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In the dumps...another failed attempt at orthodics...& general setback..

Posted by Beverly on 9/23/00 at 11:31 (028944)

You may have read a few days ago that I was trying custom orthodics again. This time, the pedorthodic person was highly reccommended by my sports med. doc. Made an appointment. He spent much time with me trying to get my temporary (and FREE) pair just right.

I pointed out that I needed something that would not push me up too high in my shoes, because I have a small dorsal bunion I don't want to irritate. 'No problem,' he said. The guy kept adjusting the fit on the temporaries until I pronounced them 'comfortable.'

But it took less than two days for the balls of my feet to hurt and for the tops of my feet (around the bunion to hurt). No, neither hurt as badly as my PF, but since I don't want to add to my problems, I switched back to my Spenco inserts. Plus, the custom orthodics only felt slightly better than my Spenco's in the heel and arch.

I don't know what to do. The temporary ones were just made out of foam.
The regular ones ($180.00) would be rigid with a soft cushioned top layer. He assures me he'll keep adjusting them until he gets them right. I'm wondering if the permnanent pair will be any different. Am I being impatient in writing this off? My toe and balls of my feet are still achey from those two days of trying the temporaries.

I'm feeling blue in general, because my a/c went out in my truck yesterday afternoon, and so I am stuck in the house all weekend. Given that I had a PF setback this week (not related to the orthodics), this is probably good for my feet but not for my state-of-mind.

Like so many of you have written, I was feeling much better last week and did just a little too much, I am paying big time now. So frustrating! I really felt like I was getting better. It was so encouraging. I felt better for about five days. It does give me hope.

While I am having a pity party, I also lost my physical therapist. She quit/taking a break. So, I have to break in a new PT. I liked my old PT so much, anyone new is going to have a hard act to follow.

I am so glad that those of you who are much better and seem to stay that way longer than a week, periodically clue us in. At six months, I feel like it has been 'forever.' I wonder when I'll get my life back.
My sports med doc is very optimistic. He says this almost always gets better but it may take another year. My new PT seemed less optimistic.

Beverly

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy S. on 9/23/00 at 12:45 (028952)

Hi Beverly, I'm sorry you're in the dumps. Sounds like a tough week you've had. Can you try to get into your usual 'Beverly's Saturday'? It sounds especially important today. . . .
Two thoughts initially came to me from reading your post:

1. Did you launch right into wearing the temporary new orthotics for hours at a time? Just about everything I read on this says you need to break them in slowly -- I think like just for an hour the first day, and then build up over the course of 1 or 2 weeks. Any new orthotic is going to change the way you walk and how your feet carry your weight, so this may be why you developed new aches and pains so quickly. I don't think I'd write them off this quickly. Maybe talk to the pedorthist, tell him what's gone on, and ask his advice?

2. I really feel for you, having lost your physical therapist. I would find that a very hard change myself after all this time and experiencing progress. The new one you've got -- I don't get an encouraging picture of her attitude (from the little I gathered from your post). I'm wondering why she would be less optimistic as to your prognosis, and express that to you, when your dr. is optimistic and, even though I know firsthand how long 6 months of PF feels, it's actually 'only' 6 months and most people still recover after a year or a year and a half, or even longer. I find my therapist's attitude vitally important. Maybe you need to find one with a more encouraging attitude before you get too deeply involved with this one? I can't see any reason for a professional to be discouraged/discouraging over your case, and at only 6 months! You have every reason to have hope! And I think it might be best to surround yourself with professionals who reinforce that.

So those are my thoughts today. Maybe this will give you more hope: I'm on day three without the aircast, still having PT, still doing the home regimen including Acu-Flex, massage, icing. And I'm walking around -- conservatively, in short spurts -- in hikers and spenco inserts (but may go for orthotics), and I feel stronger and better and am having much less pain than since this whole thing started in May '99. I'll let you know if it's still going this well after a week -- but I'm feeling very hopeful and want to pass some of this hope along to you. So here's a big handful of it just for you, Beverly. I hope you have one of those good and relaxing Beverly Saturdays for the rest of the day.
Nancy

Re: In the dumps...another failed attempt at orthodics...& general setback..

Pauline on 9/23/00 at 14:14 (028955)

Beverly,
I feel very sorry for your orthotic experience. I know how frustrated you must be. I personally have never been able to wear
orthotics with any success so I just gave up on them. I wonder
if there are just some people who can never wear them. In any case keep your chin up and continue trying the things you feel are in your best interest.

