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richard, cp

Posted by john h on 7/28/00 at 09:11 (024146)

richard: i have had numerous pairs of orthotics including custom semi rigid,rigid, and soft. i am finding that all of the orthotics cause me to feel pressure at the point where i experience PF pain (where the fascia from the great toe attaches to the heel). i do not feel this with birkenstock sandals even though they have a rigid high support in the same area. i do not have the problem if i just use the insert that comes with your run of the mill reebock or new balance. my sense is the orthotics are not helping but may be a continuous source of aggrevation? this does not make much sense since the orthotic support in the arch area should cause the fascia to pull less and provide for better healing

Re: richard, cp

Rock on 7/28/00 at 10:27 (024155)

John H.,

I think a lot of have this same situation that is probably caused by putting weight on the (rigid) scar tissue that is located at the point where the plantar fascia attaches to the calcaneus (spell?) or heel bone.

I am starting to believe that there are two kinds of pain in this situation/location that are difficult to tell apart.

1. Pain due to pressure of body weight on the scar tissue.

2. Pain due to over-stretching the plantar fascia.

My theory is that while the foot is supported in orthotics in good shoes and is in full contact with the floor/ground, type 1 pain is NOT causing further injury.

By contrast pain type 2 IS causing further injury. An example of type 2 pain is the hanging the heels over the edge of the stair calf/achilles stretch.

HTH (Hope This Helps)
Rock.
TN. USA.


Re: John

Richard, C.Ped on 7/28/00 at 10:36 (024156)

Hello John,
I have patients that had the same complaints about the inserts I made them. To solve this problem, nine times out of ten, all it takes is a simple adjustment to the arch area of the orthotic. This involves grinding off a little more material. This is why I like having the patients come to my office. I am able to take a little extra material off, have them try it, and if need be, take off more until they are comfortable.
Swelling in this area is also a problem. You can not just 'force' the swollen fascia with support. Sometimes you have to take small steps (no pun intended) in orthotic treatment. If this is necessary, I do not make the patient pay for another pair of inserts. I simply add material back to the current orthotic, and go through the same steps a before.
The inserts in your athletic shoes are not supportive. Some shoes claim that they have arch support, but it is not designed to fit your foot. Check to see if your current orthotics are properly interfaced with your shoes. Two simple ways to check this are:
1. Look to see if your orthotics are 'rounded' on the bottom. Proper interfacing requires the insert to be flat.

2. With the orthotics in your shoes and on a solid surface, push in the middle of the orthotic with your index finger. If it bends or cups upwards on the sides, it is not properly interfaced. This may not work with your rigid orthotics, but give it a try anyway.

Thanks John. Let me know how things work out.
Richard, C.Ped


Re: John

john h on 7/28/00 at 10:47 (024157)

the swelling makes sense richard since wtih increased standing during the day i can clearly see swelling in the area where the fascia attaches to the heel. i now wonder when i had the orthotics made were my feet swollen or not? i purchased the Footmax which you walk across a pad with electronic sensors to establish your foot pad. we have a good local lab here with qualifed people who make orthosis and other devices. i will visit them about my Footmax. They are semi rigid and i wonder if they will have to send them back to Footmax or can they do any grinding on a semi rigid orthotic. Your metioning of swelling also would explain why (perhaps) the birkinstock sandal does not cause much of a problem. the sandal is loose and your foot can move around and is not further constricted by swelling in the arch.

Re: richard, cp

john h on 7/28/00 at 10:54 (024159)

swelling in any part of the body is usually accompanied by pain as the body is trying imobilize and protect. i have only recently payed close attention to the swelling in the arch area. it is clearly there sometimes and that is when there is the most pain. ice does bring the swelling down. there is also a nerve (baxter nerve) located directily under the fascia where the fascia attaches to the heel. dr baxter a noted surgeon thinks pf pain comes from this nerve and so states in Wheeless Book on orthopedics. Most medical people think the pain comes from the injured fascia. i tend to think the pain is from the fascia. I had a cortisone shot into this area about 2 months ago and the pain was gone for about 2 weeks. thought i was cured!

Re: John

Richard, C.Ped on 7/28/00 at 10:54 (024160)

Hey John,
In my experience, I have seen changes in patient's feet because of swelling. I do recommend to them that I make another cast of their feet when the swelling either increases or decreases. I want to make sure they get the best intimate fit of the orthotics as possible.
Do check to see if your local lab can adjust your orthotics in any way. I hope they can.
Richard, C.Ped

Re: John

wendyn on 7/28/00 at 11:35 (024163)

Richard - what's your thoughts on Birkenstocks for those of us who have not had any luck with orthotics? I have a forefoot varus, dorsal bunion (once removed) big toe, bunionettes, um pes planus, tarsal tunnel syndrome, um - what else, some PF, tibial torsion (out) on my right leg, short heel cords, some other misalignment in my feet that goes with pes planus that I can't remember. I'm 31. Ideally I should be in orthotics but in the past (even different kinds) they've made much much worse. Birkenstocks are the only think I can wear right now.

Re: John

Richard, C.Ped on 7/28/00 at 12:48 (024171)

Hi Wendyn,
Um....wow.
As before, make sure your inserts are properly interfaced with your shoes. If you have tried other means, and the Birks are working for you right now, stick with it.
Let me think about this a little more.
Richard, C.Ped



Re: John

john h on 7/28/00 at 18:36 (024194)

wendy: i would sure like to view your feet. they must be something to behold. what is that creature from the north called: 'Big Foot' or Sasquatch or wendy.

Re: My feet

wendyn on 7/28/00 at 18:47 (024199)

Actually, my feet look a lot better than they sound like they look. Most of the problems are not real obvious to the untrained eye. And yes, it's true....I now wear rings on my toes. I figure that if I have to spend my life in Birks - my feet should look good. When God gives you lemons......

