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How much space should orthotics take up in your shoe?

Posted by Nancy N on 2/24/01 at 20:36 (039821)

Richard--

I have my appointment with a local C.Ped next Saturday and I'm hoping to go ahead and have some new orthotics made to get me the rest of the way back on track. I'm just wondering, though, how much space the full-length orthotics will take up in my shoe (I know you won't be the one making them--more's the pity--but a ballpark guess is fine). I guess what I'm really wondering is how thick they may end up being and whether or not I'll be able to transfer them between shoes. I spoke with this guy on the phone and he says he can make some that should go between shoes. I always had the 3/4 length before and those were not as much of a problem in the toe area. I can't tell how you many shoes I have now that I can't wear just with my full-length Spencos....

Thanks for your input!

Re: How much space should orthotics take up in your shoe?

Dr. Zuckerman on 2/25/01 at 06:14 (039840)

He can use different materials and thickness for the toe area. Don't worry he should be able to adjust them to fit your different pair of shoes, so long as they aren't the high heel shoes

Sorry to post in but I letting Richard sleep in this am

Re: How much space should orthotics take up in your shoe?

Richard, C.Ped on 2/26/01 at 08:23 (039896)

Thanx for letting me sleep in Dr. Z.
Nancy, send me those casts, I will take care of you!! Sorry, I could not resist.

For the shell, I use an 1/8' 30 durometer EVA. This allows plenty of room in the toe box. I have a pair of Rockport wingtips with a very shallow toe box, and I have enough room when I wear my full length.

When I make the inserts, I will ask the customer to bring the two or three most often worn shoes to see if they will fit in all. I will fit them to the most often worn pair first, of course. Then go from there.

When I do long distance fabrication, I like to have tracings of the insoles out of those shoes. That is what I use to fit them in the office, so it usually works when I make them for out of town patients.

Interfacing the orthosis with the shoe is very easy. Many people just do not take the time to do it.

Richard

Re: How much space should orthotics take up in your shoe?

Nancy N on 2/26/01 at 09:26 (039897)

Hmm--I didn't realize I could have you make them if I sent you the casts! Though, knowing my luck, the casts would break in transit :) And of course, I would probably offend this guy if I asked him to take the casts but not make the orthotics (this is the guy who uses the subortholene).

Richard, is your list of orthotics questions handy anywhere? I hate to make you re-type it, but it would be so helpful if I could have the list with me when I go on Saturday.

Thanks so much!

Re: How much space should orthotics take up in your shoe?

Richard, C.Ped on 2/26/01 at 14:26 (039913)

I would be happy to get make a list of questions. I did a search about a month ago, and I was able to find the actual post. In the mean time, try doing a search of 'Richard, C.Ped' and somewhere in there you will find a couple of long posts with all sorts of questions.
Richard

Re: How much space should orthotics take up in your shoe?

Nancy N on 2/26/01 at 14:35 (039915)

Richard--

Thanks for the info. I wonder if it should be a file with a permanent location on the site, sort of like the PF book, only smaller?

Nancy

Re: How much space should orthotics take up in your shoe?

Julie on 2/27/01 at 01:55 (039960)

Hello Nancy and Richard

Nancy, that is a useful suggestion. I often feel, when someone makes a long, informative post, that it's a shame it can't be 'caught' and preserved for posterity. A good example of making such information a permanent, accessible source is Wendy's excellent new FAQ on tarsal tunnel syndrome. If I were going for new orthotics, I would definitely want Richard's list of questions handy.

Nancy, why not take up Richard's offer to make your orthoses? They're YOUR feet, after all. I'm sure there's a a way of explaining to the doctor who casts you that you'd like the devices made by someone you know and trust.

Re: Having Richard make my orthotics

Nancy N on 2/27/01 at 09:42 (039986)

Julie--

It is a thought, having Richard make the orthotics. But I'm not sure how I'd handle adjustments, etc. I wouldn't want to go to the guy who cast me for adjustments on something he didn't make. Richard--any thoughts??

Thanks.