Re: In the dumps...another failed attempt at orthodics...& general setback..

salina on 9/23/00 at 17:23 (028963)

Hang in there, Beverly.
I know it is a hard thing to go through. I also keep going through highs and lows. One week I'm cooking huge meals for my family, and hanging out at the beach with just rubber sandals on, and seem to get through the days pretty good, as long as i keep icing.
Then I have days where I can't even get the kids on the school bus without the pain setting in.
Its confusing, and I haven't figured out what works yet.
But I always try to get a good laugh somehow during the hard days.
I have started watching more sitcoms (I used to be a 60min, 20/20, dateline, 48 hours, america's most wanted person), but since getting this pf, I have enough to deal with without worrying about the rest of the world. Too depressing.
So I go for comedies, especially Everyone loves Raymond.
I think they snuck in and filmed me and my husband for that show!!
And it helps us to laugh about things that relate to us.
And I find something funny about how ridiculous my life is now.
Some days it is either laugh or fall apart.
here's a good one. You stay up way past your bedtime, til exhaustion sets in real good, then you turn the tv on and watch all the channels you normally never watch because they are so stupid. At the point of exhaustion, it is all so hilarious.
The more tired I am, the sillier I get. Drives hubby crazy. Embarrasses the kids. but who cares? They aren't the ones that need it.
Just remember, you have had days where you felt better, and you will have those days again. So just hang on and win this small battle.
best wishes to you.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Laurie R on 9/23/00 at 17:24 (028965)

Dear Beverly,
My heart really goes out to you.This last past week was the week from hell for me. If it was not one thing it was another. I sure know how you are feeling. Thank God we have each other to talk to and to listen to.

Things will get better for you. Maybe your new therapist will turn out to be the best one ever. Keep your head up and things will get better.We are here for you.My very best to you Beverly. I am sending good thoughts your way for a better week. Laurie R

Re: In the dumps...another failed attempt at orthodics...& general setback..

Steve P on 9/23/00 at 17:26 (028966)

Beverly --- I think Nancy's onto something. Orthotics, I've always heard, should be broken in slowly over a period of a couple of weeks. One rule of thumb I've heard is: 1 hour the 1st day; 2 the 2nd; 3 the 3rd; etc., until you're wearing them full time. You might want to back off & give this a try.
???????

Steve

Re: In the dumps...another failed attempt at orthodics...& general setback..

john h on 9/23/00 at 18:07 (028972)

i am still of the personal opinion that far to many people are put in orthotics who should not be in them. if you have a structural problem they can correct then obviously you need them. if you have severe over pronation or suppination you perhaps need them. most of us have walked fine for most of our lives with what ever foot strike and stride we naturally have and more than likely this natural life long foot strike/stride did not cause your pf. this comes from some one who has 3 pair of custom $300 + orthosis and countless over the counter inserts. most if not all of these have not helped and in several cases make me worse. some doctors are quick to sell you orthotics the day you walk in the office. i am no expert by any means but i think orthosis is one item that is vastly overrated and over prescribed.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 19:06 (028979)

I think you stated it correctly. Let's look at it this way. Let's say that you have the perfect foot for orthosis which is sutalar joint excessive pronation. The perfect cast is made. The perfect materials are used. The proper wearing time is done. Now you must find the right shoe and make sure that you wear the orthosis, all the time. It's not like glasses in that you don't see if not wearing them. With orthosis the shoe wears out you must change the shoe. The patient needs to be followed-up for life to adjust and evaluate the foot and gait which can change in a life time. Now that's the perfect situation that should work but doesn't do to people being humans. Just think about the rest of the factors that need to work for an orthosis to work. I will try to list some of these.

1. Enough motion in the foot.
2. Enough fat padding in the foot so the orthosis doesn't aggravate the existing pain.
3. Must determine the right materials: semi- rigid, hard rigid, soft , gel . plastizole
4. Must determine the right shoe and make sure that it fits.
5. Education of what orthosis can and can't do is very difficult to do even if you have an IQ of 150.

6. Even if you have the perfect orthosis there is no perfect foot that can always jump,run, stand, and be able to withstand the constant daily pounding.

I have seen orthosis cause hammer toes and corns and callouses, due to the orthosis taking up to much room in the patients shoes.

I have seen orthosis reduce the only motion in the foot and cause back and knee and hip pain.

I have to stop because my orthosis are starting to hurt just thinking about this.

Seriously orthosis can and do help alot of people but so does rest,
and well constructed shoes.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 19:13 (028981)

stop reading newspaper. Send alot of time on yourself and your family. You are important. Sometimes the human mind tells the body to pay attention to my needs so it hurts the human body. When I feel down and everybody to some degree does. I just pay attention to myself it does seen to help . I must admit I haven't tried in on pf but why not laughter is the best medicine.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Barbara TX on 9/23/00 at 20:27 (028984)

Beverly darling, I am with you in setback city. KEEP THAT FIVE DAYS OF RECOVERY IN MIND. I had three pretty good days and I am clinging to that sweet memory. It really did happen and it will happen again - probably out of the blue, like it did for me. My DPM advised me that breaking in orthotics should be done for 15 minutes a day and LESS if they begin to hurt you. My best to you today. B.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy N on 9/23/00 at 20:30 (028985)

Dr. Z-

I posted earlier about correcting my gait, but I confess I am wondering if it is or isn't necessary. I'm worried more about the effects of the over-pronation on my left knee than I am on the foot.

