Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Quick answer: Arch supports and orthotics reduce foot pain by correcting biomechanical imbalances and redistributing pressure. Our Michigan podiatrists prescribe custom orthotics tailored to your gait and foot structure — providing relief for plantar fasciitis, flat feet, and chronic foot pain that over-the-counter insoles cannot match.
Treatment at Balance Foot & Ankle: Custom 3D Orthotics →
| Running Phase | Normal Biomechanics | Common Fault | Injury Result | Orthotic / Shoe Correction |
|---|---|---|---|---|
| Heel Strike / Initial Contact | Slight supination at contact; subtalar begins to pronate | Excessive heel strike (overstriding); valgus collapse at contact | Tibial stress fracture; patellofemoral pain; shin splints | Rearfoot varus post; heel cup; neutral/stability shoe |
| Midstance (foot flat) | Subtalar at neutral; tibia vertical; arch loaded | Excessive pronation (>8°); medial arch collapse; tibial internal rotation | Plantar fasciitis; posterior tibial tendinopathy; medial knee pain | Medial arch support; rearfoot post; UCBL if severe |
| Propulsion / Toe-Off | Resupination; hallux dorsiflexion 60°; windlass mechanism | Insufficient resupination; hallux limitus limits propulsion | Metatarsalgia; sesamoiditis; peroneal tendinopathy | Morton’s extension; 1st MPJ relief cutout; forefoot post |
| Float Phase (both feet off ground) | Hip extension; ankle neutral; knee flexion | Crossover gait; excessive lateral swing | IT band syndrome; hip abductor strain | Gait retraining; no orthotic correction effective |
| Swing Phase | Hip flexion; ankle neutral to slight dorsiflexion | Foot drop; hip flexor weakness; hip hiking | Hip flexor strain; proximal IT band; toe catch | AFO if foot drop; hip flexor PT; cadence increase |
| Orthotic Type | Shell Material | Rearfoot Control | Best Running ConditionShoe Pairing | |
|---|---|---|---|---|
| Custom Rigid (Polypropylene) | 3mm polypropylene; semi-flexible | 4° varus post standard; adjustable | Plantar fasciitis; pronation-driven injuries; PTTD Stage I | Neutral or stability trainer with removable insole |
| Custom Sport (Carbon Fiber) | Carbon fiber plate; lightweight | Moderate; extrinsic or intrinsic post | Speed work; racing; higher-mileage runners seeking lighter option | Racing flat or plated running shoe; snug last |
| Custom Semi-Rigid (EVA + cover) | EVA shell; accommodative top cover | Low to moderate | Metatarsalgia; neuroma; elderly runner; accommodative need | Maximum cushion trainer; wide toe box |
| OTC Stability Insert | Prefab; varying stiffness | Low to moderate; not customized | Mild overpronation; plantar fasciitis early-stage | Stability or motion control trainer |
| Metatarsal Pad (adhesive) | Adhesive felt or silicone; 3–6mm | None; forefoot only | Metatarsalgia; Morton’s neuroma; 2nd MPJ synovitis | Any running shoe; position just proximal to MT heads |
Watch: Best Insoles & Orthotics 2026 [Flat Feet, Plantar Fasciitis, Bunions] — MichiganFootDoctors YouTube
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Running biomechanics evaluation at Balance Foot & Ankle assesses foot strike pattern (heel vs. midfoot vs. forefoot), pronation/supination timing and magnitude, cadence, stride length, and hip-knee-ankle alignment during running. Abnormal mechanics — overpronation, excessive heel strike, crossover gait, and hip drop — contribute to plantar fasciitis, ITBS, medial tibial stress syndrome, stress fractures, and patellofemoral syndrome. Interventions: running-specific custom orthotics, gait retraining cues, footwear recommendations, and targeted strengthening. Running orthotics are designed for the specific biomechanical demands of running — not adapted from walking orthotics.
Runners who develop repetitive overuse injuries — plantar fasciitis, medial tibial stress syndrome (shin splints), stress fractures, IT band syndrome, or Achilles tendinopathy — often have identifiable biomechanical contributors that can be addressed to enable healthy training. At Balance Foot & Ankle PLLC, Dr. Tom Biernacki provides biomechanical gait analysis for runners, identifying the mechanical drivers of injury and implementing evidence-based corrections through orthotics, footwear changes, and gait retraining.
What Running Biomechanics Evaluation Identifies
Foot strike pattern: Excessive heel striking increases impact transients and tibial stress fracture risk; forefoot striking increases Achilles and calf load. Midfoot striking distributes impact more evenly. Pronation timing and magnitude: Overpronation (excessive eversion after contact) increases medial tibial stress syndrome, plantar fasciitis, and posterior tibial tendon stress. Delayed pronation and supinated foot posture increases lateral stress fracture and IT band syndrome risk. Cadence and step rate: Lower cadence (step rate) correlates with larger vertical loading rates and increased injury risk — cadence increase of 5-10% reduces loading rate significantly. Crossover gait: Feet crossing the midline of travel increases IT band syndrome risk — widening the step width reduces IT band tension. Hip drop (Trendelenburg gait): Contralateral pelvic drop from gluteus medius weakness creates increased tibial varus and IT band load — corrected with hip strengthening.
Running-Specific Custom Orthotics
Running orthotics differ from walking orthotics in critical ways: thinner profile to fit running shoes with thinner insole beds, semi-rigid to rigid materials appropriate for running loads (not flexible EVA), specific heel cup geometry for running heel-strike pattern, and forefoot accommodations for the higher forefoot pressure of running gait. A running orthotic must be fabricated with the intended shoe type in mind — road running shoe vs. trail shoe vs. track spike. Dr. Biernacki prescribes running orthotics based on biomechanical evaluation findings, not generic arch support prescriptions.