Re: Having Richard make my orthotics

Richard, C.Ped on 2/27/01 at 15:37 (040019)

I have made quite a few for long distance customers. I have only one that needed adjustments. With that one, it was sent back to me via US Mail. I will return it by UPS. All I need is a tracing of the insoles out of the shoe that you would mostly wear with the orthotics. That is all I use when I am interfacing the orthosis here in the office.
Richard

Re: Having Richard make my orthotics

Nancy N on 2/27/01 at 15:49 (040020)

Richard--

Hmmmm.... now you are making me think about this. I was thinking I would go ahead and have him cast me on Saturday, but now I'm not sure what I should do. Maybe I should go in with a list of questions and then compare notes with you or something. Does that sound practical? I don't know how I would be able to go in and say 'Yeah, cast me, but then I want to send them to another guy,' though. That would feel strange to me.

Feel free to drop me an email if you think we should discuss this off the boards. I really appreciate your input.

Re: Having Richard make my orthotics -- adjustment issue

Donna SL on 2/27/01 at 17:14 (040025)

Nancy,

I hope Richard doesn't take offense to this, but you need someone locally to do your adjustments. First of all the person who makes them needs to evaluate the orthotics on your feet after they are made. They should know enough about biomechanics to evaluate how you are walking in them, and correcting your gait, how they contour to your feet, etc. Is the person who would make the cast be able to evaluate them after they are made? Also even the best made orthotic in the world with the best cast corrections, may not feel right in certain places on your foot, and need certain spot adjustments. You need to be interacting with the practioner, one on one. They may do little bits at a time, and you can tell him/her how you feel on the spot. An adjustment can feel good in the office, and you walk around for a couple of hours, and something else may bother you, and you may have to go back. Sometimes corrections need to be added to the orthotic, or taken away. Sometimes the arch needs to cut down a little or a lot, or a varus or valgus correction in the rearfoot, or forefoot for example may have to be adjusted, plus a ton of other things that are not always predictable when the orthotic is made. Sometimes you have discomfort in the orthotic, and may not know yourself what is causing it, but the practioner should. I don't know how adjustments can be made looking at a pair of insoles. You may need a lot more than just interfacing an orthotic with the shoe.

The most important thing though is have someone very knowledgable in taking a foot cast. If you don't have a decent cast done, and a decent prescription done for correcting the cast, fabrication of the orthotic is a waste. The orthotic will not only be uncomfortable, it could cause injury. The practioner ordering the orthoses, and requesting the cast correction needs to be able to tell the person what is wrong with your foot through observation, and writing the prescription.

Also I recommend the person who is doing the casting, be DPM with a biomechanics background. Not every DPM takes a good cast, evaluates your biomechanics, or writes the proper prescription. I've had some very poor cast done by pods.

I had a beautiful pair of orthotics just made from an orthotist/cped off my doctors cast yet they still are going to need several adjustments. I'm still not sure if this material with all the reinforcements, etc. is giving me the control I need. It is very similar to the materials Richard uses. If it doesn't after several adjustments I will consider subortholon, or a very thin flexible polypropylene shell with a soft arch fill, and a soft top cover. I was successful with that type of orthotic in the past, so I would not rule out subortholon. It is very flexible, and can be very comfortable, in a well made orthotic. Just make sure there is a good top cover, ideally full length, and the practioner knows you will need some type of arch fill/posting for support, because the shell is so flexible. Also, an orthotic made of the above combo, is a little less bulky.

Donna

Re: Having Richard make my orthotics -- adjustment issue

Nancy N on 2/27/01 at 19:03 (040029)

Donna--

You raise a lot of very good points. I am especially worried about the gait issue, because I know I do not walk properly (the main reason, aside from PF, why I decided I should get them). And it looks like I may have the beginnings of PTT, so I don't want to wait around, and I also want to make sure I get something that takes all my foot problems into account.

I don't know about having to go to a DPM, though (no offense, Dr. Z!). My last DPM got me a truly crappy pair of orthotics that I shelled out $300 for and can basically only use as ice scrapers. I'm not at all sure that he did the casting properly. So that is one of the things I am planning to check out with this guy on Saturday--I want to make sure he knows how to get my feet into a neutral position and go from there. Dr. Z is probably the only DPM I would want to trust with my casting/money at this stage, and I've never even met him!

So... a lot to think about. Any other comments or suggestions are very welcome--I want to make sure I do it right this time and get something that will help and not hurt, like the last ones. (Thanks for the comments about the subortholene, too--I appreciate them!)