Earlier this year, I decided to break down and try the expensive custom orthotics. I got them just before a trip to Florida, where I had a lot of opportunity to walk on sand, which I would think would be an ideal break-in surface. I'd had orthotics before, so I didn't really worry about break-in time, though I didn't go for broke, either. For a few days, I was fine. Then the orthotics slowly started to bother me and after my trip, I ended up with another injection and some padding to help me adjust to the new orthotics. It helped for about a week. A different pod (couldn't get in to see mine so I saw one of his partners) adjusted the orthotics and after a few days I could hardly walk. A few weeks later, I got the cast I spent two months in.

Now, I have never had any trouble with these orthotics on my left foot, which is the good one. But the right one just doesn't seem to be able to tolerate them. I went to see an orthopedic surgeon, who told me not to wear the orthotics and gave me Viscospot cushions to try instead.

Later this summer, I did try the orthotics again. For about a week, I thought I was in heaven, but then I slowly went back to where I'd been before, and eventually stopped wearing them again because they seemed to be making it worse.

Do you think there's something wrong with the orthotics, or am I just not able to tolerate them? The ones I have are quite hard, so I don't know if another type might help. I've seen something called ArchMates in catalogs for about $10, and have been tempted to try them and see if they help since they're not so hard.

I appreciate any suggestions you might have. Thanks!

Re: In the dumps...another failed attempt at orthodics...& general setback..

Beverly on 9/23/00 at 20:47 (028987)

Thank you for all your wonderful posts. You all always know how to cheer me up.

Dr. Z., what you wrote makes alot of sense, and thank you for going into such detail. If am understanding you correctly, you are saying that custom orthodics are not neccessarily a required ingredient in treating chronic PF? After trying so many different kinds, the otc Spenco's truely came closer to being comfortable than any of the other ones I've tried... not a perfect solution, but better than the rest.
The otc inserts are mostly thin. The custom orthodics are thicker.
They just push me up too high in my shoes. The only way I can see a custom orthodic working for me is if I could have some as thin as my Spencos or have specially made shoes extra depth shoes.

I was feeling very very low today until I remembered that my worst foot, the left foot, is the 'fresher' injury (May 2000). I hurt my right foot in March 2000. It is not nearly as bad as the left foot.
That gives me a ray of hope that the newer injury has not caught up with the first injury. And I did have those few days last week when I was feeling a good bit better.

Yes, Nancy, I had a 'Beverly Saturday.' Since my a/c in my truck is out, I am having that all weekend. It is very hot down here in Texas.

Salina, I think you were the one who wrote about watching more TV. I have watched more TV in the last six months than I have in years! I've developed a real yen for the TV shows of my youth... the Nick at Nite stuff. And I thank God I am a bookworm. By the way, how is your foot feeling after the cortizone shot? I know you felt bad a few days ago, but do you see any benefits from the shot yet?

I see my sports med doc on Tuesday. So, I will get his Two cents on this orthodics issue. In his PF video, he says he thinks otc are often just as good. But in person, he encouraged me to try the custom ones.
At any rate, the night splint is now the next thing on my list, and I know I will have to be patient in giving it a breaking in period.
And I am working hard at loosing weight (trying to go from size 14 down to 10) in hopes that helps my foot.
Thanks for all your support,
Beverly

PS: An old friend who is almost 50 and has Chronic Fatigue/FM just got married last week and is now on a honeymoon in Hawaii. This both depressed me and cheered me up. I guess if someone with Chronic Fatigue/FM could meet someone and get remarried, there is hope for us single folks with PF too.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy S. on 9/23/00 at 22:39 (028994)

Beverly, I'm interested in Dr. Z's response to your orthotics question too. Although I suggested you give yours more of a try, that was sort of on general principle. I had no luck with my one $300 pair, but then I thought it might be because I was simply casted in the pod's office and they were sent out to be made. Also, they are rock-hard rigid plastic ones -- my current sports med. doc doesn't think highly of them one bit.
I tried lots of otc inserts but nothing helped more than temporarily.
THEN my PT gave me a pair of Spencos when I first started with her. At the time I took the box home and tossed it in the closet with the rest of them! But when I got the aircast and had to wear a hiking boot on the other foot, I started wearing the Spencos -- in both the cast and the hiking boot. Now that I'm just in the hikers, I have the Spencos in there, and I'll be darned, so far so good. I think they're more comfortable than any of the others -- so far. Maybe because of the placement of the arch in them and that the arch isn't too high? The arch seems a little more to the inside than in other otc inserts, and slightly farther back toward the heel. Do they feel this way to you? Anyway, they seem to hit me right. And like you say, they don't smush your foot into the top of the shoe. Ok, just listening to you and now writing back, I'm almost talking myself into not putting another pair of customs on the credit card!
Nancy

