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Off-the-shelf arch supports/orthotics

Posted by Julie on 1/28/01 at 08:17 (037568)

Richard, this is a question that has been puzzling me for a while. It's about the inserts, arch supports and orthotics that are sold over the counter. You've made it very clear over the past few months that orthotics need to be fitted precisely to the feet that are going to wear them, and with reference to the condition being dealt with by the person who is going to wear them; and that they should be made by a qualified, experienced pedorthist who is prepared to make the almost inevitably needed adjustments. So I do not understand why, or how, these pre-formed devices can be of any use or help, especially with the kinds of problems people here have - yet some people do seem to have found them satisfactory.

I would really appreciate your comments on this matter. Many thanks,

Julie

Re: Off-the-shelf arch supports/orthotics

Dr. Zuckerman on 1/28/01 at 09:36 (037569)

I will give you Dr. Z's answer until Richard is available. Yes the perfect fit and prescription is very important. There are two areas that custom orthosis address 1. is biomechanical control of abnormal function during the walkining cycle 2. Added shock absorption to the foot which already takes over 125,000 of weight during the day.

So if a person needed just shock absorption and mild abnormal biomechanical control then pre-formed devices which usually will have alot of materials for shock absorption will address the not enought shock problem .

Now if the person has a servere abnormal foot function such as abormal pronation and restricted range of motion at the big toe joint or has a foot then doesn't come into contact at the very specific timing and angle then you need to have a casted orthosis that addresses this.

One of the most interesting aspect of Richard new orthois is that his devices not only address foot function , fit and motion control but they aren't as hard as a rock. In podiatry they teach and push the plastic devices

I just had a engineer in my office and we were taking about orthosis and I showed him the orthois made by Richard I told him how I felt about that they could wear out. He asked me why do you think this. I told him that I still had the mind set that plastic will last longer. His final comment after studying the material was that this material is going to last a long er time.

So we have to always keep an open mind and i am glad that I have tried Richard's materials for orthosis in my practice. The patients are starting to report back very good results.

Re: Off-the-shelf arch supports/orthotics

Julie on 1/28/01 at 09:57 (037570)

Many thanks for this, Dr Zuckerman. Your explanation of the two functions of orthoses is very interesting and answers my puzzlement as to why otc devices can be useful to some people.

Would I be right in thinking, though, that problems could arise if a person wasn't aware of any abormality in foot function and thought the cheaper otc devices would do the trick for them? And would you say that anyone needing or thinking they need such an aid ought to be properly checked out first?

My interest in this isn't for myself - I have orthotics that are all right (I think!) and address my abnormalities (flattish feet/excessive pronation) but just generally. I was puzzled, and I'm glad to have your explanation.

Re: Off-the-shelf arch supports/orthotics

Dr. Zuckerman on 1/28/01 at 10:15 (037571)

this would depend on the stage of plantar fasciitis that the person is having . In general my feeling about pf prevention is that Early Treatment and professional evaluation is the key to avoiding long term chronic pain or surgery.

Now let's get back to the reality of when we go to the doctor.
Over the counter inserts such as the DR. School heel guard or heel protector I am not sure which one. Its the one shaped like a long horse shoe do support and control to some degree abnormal function and give added shock absorption.

So let's say that you have some mild heel soreness or achiness yes go to the store and get them . You should also take a look at your shoes. Most important what caused the pf in the first place. Since we have Scott's online book then the person does get a good introduction to plantar fasciitis

Anyone that starts a new walking program, aerobic class, increases the time and distance of any sports needs to know that plantar fasciitis is a possible injury that they need to understand and know how to prevent and treat so that it doesn't become a long term chronic problem

So the answser to your question is how do you know if over the counter inserts are right for you. I guess you can't be 100% sure unless you see a podiatrist and or orthopedic that can examine your foot and isn't just an orthois salesmen. Or just ask Richard. He the online touch and see alot of orthosis cases that do work.

Re: Off-the-shelf arch supports/orthotics

Richard, C.Ped on 1/29/01 at 08:05 (037634)

Man, I really need to get a computer for my home. Dr. Z beat me to another one!! :-) Just kidding, he said exactly how I feel about the two.