Re: Having Richard make my orthotics -- adjustment issue

Donna SL on 2/28/01 at 00:07 (040048)

Nancy,

There is an article in Biomechanics magazine on-line site on heel pain, and PF, but there is a very intesting section half way down the article which explains how gait compensations occur in result of pain. I thought you might be interested since you were concerned about your gait.

http://www.biomech.com/db_area/archives/2001/0301orthoses.bio.html

I know over the last year or two my gait changed for the worse, in response to pain, but is improving as my foot pain improves. I know I needed a different orthotic when I was in a lot of pain. It was very soft, yet was a functional orthotic, and it helped me heal. I was thrilled it enabled me to to stand and shop for a couple of hours. Now that I'm improving, and want even more support I don't like the really soft orthotic anymore, and am trying to get into something more firm again. When you injure any part of your body, you may need different treatments/appliances depending on the stage of the injury you're in. I don't think any pod should give anyone a rigid or semi rigid device when they are in the severe stages of any foot pain.

I looked at some older post that I think were yours in regard to some orthotics that were made. If that was you, then whom ever made them made a poor choice. Don't judge all DPMs by what that one practioner did. He/she didn't seem to use a quality lab, or know what they were doing. That's why I suggested going to DPM who is very experienced in biomechanics. Question their specific training in this field. There are plenty of DPMs and other non podiatry practioners, that know very little about orthoses, biomechanics, and proper casting, yet are prescribing orthotics. I explained in the above post why a good cast is critical You need a specialist in this field, especially since you may be developing PTT. Even all the above creditials are not a quarantee sometimes, and you may have to try someone else.

If you have any podiatry colleges in your state, I would call them for a recommendation. They may also have a biomechanics clinic attached for out patients. Again, ask questions. If you were having surgery would you not question the doctors credentials and knowledge? Wouldn't you also make sure they specialized in what you needed correcting? You have to do the same thing when you get a pair of orthotics made. I learned that the hard way.

There is also a podiatry site that list all kinds of things like all the podiatry colleges, orthotic labs names and numbers, etc. For example I know PROLab USA, which does quality cast corrections, may be able to suggest someone to you in your area, since they are a national lab. Click under the orthotics section for the list of orthotic labs.

The site is called Podiatry online
http://www.podiatryonline.com/solutions/bestfoot.html

If you find a good practioner they should be open to your request to not having something rigid, or even let you take the corrected cast to someone of your choice to have them fabricated. They should also listen to your needs, and let you have input into what you want, or you should not have to accept them. Ask them to show you a sample of what they would make for you. If you think it is to rigid tell them that is not acceptable. Most good doctors, will make another pair, if you cannot tolerate the first orthotic after many adjustments, or just charge a minimal fee. The actual lab cost for orthotics is not that expensive. Most quality labs will have softer plastics like subortholon, and some type of EVA. I have a rare doctor who corrects the cast himself rather than have a lab do it, so I have the option of having them made from a him, a big lab, or a private/orthotist/cped. I'm experimenting with different types of materials right now. I just recently had an orthotist/cped make a pair, because he seemed more knowlegeable on some newer materials. Once you have the cast made, and corrected, they can be taken anywhere.

Donna

Re: Having Richard make my orthotics -- adjustment issue

Nancy N on 2/28/01 at 08:48 (040062)

Donna--

Just curious--are you a doctor? Or another type of medical pro? Just wondering since you have so much detailed info on hand.

Re: Having Richard make my orthotics -- adjustment issue

Ellen W on 2/28/01 at 09:41 (040064)

Donna,

Thank you so much! That was a great article.
Ellen

Re: Having Richard make my orthotics -- adjustment issue

Richard, C.Ped on 3/01/01 at 09:07 (040164)

Hi Donna,
No offense taken:-)

To clear the air, just in case, I am not on the board to solicit business from anyone. If someone wants me to make the inserts for them, great I will and I will do my best to provide the best orthosis they have ever used. My primary job here is to provide the best answers to the many questions people have so they will not be taken advantage of or be provided crap for an orthosis. It is my fault for talking about this with Nancy on the board. I don't usually do that. Nancy, sorry for making fun of your accent....you made fun of mine too.... :-)

To be quite honest, I have made many many orthotics for long distance customers without problems (knock wood). Yes, interfacing does play a major role in the orthosis actually working. It also has to be made correctly. This includes casting, materials, molding, and grinding(or sanding).