Re: A "Merry Christmas" to "ya'all"

wendyn on 9/23/00 at 23:07 (028997)

Beverly - I am sorry to hear about your orthotic problem. I really need to wear orthotics too and I just haven't found a pair I can tolerate either, so I understand your frustration. I did try on some pairs of 'real' shoes and boots at the mall today, but I couldn't find anything that felt right. Plus, I was at an outlet store and I found out that everything there is a final sale. Way too much of a risk with my feet - so I left without buying anything.

On a different note...

You complain about your air conditioning going on your truck?


Well.

We had our first snow this week. It was accompanied with a good killing frost, winter is just around the corner.

I would not miss my a/c now!

I had to dig out the ski jackets and buy my youngest some warm gloves and mittens today. I think I would much prefer some balmy weather. I guess the grass IS always greener......

On the upside, I did a Home Depot/Wall Mart/Mall/Shoe shopping/clean out my pantry/make a real dinner day. And I still feel pretty good. The trying on shoes was the worst part, and I suspect if anything aggravated my feet at all - that was it. Unfortunately, I REALLY need to find real shoes - Birks are just not great on ice (no traction at all) and I don't think I'll make it through another winter with just them. Last winter we didn't have as much snow as we usually do, I don't think I'll get away with it two years in a row.

All the shoes and hiking boots I tried on just didn't feel like there was enough support. I think I will bring my Birks insert next time and see if that helps.

Re: Birk Boots

Barbara TX on 9/23/00 at 23:17 (029000)

Wendy - I was snooping around at the Nordstroms site looking for Birks and I saw that in the men's shoe section they had cool Birk boots. I thought they would be really great for winter... not sure if your feet are tiny or large, but i can get away with buying men's shoes sometimes. You might check them out. A frost sounds HEAVENLY to me. Down here it's still in the 90's, and we've been 80+ days without any rain. B.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 23:23 (029003)

Could be too much reduction in pronation in the left orthosis. It is important to remember that its excessive or over pronation that is bad. It the orthosis takes out too much pronation the foot won't functin correctly in the gait cycle and then the pain will come. It is important that the podiatrist watch you walk with orthosis and then without orthosis to see what exactly is happening with the present correction. It sounds like to much reduction in over-pronation is the problem.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 23:25 (029004)

This is correct not every pf needs custom orthosis. The most important evalutaion for determine whether some one might need orthosis is a complete biomechanical examination with the most immportant part of the examination being a gait cycle analysis. (watch the patient walk)

Re: A "Merry Christmas" to "ya'all"

Dr. Zuckerman on 9/23/00 at 23:27 (029005)

Where is this snow ??? I love the snow. For wrong reason i though you were part of the state of Texas.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy N on 9/24/00 at 09:18 (029011)

Dr. Z--

I understand what you're saying, except that the left foot, which indeed is the over-pronator, is the one that is fine with the orthotics. The right foot, which walks normally, is the one that doesn't seem to tolerate the orthotics. It actually feels like the arch is too high, but when I was given the injection to help adjust to the orthotics, everything felt fine until the injection wore off, so I don't know what to think. Any other ideas? Thanks much for your input.

Re: Birk Boots

wendyn on 9/24/00 at 09:49 (029014)

Thanks Barbara, I don't know if I could wear men's or not. My foot is a 6 or 6 1/2 with a really narrow heel. I really should go down to our local Birk store and try on some big ugly boots. My fashion sense has gone out the window since I really hurt my feet and started living in Birks...but I was hoping to avoid big ugly boots too. I think the Birk boots/shoes are a couple hundred bucks a pair.

It's warmed up here a bit yesterday and today, and it's a little more fall like. All our trees are turning yellow and the leaves have been dropping for about 2 weeks now. It's sunny and warm today, but that could change again over night. Lots of snow in the mountains though....

Re: A "Merry Christmas" to "ya'all"

wendyn on 9/24/00 at 09:51 (029015)

What do you mean 'for the wrong reason' - was it my southern accent? Dr Z I am in Calgary Alberta Canada - we had snow this week. It's melted now and warmed up a bit - but all the flowers are DEAD and the leaves are yellow. The mountains near here are full of snow.

The only consolation is maybe my feet will be well enough to ski a bit this year.....

Re: Birk Boots

john h on 9/24/00 at 11:34 (029026)

i was always attracted to girls in big ugly boots since that is all that was available in thule, greenland.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Barbara TX on 9/24/00 at 21:48 (029081)

Could you just wear orthosis on the overpronating foot and leave the good foot alone? Might ask the Docs about that one... B.

