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intro & ?

Posted by rebecca c. on 2/22/01 at 19:56 (039682)

I'm new around here and thought I'd tell my little story and ask for advice. I've had pf in my right foot for over 2 years and have been through the gamut of treatment: sports doctor - OTC inserts, four shots; chiropractor - deep massage (ouch!); sports PT stretching & tape; and finally a podiatrist - custom orthotics, wearing only running shoes, night splint, NSAIDs, ice, stretching and more PT (ultrasound). All to pretty much no avail. I have very high arches and very little fat pad on my feet, and a big old bone spur on my heel. My pod is very reluctant to do release surgery, he thinks it often does more harm than good. The pain I feel is such that I can no longer run, which I loved to do, but I am not crippled. I have a desk job but a consuming hobby that requires time on my feet. I don't let the pf limit my activities although I end up paying for it. I also have degenerative arthritis in the big toe joint of my other foot. The biggest bummer of all is that I am completely obsessed with my feet! I think about them ALL THE TIME! My orthotics are so rigid they aren't especially comfortable though I think that arch support helps. And the 3/4 length really aggravates the ball of my left foot. I CRAVE comfortable footwear!! So what I'd like to know is do they ever do bone spur removal surgery and ESWT? Are orthotics supposed to be comfortable? Sorry this got so long.

Re: intro & ?

Dr. Zuckerman on 2/22/01 at 20:18 (039683)

The first thing is to get orthosis that fit and are comfortable. Rigid plastic hard orthosis are doing your feet We are using EVA materila which I have found to be very comfortable and at the same time very effective.

We have been using ESWT for heel pain in over one hundred and fifty cases.
Take a look at our ESWT progress reports and inquire on the ESWT site.

So to answer your question yes surgery can be done but ESWT may be a better choice for you. The orthosis material can should be changed if they are hurting your feet. Plastic rigid orthosis can make your feet. worse.

Re: intro & ?

rebecca c. on 2/22/01 at 21:17 (039691)

Thanks for responding so quickly! What I wondered is if ESWT does anything for heel spurs or does it just treat the pf? Because in addition to the pain at the inside of my arch I can feel the spur on my heel and it hurts, too!

Re: intro & ?

BG CPed on 2/22/01 at 23:24 (039698)

I noticed you mentioned your orthotics are hard, hurt and you have very high arch. There is an article in http://www.biomech.com about cavus feet (high arch) it covers orthotics for your foot type. I dont know the exact link but it is mentioned on this site in a few of the threads...good luck

Re: intro & ?

Dr.Zuckerman on 2/23/01 at 08:16 (039716)

ESWT is used for either plantar fasciitis and or heel spur. The pain from the heel spur is due to the area not healing and unable to support your full weight during the walking cycle. The 'heel Spur' or area where the attachment of the plantar fascia is weak and not healing ESWT will stimulate the addition of fibroblasts . These are the cells that make the plantar fascia stronger and much better to support the full amount of stress at the attachment.

So the purpose of ESWT to heal this torn atachment area. I hope this is helpfl. Feel free to ask ask questions that you may have about ESWT. We have been using ESWT in over one hundred fifty cases and have alot of experience with this revolutionary procedure.

Re: intro & ?

Ellen W on 2/23/01 at 09:25 (039718)

rebecca: I know exactly what you mean about shoes. I keep thinking that if I could just find the perfect pair..... My closet is full of shoes that I buy, then don't wear. My latest fantasy is custom-made sneakers. I find a site that makes them at herseycustomshoe.com But they're pretty pricey, so for now I'll probably stick with New Balance. There are lots of good tips about shoes on this board, if you do a search.
Ellen

Re: intro & ?

