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Is this normal?

Posted by PaulS on 12/07/00 at 09:06 (034398)

It seems that most people who post here have trouble breaking in their orthotics. With me it's the opposite. I've tried two pairs prescribed by doctors, and two OTC's (Birkenstock blue 3/4 length and Formthotics). Each time I have thought: 'This the answer!', but 2 or three weeks later my soles are burning again and I'm ready to trash them. Is this normal?
Thanks for your advice.

Re: Is this normal?

Nancy N on 12/07/00 at 10:41 (034410)

I'd like to know about this, too. Mine were wonderful for the first week, but after that, I went back downhill until I was in more pain than I was before I started wearing them. It's weird, it was like I was cured for those 7 days, and then everything reversed itself. This is my first pair of custom orthotics and it happened both times that I tried to break them in. My pod even gave me a cortisone injection to try to help me adjust to them, but it didn't help. I finally gave up after the last time and now I just wear the Spencos.

Any idea why this happens?

Re: Is this normal?

Kathy on 12/07/00 at 16:47 (034430)

Nancy S,
My first orthodics made by my ex-pod where also hard and ridgid with know adjustments available, Then I heard about pedorthist from this board and my pf life was change for the better, although I've had to go back for one adjustment and a re-post I'm also one of those people who will have to go back often because of the way I wear them down. My new ones are soft and honestly I feel 80% better since I've gotten them.
Good luck and best holiday wishes,
Kathy

Re: Is this normal?

PaulS on 12/08/00 at 03:04 (034467)

Dear Nancy S.
I live in Germany and have become cynical about the way orthotics are prescribed here. In both cases I went to a sports practice which included a workshop for making orthotics. In each case the orthotics originally prescribed were found to be in need of adjustment, at a cost not significantly different from the original price. When I showed the second doctor the orthotics the first doctor had prescribed (3/4 length leather things that I was told to wear on top of the existing insoles in my sports shoes), he told me they were the worst thing I could be wearing. (I haven't tried asking my first doctor what he thinks of the orthotics of the second one, but I can imagine I would get a similar answer.) It's got to the point where I have no idea what to wear on my feet. I have tried every combination of shoes and insoles but none have provided relief beyond the first few days. My main problem is in knowing how long to persevere with orthotics that are causing pain. I'm sure like most people on this site I would be prepared to suffer any pain if I knew that in 6 months I would be cured!

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 08:45 (034477)

Hi Paul. I strongly believe that it depends on the material used in the custom inserts and how they were made. OTC inserts are OK to start for very painfull feet. Some people swear by them. I think sometimes it take some experimenting before you find the right device that works for you. We are all different.

Sometimes the 'burning' can come from sheer or sliding inside the shoe. This could be that the shoe is to big or the insert does not fit the shoe. Making custom inserts is basically a trial and error job. I have people that can put them in their shoes without any problems. Others, I am having to make constant adjustments to the orthosis. It has to be right...no two ways about it.

How were your inserts made? Were you casted? If so, how? Do you feel the burning throughout your feet, or is it from the plantar fascia? These questions may give me a better idea of what is going on with your feet.

Richard, C.Ped

Re: Is this normal?

PaulS on 12/08/00 at 10:10 (034487)

Dear Richard,
Many thanks for your reply. The othotics were made after three different processes. The first (3/4 leather) after standing on a carbon sheet and then in a foam box; the next (full length soft foam) after simply standing on a carbon sheet; and the third (full length soft fabric - recently ordered and not yet arrived) after standing again on a carbon sheet and then on a bed of tiny pins which were pushed up into and around my feet.
The term 'burning' is not very accurate; it's more of a constant dull ache in the sole (but nowhere else in the foot) that gets worse as the day goes on the more I stand or walk. My feet feel pretty normal before getting out of bed.
Many thanks again for your interest in my case.

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 10:32 (034489)

Paul, it is a good thing you caught me before lunch (sorry Nancy, had to throw a jab in there). Anyway, if you have read anything that I have written about casting for inserts, you will know how I feel about standing to take the impressions. One of the goals in making the inserts is to get the foot in sub talor neutral. If/when this is accomplished, the body weight is distributed evenly and you are able to get proper arch support. Proper arch support gives proper plantar fascia support.

When you stand in the foam box or on the sheets, the impression you get is not in neutral. If someone has flat feet or high arch feet, this is the impression you get. A proper casting impression should either be semi-weight bearing (sitting) or non-weight bearing (lying down).

The bed with the tiny pins could be a decent way to make the inserts if there were two changes in the process. One, it should be taken semi weight bearing, and two, there should be way more pins added then what is currently used. I don't know the name of the system or machine that is used here, but there are no way near enough pins to get a truly accurate form or impression of the foot.

