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Beverly and Barbara TX

Posted by Richard, C.Ped on 10/26/00 at 07:34 (031314)

I saw your comments about the orthotics making your feet feel tight in your shoes. I have a non sarcastic question: did you remove the original inserts from the shoes? If so, have you asked whoever made the orthotics if they can be adjusted and interfaced with the shoes? Extra Depth can apply to many shoes. The name comes from the P.W. Minor shoe company. I left a post the other day about New Balance. I wear full length orthotics myself and they fit fine in the New Balance. I made the shell of the orthotics using 1/8' EVA, so it will fit in most of my shoes. For shoes that do not have depth in the toe box, I 'shave' the toe area of the orthotics thiner to allow room for the toes in the shoe. You may want to consider asking someone to do this for you. It works, and it will not have a negative effect on the orthotics. You still receive the support you
need (if the inserts are made correctly (you know I had to throw that in)) in the area you need it.
Richard, C.Ped

Re: Beverly and Barbara TX

Barbara TX on 10/26/00 at 10:49 (031330)

Pedorthodude... Yes, I have removed the insert, and the heel doesn't fit and scrapes the sides of the shoes. Can an orthosis be scraped down at the heel, and with what? Also, my little arch-killers seem too arched for my bad foot. They are hard plastic with a foam & plastic insole cover. I have even thought of melting them in the microwave and then slipping on a pair of thick socks to remold them. Why not? The fumes may have an anti-inflammatory effect. I was not 'fitted' for them. I was simply given them and told to have a nice day. I have long ago dumped that DPM, and I know better now.

I will check out the NB shoes. Perhaps they will be wide enough to accomodate me. It is worth a try anyway.

I was also wondering if you might give us the site to find certified pedorthodudes throughout the country. I clicked on the link you posted last time and couldn't get through, and now I have lost the link and have had trouble searching for it. If you have it handy I would appreciate it. Maybe a pedorthodude could help me modify my inserts from hell. Many thanks, B.

Re: Beverly and Barbara TX

Richard, C.Ped on 10/26/00 at 11:24 (031333)

Messageboarddudette: Customer service.....I'll tell ya.....it is not that hard to do. What are people thinking these days??? Anyway, the inserts were not fitted to you...right? Well, I recommend you have another pair made or have these modified to fit your shoes. To find a C.Ped in your area, just type in a search for 'Board for Certification in Pedorthics'. I use MSN search. I think the link reads 'locate a C.Ped'. I just tested it for Texas, and it listed 57 C.Peds. I don't know your town, but you can type in your city and/or zip code, and it will list everyone in that area. Come to South Carolina. The temperature right now is the low 70's and sunny. I have the front and back doors open in the office. If not for the occasional fly buzzing around, the breeze is wonderful. I do not recommend using the microwave. Subtalor neutral cannot be established, which will not give you proper support. The fumes may give you the much needed anti-inflammatory effect only because it may give you an anti-respiration effect. We don't want that. It would not be a good thing (my Martha Stewart impression) :-)
If a customer came to me with a situation such as yours, the first thing I would need is a prescription. CYA, ya know??!! Anyway, what I would do is add 1/2' 40-60 durometer EVA (depending on how sensitive your feet are) to the bottom of your current insoles. I would then grind the bottom flat (we all know why....don't we?), then take the original inserts and match the bottom of the 'custom' to the original. I would trace and grind off the 'overlap' of the 'custom' until they fit inside the shoes. That is what I would do. There may be a better idea out there somewhere. Good luck!!! If you speak with someone and receive information that you think is questionable, please do not hesitiate to ask me. I will try to help as much as I can.
C.Ped Rich (AKA: Pedorthodude)
P.S. DON'T MESS WITH TEXAS!! :-)

Re: Beverly and Barbara TX

john a on 10/26/00 at 14:08 (031357)

I will never understand why you pedorthists insist on perscriptions from people (most pods) who probably know less about how to fix foot problems than you guys. CYA, maybe. But it's a darn nuisance to patients, IMHO.