Re: In the dumps...another failed attempt at orthodics...& general setback..

davidb on 9/25/00 at 09:01 (029097)

I have found that my orthotics fit best in the so-called 'extra depth' shoes made by P.W. Minor. I believe Drew shoe company also makes deep depth shoes. I've had several different kinds of orthotics--ranging from thick soft ones to semi-rigid ones and always have had plenty of room in the shoes. Unfortunately, most shoe stores do not carry those brands, so you'll have to go to a store that specializes in orthopedic shoes. That really isn't that bad, since most of those stores also have people who can help with the orthotics and know how to fit people with the proper shoes.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy N on 9/25/00 at 10:34 (029101)

Well...not really, since the overpronator is currently feeling OK, and the 'normal' one is my PF problem child. I know this sounds backwards, but that's the way it is. When I first got PF three years ago, it started in the left foot, but that one healed a few years ago and is fine now. The right one, which walks normally, is now in a lot of pain.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy S. on 9/23/00 at 12:45 (028952)

Hi Beverly, I'm sorry you're in the dumps. Sounds like a tough week you've had. Can you try to get into your usual 'Beverly's Saturday'? It sounds especially important today. . . .
Two thoughts initially came to me from reading your post:

1. Did you launch right into wearing the temporary new orthotics for hours at a time? Just about everything I read on this says you need to break them in slowly -- I think like just for an hour the first day, and then build up over the course of 1 or 2 weeks. Any new orthotic is going to change the way you walk and how your feet carry your weight, so this may be why you developed new aches and pains so quickly. I don't think I'd write them off this quickly. Maybe talk to the pedorthist, tell him what's gone on, and ask his advice?

2. I really feel for you, having lost your physical therapist. I would find that a very hard change myself after all this time and experiencing progress. The new one you've got -- I don't get an encouraging picture of her attitude (from the little I gathered from your post). I'm wondering why she would be less optimistic as to your prognosis, and express that to you, when your dr. is optimistic and, even though I know firsthand how long 6 months of PF feels, it's actually 'only' 6 months and most people still recover after a year or a year and a half, or even longer. I find my therapist's attitude vitally important. Maybe you need to find one with a more encouraging attitude before you get too deeply involved with this one? I can't see any reason for a professional to be discouraged/discouraging over your case, and at only 6 months! You have every reason to have hope! And I think it might be best to surround yourself with professionals who reinforce that.

So those are my thoughts today. Maybe this will give you more hope: I'm on day three without the aircast, still having PT, still doing the home regimen including Acu-Flex, massage, icing. And I'm walking around -- conservatively, in short spurts -- in hikers and spenco inserts (but may go for orthotics), and I feel stronger and better and am having much less pain than since this whole thing started in May '99. I'll let you know if it's still going this well after a week -- but I'm feeling very hopeful and want to pass some of this hope along to you. So here's a big handful of it just for you, Beverly. I hope you have one of those good and relaxing Beverly Saturdays for the rest of the day.
Nancy

Re: In the dumps...another failed attempt at orthodics...& general setback..

Pauline on 9/23/00 at 14:14 (028955)

Beverly,
I feel very sorry for your orthotic experience. I know how frustrated you must be. I personally have never been able to wear
orthotics with any success so I just gave up on them. I wonder
if there are just some people who can never wear them. In any case keep your chin up and continue trying the things you feel are in your best interest.

Re: In the dumps...another failed attempt at orthodics...& general setback..

salina on 9/23/00 at 17:23 (028963)

Hang in there, Beverly.
I know it is a hard thing to go through. I also keep going through highs and lows. One week I'm cooking huge meals for my family, and hanging out at the beach with just rubber sandals on, and seem to get through the days pretty good, as long as i keep icing.
Then I have days where I can't even get the kids on the school bus without the pain setting in.
Its confusing, and I haven't figured out what works yet.
But I always try to get a good laugh somehow during the hard days.
I have started watching more sitcoms (I used to be a 60min, 20/20, dateline, 48 hours, america's most wanted person), but since getting this pf, I have enough to deal with without worrying about the rest of the world. Too depressing.
So I go for comedies, especially Everyone loves Raymond.
I think they snuck in and filmed me and my husband for that show!!
And it helps us to laugh about things that relate to us.
And I find something funny about how ridiculous my life is now.
Some days it is either laugh or fall apart.
here's a good one. You stay up way past your bedtime, til exhaustion sets in real good, then you turn the tv on and watch all the channels you normally never watch because they are so stupid. At the point of exhaustion, it is all so hilarious.
The more tired I am, the sillier I get. Drives hubby crazy. Embarrasses the kids. but who cares? They aren't the ones that need it.
Just remember, you have had days where you felt better, and you will have those days again. So just hang on and win this small battle.
best wishes to you.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Laurie R on 9/23/00 at 17:24 (028965)

Dear Beverly,
My heart really goes out to you.This last past week was the week from hell for me. If it was not one thing it was another. I sure know how you are feeling. Thank God we have each other to talk to and to listen to.

