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A test to see if your orthotics are doing their job:

Posted by Jan on 12/27/00 at 16:48 (035454)

I did a little experiment the other day and thought I'd share my findings. I was fitted for my first pair of hard, custom orthotics a year ago and wore them for 6 months. At the end of the 6 months I wasn't any better so my doc. tapped my feet to see if that helped. It did, so he rebuilt my orthotics since the tape test indicated the orthotics weren't providing the mechanical control they should.
Wore my second pair of orthotics for another 6 months.....still suffering terribly.
I decided to try the experiment again after I read a post here where someone claimed they taped their feet everyday for 8 months.
I also bought over-the-counter arch supports (thick foam). I took the original custom orthotics out, used the arch supports and tape for the first day.....no pain. Not less pain, NO pain.

Hm,.....too good to be true....I pushed it to see how far I could go. Off to Ikea to shop. After 2 hours I started to notice some pain in that classic spot just in front of the heel....but it took 2 hours to get there. I don't have any pain doing ordinary things around the house, or running normal errands. I even went to 2 stores in ...dare I say, the mall!
I stopped by my doctor's office to throw my inserts at him since clearly the $5 tape is doing me more good then his $400 inserts.
I've been in the tape for 5 days now and am pain free after a week-end of indulgence (dancing, shopping, Ikea, antiquing and the grocery store all in the period of 3 days).
My doc said he has taped patient for several months becuase the tape provide the ultimate in mechanical control. I noticed now, even without tape, I don't have sharp pain in my morning steps and can stand barefoot to brush my teeth! Wow!

I spent the last 3 nights without my night splints (too get a good read on the tape's effects), still no morning pain. The tape prevents the tearing and inflammation so the night splints don't appear to be necessary.

I believe the tape will break my re-injury cycle and may be my ticket. Time will tell. I'd say I fell 90% better today and I had quite a week-end.
If you haven't tried this, it's a good test to be sure your orthotics are effective. Don't let them (the professionals) talk you into believing they work just becuase you paid top dollar. They're not wearing them and they really have few ways to be sure they're correct for you.
The arch support is shock absorbtion, the tape is mechanical control. The two together help me. I was avoiding experimenting becuase my doc told me, stay with the orthotic. There comes a point (after 1.5 years) you quit listening to them and start listening to your pain more.

PS, I don't sleep in the tape, it seems to conduct heat all too well....under an electric blanket, it's like your feet are in a frying pan. OUCH!

Feel free to email me directly for questions.

Re: A test to see if your orthotics are doing their job:

Charles T on 12/27/00 at 19:11 (035460)

Thanks for great info. What is procedure for taping? Can it be found on Web?

Re: A test to see if your orthotics are doing their job:

Jan on 12/27/00 at 19:38 (035464)

Scott has a whole section on this site about taping. (see table of contents)
His pictures are a little different then what I'm doing.
1. I wrap a piece (2 inches wide) along the side of my foot: start at the inside of your arch just below the big toe, go aroung the heel, and stop at the outside of the foot just below the little toe. This strip provides the foundation. It doesn't cross the bottom or top of the foot. Apply it where the side of your foot meets the floor all the way around.
2. Apply strips perpendicular to the first piece, across the facia. Not from the ball to the heel, but perpendicular to that. Don't cover the ball of the foot. The first strip should be just below the ball so it moves freely. Lay overlapping strips in this direction until you cover the heel.
The edges of these strips should overlay the foundation stip you put on in step 1.
3. Now apply another piece as you did in step 1 to hold down the edges of the strips from step 2.

I use 2 inch wide tape. I go through 1/2 a roll a day...so about $15 a week.
Don't pull it off hard at night. It wears on your skin. Scott mentions applying maalox first to protect the skin. Haven't tried that yet.

Re: A test to see if your orthotics are doing their job:

Pauline on 12/28/00 at 10:51 (035499)

Jan,
I'm one of those that has never been able to wear orthotics. I've had 4 pair custom made and have always had more pain with them than without.
My personal belief is that they are only required for a very limited number of foot problems i.e. when you have surgery to release the plantar fascia. When this is cut your main foot support is gone. You will need extra support for life. For plantar fasciitis I believe orthotics are gross money makers and handed out like candy.

On the other hand,you will find many people who for one reason or another are willing to ride through the pain of wearing orthotics and continue to wear them swearing to their benefits. These folks, however, have never had their foot tone tested before orthotics or after orthotics to see if the orthotics have caused the foot tone to deteriorate. You don't build foot strength by walking on hard plastic.