I don't know if you are able to look up some questions I have given to a few people here, including Nancy and Beverly, to ask ther DPM or whoever is making the inserts, but it might be worth a try.

There is a science as well as an art to making these things. If it is not right, it will not work.
Good luck. If you can't find the past posts with the questions, I will try to think of them again and let you know. If you have any other questions, please feel free to ask. I am happy to help.
Richard

Re: Is this normal?

Barbara TX on 12/08/00 at 10:51 (034491)

Pedorthodude, my othoses were casted when I was sitting with feet right in front of me with ankles hanging off the table and feet totally relaxed (so my toes sort of pointed up and slightly toward the person casting them). Is this an acceptable method for the guru all Pedorthodudes? They are rigid plastic with a bit of give (shiny, blue plastice covered with foam. They feel like I'm walking on an egg-shaped stone placed in my arch. Can ones such as these be adjusted in any way in the arch area? I mean, aside from nuking them in the microwave. B.

Re: Is this normal?

Nancy S. on 12/08/00 at 11:08 (034493)

Paul, Richard's most helpful post to me, before I went to the orthotist, was on 10/20/00. If you enter the date just like that in the Search box, Richard's post will come up in that day's posts. The questions he listed for Beverly were more recent -- may even be on this special board, if you keep looking backward till you find it.
So good to have you back from lunch now, Richard! You may come here for pheasant-under-glass and a gorgeous apple any time, if that seems a fitting lunch to you. (Warning: You'll be a guinea pig. I'm not a cook.)
I bet you do spend a lot of time trying to correct the mistakes of your competition. Too bad you can't be cloned. But maybe you can these days! There are some headlines I studiously try to overlook.
Nancy

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 11:26 (034496)

My child....casting is as casting does. :-)
In my training, we did not go over the non-weight bearing casting system very much. I don't see a problem with the way it was done only if you were put and kept in neutral during the casting.

You know how I feel about the hard plastic, so I won't even go there. I am in a good mood and I don't want that to end. If there is no posting material under the arch area, then the only way I can think of for adjustments is to use a heat gun. If you do that, the chance of reducing the effectiveness of the orthosis is huge.

Is the hard plastic part just a 3/4, then covered with the foam? If it is, this is a very inexpensive way to make inserts. Try this, while sitting, cross your leg over your knee. Take the insert and hold it up to your foot as if you were standing on it. If you have a proper fit, you should be able to hold the insert with minimal pressure and not be able to see any gaps between the insert and your arch. If it is not a proper fit, there will be a gap.

Save the microwave for popcorn. Hmmmm, that sounds good.
Should I call you the 'Mashed Potato guruette'?
Richard

Re: Is this normal?

Barbara TX on 12/08/00 at 11:59 (034498)

Richard - the foam covers the 3/4 insert, but then extends off the insert and right to the toe. They're sort of half/half, made for tennis shoes. I have worn them TWICE, and already the foam is pulling away from the plastic. A 400 dollar shame. I put them up to my arch and there are no gaps, the heel is decently cuped, and so I am wondering what's wrong. the minute I stand up I feel the lumps in my arches to the point of pain. Why we let people get away with this stuff, I have no idea. Where else can you buy a non-returnable unadjustable custom made thing that is absolutely unusable? Bottom line - is discomfort a natural part of breaking something in, or is that a sign that the inserts are poorly made and hurting your feet? Love Spudwoman.

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 13:00 (034499)

Hi spuds...
Something is going on with those things that should not be right now. I would HIGHLY recommend going back and complain about the material as well as much needed adjustments. Four hundred bucks is to much to be just throwing away like that. My customers are the boss. You need to go back and get better service.

Four hundred????!!!! Man I am charging WAY to little for mine. Oh well.

Later tater.....
Richard

Re: Is this normal?

PaulS on 12/11/00 at 08:01 (034660)

Thanks Richard (and others) for your interesting posts. What you say about non-weight-bearing casting certainly makes sense to me. In fact, I've often wondered about the value of making othotics based on castings taken from feet that have flattened and become swollen through inflammation. It seems to me as a layperson that othotics should be based on the impressions of healthy not sick feet, or how else can support be given in the right places? Anyway, I shall certainly convey your advice to whoever I next entrust with making inserts for my shoes. Thanks again.

Re: Is this normal?

Nancy N on 12/12/00 at 10:44 (034760)

Wow. I went away for the weekend and forgot to check in on this question!

Richard-- my orthotics were made by SOLO labs and are definitely hard plastic. My pod casted me with plaster strips and sent the molds off to the lab. I can sympathize with Barb's comment about the eggs under her arches--I feel the same way if I wear mine (which I haven't for months). No offers were ever made to adjust them--he gave me the impression that the problem could not possibly be in the orthotics themselves when I asked about adjustment. It's so deeply frustrating to spend $300 on something that then doesn't work and in fact seems to make things worse.