Things will get better for you. Maybe your new therapist will turn out to be the best one ever. Keep your head up and things will get better.We are here for you.My very best to you Beverly. I am sending good thoughts your way for a better week. Laurie R

Re: In the dumps...another failed attempt at orthodics...& general setback..

Steve P on 9/23/00 at 17:26 (028966)

Beverly --- I think Nancy's onto something. Orthotics, I've always heard, should be broken in slowly over a period of a couple of weeks. One rule of thumb I've heard is: 1 hour the 1st day; 2 the 2nd; 3 the 3rd; etc., until you're wearing them full time. You might want to back off & give this a try.
???????

Steve

Re: In the dumps...another failed attempt at orthodics...& general setback..

john h on 9/23/00 at 18:07 (028972)

i am still of the personal opinion that far to many people are put in orthotics who should not be in them. if you have a structural problem they can correct then obviously you need them. if you have severe over pronation or suppination you perhaps need them. most of us have walked fine for most of our lives with what ever foot strike and stride we naturally have and more than likely this natural life long foot strike/stride did not cause your pf. this comes from some one who has 3 pair of custom $300 + orthosis and countless over the counter inserts. most if not all of these have not helped and in several cases make me worse. some doctors are quick to sell you orthotics the day you walk in the office. i am no expert by any means but i think orthosis is one item that is vastly overrated and over prescribed.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 19:06 (028979)

I think you stated it correctly. Let's look at it this way. Let's say that you have the perfect foot for orthosis which is sutalar joint excessive pronation. The perfect cast is made. The perfect materials are used. The proper wearing time is done. Now you must find the right shoe and make sure that you wear the orthosis, all the time. It's not like glasses in that you don't see if not wearing them. With orthosis the shoe wears out you must change the shoe. The patient needs to be followed-up for life to adjust and evaluate the foot and gait which can change in a life time. Now that's the perfect situation that should work but doesn't do to people being humans. Just think about the rest of the factors that need to work for an orthosis to work. I will try to list some of these.

1. Enough motion in the foot.
2. Enough fat padding in the foot so the orthosis doesn't aggravate the existing pain.
3. Must determine the right materials: semi- rigid, hard rigid, soft , gel . plastizole
4. Must determine the right shoe and make sure that it fits.
5. Education of what orthosis can and can't do is very difficult to do even if you have an IQ of 150.

6. Even if you have the perfect orthosis there is no perfect foot that can always jump,run, stand, and be able to withstand the constant daily pounding.

I have seen orthosis cause hammer toes and corns and callouses, due to the orthosis taking up to much room in the patients shoes.

I have seen orthosis reduce the only motion in the foot and cause back and knee and hip pain.

I have to stop because my orthosis are starting to hurt just thinking about this.

Seriously orthosis can and do help alot of people but so does rest,
and well constructed shoes.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 19:13 (028981)

stop reading newspaper. Send alot of time on yourself and your family. You are important. Sometimes the human mind tells the body to pay attention to my needs so it hurts the human body. When I feel down and everybody to some degree does. I just pay attention to myself it does seen to help . I must admit I haven't tried in on pf but why not laughter is the best medicine.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Barbara TX on 9/23/00 at 20:27 (028984)

Beverly darling, I am with you in setback city. KEEP THAT FIVE DAYS OF RECOVERY IN MIND. I had three pretty good days and I am clinging to that sweet memory. It really did happen and it will happen again - probably out of the blue, like it did for me. My DPM advised me that breaking in orthotics should be done for 15 minutes a day and LESS if they begin to hurt you. My best to you today. B.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy N on 9/23/00 at 20:30 (028985)

Dr. Z-

I posted earlier about correcting my gait, but I confess I am wondering if it is or isn't necessary. I'm worried more about the effects of the over-pronation on my left knee than I am on the foot.

Earlier this year, I decided to break down and try the expensive custom orthotics. I got them just before a trip to Florida, where I had a lot of opportunity to walk on sand, which I would think would be an ideal break-in surface. I'd had orthotics before, so I didn't really worry about break-in time, though I didn't go for broke, either. For a few days, I was fine. Then the orthotics slowly started to bother me and after my trip, I ended up with another injection and some padding to help me adjust to the new orthotics. It helped for about a week. A different pod (couldn't get in to see mine so I saw one of his partners) adjusted the orthotics and after a few days I could hardly walk. A few weeks later, I got the cast I spent two months in.

Now, I have never had any trouble with these orthotics on my left foot, which is the good one. But the right one just doesn't seem to be able to tolerate them. I went to see an orthopedic surgeon, who told me not to wear the orthotics and gave me Viscospot cushions to try instead.