You will also notice that orthotics are sold only in developed countries.
I would like to see a study done on patients visiting Pods to see how many are advised they need orthotics and how many patients actually purchase them because their insurance covers the pair. Once a patient is told about orthotics the next sentense is 'your insurance will cover it' this
is because this was check out before you got in the door. They are a lot easier to sell when paid for by insurance. I would also like to know how much income loss there would be if orthotics were NOT sold in a medical office for a year.

My advise purchase them if you want, wear them if you get comfort and throw them out if your in pain.

Re: A test to see if your orthotics are doing their job:

wendyn on 12/28/00 at 17:23 (035518)

A friend of mine at work went to a podiatrist I used to go to. Based on my past experience- I suggested that if he told her she needed orthotics - that she ask for the prescription, rather than just have them made there. Then she could decide where to have it filled. She asked the receptionist if this was possible - and the receptionist was stunned that she would make such a request. She said - well - but that's their business! They did give her the prescription - but this is almost a conflict of interest isn't it - I mean the doctor doesn't prescribe you penicillin and then turn around, sell it to you and make a profit! This is what happens when a doctor decided you need orthotics and that they just happen to make them!

I think a good doctor will be perfectly willing to give you the prescription and let you decide where you want the orthotics made - unless of course most of their income is coming from the orthotics...and that's another problem all on its own.

Re: A test to see if your orthotics are doing their job:

Nancy N on 12/28/00 at 22:51 (035545)

Do any of you know if a GP can prescribe orthotics? I think I will need them because I overpronate with my left foot, and don't want to have knee/hip/back problems because of it. But my pod left his group, and I have basically been viewing the OrthoWave study doctors as my docs for the moment. I could go to someone else in my ex-pod's group, but since they send out to the lab to have them made, and I already have one pair from them that hurt and nobody seemed to think there could possibly be anything wrong with the orthotics. So I'd rather not go there. I'm thinking if I see my GP and explain the situation, if she writes the Rx, I can pick someone to make them for me. Sound reasonable? Or do you think I need to check with my insurance to see if it makes a difference to them?

Re: A test to see if your orthotics are doing their job:

Richard, C.Ped on 12/29/00 at 11:51 (035562)

I certainly understand how the majority of the people that have had hard plastic inserts made, are unhappy with them. Basically, I think they are crap. I have tried to get the plastic to create the intimate fit that I get with the EVA material, but it just does not happen.

There was a comment about professionals not having to wear orthotics, so we do not know what it is like. I have been wearing them since my third day of schooling (it took me that long to make my first pair :-)). I love them. I do not wear shoes without them because they are so comfortable.

Another comment was about the charges and making a living. This is what I do. I make orthotics for a living. I have to be good at what I do as well as supply a high (if not the highest) quality product. It is obvious that many people here paid quite a bit of money for...well, crap. Our schooling did not even go over the hard plastic...it was not an option.

It is also obvious that there are so many people were provided their inserts by someone who did not know what they were doing. I know what I am doing and so do my partners. We know exactly what to do for different conditions.

No two feet are alike. You have to know what is going on with the patient by giving a thorough examination of their feet. I am trained to look for specific areas for specific problems. The patient may come to me with PF, but it is my job to find out exactly what is going on with their feet and ankles.

Properly made orthotics are certainly more that just supporting the foot after cutting the fascia. If they are made correctly, they will be supporting the fascia properly. Hopefully, this will make surgery a last option.

Jan, I am happy that the tape is working for you. Again, it obviously sounds like you had a bad experience with your hard plastic inserts.

If I come across as defensive, well, I am. I have read many posts here about the lack of service that people get, and it ticks me off. It is giving me and my profession a bad name. I know first hand that the inserts will help....IF MADE CORRECTLY.

A comment about insurance was posted. I ask about insurance because most plans will cover the inserts. I don't see anything wrong with asking. I do not tell people automatically that it will be covered. It all depends on the plan they have. I do not charge $400.00. My charge is $250.00, but to someone without insurance, it might as well be $400.00. If their insurance does not cover the inserts, I will work out a payment plan in order to ease the burden. As to the charges, you have to understand what all is involved with making the inserts. There is quite a bit of time and materials as well as all the overhead.

I apologize for the venting. It is not meant to be towards you guys. I am just sick and tired of people receiving crap for products and services when there are people out there who can provide better.

I also have a headache, so that is fueling my impatience. Sorry about that.

Here is the real test to see if your hard plastic orthotics are doing their job. Wait for a bitter cold morning. Go out to your car with the iced over windshield. Grip the hard plastic orthotics tightly in your right hand. Scrape the windshield. See, they are good for something after all!!! :-)~

Have a great day and wonderful new year (headache free I hope).
Richard, C.Ped, O.S.T.