And yes - this has freaked out my 15 year old son. Oh well, mothers are embarassing to teenagers no matter what. One day I'll show up at his school with one of those fake nose rings in.....really mess with his head.


Re: richard, cp

Rock on 7/28/00 at 10:27 (024155)

John H.,

I think a lot of have this same situation that is probably caused by putting weight on the (rigid) scar tissue that is located at the point where the plantar fascia attaches to the calcaneus (spell?) or heel bone.

I am starting to believe that there are two kinds of pain in this situation/location that are difficult to tell apart.

1. Pain due to pressure of body weight on the scar tissue.

2. Pain due to over-stretching the plantar fascia.

My theory is that while the foot is supported in orthotics in good shoes and is in full contact with the floor/ground, type 1 pain is NOT causing further injury.

By contrast pain type 2 IS causing further injury. An example of type 2 pain is the hanging the heels over the edge of the stair calf/achilles stretch.

HTH (Hope This Helps)
Rock.
TN. USA.


Re: John

Richard, C.Ped on 7/28/00 at 10:36 (024156)

Hello John,
I have patients that had the same complaints about the inserts I made them. To solve this problem, nine times out of ten, all it takes is a simple adjustment to the arch area of the orthotic. This involves grinding off a little more material. This is why I like having the patients come to my office. I am able to take a little extra material off, have them try it, and if need be, take off more until they are comfortable.
Swelling in this area is also a problem. You can not just 'force' the swollen fascia with support. Sometimes you have to take small steps (no pun intended) in orthotic treatment. If this is necessary, I do not make the patient pay for another pair of inserts. I simply add material back to the current orthotic, and go through the same steps a before.
The inserts in your athletic shoes are not supportive. Some shoes claim that they have arch support, but it is not designed to fit your foot. Check to see if your current orthotics are properly interfaced with your shoes. Two simple ways to check this are:
1. Look to see if your orthotics are 'rounded' on the bottom. Proper interfacing requires the insert to be flat.

2. With the orthotics in your shoes and on a solid surface, push in the middle of the orthotic with your index finger. If it bends or cups upwards on the sides, it is not properly interfaced. This may not work with your rigid orthotics, but give it a try anyway.

Thanks John. Let me know how things work out.
Richard, C.Ped


Re: John

john h on 7/28/00 at 10:47 (024157)

the swelling makes sense richard since wtih increased standing during the day i can clearly see swelling in the area where the fascia attaches to the heel. i now wonder when i had the orthotics made were my feet swollen or not? i purchased the Footmax which you walk across a pad with electronic sensors to establish your foot pad. we have a good local lab here with qualifed people who make orthosis and other devices. i will visit them about my Footmax. They are semi rigid and i wonder if they will have to send them back to Footmax or can they do any grinding on a semi rigid orthotic. Your metioning of swelling also would explain why (perhaps) the birkinstock sandal does not cause much of a problem. the sandal is loose and your foot can move around and is not further constricted by swelling in the arch.

Re: richard, cp

john h on 7/28/00 at 10:54 (024159)

swelling in any part of the body is usually accompanied by pain as the body is trying imobilize and protect. i have only recently payed close attention to the swelling in the arch area. it is clearly there sometimes and that is when there is the most pain. ice does bring the swelling down. there is also a nerve (baxter nerve) located directily under the fascia where the fascia attaches to the heel. dr baxter a noted surgeon thinks pf pain comes from this nerve and so states in Wheeless Book on orthopedics. Most medical people think the pain comes from the injured fascia. i tend to think the pain is from the fascia. I had a cortisone shot into this area about 2 months ago and the pain was gone for about 2 weeks. thought i was cured!

Re: John

Richard, C.Ped on 7/28/00 at 10:54 (024160)

Hey John,
In my experience, I have seen changes in patient's feet because of swelling. I do recommend to them that I make another cast of their feet when the swelling either increases or decreases. I want to make sure they get the best intimate fit of the orthotics as possible.
Do check to see if your local lab can adjust your orthotics in any way. I hope they can.
Richard, C.Ped

Re: John

wendyn on 7/28/00 at 11:35 (024163)

Richard - what's your thoughts on Birkenstocks for those of us who have not had any luck with orthotics? I have a forefoot varus, dorsal bunion (once removed) big toe, bunionettes, um pes planus, tarsal tunnel syndrome, um - what else, some PF, tibial torsion (out) on my right leg, short heel cords, some other misalignment in my feet that goes with pes planus that I can't remember. I'm 31. Ideally I should be in orthotics but in the past (even different kinds) they've made much much worse. Birkenstocks are the only think I can wear right now.

Re: John

Richard, C.Ped on 7/28/00 at 12:48 (024171)

Hi Wendyn,
Um....wow.
As before, make sure your inserts are properly interfaced with your shoes. If you have tried other means, and the Birks are working for you right now, stick with it.
Let me think about this a little more.
Richard, C.Ped



Re: John

john h on 7/28/00 at 18:36 (024194)

wendy: i would sure like to view your feet. they must be something to behold. what is that creature from the north called: 'Big Foot' or Sasquatch or wendy.

Re: My feet

wendyn on 7/28/00 at 18:47 (024199)

Actually, my feet look a lot better than they sound like they look. Most of the problems are not real obvious to the untrained eye. And yes, it's true....I now wear rings on my toes. I figure that if I have to spend my life in Birks - my feet should look good. When God gives you lemons......

And yes - this has freaked out my 15 year old son. Oh well, mothers are embarassing to teenagers no matter what. One day I'll show up at his school with one of those fake nose rings in.....really mess with his head.