Later this summer, I did try the orthotics again. For about a week, I thought I was in heaven, but then I slowly went back to where I'd been before, and eventually stopped wearing them again because they seemed to be making it worse.

Do you think there's something wrong with the orthotics, or am I just not able to tolerate them? The ones I have are quite hard, so I don't know if another type might help. I've seen something called ArchMates in catalogs for about $10, and have been tempted to try them and see if they help since they're not so hard.

I appreciate any suggestions you might have. Thanks!

Re: In the dumps...another failed attempt at orthodics...& general setback..

Beverly on 9/23/00 at 20:47 (028987)

Thank you for all your wonderful posts. You all always know how to cheer me up.

Dr. Z., what you wrote makes alot of sense, and thank you for going into such detail. If am understanding you correctly, you are saying that custom orthodics are not neccessarily a required ingredient in treating chronic PF? After trying so many different kinds, the otc Spenco's truely came closer to being comfortable than any of the other ones I've tried... not a perfect solution, but better than the rest.
The otc inserts are mostly thin. The custom orthodics are thicker.
They just push me up too high in my shoes. The only way I can see a custom orthodic working for me is if I could have some as thin as my Spencos or have specially made shoes extra depth shoes.

I was feeling very very low today until I remembered that my worst foot, the left foot, is the 'fresher' injury (May 2000). I hurt my right foot in March 2000. It is not nearly as bad as the left foot.
That gives me a ray of hope that the newer injury has not caught up with the first injury. And I did have those few days last week when I was feeling a good bit better.

Yes, Nancy, I had a 'Beverly Saturday.' Since my a/c in my truck is out, I am having that all weekend. It is very hot down here in Texas.

Salina, I think you were the one who wrote about watching more TV. I have watched more TV in the last six months than I have in years! I've developed a real yen for the TV shows of my youth... the Nick at Nite stuff. And I thank God I am a bookworm. By the way, how is your foot feeling after the cortizone shot? I know you felt bad a few days ago, but do you see any benefits from the shot yet?

I see my sports med doc on Tuesday. So, I will get his Two cents on this orthodics issue. In his PF video, he says he thinks otc are often just as good. But in person, he encouraged me to try the custom ones.
At any rate, the night splint is now the next thing on my list, and I know I will have to be patient in giving it a breaking in period.
And I am working hard at loosing weight (trying to go from size 14 down to 10) in hopes that helps my foot.
Thanks for all your support,
Beverly

PS: An old friend who is almost 50 and has Chronic Fatigue/FM just got married last week and is now on a honeymoon in Hawaii. This both depressed me and cheered me up. I guess if someone with Chronic Fatigue/FM could meet someone and get remarried, there is hope for us single folks with PF too.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy S. on 9/23/00 at 22:39 (028994)

Beverly, I'm interested in Dr. Z's response to your orthotics question too. Although I suggested you give yours more of a try, that was sort of on general principle. I had no luck with my one $300 pair, but then I thought it might be because I was simply casted in the pod's office and they were sent out to be made. Also, they are rock-hard rigid plastic ones -- my current sports med. doc doesn't think highly of them one bit.
I tried lots of otc inserts but nothing helped more than temporarily.
THEN my PT gave me a pair of Spencos when I first started with her. At the time I took the box home and tossed it in the closet with the rest of them! But when I got the aircast and had to wear a hiking boot on the other foot, I started wearing the Spencos -- in both the cast and the hiking boot. Now that I'm just in the hikers, I have the Spencos in there, and I'll be darned, so far so good. I think they're more comfortable than any of the others -- so far. Maybe because of the placement of the arch in them and that the arch isn't too high? The arch seems a little more to the inside than in other otc inserts, and slightly farther back toward the heel. Do they feel this way to you? Anyway, they seem to hit me right. And like you say, they don't smush your foot into the top of the shoe. Ok, just listening to you and now writing back, I'm almost talking myself into not putting another pair of customs on the credit card!
Nancy

Re: A "Merry Christmas" to "ya'all"

wendyn on 9/23/00 at 23:07 (028997)

Beverly - I am sorry to hear about your orthotic problem. I really need to wear orthotics too and I just haven't found a pair I can tolerate either, so I understand your frustration. I did try on some pairs of 'real' shoes and boots at the mall today, but I couldn't find anything that felt right. Plus, I was at an outlet store and I found out that everything there is a final sale. Way too much of a risk with my feet - so I left without buying anything.

On a different note...

You complain about your air conditioning going on your truck?


Well.

We had our first snow this week. It was accompanied with a good killing frost, winter is just around the corner.

I would not miss my a/c now!

I had to dig out the ski jackets and buy my youngest some warm gloves and mittens today. I think I would much prefer some balmy weather. I guess the grass IS always greener......