Next time, Richard, I'll be going to one of your pedorthic kinsmen for a better pair, I certainly hope.

Re: Is this normal?

Nancy N on 12/07/00 at 10:41 (034410)

I'd like to know about this, too. Mine were wonderful for the first week, but after that, I went back downhill until I was in more pain than I was before I started wearing them. It's weird, it was like I was cured for those 7 days, and then everything reversed itself. This is my first pair of custom orthotics and it happened both times that I tried to break them in. My pod even gave me a cortisone injection to try to help me adjust to them, but it didn't help. I finally gave up after the last time and now I just wear the Spencos.

Any idea why this happens?

Re: Is this normal?

Kathy on 12/07/00 at 16:47 (034430)

Nancy S,
My first orthodics made by my ex-pod where also hard and ridgid with know adjustments available, Then I heard about pedorthist from this board and my pf life was change for the better, although I've had to go back for one adjustment and a re-post I'm also one of those people who will have to go back often because of the way I wear them down. My new ones are soft and honestly I feel 80% better since I've gotten them.
Good luck and best holiday wishes,
Kathy

Re: Is this normal?

PaulS on 12/08/00 at 03:04 (034467)

Dear Nancy S.
I live in Germany and have become cynical about the way orthotics are prescribed here. In both cases I went to a sports practice which included a workshop for making orthotics. In each case the orthotics originally prescribed were found to be in need of adjustment, at a cost not significantly different from the original price. When I showed the second doctor the orthotics the first doctor had prescribed (3/4 length leather things that I was told to wear on top of the existing insoles in my sports shoes), he told me they were the worst thing I could be wearing. (I haven't tried asking my first doctor what he thinks of the orthotics of the second one, but I can imagine I would get a similar answer.) It's got to the point where I have no idea what to wear on my feet. I have tried every combination of shoes and insoles but none have provided relief beyond the first few days. My main problem is in knowing how long to persevere with orthotics that are causing pain. I'm sure like most people on this site I would be prepared to suffer any pain if I knew that in 6 months I would be cured!

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 08:45 (034477)

Hi Paul. I strongly believe that it depends on the material used in the custom inserts and how they were made. OTC inserts are OK to start for very painfull feet. Some people swear by them. I think sometimes it take some experimenting before you find the right device that works for you. We are all different.

Sometimes the 'burning' can come from sheer or sliding inside the shoe. This could be that the shoe is to big or the insert does not fit the shoe. Making custom inserts is basically a trial and error job. I have people that can put them in their shoes without any problems. Others, I am having to make constant adjustments to the orthosis. It has to be right...no two ways about it.

How were your inserts made? Were you casted? If so, how? Do you feel the burning throughout your feet, or is it from the plantar fascia? These questions may give me a better idea of what is going on with your feet.

Richard, C.Ped

Re: Is this normal?

PaulS on 12/08/00 at 10:10 (034487)

Dear Richard,
Many thanks for your reply. The othotics were made after three different processes. The first (3/4 leather) after standing on a carbon sheet and then in a foam box; the next (full length soft foam) after simply standing on a carbon sheet; and the third (full length soft fabric - recently ordered and not yet arrived) after standing again on a carbon sheet and then on a bed of tiny pins which were pushed up into and around my feet.
The term 'burning' is not very accurate; it's more of a constant dull ache in the sole (but nowhere else in the foot) that gets worse as the day goes on the more I stand or walk. My feet feel pretty normal before getting out of bed.
Many thanks again for your interest in my case.

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 10:32 (034489)

Paul, it is a good thing you caught me before lunch (sorry Nancy, had to throw a jab in there). Anyway, if you have read anything that I have written about casting for inserts, you will know how I feel about standing to take the impressions. One of the goals in making the inserts is to get the foot in sub talor neutral. If/when this is accomplished, the body weight is distributed evenly and you are able to get proper arch support. Proper arch support gives proper plantar fascia support.

When you stand in the foam box or on the sheets, the impression you get is not in neutral. If someone has flat feet or high arch feet, this is the impression you get. A proper casting impression should either be semi-weight bearing (sitting) or non-weight bearing (lying down).

The bed with the tiny pins could be a decent way to make the inserts if there were two changes in the process. One, it should be taken semi weight bearing, and two, there should be way more pins added then what is currently used. I don't know the name of the system or machine that is used here, but there are no way near enough pins to get a truly accurate form or impression of the foot.

I don't know if you are able to look up some questions I have given to a few people here, including Nancy and Beverly, to ask ther DPM or whoever is making the inserts, but it might be worth a try.

There is a science as well as an art to making these things. If it is not right, it will not work.
Good luck. If you can't find the past posts with the questions, I will try to think of them again and let you know. If you have any other questions, please feel free to ask. I am happy to help.
Richard

Re: Is this normal?