After reading your posts and speaking with you a few weeks ago, I have noticed that you have not been provided with a quality product. I have
treated people that consider themselves to have the 'worst feet in the world', but if you have someone that knows what he/she is doing with the orthosis, they can really be helped in a wonderful way.

If I seem a little defensive, well, I guess I am. You have read my posts before, and this is nothing new. I am tired of people getting crappy treatment with junk orthotics. Do I think I am the best?? No way. That is my father in law...Mike :-) Sorry, trying to lighten the mood. There are many C.Peds out there who are great at what they do, but with any business, there are those that will unfortunatly (sp?) take advantage of others. Kind of like Bizarro C.Peds. We know what works (BTW not just EVA, there are other great materials that are used for different conditions), and we know how to make it work.

Be careful how you comprehend what you read. Sometimes articles are written about one specific foot type, but it can sound like many types.

Since you can't hear me talk or see my expressions, I wanted to let you know that I am writing this with a smile. I don't mean to be malicious in any way. So again, no offense taken. :-)~
Have a great day!!
Richard

Re: Richard's accent.

Nancy N on 3/01/01 at 11:21 (040186)

Now Richard.... did I really make fun of your accent? I can't help being an ol' Yankee from PA. I could have imitated the folks around me in NY/NJ (no offense to anyone else who lives here--I'm from PA Dutch country which has its own weird accents, trust me!) ;) I actually pick up accents really quickly, so next time I'll try a different one and see if you like it better! (I wonder how many different accents are represented on this board, actually--we should have a Heelspurs.com convention sometime and finally meet each other!)

Actually, you don't have as strong a Southern accent as I thought you might have. And it was great to talk to you about my options and things I should check out, so in the end, the accent really doesn't matter at all! :)

Re: Having Richard make my orthotics -- adjustment issue

Donna SL on 3/01/01 at 14:11 (040199)

Richard,

I'm not saying there is anything wrong with orthotics being made long distance. Practioners send out for orthotics to made all the time to labs in different states. I just wanted Nancy to be aware, that someone needs to be evaluating the orthotics locally, and possibly do adjustments.

The orthotics I just received from the orthotist/cped are of a very nice quality. Instead of using EVA he used Pro XP2 (from Uco International) as the base which is around 50 durometer, and the shell is made from tri-lam consisting of micro cell puff and poron. The orthotic is reinforced with a material called thermoknit. I'm curious if you have worked with these materials, and know the pros and cons of Pro XP2 vs EVA. I've been told Pro XP2 is resistant to bottoming out. It looks and feels very much like EVA.

The orthotics fit perfectly to my foot, and are pretty stable considering they are not plastic. Although the arch area fits perfectly it is causing some irritation, and may feel better, when some bulk is reduced from the bottom. It may also be due to me having a high arch, and I cannot take a full contour like the article on cavus feet mentioned. I also may need some additional reinforcement, or wedging on the lateral side of the orthotic. Even though these are intrinsically corrected, since I'm a severe supinator, this material does not hold my foot as well on the lateral heel side as well as a plastic shell does. But the material is more forgiving, and more comfortable, so it seems some sacrifice needs to be made. Also I have an intrinsic forefoot valgus correction in the orthotic, and the material seems to be supporting the forefoot very well. Even with such a nice design I still may need other adjustments, because I'm still sensitive in certain areas as a result pf, and other injuries. I may even have to have the cast changed itself to add more fill to the arch area, if the above adjustments don't work.

I'm not saying everyone needs this many adjustments, but sometimes things are unpredictable, no matter how well the orthotic is made. Especially when you are dealing with someone who is suffering from a lot of foot injuries. More adjustments, or accomadations than usual may be necessary, and ideally it is more advantageous to be working with someone locally to supervise, and do these adjustments.

P.S. After speaking with you on the phone, I don't think you have a malicious bone in your body. I think we all need to be able to express our opinions, share our experiences, and brainstorm a little, so we can all learn from each other.

Donna

Re: Having Richard make my orthotics -- adjustment issue

Richard, C.Ped on 3/01/01 at 15:14 (040205)

That is good to know. I do agree that someone with so much going on with their feet such as you, would benefit more using a local dude.

The material sounds good. I will have to look into it.

Good luck with the new inserts!!
Richard

Re: Richard's accent.

