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Have question, will answer!

Posted by Richard, C.Ped, O.S.T. on 7/26/00 at 14:36 (024017)

About a week ago I gave an answer or two to questions about custom orthotics. I left my e-mail address and stated that if anyone else had questions about orthotics, please feel free to contact me. I was bombarded with questions. I want to thank each and every one of you who sent questions to me. I hope my answers were informative and useful to you. I still get questions daily. I want to encourage everyone that if you have questions about custom orthotics or proper shoe fit, please contact me and I will answer your questions the best I can. I am a Board Certified Pedorthist and Orthopedic Shoe Technician.
Again, thanks for the questions. I look forward to hearing from you. If you want to post your questions on the message board, feel free. I do check it daily.

Richard Graham, C.Ped, O.S.T.



Re: Have question, will answer!

Scott R on 7/26/00 at 17:39 (024038)

Please ask your questions to Richard, C.Ped, O.S.T. here in the message board instead of emailing them to him (unless he over-rides this request of mine and wants them to be by email). That way, others can see the information and it gets archived with the rest of the messages for future searches.

Re: Have question, will answer!

Richard, C.Ped on 7/26/00 at 20:28 (024054)

Thanks Scott. I have no problem answering questions on the board. I want people to be free to ask me anything they like. Some answers may vary per person. I offer the e-mail option so as to not break patient confidence laws.
Richard Graham, C.Ped

Re: Have question, will answer!

JudyS on 7/26/00 at 21:34 (024061)

First Richard, thanks for being willing to be bombarded with questions! Here goes; I'm on my fourth pair of orthotics. The second were from a plaster cast, the third and fourth from walking across a computer-pad thing. This last one is the 'marathoner' from Footmaxx. I got that one because ALL of the previous ones were just too rigid. My question is: how the heck do you know if they're effective or if they need to be altered? What with heel pain, arch pain, and more arch pain, how do you know it's not making things worse? The logical answer to that is- does the pain get reduced when there are no orthotics? The answer to that answer is - who knows! There is so much confusing pain that it's impossible to tell which end is up!

Re: Judy

Richard, C.Ped on 7/27/00 at 14:34 (024107)

Hi Judy,
I don't mind questions at all because I enjoy sharing information. Fourth pair or inserts...huh? Wow. I, personally, prefer the foam box semi-weight bearing casting method. There are different computer pad thingies that I do NOT like at all. Some raise sensors that shape to your foot. The problem is that there are not enough sensors to get every detain of your foot. I have never heard of Footmaxx, so I can not comment on that.

My experience has taught me that there are many, many (did I say many?) orthotic manufacturers that do not properly interface the orthotic to the shoe. Many people are still stuck in the 'dark ages' of orthotic fabrication. They still swear by and use the hard plastic 'window scrapers' (great for winter use :-)). They are very ridgid and do not provide proper cushion. The way impressions of your feet are taken play a major factor as well. I have learned that the best impressions are taken in a sitting position or semi-weight bearing position. Never stand in the foam box. This causes the foam or any other impression material to 'bottom out'. This will not give you proper arch support.

I have seen some funky orthotics come in my door which leave me scratching my head wondering what was being treated. Most of the time, with my PF patients, I do use ridgid material. It depends on what the physician suggests as well. When I use the rigid material, most of my PF patients have had extreme relief in 2-3 weeks. Now, this all depends of the severity of the PF. The material I use is a rubber material called ethel vinyl acetate or EVA for short. The material is measured by durometers. That tell you how dense the material is. I use a 60 durometer EVA for PF. For diabetics, I use a less dense EVA. Usually a 40 durometer. The EVA is for posting. The shell of the orthotic is usually a softer EVA.

Make sure of these things:
1. Your orthotics sit flat within your shoes. If they 'cup' when you press your index finger in the center, they need to be adjusted. The cupping causes pain and discomfort, usually on the lateral side. Most places, depending on their policy, will adjust your orthotic. Along the same lines, make sure your orthotic are flat on the bottom, not rounded.

2. Some people require a 'breaking in period' with new orthotics. Wear them for about an hour the first day. When your feet start to feel tired, take the inserts out, and put the inserts that came with the shoes back in. Go a little longer the next day, and so on.

