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high arched woes

Posted by Donna SL on 1/25/01 at 05:51 (037306)

Dear Doctors,

I have high arches and seem to be supinating much more on my right foot,
and am wondering if it could be due to a mild plantarflexed first ray that I have, or from my gait being thrown off in the last couple of years from the wrong orthotics. Can it be fixed though foot manipulation or PT ?

I'm getting better after suffering from bilateral heel and arch pain, and peroneal tendonitis over the past 2 years. At one time I couldn't stand more than 10 minutes at a time. Most of the injuries were from being put into inverted semi rigid orthotics and motion control shoes, which I wore for around 1 1/2 years. (My biomechanics were misdiagoned 2 years ago by another podiatrist) Last April I went to new pod, and soon as he reveresed the other doctors treatements I started to improve. (lateral posted soft orthotics, neutral shoes, intensive PT etc.). He thinks most of my heel pain was from tendonitis, because if was in the bottom edges of the heel. I also have had insertion point PF pain in both feet. I always had ball of foot pain unless in very cushioned shoes.

I would like to stop being dependent on custom orthotics. My current pod would like to see me stop wearing them. They enabled me to walk when I was in severe pain, but have caused, and are continuing to cause other problems. I don't think they are that comfortable and a little too soft , even though they have helped the heel pain. I tried spenco cross trainers with a small lateral wedge in the shoe the last few days and was able to walk in them a couple of hours, with only mild to medium discomfort. In certain ways my feet felt better, even though they were not as stable. I put some tape only on the arch. A couple of months ago I couldn't wear epenco OTC's more than a few minutes without getting severe heel pain. There doesn't seem to be any OTCs on the market for the cavous foot.

I recently had an MRI done on both feet and ankles, and it shows the fascia is normal, but fluid in both ankles, and midfoot, and big toe joints. Last May I had a positve bone scan. I felt something pop in my right arch around a year ago, but my doctor never figured out what got injured. The pain in my arch is just starting to calm down. I also have a 3 year old osteochondral injury on the left talor dome that has improved. My pain level has improved by around 70%, but I still can flare up if I'm not careful

I'm also getting PT on my back, and some oeteopathic manipulation. They are trying to see if the above will help my gait.

With my foot type, would it be destructive to not wear orthotics? Should I continue to try to find someone to make the ultimately comfortable orthotic? Will all the PT in the world not help me from supinating if I have a plantar flexed ray in my right foot? (The heel varus corrected with the coleman block test). This also seems to cause sesamoiditis in my right toe.

After reading the January Biomechanic Magazine article on cavous feet, it sort of scared me into not wearing orthotics. I sort of feel I should be able to train my body to get used to walking again without them though. Also, it is very difficult to find someone who knows how to make a good orthotic for high arched sensitive feet. I met with pedorthist the other day, who seems very knowledgeable about orthotics for my foot type, but he is very expensive, and I've already invested thousands of dollars in past orthotics through DPM's. I'm also moving to the U.K in a few years, and would have to hope I found someone there too.

Do you know of any good pre fab orthotics on the market for high arches, like that were described in the article?

Sorry about the long post.

Donna

Re: high arched woes

Dr. Biehler on 1/25/01 at 10:50 (037324)

You are right, the wrong orthotics can be very painfull. You have a lot of good questions and most of the answers depend upon the amount of range of motion you have in the several loints of the foot that are involved, ie. how flexible is the plantarflexed first metatarsal, is there a range of motion in the subtaylor joint, midtarsal joint and how much of your varus heel in bony in origination. A lot of answers can be had fron a floriscopic joint range of motion exam. (PIPE)f you do have a very ridgid cavus foot there are either surgeries that can help or very accomodative orthotics. Dr. B.

Re: high arched woes

Barbara TX on 1/25/01 at 11:25 (037327)

Dr. B - Where does someone get the fluoroscopic joint motion exam that you describe? A DPM or radiology center? B.

Re: high arched woes

Dr. Biehler on 1/25/01 at 18:30 (037360)

Either a podiatrist or orthopedic that has the equipment. For the foot and ankle I feel you should try to find a podiatrist that does it. Dr.B.