Barbara TX on 12/08/00 at 10:51 (034491)

Pedorthodude, my othoses were casted when I was sitting with feet right in front of me with ankles hanging off the table and feet totally relaxed (so my toes sort of pointed up and slightly toward the person casting them). Is this an acceptable method for the guru all Pedorthodudes? They are rigid plastic with a bit of give (shiny, blue plastice covered with foam. They feel like I'm walking on an egg-shaped stone placed in my arch. Can ones such as these be adjusted in any way in the arch area? I mean, aside from nuking them in the microwave. B.

Re: Is this normal?

Nancy S. on 12/08/00 at 11:08 (034493)

Paul, Richard's most helpful post to me, before I went to the orthotist, was on 10/20/00. If you enter the date just like that in the Search box, Richard's post will come up in that day's posts. The questions he listed for Beverly were more recent -- may even be on this special board, if you keep looking backward till you find it.
So good to have you back from lunch now, Richard! You may come here for pheasant-under-glass and a gorgeous apple any time, if that seems a fitting lunch to you. (Warning: You'll be a guinea pig. I'm not a cook.)
I bet you do spend a lot of time trying to correct the mistakes of your competition. Too bad you can't be cloned. But maybe you can these days! There are some headlines I studiously try to overlook.
Nancy

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 11:26 (034496)

My child....casting is as casting does. :-)
In my training, we did not go over the non-weight bearing casting system very much. I don't see a problem with the way it was done only if you were put and kept in neutral during the casting.

You know how I feel about the hard plastic, so I won't even go there. I am in a good mood and I don't want that to end. If there is no posting material under the arch area, then the only way I can think of for adjustments is to use a heat gun. If you do that, the chance of reducing the effectiveness of the orthosis is huge.

Is the hard plastic part just a 3/4, then covered with the foam? If it is, this is a very inexpensive way to make inserts. Try this, while sitting, cross your leg over your knee. Take the insert and hold it up to your foot as if you were standing on it. If you have a proper fit, you should be able to hold the insert with minimal pressure and not be able to see any gaps between the insert and your arch. If it is not a proper fit, there will be a gap.

Save the microwave for popcorn. Hmmmm, that sounds good.
Should I call you the 'Mashed Potato guruette'?
Richard

Re: Is this normal?

Barbara TX on 12/08/00 at 11:59 (034498)

Richard - the foam covers the 3/4 insert, but then extends off the insert and right to the toe. They're sort of half/half, made for tennis shoes. I have worn them TWICE, and already the foam is pulling away from the plastic. A 400 dollar shame. I put them up to my arch and there are no gaps, the heel is decently cuped, and so I am wondering what's wrong. the minute I stand up I feel the lumps in my arches to the point of pain. Why we let people get away with this stuff, I have no idea. Where else can you buy a non-returnable unadjustable custom made thing that is absolutely unusable? Bottom line - is discomfort a natural part of breaking something in, or is that a sign that the inserts are poorly made and hurting your feet? Love Spudwoman.

Re: Is this normal?

Richard, C.Ped on 12/08/00 at 13:00 (034499)

Hi spuds...
Something is going on with those things that should not be right now. I would HIGHLY recommend going back and complain about the material as well as much needed adjustments. Four hundred bucks is to much to be just throwing away like that. My customers are the boss. You need to go back and get better service.

Four hundred????!!!! Man I am charging WAY to little for mine. Oh well.

Later tater.....
Richard

Re: Is this normal?

PaulS on 12/11/00 at 08:01 (034660)

Thanks Richard (and others) for your interesting posts. What you say about non-weight-bearing casting certainly makes sense to me. In fact, I've often wondered about the value of making othotics based on castings taken from feet that have flattened and become swollen through inflammation. It seems to me as a layperson that othotics should be based on the impressions of healthy not sick feet, or how else can support be given in the right places? Anyway, I shall certainly convey your advice to whoever I next entrust with making inserts for my shoes. Thanks again.

Re: Is this normal?

Nancy N on 12/12/00 at 10:44 (034760)

Wow. I went away for the weekend and forgot to check in on this question!

Richard-- my orthotics were made by SOLO labs and are definitely hard plastic. My pod casted me with plaster strips and sent the molds off to the lab. I can sympathize with Barb's comment about the eggs under her arches--I feel the same way if I wear mine (which I haven't for months). No offers were ever made to adjust them--he gave me the impression that the problem could not possibly be in the orthotics themselves when I asked about adjustment. It's so deeply frustrating to spend $300 on something that then doesn't work and in fact seems to make things worse.

Next time, Richard, I'll be going to one of your pedorthic kinsmen for a better pair, I certainly hope.