On the upside, I did a Home Depot/Wall Mart/Mall/Shoe shopping/clean out my pantry/make a real dinner day. And I still feel pretty good. The trying on shoes was the worst part, and I suspect if anything aggravated my feet at all - that was it. Unfortunately, I REALLY need to find real shoes - Birks are just not great on ice (no traction at all) and I don't think I'll make it through another winter with just them. Last winter we didn't have as much snow as we usually do, I don't think I'll get away with it two years in a row.

All the shoes and hiking boots I tried on just didn't feel like there was enough support. I think I will bring my Birks insert next time and see if that helps.

Re: Birk Boots

Barbara TX on 9/23/00 at 23:17 (029000)

Wendy - I was snooping around at the Nordstroms site looking for Birks and I saw that in the men's shoe section they had cool Birk boots. I thought they would be really great for winter... not sure if your feet are tiny or large, but i can get away with buying men's shoes sometimes. You might check them out. A frost sounds HEAVENLY to me. Down here it's still in the 90's, and we've been 80+ days without any rain. B.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 23:23 (029003)

Could be too much reduction in pronation in the left orthosis. It is important to remember that its excessive or over pronation that is bad. It the orthosis takes out too much pronation the foot won't functin correctly in the gait cycle and then the pain will come. It is important that the podiatrist watch you walk with orthosis and then without orthosis to see what exactly is happening with the present correction. It sounds like to much reduction in over-pronation is the problem.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Dr. Zuckerman on 9/23/00 at 23:25 (029004)

This is correct not every pf needs custom orthosis. The most important evalutaion for determine whether some one might need orthosis is a complete biomechanical examination with the most immportant part of the examination being a gait cycle analysis. (watch the patient walk)

Re: A "Merry Christmas" to "ya'all"

Dr. Zuckerman on 9/23/00 at 23:27 (029005)

Where is this snow ??? I love the snow. For wrong reason i though you were part of the state of Texas.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy N on 9/24/00 at 09:18 (029011)

Dr. Z--

I understand what you're saying, except that the left foot, which indeed is the over-pronator, is the one that is fine with the orthotics. The right foot, which walks normally, is the one that doesn't seem to tolerate the orthotics. It actually feels like the arch is too high, but when I was given the injection to help adjust to the orthotics, everything felt fine until the injection wore off, so I don't know what to think. Any other ideas? Thanks much for your input.

Re: Birk Boots

wendyn on 9/24/00 at 09:49 (029014)

Thanks Barbara, I don't know if I could wear men's or not. My foot is a 6 or 6 1/2 with a really narrow heel. I really should go down to our local Birk store and try on some big ugly boots. My fashion sense has gone out the window since I really hurt my feet and started living in Birks...but I was hoping to avoid big ugly boots too. I think the Birk boots/shoes are a couple hundred bucks a pair.

It's warmed up here a bit yesterday and today, and it's a little more fall like. All our trees are turning yellow and the leaves have been dropping for about 2 weeks now. It's sunny and warm today, but that could change again over night. Lots of snow in the mountains though....

Re: A "Merry Christmas" to "ya'all"

wendyn on 9/24/00 at 09:51 (029015)

What do you mean 'for the wrong reason' - was it my southern accent? Dr Z I am in Calgary Alberta Canada - we had snow this week. It's melted now and warmed up a bit - but all the flowers are DEAD and the leaves are yellow. The mountains near here are full of snow.

The only consolation is maybe my feet will be well enough to ski a bit this year.....

Re: Birk Boots

john h on 9/24/00 at 11:34 (029026)

i was always attracted to girls in big ugly boots since that is all that was available in thule, greenland.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Barbara TX on 9/24/00 at 21:48 (029081)

Could you just wear orthosis on the overpronating foot and leave the good foot alone? Might ask the Docs about that one... B.

Re: In the dumps...another failed attempt at orthodics...& general setback..

davidb on 9/25/00 at 09:01 (029097)

I have found that my orthotics fit best in the so-called 'extra depth' shoes made by P.W. Minor. I believe Drew shoe company also makes deep depth shoes. I've had several different kinds of orthotics--ranging from thick soft ones to semi-rigid ones and always have had plenty of room in the shoes. Unfortunately, most shoe stores do not carry those brands, so you'll have to go to a store that specializes in orthopedic shoes. That really isn't that bad, since most of those stores also have people who can help with the orthotics and know how to fit people with the proper shoes.

Re: In the dumps...another failed attempt at orthodics...& general setback..

Nancy N on 9/25/00 at 10:34 (029101)

Well...not really, since the overpronator is currently feeling OK, and the 'normal' one is my PF problem child. I know this sounds backwards, but that's the way it is. When I first got PF three years ago, it started in the left foot, but that one healed a few years ago and is fine now. The right one, which walks normally, is now in a lot of pain.