Re: high arched woes

Kay S on 1/25/01 at 19:40 (037368)

Donna---I can't comment on your foot problems, but if you are interested in having good orthotics made, Richard, the board's pedorthist, will talk to you online, talk to your doctor, make a recommendation, and make your orthotics.............all via FedEx! I have just gotten a new pair from Richard and, like you, have had numerous other types. I have a high arch, and long history of pf and other things, but let me tell you, these are feeling quite good and giving me some much-needed heel relief so far. Please consider talking to him about this!
Kay

Re: high arched woes

Donna SL on 1/25/01 at 21:46 (037384)

Hi Kay,

Thanks so much for the advice, but I need to have someone locally, because I know from past experience with my feet, I'd probably need many adjustments.

Can you please describe what your orthotics are like? Do you have any excessive supination, or forefoot problems?

Also, my podiatrist makes his own orthotics. He's excellent biomechanically, and diagnosed my problem, but he's from the old school when it comes to orthotic materials. He didn't make soft ones the very first time even though they were the right correction. He used the ice scraper plastic. I couldn't wear them. He made a second pair out of slightly softer plastic that still hurt. I finally demanded he make something I could walk in, and he made them out of a really soft material (plaztozote) that felt great initially, but the durability stinks on them, and he has to refurbish them every month or so, and they are starting to get distorted, and causing all kinds of back problems, and even some foot pain.

I told him I read how the cpeds are using EVA, and he hasn't really worked with that material in the past, but agreed to try it. He's been stalling around in making me a new pair. He's also charged me for the two ice scraper ones that I can't wear, and wants to charge me for the EVA ones. He's also charged a fortune in office visits, the orthotics, and for adjustments.

I'd rather work with a pedorthist who is more up to date on orthotic mateials. I met with one who is very good, but very expensive, amd only includes two free adjustments. I called another today, who seems quite reasonable, and said he as 20 years of experience, but didn't meet him yet. My next pair will definatley be from a Cped, or Orthotist. There are only a couple of pedorthist and orthotist in my city, but tons of podiatrist, who send the cast out to labs to make the orthotics.

I'll probably have a couple of questions for Richard.

Thanks again, Donna

Re: high arched woes

Donna SL on 1/26/01 at 01:28 (037399)

Dr B.

Thanks for responding so soon. I don't think my feet are that rigid yet, and I've been working on my flexibility. I was told my range of motion is good, but if I don't stretch every day I'll tighten up again in my calves. It seems like I've been less tight in general the last few days in my entire body since I stopped wearing my prescription orthotics, even though my feet are less stable laterally.

What does a floriscope ROM exam show that a manual one doesn't? Is it a painful test?

My concern is that in the biomech article they mentioned all the strains and stress the high arched foot get, and how eventualy it can become fixed in a varus position, and all these other tendon problems. I got the impression you needed to be in a funcional orthotic to prevent this. (i.e one made from a neutral cast). Do I need to be in a functional orthotic, or will an accomadative one as you mentioned be ok if my feet and body eventually feel better in that type even though I have a little more foot motion than normal?

Would the fluid in the ankles (mostly in the tibiotalar, and subtalar joint and the surrounding ligaments, and the lateral gutter of both ankles) be from the stress of supination? My feet aren't very stable right now, but I'm hoping they will get stronger.

I would be terrified to have foot surgery after reading about so many surgical problems.

I'm able to walk around for a couple of hours now, and the heel pain isn't nearly as bad as it was a few months ago, but there been very few days when my feet don't hurt from one thing or another, after I've been on them for a while. The only orthotics I have are my current prescription ones that are causing problems, or spenco cross training OTC ones.

Ny current doctor keeps saying his goal is get me out of functional orthotics.

Donna

Re: high arched woes

Richard, C.Ped on 1/26/01 at 08:13 (037408)

Hi Donna,
My experience has taught me that hard plastic orthotics do not properly support the high arched foot. They also almost always never properly support the normal arch either. I have tested and tested and I get the same results always. The plastic stuff just does not get the intimate fit of EVA. I don't have stock in EVA, and have not ties to any company. I had to have it proven to me that it works..and it does, very well.