Re: A test to see if your orthotics are doing their job:

Dr. Zuckerman on 12/31/00 at 17:01 (035729)

Hi Richard,

The ice scrapper is a great idea. We use them for door stoppers or ash trays

By the way vioxx 50 mgs is great for headaches.

Believe me group Richard knows how to make a orthosis. I have seen his work. his understandng of the biomechanic of the lower extremity is tops.

Happy New Year.

Dr. Z

Re: tape

Julie on 1/18/01 at 13:18 (036799)

Jan, hi

It's three weeks since you posted your message, but I've just got home from India and am catching up and want to respond. I too have found taping 'the' great help: I have been using Scott's simple two-strip method and it has worked beautifully. I am MUCH better now (more about this later, after I've finished my catching up) and am beginning to wean myself off tape. But it has definitely been a great help.

However - so have my new orthotics. I had my 7-year-old pair replaced, and the new ones, which feel quite different (doubtless because my feet and my gait have changed over the elapsed time) have also contributed to the improvement. I guess the answer, as so many have said, is that every case is individual and that we all have to search for and find, by trial and error, whatever is going to work for us.

All the best, Julie

Re: A test to see if your orthotics are doing their job:

Charles T on 12/27/00 at 19:11 (035460)

Thanks for great info. What is procedure for taping? Can it be found on Web?

Re: A test to see if your orthotics are doing their job:

Jan on 12/27/00 at 19:38 (035464)

Scott has a whole section on this site about taping. (see table of contents)
His pictures are a little different then what I'm doing.
1. I wrap a piece (2 inches wide) along the side of my foot: start at the inside of your arch just below the big toe, go aroung the heel, and stop at the outside of the foot just below the little toe. This strip provides the foundation. It doesn't cross the bottom or top of the foot. Apply it where the side of your foot meets the floor all the way around.
2. Apply strips perpendicular to the first piece, across the facia. Not from the ball to the heel, but perpendicular to that. Don't cover the ball of the foot. The first strip should be just below the ball so it moves freely. Lay overlapping strips in this direction until you cover the heel.
The edges of these strips should overlay the foundation stip you put on in step 1.
3. Now apply another piece as you did in step 1 to hold down the edges of the strips from step 2.

I use 2 inch wide tape. I go through 1/2 a roll a day...so about $15 a week.
Don't pull it off hard at night. It wears on your skin. Scott mentions applying maalox first to protect the skin. Haven't tried that yet.

Re: A test to see if your orthotics are doing their job:

Pauline on 12/28/00 at 10:51 (035499)

Jan,
I'm one of those that has never been able to wear orthotics. I've had 4 pair custom made and have always had more pain with them than without.
My personal belief is that they are only required for a very limited number of foot problems i.e. when you have surgery to release the plantar fascia. When this is cut your main foot support is gone. You will need extra support for life. For plantar fasciitis I believe orthotics are gross money makers and handed out like candy.

On the other hand,you will find many people who for one reason or another are willing to ride through the pain of wearing orthotics and continue to wear them swearing to their benefits. These folks, however, have never had their foot tone tested before orthotics or after orthotics to see if the orthotics have caused the foot tone to deteriorate. You don't build foot strength by walking on hard plastic.

You will also notice that orthotics are sold only in developed countries.
I would like to see a study done on patients visiting Pods to see how many are advised they need orthotics and how many patients actually purchase them because their insurance covers the pair. Once a patient is told about orthotics the next sentense is 'your insurance will cover it' this
is because this was check out before you got in the door. They are a lot easier to sell when paid for by insurance. I would also like to know how much income loss there would be if orthotics were NOT sold in a medical office for a year.

My advise purchase them if you want, wear them if you get comfort and throw them out if your in pain.

Re: A test to see if your orthotics are doing their job:

wendyn on 12/28/00 at 17:23 (035518)

A friend of mine at work went to a podiatrist I used to go to. Based on my past experience- I suggested that if he told her she needed orthotics - that she ask for the prescription, rather than just have them made there. Then she could decide where to have it filled. She asked the receptionist if this was possible - and the receptionist was stunned that she would make such a request. She said - well - but that's their business! They did give her the prescription - but this is almost a conflict of interest isn't it - I mean the doctor doesn't prescribe you penicillin and then turn around, sell it to you and make a profit! This is what happens when a doctor decided you need orthotics and that they just happen to make them!

I think a good doctor will be perfectly willing to give you the prescription and let you decide where you want the orthotics made - unless of course most of their income is coming from the orthotics...and that's another problem all on its own.