So, Dr. Z, an engineer, huh? Cool!!
Richard

Re: Off-the-shelf arch supports/orthotics

Katherine on 2/07/01 at 22:30 (038402)

Dr. Z:

I'm VERY new to this board (tonight) and have tried hard white plastic (aabout $30 at the podiatrist's office) and they hurt! When I asked him about customs, he said the 'soft' ones wear out and don't support well. I said that maybe because I'm so sensitive to hte hard ones, I should try these - the PT place makes them and when they say custom, I'm assuming 'cast'. What is this material the other doctors are referring to that you use and how great it is? I'd like to read about it and be more informed when I take the plunge (financially speaking!). My insurance is not going to cover them, btw.

Thank,
Katherine
P.S. I have high arches and a callous on my big toe underside. The outer heals o fmy shoes wear down, as I tend to scuff when I walk. My feet also point outward while walking, but not extremely (too many ballet lessons as a kid).
Thanks,
Katherine

Re: Off-the-shelf arch supports/orthotics

Richard, C.Ped on 2/08/01 at 07:40 (038423)

Hi Katherine,
I can sense your frustration. The material I use is called Ethyl Vinyl Acetate, or EVA for short. It is a type of rubber. It's durability is measured in durometers. Rigid EVA is about a 60-65 durometer. Semi is about a 55, and soft is 40. For someone like you, I would start them off with 40 durometer posting and around a 30 durometer shell.

The shell is the part that actually touches your feet. The posting is the part that gives the orthosis the support.

I only use the hard plastic as a modification to the orthosis, such as limiting the motion of the hallux in a turf toe patient. Hard plastic can not get the same fit as EVA. Believe me, I have tried and tried again.

You may want to find a pedorthist in your area. Go to my web site by clicking on my name at the top of this message board, and it will take you right there. Scroll down to the bottom where my links are found (feel free to read the web site if you want to, of course). There is a link that states 'locate a C.Ped'. Click on that and it will take you to a site where you can type in your city and/or zip code and it will list all the C.Peds in or around your area.

Double check your insurance. I have found out (the hard way) that sometimes it is all in the wording. Find out about DME (durable medical equipment) coverage for inserts for shoes. That is what the insurance companies I deal with call them. If I say 'orthotics' or 'orthosis' there is usally this long pause before they finally ask 'do you mean inserts?'

If you have any other questions about materials or advice someone gives you, feel free to ask me, the doctors, and even the other people here. We want to help, that is why we are here.

Re: Off-the-shelf arch supports/orthotics

Dr. Zuckerman on 1/28/01 at 09:36 (037569)

I will give you Dr. Z's answer until Richard is available. Yes the perfect fit and prescription is very important. There are two areas that custom orthosis address 1. is biomechanical control of abnormal function during the walkining cycle 2. Added shock absorption to the foot which already takes over 125,000 of weight during the day.

So if a person needed just shock absorption and mild abnormal biomechanical control then pre-formed devices which usually will have alot of materials for shock absorption will address the not enought shock problem .

Now if the person has a servere abnormal foot function such as abormal pronation and restricted range of motion at the big toe joint or has a foot then doesn't come into contact at the very specific timing and angle then you need to have a casted orthosis that addresses this.

One of the most interesting aspect of Richard new orthois is that his devices not only address foot function , fit and motion control but they aren't as hard as a rock. In podiatry they teach and push the plastic devices

I just had a engineer in my office and we were taking about orthosis and I showed him the orthois made by Richard I told him how I felt about that they could wear out. He asked me why do you think this. I told him that I still had the mind set that plastic will last longer. His final comment after studying the material was that this material is going to last a long er time.

So we have to always keep an open mind and i am glad that I have tried Richard's materials for orthosis in my practice. The patients are starting to report back very good results.

Re: Off-the-shelf arch supports/orthotics

Julie on 1/28/01 at 09:57 (037570)

Many thanks for this, Dr Zuckerman. Your explanation of the two functions of orthoses is very interesting and answers my puzzlement as to why otc devices can be useful to some people.

Would I be right in thinking, though, that problems could arise if a person wasn't aware of any abormality in foot function and thought the cheaper otc devices would do the trick for them? And would you say that anyone needing or thinking they need such an aid ought to be properly checked out first?