You can get an awesome rigid full contact orthosis that is actually very comfortable to wear. There are so many doctors that only know about the old school carboplast, and are very skeptical when it comes to using new materials. I know EVA works.

You do have to remember one thing.....whoever makes the orthosis has to know what they are doing!!! It take proper knowledge, equipment, as well as talent to make these things.

I could tell you about all the people come in here with their crappy orthosis from another company as well as a new prescription for me to either make a whole new pair, or to try to salvage what they currently have.

Anyway, sorry for the rant. If you have any questions about anything, including what to ask the pedorthist, please feel free to let me know. You can also get in touch with me via email.
Take care, and good luck!!
Richard, C.Ped

Re: high arched woes

Donna SL on 1/26/01 at 08:36 (037410)

Richard,

Thanks so much. I will have more questions. As I think of them I will post them to the orthotics section, or email you. Is it ok to call you once if I need to?

Donna

Re: high arched woes

Dr. Biehler on 1/26/01 at 10:03 (037416)

Donna, I suggest you talk to Richard. A functional orthotic is only as good as the change/control in the range of motion that it is able to accomplish, if this is needed. In most high arch feet there is not that much motion to work with so accomadation is ususally called for. Depending on the shape and rigidity of the foot, this is where the postings become so important. Dr.B.

Re: high arched woes - to Donna and Richard

Sue R on 1/26/01 at 10:53 (037424)

Hi Donna.

I also have high arched feet and have both heel and arch pain in both, esp my right one. I had custom orthotics for about 5 years and they worked great. Then I had another bout of pf and got another pair, even more rigid, and can't wear them. I would also like to try something else but am hesitant to put more money into something I can't tolerate.

Do you have arch pain too? I think mine makes the orthotics difficult to wear. The one think that is helping me right now is taping. It gives me some relief but I'm still in a lot of pain. Stretching helps me some too.

Richard, what do I need to know to find something that works? My arches are extremely high, my feet are very flexible that collapse when I bear weight, and my gait and alignment are normal, with no stress fractures, normal mri, etc. These high arches just seem to be my problem and I'm NOT willing to cut them. Doesn't seem like that's a solution for me.

Thanks for your help!
Sue R

Re: high arched woes

Richard, C.Ped on 1/26/01 at 11:28 (037429)

If you have any questions, please feel free to ask. My phone here is
803-794-5550. My office hours are usually 9-5 and closed 1-2 M-F. I also have AOL Instant Messenger, buddy name 'metatarsalgia' and MSN instant messinger, name metatarsalgia@hotmail.com''>'metatarsalgia@hotmail.com' . If you see me on line and want to chat, feel free. That goes for anyone else as well.
Richard, C.Ped

Re: high arched woes - to Donna and Richard

Donna SL on 1/26/01 at 12:05 (037433)

Hi Sue,

I had heel and arch pain also, and my right was much more severe, than my left. I think last Feb. I must have injured something in that arch, because I heard a pop, and that's when the severe pain started. My right arch collapses somewhat also when I move forward. I couldn't tolerate anything hard touching my arch. Even when it started to feel better, as soon as I put any plastic near it the arch would start to hurt again. Even if a soft one pushed on it too hard it got irritated. I had to have my doctor lower the arch in the soft ones too. They provided enough stability in the shoe to keep my foot from moving around too much so things could heal. I just think that now as I'm gettng better, and the orthotics are getting softer, they are causing more problems in other parts of my body. I used to be able to tolerate my old semi rigid plastic ones, but I can even stand them now.

What I found helped me tremendouly in reducing the heel pain, is getting physical therapy on the calves (esp. the peroneals around the ankle) along with the foot, and wearing night splints. The PT actually did ultrasound, deep tissue massage, and elec stim on my calves, and shins. She also just started working intensly on hamstrings, and my IT Bands, because they were tight too. This week is the best my feet have felt in around a year, even though they are not 100% better. Strectching on my own was not enough. I also just bought a thumper massager for homemedics, and that seems to help too.