Re: A test to see if your orthotics are doing their job:

Nancy N on 12/28/00 at 22:51 (035545)

Do any of you know if a GP can prescribe orthotics? I think I will need them because I overpronate with my left foot, and don't want to have knee/hip/back problems because of it. But my pod left his group, and I have basically been viewing the OrthoWave study doctors as my docs for the moment. I could go to someone else in my ex-pod's group, but since they send out to the lab to have them made, and I already have one pair from them that hurt and nobody seemed to think there could possibly be anything wrong with the orthotics. So I'd rather not go there. I'm thinking if I see my GP and explain the situation, if she writes the Rx, I can pick someone to make them for me. Sound reasonable? Or do you think I need to check with my insurance to see if it makes a difference to them?

Re: A test to see if your orthotics are doing their job:

Richard, C.Ped on 12/29/00 at 11:51 (035562)

I certainly understand how the majority of the people that have had hard plastic inserts made, are unhappy with them. Basically, I think they are crap. I have tried to get the plastic to create the intimate fit that I get with the EVA material, but it just does not happen.

There was a comment about professionals not having to wear orthotics, so we do not know what it is like. I have been wearing them since my third day of schooling (it took me that long to make my first pair :-)). I love them. I do not wear shoes without them because they are so comfortable.

Another comment was about the charges and making a living. This is what I do. I make orthotics for a living. I have to be good at what I do as well as supply a high (if not the highest) quality product. It is obvious that many people here paid quite a bit of money for...well, crap. Our schooling did not even go over the hard plastic...it was not an option.

It is also obvious that there are so many people were provided their inserts by someone who did not know what they were doing. I know what I am doing and so do my partners. We know exactly what to do for different conditions.

No two feet are alike. You have to know what is going on with the patient by giving a thorough examination of their feet. I am trained to look for specific areas for specific problems. The patient may come to me with PF, but it is my job to find out exactly what is going on with their feet and ankles.

Properly made orthotics are certainly more that just supporting the foot after cutting the fascia. If they are made correctly, they will be supporting the fascia properly. Hopefully, this will make surgery a last option.

Jan, I am happy that the tape is working for you. Again, it obviously sounds like you had a bad experience with your hard plastic inserts.

If I come across as defensive, well, I am. I have read many posts here about the lack of service that people get, and it ticks me off. It is giving me and my profession a bad name. I know first hand that the inserts will help....IF MADE CORRECTLY.

A comment about insurance was posted. I ask about insurance because most plans will cover the inserts. I don't see anything wrong with asking. I do not tell people automatically that it will be covered. It all depends on the plan they have. I do not charge $400.00. My charge is $250.00, but to someone without insurance, it might as well be $400.00. If their insurance does not cover the inserts, I will work out a payment plan in order to ease the burden. As to the charges, you have to understand what all is involved with making the inserts. There is quite a bit of time and materials as well as all the overhead.

I apologize for the venting. It is not meant to be towards you guys. I am just sick and tired of people receiving crap for products and services when there are people out there who can provide better.

I also have a headache, so that is fueling my impatience. Sorry about that.

Here is the real test to see if your hard plastic orthotics are doing their job. Wait for a bitter cold morning. Go out to your car with the iced over windshield. Grip the hard plastic orthotics tightly in your right hand. Scrape the windshield. See, they are good for something after all!!! :-)~

Have a great day and wonderful new year (headache free I hope).
Richard, C.Ped, O.S.T.

Re: A test to see if your orthotics are doing their job:

Dr. Zuckerman on 12/31/00 at 17:01 (035729)

Hi Richard,

The ice scrapper is a great idea. We use them for door stoppers or ash trays

By the way vioxx 50 mgs is great for headaches.

Believe me group Richard knows how to make a orthosis. I have seen his work. his understandng of the biomechanic of the lower extremity is tops.

Happy New Year.

Dr. Z

Re: tape

Julie on 1/18/01 at 13:18 (036799)

Jan, hi

It's three weeks since you posted your message, but I've just got home from India and am catching up and want to respond. I too have found taping 'the' great help: I have been using Scott's simple two-strip method and it has worked beautifully. I am MUCH better now (more about this later, after I've finished my catching up) and am beginning to wean myself off tape. But it has definitely been a great help.

However - so have my new orthotics. I had my 7-year-old pair replaced, and the new ones, which feel quite different (doubtless because my feet and my gait have changed over the elapsed time) have also contributed to the improvement. I guess the answer, as so many have said, is that every case is individual and that we all have to search for and find, by trial and error, whatever is going to work for us.

All the best, Julie