Richard, C.Ped on 3/02/01 at 07:40 (040255)

My father is from Ohio, so I am half yankee. I had an Australian friend when I was a kid, so I always wished I spoke with that accent. That would be cool.
Richard

Re: NJ orthotic makers

Lee S. on 3/26/01 at 15:11 (042547)

Helene Manno in Cliffside NJ is an excellent podiatrist who has made my orthotics for twenty years. She takes a mold of your foot and will make sure the orthotic lab does a great job.

Re: How much space should orthotics take up in your shoe?

Dr. Zuckerman on 2/25/01 at 06:14 (039840)

He can use different materials and thickness for the toe area. Don't worry he should be able to adjust them to fit your different pair of shoes, so long as they aren't the high heel shoes

Sorry to post in but I letting Richard sleep in this am

Re: How much space should orthotics take up in your shoe?

Richard, C.Ped on 2/26/01 at 08:23 (039896)

Thanx for letting me sleep in Dr. Z.
Nancy, send me those casts, I will take care of you!! Sorry, I could not resist.

For the shell, I use an 1/8' 30 durometer EVA. This allows plenty of room in the toe box. I have a pair of Rockport wingtips with a very shallow toe box, and I have enough room when I wear my full length.

When I make the inserts, I will ask the customer to bring the two or three most often worn shoes to see if they will fit in all. I will fit them to the most often worn pair first, of course. Then go from there.

When I do long distance fabrication, I like to have tracings of the insoles out of those shoes. That is what I use to fit them in the office, so it usually works when I make them for out of town patients.

Interfacing the orthosis with the shoe is very easy. Many people just do not take the time to do it.

Richard

Re: How much space should orthotics take up in your shoe?

Nancy N on 2/26/01 at 09:26 (039897)

Hmm--I didn't realize I could have you make them if I sent you the casts! Though, knowing my luck, the casts would break in transit :) And of course, I would probably offend this guy if I asked him to take the casts but not make the orthotics (this is the guy who uses the subortholene).

Richard, is your list of orthotics questions handy anywhere? I hate to make you re-type it, but it would be so helpful if I could have the list with me when I go on Saturday.

Thanks so much!

Re: How much space should orthotics take up in your shoe?

Richard, C.Ped on 2/26/01 at 14:26 (039913)

I would be happy to get make a list of questions. I did a search about a month ago, and I was able to find the actual post. In the mean time, try doing a search of 'Richard, C.Ped' and somewhere in there you will find a couple of long posts with all sorts of questions.
Richard

Re: How much space should orthotics take up in your shoe?

Nancy N on 2/26/01 at 14:35 (039915)

Richard--

Thanks for the info. I wonder if it should be a file with a permanent location on the site, sort of like the PF book, only smaller?

Nancy

Re: How much space should orthotics take up in your shoe?

Julie on 2/27/01 at 01:55 (039960)

Hello Nancy and Richard

Nancy, that is a useful suggestion. I often feel, when someone makes a long, informative post, that it's a shame it can't be 'caught' and preserved for posterity. A good example of making such information a permanent, accessible source is Wendy's excellent new FAQ on tarsal tunnel syndrome. If I were going for new orthotics, I would definitely want Richard's list of questions handy.

Nancy, why not take up Richard's offer to make your orthoses? They're YOUR feet, after all. I'm sure there's a a way of explaining to the doctor who casts you that you'd like the devices made by someone you know and trust.

Re: Having Richard make my orthotics

Nancy N on 2/27/01 at 09:42 (039986)

Julie--

It is a thought, having Richard make the orthotics. But I'm not sure how I'd handle adjustments, etc. I wouldn't want to go to the guy who cast me for adjustments on something he didn't make. Richard--any thoughts??

Thanks.

Re: Having Richard make my orthotics

Richard, C.Ped on 2/27/01 at 15:37 (040019)

I have made quite a few for long distance customers. I have only one that needed adjustments. With that one, it was sent back to me via US Mail. I will return it by UPS. All I need is a tracing of the insoles out of the shoe that you would mostly wear with the orthotics. That is all I use when I am interfacing the orthosis here in the office.
Richard

Re: Having Richard make my orthotics

Nancy N on 2/27/01 at 15:49 (040020)

Richard--

Hmmmm.... now you are making me think about this. I was thinking I would go ahead and have him cast me on Saturday, but now I'm not sure what I should do. Maybe I should go in with a list of questions and then compare notes with you or something. Does that sound practical? I don't know how I would be able to go in and say 'Yeah, cast me, but then I want to send them to another guy,' though. That would feel strange to me.