I'm experimenting not wearing my orthotics this week. I only put two big pieces of tape under the arch areas strapped tight to protect them. I didn't do the complete taping job to restrict any motion in my feet. I just used regular spenco cross trainers with a small lateral wedge in my shoes that my doctor gave me, under the spencos. So far this week my feet still feel pretty good, and the last few days all this stiffness in my back and legs seem to be dissapearing. Also, over the last few months I was waking up feeling stiff as a board, and it took around 5 minutes before I could start walking around. Since I stopped wearing the orthotics, I got right up and didn't have any stiffness with or without the nightsplints, which seems almost miraculous. It may be because the orthotics were getting too soft, or were too controlling.

I think Dr. B might be right. I think high arched feet are stiff, and don't have much range of motion, and causes the body not to absorb shock very well. I think a soft functional orthotic will help you heal, but once you feet start to get better, it's not good to have them in such a restrictive position.

One of the pedorthist I saw last week said it's important to have an orthotic with an elevated heel, but I think you have to be careful it doesn't push you out of the shoe.

Look at the on-line article in Jan issue of Biomechanics magazine on cavus feet at http://www.biomech.com under orthoses section.

Good Luck, Donna

Re: high arched woes - to Donna and Richard

Scott R on 1/26/01 at 12:32 (037436)

Richard, of course you're on my good side or I wouldn't have made the seperate 'shoe' category. It's OK to answer questions from patients in the ask the doctor board.

Re: high arched woes - to Donna and Richard

Richard, C.Ped on 1/26/01 at 13:48 (037442)

Sue,
Since Scott said that it is OK to answer here, I will. Extremely high arches need support. Basically, that is it. There could be other things playing a role as well. I see dropped first rays in here quite often. With a FCO (full contact orthosis), you want to try to distribute the body weight as evenly as possible. Posting plays a factor as well.

As for someone being 'well enough' to quit wearing the inserts, my question is, why would you want to quit? If you have a well made pair, I think the benefits are lifetime. Especially if you have high or low arches. Think of your high arches. Think of the pounding they go through daily with out some type of support. Ouch! I would want that extra support under there whenever my feet hit the floor.

If you decide to have another pair made, make sure it is not the plastic stuff. I can almost promise that it will not touch your arch as it should. If you have them made, check them right then and there in the shop to see if the touch your arch. Sit with one leg crossed over the other and place the orthosis to your foot. Is there a gap? You should not have to press hard. Just lightly place it on your foot. Gap = bad.
No gap = good.

What material was used to make your current inserts?
Richard

Re: high arched woes - to Donna and Richard

Sue R on 1/27/01 at 17:44 (037540)

Richard,

My new orthotics are Healthflex brand made by the Langer Biomechanics Group. The brochure says they are made in 23 separate steps using various materials and components....not sure what exactly. They are hard, and I'm not sure of the materials but I can ask my podiatrist. It says they have a 6 month guarantee and I'm past that so I should have done something about them before now (8 months later)!

What should I look for in an orthotic in terms of materials? Thanks for any help you can provide.

Sue R

Re: high arched woes - to Donna and Richard

Richard, C.Ped on 1/29/01 at 08:23 (037636)

Mornin' Sue,
23 steps??? Let's see, let me count how many steps it takes me to finish one pair...wait a sec... I counted 8. Does that mean I win?? :-)
Sounds like a 'bells and whistles' routine. Most people here know that I use EVA to fabricate my orthosis. I have tried many other materials, and this works the best in my opinion.

If you mention it, many physicians are skeptical in using anything other than the plastic stuff (Hello Dr. Z). EVA holds up very well to pressure and the arches do not collapse easily at all.

Good luck to you!!
Richard

Re: high arched woes

Dr. Biehler on 1/25/01 at 10:50 (037324)

You are right, the wrong orthotics can be very painfull. You have a lot of good questions and most of the answers depend upon the amount of range of motion you have in the several loints of the foot that are involved, ie. how flexible is the plantarflexed first metatarsal, is there a range of motion in the subtaylor joint, midtarsal joint and how much of your varus heel in bony in origination. A lot of answers can be had fron a floriscopic joint range of motion exam. (PIPE)f you do have a very ridgid cavus foot there are either surgeries that can help or very accomodative orthotics. Dr. B.