3. Ask you physician or pedorthist what material your inserts will be made out of. Ask to see a sample. Look for a well defined arch and heel cup.

4. Wear your orthotics (and shoes of course) every time your feet touch the floor. I have ankle pain every morning after playing volleyball. If I do not put my feet in my shoes with my inserts...well, let's just say, ouch. The same goes for PF, and other sports type injuries.

5. If the arch area seems to 'high' and is causing pain, even after the 'break in period', ask the physician or pedorthist if the inserts can be adjusted. That is one of the problems with sending out to have inserts made. Adjustments can not be made right then and there. You have to wait for them to be shipped to and fro. Find someone who can do adjustments in the office. That way, you can try them on again, and if adjustments are needed, it can be done on the spot.

I know I tend to ramble, so, I hope I answered your question. If not, please let me know. I also hope that I spelled everything correctly. If not, I'm sorry.
Good luck!
Richard Graham, C.Ped, O.S.T.


Re: Have question, will answer!

Jan on 7/27/00 at 18:29 (024117)

Ah! A doctor in our chain! Great! And one willing to get involved. Even greater! OK, here're my question:
I seem to have some recent tingling sensations in one of my feet (I have bi-lateral PF and the worse foot is in a velcro boot, this is the one that's tingling). I've noticed in the last 2-3 weeks (I've been in the boot for 4) that if I so much as touch the skin on the bottom of my foot it feels like a small electrical surge (like if you accidently zap yourself on an outlet at home). This is different from the normal nail-in-my-heel or throbbing pain and it is across a larger surface area.
Any thoughts on this? It's new and the other 'normal' pf pain has been there a year.



Re: Jan

Richard, C.Ped on 7/28/00 at 08:10 (024139)

Hi Jan,
I am not a doctor. And I truly do not claim to be. I am a Board Certified Pedorthist as well as an Orthopedic Shoe Technician. The majority of the patients I see are referred to me by physicians. I treat a wide variety of foot conditions such as sports injuries which include PF, turf toe, ect., as well as the diabetic foot. Please feel free to visit my web site to learn more about the profession of pedorthics:
http://msnhomepages.talkcity.com/SupportSt/metatarsalgia/

You have a very good question. I will do my best to research this and post another message soon. In the mean time, I hope someone else, will have a suggestion.
Talk to you soon,
Richard, C.Ped, O.S.T.


Re: Have question, will answer!

Scott R on 7/26/00 at 17:39 (024038)

Please ask your questions to Richard, C.Ped, O.S.T. here in the message board instead of emailing them to him (unless he over-rides this request of mine and wants them to be by email). That way, others can see the information and it gets archived with the rest of the messages for future searches.

Re: Have question, will answer!

Richard, C.Ped on 7/26/00 at 20:28 (024054)

Thanks Scott. I have no problem answering questions on the board. I want people to be free to ask me anything they like. Some answers may vary per person. I offer the e-mail option so as to not break patient confidence laws.
Richard Graham, C.Ped

Re: Have question, will answer!

JudyS on 7/26/00 at 21:34 (024061)

First Richard, thanks for being willing to be bombarded with questions! Here goes; I'm on my fourth pair of orthotics. The second were from a plaster cast, the third and fourth from walking across a computer-pad thing. This last one is the 'marathoner' from Footmaxx. I got that one because ALL of the previous ones were just too rigid. My question is: how the heck do you know if they're effective or if they need to be altered? What with heel pain, arch pain, and more arch pain, how do you know it's not making things worse? The logical answer to that is- does the pain get reduced when there are no orthotics? The answer to that answer is - who knows! There is so much confusing pain that it's impossible to tell which end is up!

Re: Judy

Richard, C.Ped on 7/27/00 at 14:34 (024107)

Hi Judy,
I don't mind questions at all because I enjoy sharing information. Fourth pair or inserts...huh? Wow. I, personally, prefer the foam box semi-weight bearing casting method. There are different computer pad thingies that I do NOT like at all. Some raise sensors that shape to your foot. The problem is that there are not enough sensors to get every detain of your foot. I have never heard of Footmaxx, so I can not comment on that.