Sean Tambling - C. Ped - Master Bootfitter on 2/23/01 at 12:43 (039734)

Rebecca,
The material in the orthotic can make a hugh difference. Our office makes custom orthotics mostly out of EVA. It is a type of foam that will support the foot well and also add some shock absorbsion. We also will remove the material from the bottom of the heel cup and add PQ (it is a substance simular to silicon but we can control the density of it). The heel cup being made of EVA gives the support and heel control you need and the PQ gives the extra amount of shock absorbsion that you need. Also, we only make full length EVA orthotics for all running shoes. Good luck. Ps. Above was my professional opinion, This in my personal opinion. Take it easy on the running. Give your body a chance to heel completely first. If you let it heel completely you may have a chance a getting back to the sport you love. Even then take it very slow. Stretch, Stretch, Stretch,Run only on soft surfaces at first,Run for very short distances at first. Example: Stretch, run slow for 1/4 mile, stretch. Next time, stretch, runs 1/3 mile, stretch ect......... If you let your body heel and be patient, you just might be able to get back to running. Don't get discouraged!!!! Just be patient.

Re: intro & ?

JudyS on 2/23/01 at 16:48 (039744)

Yes, Mr. CPed, we did see that article a couple of weeks ago via this website. Thanks for mentioning it again. I even gave it to my Pod who was very willing to peruse it. Are you its author?

Re: intro & ?

Richard, C.Ped on 2/24/01 at 11:54 (039799)

Hi Rebecca,
I am concerned about your orthotics. Yes, they should be comfortable to wear. The hard plastic (or window scrapers as I like to call them) do not get the proper fit to your arch that you need. The support is not there.
Also, I think it is hurting the ball of your feet because it is not tapered at the end. It may have 1/8' thickness of material. Ouch.

I don't recommend an off the shelf insert. I do recommend a properly made custom orthosis. Materials do play a factor. As Dr. Z and Sean stated, EVA is great for proper support. I am concerend about the arthritis as well.

If you decide to have another pair of inserts made, please let us know first. Dr. Z, Sean and myself will be happy to give you advice and questions to ask to help you go in the right direction.
Richard, C.Ped

Re: intro & ?

rebecca c. on 2/24/01 at 12:58 (039802)

Dr. Z, Sean and Richard,
Thanks for your response. The orthotics that Sean described sound heavenly. I live in California, so how does one go about get orthotics like that around here? I spoke to the guy yesterday that cast my feet and had my current pair made (not my pod) about my concerns and discomfort and he thought I probably couldn't wear the kind he can make and he'd give me a refund. I have had them re-made once already. This guy thought I should try OTC inserts. Do you think I just shouldn't wear them at all until I get this sorted out? Thanks, I appreciate your advice.

Re: intro & ?

Dr. Biehler on 2/25/01 at 08:53 (039845)

If you are having degenerative joint disease in your right toe, this could be causing a functional hallux limitus which in turn is putting too much tension on your plantar fascia of the right foot. This is an area that must be addressed when contenmplating orthotics and or shoes. Dr. B.

Re: intro & ?

Richard, C.Ped on 2/26/01 at 08:09 (039892)

Rebecca,
Could you send me your email? I have some suggestions for you.
Richard

Re: intro & ?

Dr. Zuckerman on 2/22/01 at 20:18 (039683)

The first thing is to get orthosis that fit and are comfortable. Rigid plastic hard orthosis are doing your feet We are using EVA materila which I have found to be very comfortable and at the same time very effective.

We have been using ESWT for heel pain in over one hundred and fifty cases.
Take a look at our ESWT progress reports and inquire on the ESWT site.

So to answer your question yes surgery can be done but ESWT may be a better choice for you. The orthosis material can should be changed if they are hurting your feet. Plastic rigid orthosis can make your feet. worse.

Re: intro & ?

rebecca c. on 2/22/01 at 21:17 (039691)

Thanks for responding so quickly! What I wondered is if ESWT does anything for heel spurs or does it just treat the pf? Because in addition to the pain at the inside of my arch I can feel the spur on my heel and it hurts, too!

Re: intro & ?

BG CPed on 2/22/01 at 23:24 (039698)

I noticed you mentioned your orthotics are hard, hurt and you have very high arch. There is an article in http://www.biomech.com about cavus feet (high arch) it covers orthotics for your foot type. I dont know the exact link but it is mentioned on this site in a few of the threads...good luck

Re: intro & ?