Re: high arched woes

Barbara TX on 1/25/01 at 11:25 (037327)

Dr. B - Where does someone get the fluoroscopic joint motion exam that you describe? A DPM or radiology center? B.

Re: high arched woes

Dr. Biehler on 1/25/01 at 18:30 (037360)

Either a podiatrist or orthopedic that has the equipment. For the foot and ankle I feel you should try to find a podiatrist that does it. Dr.B.

Re: high arched woes

Kay S on 1/25/01 at 19:40 (037368)

Donna---I can't comment on your foot problems, but if you are interested in having good orthotics made, Richard, the board's pedorthist, will talk to you online, talk to your doctor, make a recommendation, and make your orthotics.............all via FedEx! I have just gotten a new pair from Richard and, like you, have had numerous other types. I have a high arch, and long history of pf and other things, but let me tell you, these are feeling quite good and giving me some much-needed heel relief so far. Please consider talking to him about this!
Kay

Re: high arched woes

Donna SL on 1/25/01 at 21:46 (037384)

Hi Kay,

Thanks so much for the advice, but I need to have someone locally, because I know from past experience with my feet, I'd probably need many adjustments.

Can you please describe what your orthotics are like? Do you have any excessive supination, or forefoot problems?

Also, my podiatrist makes his own orthotics. He's excellent biomechanically, and diagnosed my problem, but he's from the old school when it comes to orthotic materials. He didn't make soft ones the very first time even though they were the right correction. He used the ice scraper plastic. I couldn't wear them. He made a second pair out of slightly softer plastic that still hurt. I finally demanded he make something I could walk in, and he made them out of a really soft material (plaztozote) that felt great initially, but the durability stinks on them, and he has to refurbish them every month or so, and they are starting to get distorted, and causing all kinds of back problems, and even some foot pain.

I told him I read how the cpeds are using EVA, and he hasn't really worked with that material in the past, but agreed to try it. He's been stalling around in making me a new pair. He's also charged me for the two ice scraper ones that I can't wear, and wants to charge me for the EVA ones. He's also charged a fortune in office visits, the orthotics, and for adjustments.

I'd rather work with a pedorthist who is more up to date on orthotic mateials. I met with one who is very good, but very expensive, amd only includes two free adjustments. I called another today, who seems quite reasonable, and said he as 20 years of experience, but didn't meet him yet. My next pair will definatley be from a Cped, or Orthotist. There are only a couple of pedorthist and orthotist in my city, but tons of podiatrist, who send the cast out to labs to make the orthotics.

I'll probably have a couple of questions for Richard.

Thanks again, Donna

Re: high arched woes

Donna SL on 1/26/01 at 01:28 (037399)

Dr B.

Thanks for responding so soon. I don't think my feet are that rigid yet, and I've been working on my flexibility. I was told my range of motion is good, but if I don't stretch every day I'll tighten up again in my calves. It seems like I've been less tight in general the last few days in my entire body since I stopped wearing my prescription orthotics, even though my feet are less stable laterally.

What does a floriscope ROM exam show that a manual one doesn't? Is it a painful test?

My concern is that in the biomech article they mentioned all the strains and stress the high arched foot get, and how eventualy it can become fixed in a varus position, and all these other tendon problems. I got the impression you needed to be in a funcional orthotic to prevent this. (i.e one made from a neutral cast). Do I need to be in a functional orthotic, or will an accomadative one as you mentioned be ok if my feet and body eventually feel better in that type even though I have a little more foot motion than normal?

Would the fluid in the ankles (mostly in the tibiotalar, and subtalar joint and the surrounding ligaments, and the lateral gutter of both ankles) be from the stress of supination? My feet aren't very stable right now, but I'm hoping they will get stronger.

I would be terrified to have foot surgery after reading about so many surgical problems.

I'm able to walk around for a couple of hours now, and the heel pain isn't nearly as bad as it was a few months ago, but there been very few days when my feet don't hurt from one thing or another, after I've been on them for a while. The only orthotics I have are my current prescription ones that are causing problems, or spenco cross training OTC ones.