My experience has taught me that there are many, many (did I say many?) orthotic manufacturers that do not properly interface the orthotic to the shoe. Many people are still stuck in the 'dark ages' of orthotic fabrication. They still swear by and use the hard plastic 'window scrapers' (great for winter use :-)). They are very ridgid and do not provide proper cushion. The way impressions of your feet are taken play a major factor as well. I have learned that the best impressions are taken in a sitting position or semi-weight bearing position. Never stand in the foam box. This causes the foam or any other impression material to 'bottom out'. This will not give you proper arch support.

I have seen some funky orthotics come in my door which leave me scratching my head wondering what was being treated. Most of the time, with my PF patients, I do use ridgid material. It depends on what the physician suggests as well. When I use the rigid material, most of my PF patients have had extreme relief in 2-3 weeks. Now, this all depends of the severity of the PF. The material I use is a rubber material called ethel vinyl acetate or EVA for short. The material is measured by durometers. That tell you how dense the material is. I use a 60 durometer EVA for PF. For diabetics, I use a less dense EVA. Usually a 40 durometer. The EVA is for posting. The shell of the orthotic is usually a softer EVA.

Make sure of these things:
1. Your orthotics sit flat within your shoes. If they 'cup' when you press your index finger in the center, they need to be adjusted. The cupping causes pain and discomfort, usually on the lateral side. Most places, depending on their policy, will adjust your orthotic. Along the same lines, make sure your orthotic are flat on the bottom, not rounded.

2. Some people require a 'breaking in period' with new orthotics. Wear them for about an hour the first day. When your feet start to feel tired, take the inserts out, and put the inserts that came with the shoes back in. Go a little longer the next day, and so on.

3. Ask you physician or pedorthist what material your inserts will be made out of. Ask to see a sample. Look for a well defined arch and heel cup.

4. Wear your orthotics (and shoes of course) every time your feet touch the floor. I have ankle pain every morning after playing volleyball. If I do not put my feet in my shoes with my inserts...well, let's just say, ouch. The same goes for PF, and other sports type injuries.

5. If the arch area seems to 'high' and is causing pain, even after the 'break in period', ask the physician or pedorthist if the inserts can be adjusted. That is one of the problems with sending out to have inserts made. Adjustments can not be made right then and there. You have to wait for them to be shipped to and fro. Find someone who can do adjustments in the office. That way, you can try them on again, and if adjustments are needed, it can be done on the spot.

I know I tend to ramble, so, I hope I answered your question. If not, please let me know. I also hope that I spelled everything correctly. If not, I'm sorry.
Good luck!
Richard Graham, C.Ped, O.S.T.


Re: Have question, will answer!

Jan on 7/27/00 at 18:29 (024117)

Ah! A doctor in our chain! Great! And one willing to get involved. Even greater! OK, here're my question:
I seem to have some recent tingling sensations in one of my feet (I have bi-lateral PF and the worse foot is in a velcro boot, this is the one that's tingling). I've noticed in the last 2-3 weeks (I've been in the boot for 4) that if I so much as touch the skin on the bottom of my foot it feels like a small electrical surge (like if you accidently zap yourself on an outlet at home). This is different from the normal nail-in-my-heel or throbbing pain and it is across a larger surface area.
Any thoughts on this? It's new and the other 'normal' pf pain has been there a year.



Re: Jan

Richard, C.Ped on 7/28/00 at 08:10 (024139)

Hi Jan,
I am not a doctor. And I truly do not claim to be. I am a Board Certified Pedorthist as well as an Orthopedic Shoe Technician. The majority of the patients I see are referred to me by physicians. I treat a wide variety of foot conditions such as sports injuries which include PF, turf toe, ect., as well as the diabetic foot. Please feel free to visit my web site to learn more about the profession of pedorthics:
http://msnhomepages.talkcity.com/SupportSt/metatarsalgia/

You have a very good question. I will do my best to research this and post another message soon. In the mean time, I hope someone else, will have a suggestion.
Talk to you soon,
Richard, C.Ped, O.S.T.