Re: Beverly and Barbara TX

salina on 10/26/00 at 15:29 (031365)

When I was given my orthotics, I asked about shoes, etc.
And was really given no guidance. I kept thinking that was weird.
He just said, take the orthotics with me whenever I go buy new shoes, to make sure they fit in there. I took the original inserts out before putting the orthotics in. But it still feels like I am busting out of my shoes.
It seems like with orthotics costing so much anyway, you should also get a pair of shoes that were made just for you, that go with the orthotics.

Re: Re:

Richard, C.Ped on 10/26/00 at 15:45 (031367)

Prescriptions are a necessity to have the orthotics and or shoes covered by insurance companies. Granted, there are medical professionals out there who do not know much about foot care. I don't know about your town, but I work closely with wonderful physicians ranging from DPMs,orthopaedic surgeons, to family practice. Pedorthists are not physicians. We are not allowed to diagnose. If I were to make custom orthotics for someone with a diagnosable condition, I could get in a heck of a lot of trouble with the Pedorthic Footwear Association as well as lose my certification to practice pedorthics. If I did this, I would be diagnosing and treating the condition. It would be the same as a pharmacist selling medications to a sick person without an RX. I understand that it can be a 'darn nuisance', but I see this as secondary to losing a business and livelyhood in which I have worked very hard to maintain. Trust me, I care very deeply about my patients. I have tried to work with those who come to me off the street by calling their physician and giving them my recomendation of what type or orthotics they need. It ends up the same way every time. The physician wants to see the patient first. Again, insurance companies need the RX to cover the work done. To get the best care, this is the way to go. That is my opinion, and I am sticking to it. Sorry, I don't know what IMHO means.
Richard

Re: John

Nancy N on 10/26/00 at 15:54 (031372)

Richard--

IMHO means 'In My Humble Opinion.' :)

Nancy

Re: John

john a on 10/26/00 at 15:54 (031373)

IMHO = 'In My Humble Opinion'. I do appreciate that you are forced to get prescriptions from your customers by your profession, but I still think the policy, however well-intentioned, has gone awry. Orthotics are not medications. We go to the store and buy footwear that harms us all the time. Having a pedorthist custom-make something can only be better for us. IMHO, of course :-)

Re: Beverly and Barbara TX

Beverly on 10/26/00 at 15:54 (031374)

Orthodicdude,

With my first set of orthodics I was given no guidance on shoes. They were made by my pod - 3/4 ... soft style. Not knowing enough and getting bad information from the pod's secretary, I tried them with the inserts, placing the orthodics in the shoes. I did have the good sense to go up a size in athletic shoes. However, this ended up giving me a small dorsal bunion. And even after having them adjusted, the orthodics did me no good. I wore them for about a month. Later, I tried them without the inserts, but I still felt too high up in the shoe.

The second set made many months later and with me alot more informed were made by an orthodic dude such as yourself. He worked and worked to get them thin enough for me to tolerate them on the tops of my feet. This set was full length. New Balance does not agree with me, but I have a pair of Brooks Beast that are very roomy in the toe box. Even the Brooks with the orthodic sans shoe insert, pushed me up too high in my shoes and within two days, I saw it was irriating my tiny bunion I hope to keep tiny.

I have concluded that orthodics might work for me if I had some extra depth shoes like the PW Minors. As expensive as orthodics are, the one thing I did right this time was go with a temporary set first. The temps were free. If I ever found something that works, I would gladly spend the money.

Thanks for asking,
Beverly

Re: John

Richard, C.Ped on 10/26/00 at 16:02 (031375)

Thanx for the IMHO information. I thought you were cursing me out or something.:-) I understand your frustration, and looking back at my reply, I hope I was not offensive to you in any way. Orthotics, to me, are similar to medications. They can reduce pain, and help heal. This day and age, the way the world is going, CYA is the best way to describe it. I do not want anyone suing me for malpractice. I am made to carry malpractice insurance for that purpose.
Richard

Re: Beverly and Barbara TX

Richard, C.Ped on 10/26/00 at 16:12 (031378)