Feel free to drop me an email if you think we should discuss this off the boards. I really appreciate your input.

Re: Having Richard make my orthotics -- adjustment issue

Donna SL on 2/27/01 at 17:14 (040025)

Nancy,

I hope Richard doesn't take offense to this, but you need someone locally to do your adjustments. First of all the person who makes them needs to evaluate the orthotics on your feet after they are made. They should know enough about biomechanics to evaluate how you are walking in them, and correcting your gait, how they contour to your feet, etc. Is the person who would make the cast be able to evaluate them after they are made? Also even the best made orthotic in the world with the best cast corrections, may not feel right in certain places on your foot, and need certain spot adjustments. You need to be interacting with the practioner, one on one. They may do little bits at a time, and you can tell him/her how you feel on the spot. An adjustment can feel good in the office, and you walk around for a couple of hours, and something else may bother you, and you may have to go back. Sometimes corrections need to be added to the orthotic, or taken away. Sometimes the arch needs to cut down a little or a lot, or a varus or valgus correction in the rearfoot, or forefoot for example may have to be adjusted, plus a ton of other things that are not always predictable when the orthotic is made. Sometimes you have discomfort in the orthotic, and may not know yourself what is causing it, but the practioner should. I don't know how adjustments can be made looking at a pair of insoles. You may need a lot more than just interfacing an orthotic with the shoe.

The most important thing though is have someone very knowledgable in taking a foot cast. If you don't have a decent cast done, and a decent prescription done for correcting the cast, fabrication of the orthotic is a waste. The orthotic will not only be uncomfortable, it could cause injury. The practioner ordering the orthoses, and requesting the cast correction needs to be able to tell the person what is wrong with your foot through observation, and writing the prescription.

Also I recommend the person who is doing the casting, be DPM with a biomechanics background. Not every DPM takes a good cast, evaluates your biomechanics, or writes the proper prescription. I've had some very poor cast done by pods.

I had a beautiful pair of orthotics just made from an orthotist/cped off my doctors cast yet they still are going to need several adjustments. I'm still not sure if this material with all the reinforcements, etc. is giving me the control I need. It is very similar to the materials Richard uses. If it doesn't after several adjustments I will consider subortholon, or a very thin flexible polypropylene shell with a soft arch fill, and a soft top cover. I was successful with that type of orthotic in the past, so I would not rule out subortholon. It is very flexible, and can be very comfortable, in a well made orthotic. Just make sure there is a good top cover, ideally full length, and the practioner knows you will need some type of arch fill/posting for support, because the shell is so flexible. Also, an orthotic made of the above combo, is a little less bulky.

Donna

Re: Having Richard make my orthotics -- adjustment issue

Nancy N on 2/27/01 at 19:03 (040029)

Donna--

You raise a lot of very good points. I am especially worried about the gait issue, because I know I do not walk properly (the main reason, aside from PF, why I decided I should get them). And it looks like I may have the beginnings of PTT, so I don't want to wait around, and I also want to make sure I get something that takes all my foot problems into account.

I don't know about having to go to a DPM, though (no offense, Dr. Z!). My last DPM got me a truly crappy pair of orthotics that I shelled out $300 for and can basically only use as ice scrapers. I'm not at all sure that he did the casting properly. So that is one of the things I am planning to check out with this guy on Saturday--I want to make sure he knows how to get my feet into a neutral position and go from there. Dr. Z is probably the only DPM I would want to trust with my casting/money at this stage, and I've never even met him!

So... a lot to think about. Any other comments or suggestions are very welcome--I want to make sure I do it right this time and get something that will help and not hurt, like the last ones. (Thanks for the comments about the subortholene, too--I appreciate them!)

Re: Having Richard make my orthotics -- adjustment issue

Donna SL on 2/28/01 at 00:07 (040048)

Nancy,

There is an article in Biomechanics magazine on-line site on heel pain, and PF, but there is a very intesting section half way down the article which explains how gait compensations occur in result of pain. I thought you might be interested since you were concerned about your gait.

http://www.biomech.com/db_area/archives/2001/0301orthoses.bio.html

I know over the last year or two my gait changed for the worse, in response to pain, but is improving as my foot pain improves. I know I needed a different orthotic when I was in a lot of pain. It was very soft, yet was a functional orthotic, and it helped me heal. I was thrilled it enabled me to to stand and shop for a couple of hours. Now that I'm improving, and want even more support I don't like the really soft orthotic anymore, and am trying to get into something more firm again. When you injure any part of your body, you may need different treatments/appliances depending on the stage of the injury you're in. I don't think any pod should give anyone a rigid or semi rigid device when they are in the severe stages of any foot pain.