Ny current doctor keeps saying his goal is get me out of functional orthotics.

Donna

Re: high arched woes

Richard, C.Ped on 1/26/01 at 08:13 (037408)

Hi Donna,
My experience has taught me that hard plastic orthotics do not properly support the high arched foot. They also almost always never properly support the normal arch either. I have tested and tested and I get the same results always. The plastic stuff just does not get the intimate fit of EVA. I don't have stock in EVA, and have not ties to any company. I had to have it proven to me that it works..and it does, very well.

You can get an awesome rigid full contact orthosis that is actually very comfortable to wear. There are so many doctors that only know about the old school carboplast, and are very skeptical when it comes to using new materials. I know EVA works.

You do have to remember one thing.....whoever makes the orthosis has to know what they are doing!!! It take proper knowledge, equipment, as well as talent to make these things.

I could tell you about all the people come in here with their crappy orthosis from another company as well as a new prescription for me to either make a whole new pair, or to try to salvage what they currently have.

Anyway, sorry for the rant. If you have any questions about anything, including what to ask the pedorthist, please feel free to let me know. You can also get in touch with me via email.
Take care, and good luck!!
Richard, C.Ped

Re: high arched woes

Donna SL on 1/26/01 at 08:36 (037410)

Richard,

Thanks so much. I will have more questions. As I think of them I will post them to the orthotics section, or email you. Is it ok to call you once if I need to?

Donna

Re: high arched woes

Dr. Biehler on 1/26/01 at 10:03 (037416)

Donna, I suggest you talk to Richard. A functional orthotic is only as good as the change/control in the range of motion that it is able to accomplish, if this is needed. In most high arch feet there is not that much motion to work with so accomadation is ususally called for. Depending on the shape and rigidity of the foot, this is where the postings become so important. Dr.B.

Re: high arched woes - to Donna and Richard

Sue R on 1/26/01 at 10:53 (037424)

Hi Donna.

I also have high arched feet and have both heel and arch pain in both, esp my right one. I had custom orthotics for about 5 years and they worked great. Then I had another bout of pf and got another pair, even more rigid, and can't wear them. I would also like to try something else but am hesitant to put more money into something I can't tolerate.

Do you have arch pain too? I think mine makes the orthotics difficult to wear. The one think that is helping me right now is taping. It gives me some relief but I'm still in a lot of pain. Stretching helps me some too.

Richard, what do I need to know to find something that works? My arches are extremely high, my feet are very flexible that collapse when I bear weight, and my gait and alignment are normal, with no stress fractures, normal mri, etc. These high arches just seem to be my problem and I'm NOT willing to cut them. Doesn't seem like that's a solution for me.

Thanks for your help!
Sue R

Re: high arched woes

Richard, C.Ped on 1/26/01 at 11:28 (037429)

If you have any questions, please feel free to ask. My phone here is
803-794-5550. My office hours are usually 9-5 and closed 1-2 M-F. I also have AOL Instant Messenger, buddy name 'metatarsalgia' and MSN instant messinger, name metatarsalgia@hotmail.com''>'metatarsalgia@hotmail.com' . If you see me on line and want to chat, feel free. That goes for anyone else as well.
Richard, C.Ped

Re: high arched woes - to Donna and Richard

Donna SL on 1/26/01 at 12:05 (037433)

Hi Sue,

I had heel and arch pain also, and my right was much more severe, than my left. I think last Feb. I must have injured something in that arch, because I heard a pop, and that's when the severe pain started. My right arch collapses somewhat also when I move forward. I couldn't tolerate anything hard touching my arch. Even when it started to feel better, as soon as I put any plastic near it the arch would start to hurt again. Even if a soft one pushed on it too hard it got irritated. I had to have my doctor lower the arch in the soft ones too. They provided enough stability in the shoe to keep my foot from moving around too much so things could heal. I just think that now as I'm gettng better, and the orthotics are getting softer, they are causing more problems in other parts of my body. I used to be able to tolerate my old semi rigid plastic ones, but I can even stand them now.