Sorry about all the trouble you are having. PW is a great shoe company. Other vendors which I am very happy with are Drew and Apex.
They both have wonderful as well as comfortable casual and dress shoes. I have two pair of Drew dress shoes myself. PW has this shoe called 'Heidi'. I like this shoe because it agrees with hammertoes, mallet toes as well as bunions. This is a shoe I would recommend to your physician. Reason being: the upper of the shoe (the area leading from the bottom laces to the toe) stretches to accomodate these conditions. PW calls the material 'Xsensible'. I have never tried to look up PW on the web, so I do not know if they have pictures, let alone, a web site. You may want to give it a try. I like these shoes so much, I do not have a problem putting them on my diabetic patients.
Good luck!
Richard

Re: John

john a on 10/26/00 at 16:13 (031380)

Don't worry Richard, I still think you are a Class Act.

Re: John

Nancy S. on 10/26/00 at 16:24 (031382)

Having just been to an orthotist today, I have to agree with Richard, John. Aside from the malpractice possibilities, a diagnosis from a doctor just makes sense and gives the orthotics-maker firmer info. to go on. Anyone can walk in off the street and say 'I think I have a heel spur' or something, but a written diagnosis from a doc gives the pedorthist or orthotist a big headstart. From reading the script, the orthotist today was able to plunge right in and maneuver my feet around and find the pain easily. The script also gave him a clue about how much support I need -- what materials to use, etc. If I had walked in not knowing that I have tendonitis on top of PF, the orthotist might have missed out on important info. for the structure of my orthotics.
I suppose you could leave it to the pedorthist/orthotist to diagnose everything, IF it were legal, but then you'd be paying for that schooling and experience and responsibility there instead of at the doctor's office. It's a wash, I think. Plus the doctor's script is based on weeks or months of following your case -- I don't think I'd want orthotics made from a onetime, on-the-spot diagnosis.
Nancy

Re: To Richard. Shoe question

Beverly on 10/26/00 at 22:30 (031419)

Thanks Richard for the extra-depth shoe suggestions. Do they have a firm footbed? I have done best with a Birk Arizona sandal, the Brooks Beast running shoe which has a really builtup heel/very firm shank,
and the Dansko Meta sandal. What they all have in common is a 'firm' feeling. And they all have a fairly high arch. I usually wear a Spenco orthodic arch style otc insert in the athletic shoe.

I think I could wear an orthodic if I could just find the shoe that does not rub the tops of my feet. The irony is that I have a fairly narrow foot. Mid-way between an A and a B width. But since hurting my feet, I don't like anything to feel tight.

Thanks,
Beverly

Re: John

Julie F on 10/27/00 at 02:13 (031423)

Hi John

I don't think it's the same thing at all. A health professional is in a position of trust, and is explicitly or implicitly claiming to be qualified and able to help and heal. He has to justify that trust and show himself worthy of making that claim by, amongst other things, sticking to the rules of his profession. In contrast, the shoe store salesman hasn't set himself up as someone who can help. He's just selling shoes. We go to the supermarket too, and buy and eat food all the time that harms us, but the supermarket manager hasn't set himself up as someone whose products can cure our ills, he's just selling food. When we buy something OTC we take our chances in the market.I don't think I'd like to see orthoses in that category.

Re: John

Richard, C.Ped on 10/27/00 at 07:55 (031433)

You seem pretty cool as well, mug shot and all. :-)
Richard

Re: To Richard. Shoe question

Richard, C.Ped on 10/27/00 at 08:16 (031435)

Good morning Beverly. I have to begin by saying that I have no ties or stock with PW Minor at all. PW Heidi shoes come with a gel type footbed with cloth on the top. It has some cushion, but is still generic. The sole of the shoe is very sturdy, though. It is a great shoe. You should not have a problem finding a pair that fit. They do come in narrow. I understand your concern about having shoes that do not rub the top of your feet. I highly recommend these. They are really good for active people because they hold up very well. Since I accept Medicare (now everyone knows how poor I really am now), I have repeat patients coming back yearly for shoes (MCare pays for one pair per year and three inserts per year if you are diabetic). Almost all of the people want the PW shoes again. Try looking up 'orthopedic shoes' in the yellow pages. It should list the companies that might carry PW shoes. Or look up the BCP web page to find a C.Ped in your area. I just did a search on MSN for PW Minor, and did not find anything for the company itself. Good Luck!!
Richard, C.Ped

Re: Thanks Richard...