I looked at some older post that I think were yours in regard to some orthotics that were made. If that was you, then whom ever made them made a poor choice. Don't judge all DPMs by what that one practioner did. He/she didn't seem to use a quality lab, or know what they were doing. That's why I suggested going to DPM who is very experienced in biomechanics. Question their specific training in this field. There are plenty of DPMs and other non podiatry practioners, that know very little about orthoses, biomechanics, and proper casting, yet are prescribing orthotics. I explained in the above post why a good cast is critical You need a specialist in this field, especially since you may be developing PTT. Even all the above creditials are not a quarantee sometimes, and you may have to try someone else.

If you have any podiatry colleges in your state, I would call them for a recommendation. They may also have a biomechanics clinic attached for out patients. Again, ask questions. If you were having surgery would you not question the doctors credentials and knowledge? Wouldn't you also make sure they specialized in what you needed correcting? You have to do the same thing when you get a pair of orthotics made. I learned that the hard way.

There is also a podiatry site that list all kinds of things like all the podiatry colleges, orthotic labs names and numbers, etc. For example I know PROLab USA, which does quality cast corrections, may be able to suggest someone to you in your area, since they are a national lab. Click under the orthotics section for the list of orthotic labs.

The site is called Podiatry online
http://www.podiatryonline.com/solutions/bestfoot.html

If you find a good practioner they should be open to your request to not having something rigid, or even let you take the corrected cast to someone of your choice to have them fabricated. They should also listen to your needs, and let you have input into what you want, or you should not have to accept them. Ask them to show you a sample of what they would make for you. If you think it is to rigid tell them that is not acceptable. Most good doctors, will make another pair, if you cannot tolerate the first orthotic after many adjustments, or just charge a minimal fee. The actual lab cost for orthotics is not that expensive. Most quality labs will have softer plastics like subortholon, and some type of EVA. I have a rare doctor who corrects the cast himself rather than have a lab do it, so I have the option of having them made from a him, a big lab, or a private/orthotist/cped. I'm experimenting with different types of materials right now. I just recently had an orthotist/cped make a pair, because he seemed more knowlegeable on some newer materials. Once you have the cast made, and corrected, they can be taken anywhere.

Donna

Re: Having Richard make my orthotics -- adjustment issue

Nancy N on 2/28/01 at 08:48 (040062)

Donna--

Just curious--are you a doctor? Or another type of medical pro? Just wondering since you have so much detailed info on hand.

Re: Having Richard make my orthotics -- adjustment issue

Ellen W on 2/28/01 at 09:41 (040064)

Donna,

Thank you so much! That was a great article.
Ellen

Re: Having Richard make my orthotics -- adjustment issue

Richard, C.Ped on 3/01/01 at 09:07 (040164)

Hi Donna,
No offense taken:-)

To clear the air, just in case, I am not on the board to solicit business from anyone. If someone wants me to make the inserts for them, great I will and I will do my best to provide the best orthosis they have ever used. My primary job here is to provide the best answers to the many questions people have so they will not be taken advantage of or be provided crap for an orthosis. It is my fault for talking about this with Nancy on the board. I don't usually do that. Nancy, sorry for making fun of your accent....you made fun of mine too.... :-)

To be quite honest, I have made many many orthotics for long distance customers without problems (knock wood). Yes, interfacing does play a major role in the orthosis actually working. It also has to be made correctly. This includes casting, materials, molding, and grinding(or sanding).

After reading your posts and speaking with you a few weeks ago, I have noticed that you have not been provided with a quality product. I have
treated people that consider themselves to have the 'worst feet in the world', but if you have someone that knows what he/she is doing with the orthosis, they can really be helped in a wonderful way.

