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Would you please comment on my thinking

Posted by Dr. Zuckerman on 1/21/01 at 13:32 (037001)

Hello Dr. Z,

Yes, please do post it. Thank you for your thoughtful response.

Best regards,

Marjorie
-----Original Message-----
From: footcare@home.com <footcare@home.com>
To: Marjorie Robertson <marobertson@erols.com>
Date: Saturday, January 20, 2001 8:06 PM
Subject: RE: orthotics/shoe inserts

Hi,

With an orthosis you need to first find out if you have excessive motion when you walk. Pronation is normal it is EXCESSIVE pronation that isn't normal. So it is very difficult to determine which orthosis is the best for you without seeing you walk. You do say your arch don't collapse very much. This is probaby due to the fact that you don't have excessive pronation and that you lack or have decease pronation. This is very common in a high or higher then normal arch.,

So what does all this mean for you. . You need to have a cast of your foot and the arch filled in with a semi rigid type of orthois to bring the ground up to the foot. You see orthois are like platforms that allow the foot to strike the ground at the proper angle. For example if you have a chair with one leg shorter then the other three it is off balance . So everytime that you move ( walk) the chair if offi balance and the weight of your body isn't proper placed and you will fall. This is a simialar effect with improperly casting orthosis. The fact that you foot isn't in contact with the orthosis is more important then the type orthois. Pose this quesiton ot Richard on heelspurs,.comn you will find him very helpful. So get a new cast. Use materials that are stronger which isn't the samething as rigid.

Sincerely yours,

Dr. Z

PS: Do you mind if I post this to Richard and the heelspurs.com board. This is a very important concept for patietns to understand that strong isn't necessary rigid and thtat the orthosis need to fit the foot like a glove fits the hand. There shouldn't be any gap between the arch and foot.
-----Original Message-----
From: Marjorie Robertson [mailto:marobertson@erols.com]
Sent: Saturday, January 20, 2001 4:40 PM
To: footcare@home.com
Subject: orthotics/shoe inserts

Hello Dr. Z,

I trust that you received my lengthy foot bio.

I'm writing for another reason: orthotics. I've read the info on heelspurs.com, particularly about the Powerstep inserts.

I have rigid orthotics (2-yrs. old) that do not touch my arch when standing (my arches don't collapse that much). I had semi-rigid four years ago, but after a month of using them, a podiatrist told me they were wrong for me, that I should have rigid (which I do now).

I've recently spoken with physical therapists who tell me that I need semirigid that come all the way up to my arch.

I have heard so many different things from doctors and physical therapists, I don't know what to believe. I do think that I need new orthotics and support up to my arch to let my fascia heal. (I've been taping and using small meta pads in the arch area. Since doing so, I've no pain and a little tenderness on occasion at the end of the day, though I don't move around much.)

What is your opinion on orthotics and the type of orthotic? Rigid to hold my foot completely in place? Or semirigid to allow the orthotic to absorb shock and the fascia to move?

Best regards,

Marjorie Robertson

Re: Would you please comment on my thinking

Richard, C.Ped on 1/22/01 at 07:17 (037066)

Hi Dr. Z,
I totally agree with you and your answer about pronation vs. excessive pronation. I believe that the hardness of the orthosis can all come down to how active the patient is. I have athletes of all types come to have inserts made for different reasons. I will almost always put them in a more rigid (65 durometer EVA posting) orthosis. If someone comes to me that is not very active, I will put them in a softer orthosis.

It also comes down to what you are trying to treat and or prevent. One of the main goals of an orthosis is to distribute excessive weight away from high pressure areas.

It is my opinion that almost everyone that walks can benefit in some way by wearing custom insoles. If made correctly and without that hard stuff (I will be nice today and not call it crap), the orthosis will basically give you a better purchase with the ground. Also, just as you stated, the orthosis should bring the floor to the foot.

This is not the businessman saying this, this is somone that had to be convinced that the insoles were a benefit at first. I was a skeptic, until I made my first pair and started wearing them. I honestly do not like to wear shoes without them. If I do, it seems uncomfortable.

Richard, C.Ped

Re: Would you please comment on my thinking

Richard, C.Ped on 1/22/01 at 07:17 (037066)

Hi Dr. Z,
I totally agree with you and your answer about pronation vs. excessive pronation. I believe that the hardness of the orthosis can all come down to how active the patient is. I have athletes of all types come to have inserts made for different reasons. I will almost always put them in a more rigid (65 durometer EVA posting) orthosis. If someone comes to me that is not very active, I will put them in a softer orthosis.

It also comes down to what you are trying to treat and or prevent. One of the main goals of an orthosis is to distribute excessive weight away from high pressure areas.

It is my opinion that almost everyone that walks can benefit in some way by wearing custom insoles. If made correctly and without that hard stuff (I will be nice today and not call it crap), the orthosis will basically give you a better purchase with the ground. Also, just as you stated, the orthosis should bring the floor to the foot.

This is not the businessman saying this, this is somone that had to be convinced that the insoles were a benefit at first. I was a skeptic, until I made my first pair and started wearing them. I honestly do not like to wear shoes without them. If I do, it seems uncomfortable.

Richard, C.Ped