Beverly on 10/27/00 at 20:01 (031486)

eom...

Re: Beverly and Barbara TX

Barbara TX on 10/26/00 at 10:49 (031330)

Pedorthodude... Yes, I have removed the insert, and the heel doesn't fit and scrapes the sides of the shoes. Can an orthosis be scraped down at the heel, and with what? Also, my little arch-killers seem too arched for my bad foot. They are hard plastic with a foam & plastic insole cover. I have even thought of melting them in the microwave and then slipping on a pair of thick socks to remold them. Why not? The fumes may have an anti-inflammatory effect. I was not 'fitted' for them. I was simply given them and told to have a nice day. I have long ago dumped that DPM, and I know better now.

I will check out the NB shoes. Perhaps they will be wide enough to accomodate me. It is worth a try anyway.

I was also wondering if you might give us the site to find certified pedorthodudes throughout the country. I clicked on the link you posted last time and couldn't get through, and now I have lost the link and have had trouble searching for it. If you have it handy I would appreciate it. Maybe a pedorthodude could help me modify my inserts from hell. Many thanks, B.

Re: Beverly and Barbara TX

Richard, C.Ped on 10/26/00 at 11:24 (031333)

Messageboarddudette: Customer service.....I'll tell ya.....it is not that hard to do. What are people thinking these days??? Anyway, the inserts were not fitted to you...right? Well, I recommend you have another pair made or have these modified to fit your shoes. To find a C.Ped in your area, just type in a search for 'Board for Certification in Pedorthics'. I use MSN search. I think the link reads 'locate a C.Ped'. I just tested it for Texas, and it listed 57 C.Peds. I don't know your town, but you can type in your city and/or zip code, and it will list everyone in that area. Come to South Carolina. The temperature right now is the low 70's and sunny. I have the front and back doors open in the office. If not for the occasional fly buzzing around, the breeze is wonderful. I do not recommend using the microwave. Subtalor neutral cannot be established, which will not give you proper support. The fumes may give you the much needed anti-inflammatory effect only because it may give you an anti-respiration effect. We don't want that. It would not be a good thing (my Martha Stewart impression) :-)
If a customer came to me with a situation such as yours, the first thing I would need is a prescription. CYA, ya know??!! Anyway, what I would do is add 1/2' 40-60 durometer EVA (depending on how sensitive your feet are) to the bottom of your current insoles. I would then grind the bottom flat (we all know why....don't we?), then take the original inserts and match the bottom of the 'custom' to the original. I would trace and grind off the 'overlap' of the 'custom' until they fit inside the shoes. That is what I would do. There may be a better idea out there somewhere. Good luck!!! If you speak with someone and receive information that you think is questionable, please do not hesitiate to ask me. I will try to help as much as I can.
C.Ped Rich (AKA: Pedorthodude)
P.S. DON'T MESS WITH TEXAS!! :-)

Re: Beverly and Barbara TX

john a on 10/26/00 at 14:08 (031357)

I will never understand why you pedorthists insist on perscriptions from people (most pods) who probably know less about how to fix foot problems than you guys. CYA, maybe. But it's a darn nuisance to patients, IMHO.

Re: Beverly and Barbara TX

salina on 10/26/00 at 15:29 (031365)

When I was given my orthotics, I asked about shoes, etc.
And was really given no guidance. I kept thinking that was weird.
He just said, take the orthotics with me whenever I go buy new shoes, to make sure they fit in there. I took the original inserts out before putting the orthotics in. But it still feels like I am busting out of my shoes.
It seems like with orthotics costing so much anyway, you should also get a pair of shoes that were made just for you, that go with the orthotics.