If I seem a little defensive, well, I guess I am. You have read my posts before, and this is nothing new. I am tired of people getting crappy treatment with junk orthotics. Do I think I am the best?? No way. That is my father in law...Mike :-) Sorry, trying to lighten the mood. There are many C.Peds out there who are great at what they do, but with any business, there are those that will unfortunatly (sp?) take advantage of others. Kind of like Bizarro C.Peds. We know what works (BTW not just EVA, there are other great materials that are used for different conditions), and we know how to make it work.

Be careful how you comprehend what you read. Sometimes articles are written about one specific foot type, but it can sound like many types.

Since you can't hear me talk or see my expressions, I wanted to let you know that I am writing this with a smile. I don't mean to be malicious in any way. So again, no offense taken. :-)~
Have a great day!!
Richard

Re: Richard's accent.

Nancy N on 3/01/01 at 11:21 (040186)

Now Richard.... did I really make fun of your accent? I can't help being an ol' Yankee from PA. I could have imitated the folks around me in NY/NJ (no offense to anyone else who lives here--I'm from PA Dutch country which has its own weird accents, trust me!) ;) I actually pick up accents really quickly, so next time I'll try a different one and see if you like it better! (I wonder how many different accents are represented on this board, actually--we should have a Heelspurs.com convention sometime and finally meet each other!)

Actually, you don't have as strong a Southern accent as I thought you might have. And it was great to talk to you about my options and things I should check out, so in the end, the accent really doesn't matter at all! :)

Re: Having Richard make my orthotics -- adjustment issue

Donna SL on 3/01/01 at 14:11 (040199)

Richard,

I'm not saying there is anything wrong with orthotics being made long distance. Practioners send out for orthotics to made all the time to labs in different states. I just wanted Nancy to be aware, that someone needs to be evaluating the orthotics locally, and possibly do adjustments.

The orthotics I just received from the orthotist/cped are of a very nice quality. Instead of using EVA he used Pro XP2 (from Uco International) as the base which is around 50 durometer, and the shell is made from tri-lam consisting of micro cell puff and poron. The orthotic is reinforced with a material called thermoknit. I'm curious if you have worked with these materials, and know the pros and cons of Pro XP2 vs EVA. I've been told Pro XP2 is resistant to bottoming out. It looks and feels very much like EVA.

The orthotics fit perfectly to my foot, and are pretty stable considering they are not plastic. Although the arch area fits perfectly it is causing some irritation, and may feel better, when some bulk is reduced from the bottom. It may also be due to me having a high arch, and I cannot take a full contour like the article on cavus feet mentioned. I also may need some additional reinforcement, or wedging on the lateral side of the orthotic. Even though these are intrinsically corrected, since I'm a severe supinator, this material does not hold my foot as well on the lateral heel side as well as a plastic shell does. But the material is more forgiving, and more comfortable, so it seems some sacrifice needs to be made. Also I have an intrinsic forefoot valgus correction in the orthotic, and the material seems to be supporting the forefoot very well. Even with such a nice design I still may need other adjustments, because I'm still sensitive in certain areas as a result pf, and other injuries. I may even have to have the cast changed itself to add more fill to the arch area, if the above adjustments don't work.

I'm not saying everyone needs this many adjustments, but sometimes things are unpredictable, no matter how well the orthotic is made. Especially when you are dealing with someone who is suffering from a lot of foot injuries. More adjustments, or accomadations than usual may be necessary, and ideally it is more advantageous to be working with someone locally to supervise, and do these adjustments.

P.S. After speaking with you on the phone, I don't think you have a malicious bone in your body. I think we all need to be able to express our opinions, share our experiences, and brainstorm a little, so we can all learn from each other.

Donna

Re: Having Richard make my orthotics -- adjustment issue

Richard, C.Ped on 3/01/01 at 15:14 (040205)

That is good to know. I do agree that someone with so much going on with their feet such as you, would benefit more using a local dude.

The material sounds good. I will have to look into it.

Good luck with the new inserts!!
Richard

Re: Richard's accent.

Richard, C.Ped on 3/02/01 at 07:40 (040255)

My father is from Ohio, so I am half yankee. I had an Australian friend when I was a kid, so I always wished I spoke with that accent. That would be cool.
Richard

Re: NJ orthotic makers

Lee S. on 3/26/01 at 15:11 (042547)

Helene Manno in Cliffside NJ is an excellent podiatrist who has made my orthotics for twenty years. She takes a mold of your foot and will make sure the orthotic lab does a great job.