Dr.Zuckerman on 2/23/01 at 08:16 (039716)

ESWT is used for either plantar fasciitis and or heel spur. The pain from the heel spur is due to the area not healing and unable to support your full weight during the walking cycle. The 'heel Spur' or area where the attachment of the plantar fascia is weak and not healing ESWT will stimulate the addition of fibroblasts . These are the cells that make the plantar fascia stronger and much better to support the full amount of stress at the attachment.

So the purpose of ESWT to heal this torn atachment area. I hope this is helpfl. Feel free to ask ask questions that you may have about ESWT. We have been using ESWT in over one hundred fifty cases and have alot of experience with this revolutionary procedure.

Re: intro & ?

Ellen W on 2/23/01 at 09:25 (039718)

rebecca: I know exactly what you mean about shoes. I keep thinking that if I could just find the perfect pair..... My closet is full of shoes that I buy, then don't wear. My latest fantasy is custom-made sneakers. I find a site that makes them at herseycustomshoe.com But they're pretty pricey, so for now I'll probably stick with New Balance. There are lots of good tips about shoes on this board, if you do a search.
Ellen

Re: intro & ?

Sean Tambling - C. Ped - Master Bootfitter on 2/23/01 at 12:43 (039734)

Rebecca,
The material in the orthotic can make a hugh difference. Our office makes custom orthotics mostly out of EVA. It is a type of foam that will support the foot well and also add some shock absorbsion. We also will remove the material from the bottom of the heel cup and add PQ (it is a substance simular to silicon but we can control the density of it). The heel cup being made of EVA gives the support and heel control you need and the PQ gives the extra amount of shock absorbsion that you need. Also, we only make full length EVA orthotics for all running shoes. Good luck. Ps. Above was my professional opinion, This in my personal opinion. Take it easy on the running. Give your body a chance to heel completely first. If you let it heel completely you may have a chance a getting back to the sport you love. Even then take it very slow. Stretch, Stretch, Stretch,Run only on soft surfaces at first,Run for very short distances at first. Example: Stretch, run slow for 1/4 mile, stretch. Next time, stretch, runs 1/3 mile, stretch ect......... If you let your body heel and be patient, you just might be able to get back to running. Don't get discouraged!!!! Just be patient.

Re: intro & ?

JudyS on 2/23/01 at 16:48 (039744)

Yes, Mr. CPed, we did see that article a couple of weeks ago via this website. Thanks for mentioning it again. I even gave it to my Pod who was very willing to peruse it. Are you its author?

Re: intro & ?

Richard, C.Ped on 2/24/01 at 11:54 (039799)

Hi Rebecca,
I am concerned about your orthotics. Yes, they should be comfortable to wear. The hard plastic (or window scrapers as I like to call them) do not get the proper fit to your arch that you need. The support is not there.
Also, I think it is hurting the ball of your feet because it is not tapered at the end. It may have 1/8' thickness of material. Ouch.

I don't recommend an off the shelf insert. I do recommend a properly made custom orthosis. Materials do play a factor. As Dr. Z and Sean stated, EVA is great for proper support. I am concerend about the arthritis as well.

If you decide to have another pair of inserts made, please let us know first. Dr. Z, Sean and myself will be happy to give you advice and questions to ask to help you go in the right direction.
Richard, C.Ped

Re: intro & ?

rebecca c. on 2/24/01 at 12:58 (039802)

Dr. Z, Sean and Richard,
Thanks for your response. The orthotics that Sean described sound heavenly. I live in California, so how does one go about get orthotics like that around here? I spoke to the guy yesterday that cast my feet and had my current pair made (not my pod) about my concerns and discomfort and he thought I probably couldn't wear the kind he can make and he'd give me a refund. I have had them re-made once already. This guy thought I should try OTC inserts. Do you think I just shouldn't wear them at all until I get this sorted out? Thanks, I appreciate your advice.

Re: intro & ?

Dr. Biehler on 2/25/01 at 08:53 (039845)

If you are having degenerative joint disease in your right toe, this could be causing a functional hallux limitus which in turn is putting too much tension on your plantar fascia of the right foot. This is an area that must be addressed when contenmplating orthotics and or shoes. Dr. B.

Re: intro & ?

Richard, C.Ped on 2/26/01 at 08:09 (039892)

Rebecca,
Could you send me your email? I have some suggestions for you.
Richard