Re: Re:

Richard, C.Ped on 10/26/00 at 15:45 (031367)

Prescriptions are a necessity to have the orthotics and or shoes covered by insurance companies. Granted, there are medical professionals out there who do not know much about foot care. I don't know about your town, but I work closely with wonderful physicians ranging from DPMs,orthopaedic surgeons, to family practice. Pedorthists are not physicians. We are not allowed to diagnose. If I were to make custom orthotics for someone with a diagnosable condition, I could get in a heck of a lot of trouble with the Pedorthic Footwear Association as well as lose my certification to practice pedorthics. If I did this, I would be diagnosing and treating the condition. It would be the same as a pharmacist selling medications to a sick person without an RX. I understand that it can be a 'darn nuisance', but I see this as secondary to losing a business and livelyhood in which I have worked very hard to maintain. Trust me, I care very deeply about my patients. I have tried to work with those who come to me off the street by calling their physician and giving them my recomendation of what type or orthotics they need. It ends up the same way every time. The physician wants to see the patient first. Again, insurance companies need the RX to cover the work done. To get the best care, this is the way to go. That is my opinion, and I am sticking to it. Sorry, I don't know what IMHO means.
Richard

Re: John

Nancy N on 10/26/00 at 15:54 (031372)

Richard--

IMHO means 'In My Humble Opinion.' :)

Nancy

Re: John

john a on 10/26/00 at 15:54 (031373)

IMHO = 'In My Humble Opinion'. I do appreciate that you are forced to get prescriptions from your customers by your profession, but I still think the policy, however well-intentioned, has gone awry. Orthotics are not medications. We go to the store and buy footwear that harms us all the time. Having a pedorthist custom-make something can only be better for us. IMHO, of course :-)

Re: Beverly and Barbara TX

Beverly on 10/26/00 at 15:54 (031374)

Orthodicdude,

With my first set of orthodics I was given no guidance on shoes. They were made by my pod - 3/4 ... soft style. Not knowing enough and getting bad information from the pod's secretary, I tried them with the inserts, placing the orthodics in the shoes. I did have the good sense to go up a size in athletic shoes. However, this ended up giving me a small dorsal bunion. And even after having them adjusted, the orthodics did me no good. I wore them for about a month. Later, I tried them without the inserts, but I still felt too high up in the shoe.

The second set made many months later and with me alot more informed were made by an orthodic dude such as yourself. He worked and worked to get them thin enough for me to tolerate them on the tops of my feet. This set was full length. New Balance does not agree with me, but I have a pair of Brooks Beast that are very roomy in the toe box. Even the Brooks with the orthodic sans shoe insert, pushed me up too high in my shoes and within two days, I saw it was irriating my tiny bunion I hope to keep tiny.

I have concluded that orthodics might work for me if I had some extra depth shoes like the PW Minors. As expensive as orthodics are, the one thing I did right this time was go with a temporary set first. The temps were free. If I ever found something that works, I would gladly spend the money.

Thanks for asking,
Beverly

Re: John

Richard, C.Ped on 10/26/00 at 16:02 (031375)

Thanx for the IMHO information. I thought you were cursing me out or something.:-) I understand your frustration, and looking back at my reply, I hope I was not offensive to you in any way. Orthotics, to me, are similar to medications. They can reduce pain, and help heal. This day and age, the way the world is going, CYA is the best way to describe it. I do not want anyone suing me for malpractice. I am made to carry malpractice insurance for that purpose.
Richard

Re: Beverly and Barbara TX

Richard, C.Ped on 10/26/00 at 16:12 (031378)

Sorry about all the trouble you are having. PW is a great shoe company. Other vendors which I am very happy with are Drew and Apex.
They both have wonderful as well as comfortable casual and dress shoes. I have two pair of Drew dress shoes myself. PW has this shoe called 'Heidi'. I like this shoe because it agrees with hammertoes, mallet toes as well as bunions. This is a shoe I would recommend to your physician. Reason being: the upper of the shoe (the area leading from the bottom laces to the toe) stretches to accomodate these conditions. PW calls the material 'Xsensible'. I have never tried to look up PW on the web, so I do not know if they have pictures, let alone, a web site. You may want to give it a try. I like these shoes so much, I do not have a problem putting them on my diabetic patients.
Good luck!
Richard

Re: John

john a on 10/26/00 at 16:13 (031380)

Don't worry Richard, I still think you are a Class Act.

