problems. Custom-made orthotics are commonly prescribed for the treatment of heel pain and plantar fasciitis. However they can be prescribed to help alleviate shin splints, forefoot pain from a pinched nerve, pain under a metatarsal, arthritis in the foot and sometimes back or knee pain, if the condition is related to poor foot biomechanics.

Experts agree that mild conditions may be satisfactorily addressed with one of many pre-fabricated arch supports or foot beds available. But for moderate and severe pain, a foot with a significant deformity or an obese patient, a custom fabricated orthotic may be required to reduce the symptoms and help prevent them from recurring.

If you are considering trying an arch support.

In general, a hiker or back-packer heading out for a long distance trip should consider the use of some type of arch support if he or she has experienced any foot pain or even knee or low-back pain. In addition, with footwear becoming lighter, along with other gear, long-distance hikers should be careful that their shoes do not make them more prone to injuries, Dr. Julien suggests. Adding an arch support may improve the performance of the shoe or boot.

Trying a pre-fabricated arch support or footbed may help reduce symptoms and possibly prevent further problems. Due to the wide variation in products, best results will likely be achieved making a purchase in a location with a knowledgeable staff. Some podiatrists also stock pre-fabricated orthotics in their offices as well, and will be able to dispense a well fitting brand name product. Some of the manufacturers of arch supports will allow on-line purchases.

For conditions that do not yield to an “over-the-counter” product, a prescription orthotic from a podiatrist is the next step. A footbed or orthotic may become part of your standard equipment, or, like Justin Lichter, you may mix and match products for more complete comfort. Regardless of what type of arch support you choose, if necessary, the additional few ounces added to the weight of your gear will pay you back when you can spend more time on the trail with pain-free feet.

 
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Howard E. Friedman