Gait Retraining
Evidence-based gait retraining cues reduce injury-producing biomechanics without orthotic dependence: Cadence increase (step rate +5-10%) reduces ground reaction force transients — a metronome app facilitates this. Widening step width by 5-10 cm reduces IT band tension in crossover gait — “run on train tracks” cue. Forward lean from ankles reduces heel strike magnitude. Midfoot strike transition in appropriate patients reduces tibial impact loading. Gait retraining is combined with targeted strengthening — gluteus medius, hip external rotators, calf/peroneal — to address the muscular drivers of abnormal mechanics.
Dr. Tom's Product Recommendations
Brooks Adrenaline GTS 23 Stability Runner
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Premium stability running shoe — the recommended starting point for runners with overpronation identified on gait analysis, providing medial guide rail support during training.
Dr. Tom says: “My podiatrist analyzed my running gait and recommended Brooks Adrenaline to control my overpronation — my shin splints resolved within 4 weeks of the shoe change.”
Overpronation running, gait analysis stability shoe, medial tibial stress syndrome runner
Stability shoe — not for neutral or high-arch runners identified on gait analysis
Disclosure: We earn a commission at no extra cost to you.
Garmin Running Dynamics Pod
⭐ Highly Rated | Foundation Wellness Partner | 30% Commission
Wearable running metrics sensor — measures cadence, ground contact time, vertical oscillation, and step length during training runs, supporting gait retraining programs.
Dr. Tom says: “My podiatrist recommended tracking my running cadence with a pod during gait retraining and the data helped me increase my step rate to reduce impact.”
Running cadence monitoring, gait retraining data, vertical oscillation step rate
Data collection tool — interpretation requires biomechanics expertise; values alone are not prescriptive
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Identifies specific mechanical contributors to repetitive running injuries
- Running-specific custom orthotics designed for the actual demands of running gait
- Gait retraining with simple cues produces measurable injury reduction without surgery
- Footwear recommendations matched to the runner’s specific biomechanical findings
❌ Cons / Risks
- Running gait retraining requires weeks of conscious effort to produce lasting changes
- Running orthotics require break-in period and must fit the intended running shoe
- Gait video analysis quality varies widely — in-person dynamic assessment is superior to one-plane video
Dr. Tom Biernacki’s Recommendation
Running injuries are a biomechanics problem as much as a tissue problem. When I see a runner with medial tibial stress syndrome, I want to know their cadence, their foot strike pattern, and whether they have hip drop on the injured side. The orthotic addresses the foot mechanics; the gait cue addresses the central pattern. Together, they address both the local biomechanical stress and the whole-body movement pattern driving the injury. The runners I treat successfully are the ones willing to do both — change the orthotic AND work on their gait.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
What is overpronation and why does it cause running injuries?
Pronation is the normal inward roll of the foot after heel contact — it distributes impact forces and allows the foot to adapt to terrain. Overpronation is excessive or prolonged pronation beyond the normal range — causing increased torsional stress on the tibia, plantar fascia, and posterior tibial tendon. In runners, overpronation is associated with medial tibial stress syndrome (shin splints), plantar fasciitis, posterior tibial tendinopathy, and knee pain. Overpronation is identified on gait analysis and managed with stability running shoes, custom orthotics with medial heel posting, and targeted hip and calf strengthening.
How do running orthotics differ from regular orthotics?
Running orthotics are designed specifically for the biomechanical demands of running gait: higher impact forces (2-3x body weight vs. 1x for walking), forefoot loading during push-off, faster pronation-supination cycles, and need to fit thin running shoe insole beds. Running orthotics use thinner, denser materials (carbon fiber, semi-rigid polypropylene) rather than the softer materials appropriate for walking. They are prescription devices calibrated to the runner’s specific biomechanical findings — overpronation, supination, forefoot valgus/varus — not generic arch supports.
Does running with flat feet cause injuries?
Flat feet alone do not cause running injuries — many high-level runners with flat feet train and race without problems. The relevant factor is how the foot functions during running: excessive, prolonged pronation (overpronation) in combination with other biomechanical factors (low cadence, hip weakness, crossover gait) creates the conditions for overuse injury. Some flat-footed runners benefit from motion control shoes or orthotics; others run perfectly well without intervention. Gait analysis determines whether the flat foot is functionally problematic or biomechanically compensated.
What is runner’s gait analysis?
Runner’s gait analysis is a systematic evaluation of running mechanics to identify biomechanical contributors to injury and inefficiency. At minimum, it includes assessment of: foot strike pattern (heel, midfoot, forefoot), pronation/supination timing and magnitude, cadence (steps per minute), stride length, vertical oscillation, hip drop (Trendelenburg), crossover gait (step width), and overall alignment. Video is recorded at multiple angles during treadmill running. Findings guide specific interventions — orthotic prescription, shoe change, cadence training, step width modification, or targeted strengthening — based on which mechanics are abnormal and injury-producing.
Michigan Foot Pain? See Dr. Biernacki In Person
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When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Custom orthotics typically responds best to early podiatrist evaluation, conservative treatments such as supportive footwear and targeted physical therapy, and—when needed—custom orthotics or in-office procedures. Most patients see meaningful improvement within 4-6 weeks of starting a structured treatment plan. Schedule an evaluation at our Howell or Bloomfield Hills office for a clinical assessment.
What is Custom orthotics?
Custom orthotics is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of custom orthotics include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of custom orthotics respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from custom orthotics varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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