Re: John

Nancy S. on 10/26/00 at 16:24 (031382)

Having just been to an orthotist today, I have to agree with Richard, John. Aside from the malpractice possibilities, a diagnosis from a doctor just makes sense and gives the orthotics-maker firmer info. to go on. Anyone can walk in off the street and say 'I think I have a heel spur' or something, but a written diagnosis from a doc gives the pedorthist or orthotist a big headstart. From reading the script, the orthotist today was able to plunge right in and maneuver my feet around and find the pain easily. The script also gave him a clue about how much support I need -- what materials to use, etc. If I had walked in not knowing that I have tendonitis on top of PF, the orthotist might have missed out on important info. for the structure of my orthotics.
I suppose you could leave it to the pedorthist/orthotist to diagnose everything, IF it were legal, but then you'd be paying for that schooling and experience and responsibility there instead of at the doctor's office. It's a wash, I think. Plus the doctor's script is based on weeks or months of following your case -- I don't think I'd want orthotics made from a onetime, on-the-spot diagnosis.
Nancy

Re: To Richard. Shoe question

Beverly on 10/26/00 at 22:30 (031419)

Thanks Richard for the extra-depth shoe suggestions. Do they have a firm footbed? I have done best with a Birk Arizona sandal, the Brooks Beast running shoe which has a really builtup heel/very firm shank,
and the Dansko Meta sandal. What they all have in common is a 'firm' feeling. And they all have a fairly high arch. I usually wear a Spenco orthodic arch style otc insert in the athletic shoe.

I think I could wear an orthodic if I could just find the shoe that does not rub the tops of my feet. The irony is that I have a fairly narrow foot. Mid-way between an A and a B width. But since hurting my feet, I don't like anything to feel tight.

Thanks,
Beverly

Re: John

Julie F on 10/27/00 at 02:13 (031423)

Hi John

I don't think it's the same thing at all. A health professional is in a position of trust, and is explicitly or implicitly claiming to be qualified and able to help and heal. He has to justify that trust and show himself worthy of making that claim by, amongst other things, sticking to the rules of his profession. In contrast, the shoe store salesman hasn't set himself up as someone who can help. He's just selling shoes. We go to the supermarket too, and buy and eat food all the time that harms us, but the supermarket manager hasn't set himself up as someone whose products can cure our ills, he's just selling food. When we buy something OTC we take our chances in the market.I don't think I'd like to see orthoses in that category.

Re: John

Richard, C.Ped on 10/27/00 at 07:55 (031433)

You seem pretty cool as well, mug shot and all. :-)
Richard

Re: To Richard. Shoe question

Richard, C.Ped on 10/27/00 at 08:16 (031435)

Good morning Beverly. I have to begin by saying that I have no ties or stock with PW Minor at all. PW Heidi shoes come with a gel type footbed with cloth on the top. It has some cushion, but is still generic. The sole of the shoe is very sturdy, though. It is a great shoe. You should not have a problem finding a pair that fit. They do come in narrow. I understand your concern about having shoes that do not rub the top of your feet. I highly recommend these. They are really good for active people because they hold up very well. Since I accept Medicare (now everyone knows how poor I really am now), I have repeat patients coming back yearly for shoes (MCare pays for one pair per year and three inserts per year if you are diabetic). Almost all of the people want the PW shoes again. Try looking up 'orthopedic shoes' in the yellow pages. It should list the companies that might carry PW shoes. Or look up the BCP web page to find a C.Ped in your area. I just did a search on MSN for PW Minor, and did not find anything for the company itself. Good Luck!!
Richard, C.Ped

Re: Thanks Richard...

Beverly on 10/27/00 at 20:01 (031486)

eom...