What I found helped me tremendouly in reducing the heel pain, is getting physical therapy on the calves (esp. the peroneals around the ankle) along with the foot, and wearing night splints. The PT actually did ultrasound, deep tissue massage, and elec stim on my calves, and shins. She also just started working intensly on hamstrings, and my IT Bands, because they were tight too. This week is the best my feet have felt in around a year, even though they are not 100% better. Strectching on my own was not enough. I also just bought a thumper massager for homemedics, and that seems to help too.

I'm experimenting not wearing my orthotics this week. I only put two big pieces of tape under the arch areas strapped tight to protect them. I didn't do the complete taping job to restrict any motion in my feet. I just used regular spenco cross trainers with a small lateral wedge in my shoes that my doctor gave me, under the spencos. So far this week my feet still feel pretty good, and the last few days all this stiffness in my back and legs seem to be dissapearing. Also, over the last few months I was waking up feeling stiff as a board, and it took around 5 minutes before I could start walking around. Since I stopped wearing the orthotics, I got right up and didn't have any stiffness with or without the nightsplints, which seems almost miraculous. It may be because the orthotics were getting too soft, or were too controlling.

I think Dr. B might be right. I think high arched feet are stiff, and don't have much range of motion, and causes the body not to absorb shock very well. I think a soft functional orthotic will help you heal, but once you feet start to get better, it's not good to have them in such a restrictive position.

One of the pedorthist I saw last week said it's important to have an orthotic with an elevated heel, but I think you have to be careful it doesn't push you out of the shoe.

Look at the on-line article in Jan issue of Biomechanics magazine on cavus feet at http://www.biomech.com under orthoses section.

Good Luck, Donna

Re: high arched woes - to Donna and Richard

Scott R on 1/26/01 at 12:32 (037436)

Richard, of course you're on my good side or I wouldn't have made the seperate 'shoe' category. It's OK to answer questions from patients in the ask the doctor board.

Re: high arched woes - to Donna and Richard

Richard, C.Ped on 1/26/01 at 13:48 (037442)

Sue,
Since Scott said that it is OK to answer here, I will. Extremely high arches need support. Basically, that is it. There could be other things playing a role as well. I see dropped first rays in here quite often. With a FCO (full contact orthosis), you want to try to distribute the body weight as evenly as possible. Posting plays a factor as well.

As for someone being 'well enough' to quit wearing the inserts, my question is, why would you want to quit? If you have a well made pair, I think the benefits are lifetime. Especially if you have high or low arches. Think of your high arches. Think of the pounding they go through daily with out some type of support. Ouch! I would want that extra support under there whenever my feet hit the floor.

If you decide to have another pair made, make sure it is not the plastic stuff. I can almost promise that it will not touch your arch as it should. If you have them made, check them right then and there in the shop to see if the touch your arch. Sit with one leg crossed over the other and place the orthosis to your foot. Is there a gap? You should not have to press hard. Just lightly place it on your foot. Gap = bad.
No gap = good.

What material was used to make your current inserts?
Richard

Re: high arched woes - to Donna and Richard

Sue R on 1/27/01 at 17:44 (037540)

Richard,

My new orthotics are Healthflex brand made by the Langer Biomechanics Group. The brochure says they are made in 23 separate steps using various materials and components....not sure what exactly. They are hard, and I'm not sure of the materials but I can ask my podiatrist. It says they have a 6 month guarantee and I'm past that so I should have done something about them before now (8 months later)!

What should I look for in an orthotic in terms of materials? Thanks for any help you can provide.

Sue R

Re: high arched woes - to Donna and Richard

Richard, C.Ped on 1/29/01 at 08:23 (037636)

Mornin' Sue,
23 steps??? Let's see, let me count how many steps it takes me to finish one pair...wait a sec... I counted 8. Does that mean I win?? :-)
Sounds like a 'bells and whistles' routine. Most people here know that I use EVA to fabricate my orthosis. I have tried many other materials, and this works the best in my opinion.

If you mention it, many physicians are skeptical in using anything other than the plastic stuff (Hello Dr. Z). EVA holds up very well to pressure and the arches do not collapse easily at all.

Good luck to you!!
Richard