My interest in this isn't for myself - I have orthotics that are all right (I think!) and address my abnormalities (flattish feet/excessive pronation) but just generally. I was puzzled, and I'm glad to have your explanation.

Re: Off-the-shelf arch supports/orthotics

Dr. Zuckerman on 1/28/01 at 10:15 (037571)

this would depend on the stage of plantar fasciitis that the person is having . In general my feeling about pf prevention is that Early Treatment and professional evaluation is the key to avoiding long term chronic pain or surgery.

Now let's get back to the reality of when we go to the doctor.
Over the counter inserts such as the DR. School heel guard or heel protector I am not sure which one. Its the one shaped like a long horse shoe do support and control to some degree abnormal function and give added shock absorption.

So let's say that you have some mild heel soreness or achiness yes go to the store and get them . You should also take a look at your shoes. Most important what caused the pf in the first place. Since we have Scott's online book then the person does get a good introduction to plantar fasciitis

Anyone that starts a new walking program, aerobic class, increases the time and distance of any sports needs to know that plantar fasciitis is a possible injury that they need to understand and know how to prevent and treat so that it doesn't become a long term chronic problem

So the answser to your question is how do you know if over the counter inserts are right for you. I guess you can't be 100% sure unless you see a podiatrist and or orthopedic that can examine your foot and isn't just an orthois salesmen. Or just ask Richard. He the online touch and see alot of orthosis cases that do work.

Re: Off-the-shelf arch supports/orthotics

Richard, C.Ped on 1/29/01 at 08:05 (037634)

Man, I really need to get a computer for my home. Dr. Z beat me to another one!! :-) Just kidding, he said exactly how I feel about the two.

So, Dr. Z, an engineer, huh? Cool!!
Richard

Re: Off-the-shelf arch supports/orthotics

Katherine on 2/07/01 at 22:30 (038402)

Dr. Z:

I'm VERY new to this board (tonight) and have tried hard white plastic (aabout $30 at the podiatrist's office) and they hurt! When I asked him about customs, he said the 'soft' ones wear out and don't support well. I said that maybe because I'm so sensitive to hte hard ones, I should try these - the PT place makes them and when they say custom, I'm assuming 'cast'. What is this material the other doctors are referring to that you use and how great it is? I'd like to read about it and be more informed when I take the plunge (financially speaking!). My insurance is not going to cover them, btw.

Thank,
Katherine
P.S. I have high arches and a callous on my big toe underside. The outer heals o fmy shoes wear down, as I tend to scuff when I walk. My feet also point outward while walking, but not extremely (too many ballet lessons as a kid).
Thanks,
Katherine

Re: Off-the-shelf arch supports/orthotics

Richard, C.Ped on 2/08/01 at 07:40 (038423)

Hi Katherine,
I can sense your frustration. The material I use is called Ethyl Vinyl Acetate, or EVA for short. It is a type of rubber. It's durability is measured in durometers. Rigid EVA is about a 60-65 durometer. Semi is about a 55, and soft is 40. For someone like you, I would start them off with 40 durometer posting and around a 30 durometer shell.

The shell is the part that actually touches your feet. The posting is the part that gives the orthosis the support.

I only use the hard plastic as a modification to the orthosis, such as limiting the motion of the hallux in a turf toe patient. Hard plastic can not get the same fit as EVA. Believe me, I have tried and tried again.

You may want to find a pedorthist in your area. Go to my web site by clicking on my name at the top of this message board, and it will take you right there. Scroll down to the bottom where my links are found (feel free to read the web site if you want to, of course). There is a link that states 'locate a C.Ped'. Click on that and it will take you to a site where you can type in your city and/or zip code and it will list all the C.Peds in or around your area.

Double check your insurance. I have found out (the hard way) that sometimes it is all in the wording. Find out about DME (durable medical equipment) coverage for inserts for shoes. That is what the insurance companies I deal with call them. If I say 'orthotics' or 'orthosis' there is usally this long pause before they finally ask 'do you mean inserts?'

If you have any other questions about materials or advice someone gives you, feel free to ask me, the doctors, and even the other people here. We want to help, that is why we are here.