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ongoing numbness with new orthotics

Posted by Marjorie R. on 5/08/01 at hrmin (047018)

Dear Doctors,

In January 2001 I was fitted for new orthotics by a physical therapist at Northern Virginia Sports Med. Institute. After a few tries and tweaking to get the fit right and with each breaking in period (1 hr. increments increased each day), I've developed numbness in my outside toes (especially the left foot) and even in the two outside fingers of my hands. The first pair caused much numbness, the second pair less numbness, now this third pair has caused numbness after only 2 days. The numbness disappears within a few days of stopping use of the new orthotics and returning to taping and my old, improper orthotics.

I am on my feet very little, sit in an ergo. correct chair, have stopped the breaking in period to allow more time to adjust, changed the lacing in my shoes, even put up with numbness to see if my body would adapt somehow. I've had pf off and on for 6 years, had the ESWT in Sept., but have high arches and didn't have proper arch support in my old, completely wrong orthotics. Taping has been great but healing has been slow.

I'm now angry and frustrated. The pt has never encountered this and is doing the best job she can. I trust her because her treatment of my problem has been excellent so far. But she's just not getting the fit right and my body, my posture, are telling me so.

Have you seen this before? Please advise.
Thank you,
Marjorie

Re: ongoing numbness with new orthotics

Dr. Zuckerman on 5/08/01 at 10:55 (047029)

Where does the orthosis end . Do you have an extension on the orthosis?

Re: ongoing numbness with new orthotics

wendyn on 5/08/01 at 13:47 (047056)

marjorie - there is no way that the orthotics are causing problems with your hands. You need to have an evaluation to make sure there is nothing else going on in your body. You could have some impinged nerves - or you could have a systemic problem. Have you mentioned the numb fingers to your doctor?

Re: ongoing numbness with new orthotics

Dr. David S. Wander on 5/08/01 at 14:01 (047057)

If you are also having numbness in your hands, I certainly would not be blaming the orthoses that were fabricated. If there is some numbness in the foot that only occurs with the orthoses, there must be some impingement on the nerve while you are wearing the orthoses. However, if you are also having numbness in your hands or fingers I would have a thorough evaluation by your internist as soon as possible.

Re: ongoing numbness with new orthotics

Marjorie R. on 5/09/01 at 07:11 (047127)

The orthosis ends below the ball of my foot but the fabric continues along the full length of my foot.

Re: ongoing numbness with new orthotics

Marjorie R. on 5/09/01 at 07:25 (047129)

My pt agrees that if I have numbness in my hands when wearing the orthoses, I should see an internist.

I entirely disagree. The numbness and tingling in both the outside toes and outside fingers occur ONLY when I'm breaking in new orthoses and it seems plain to me that the heel counter or something about the orthoses is throwing off my entire posture enough to irritate not only the sciatica (because it occurs when I sit on my sitting bones during the breaking in period) and a nerve higher up below the neck, which affects the outside fingers. (In fact, when I looked at my posture in the mirror while naked and using the new orthoses, my lower back has an extreme curvature, something that is not there otherwise.)

I am an extremely healthy eater, I do yoga and swim regularly, which is to say that I'm muscular and flexible. But besides that, the probs only occur when I'm breaking in new orthoses and go away when I return to only taping and have never occured in my life until the times when I've been breaking in new orthoses over the past 4 months.

So, they need to get it right and they're trying, but maybe they won't. My pt says now she'll remove the 'heel correction' entirely to see if that does it.

I was wondering if any of you have seen this before and how it was resolved, though perhaps it would be of no use to me because each of us (and our feet) is unique. I just thought it good to ask.
Thanks.

Re: ongoing numbness with new orthotics

wendyn on 5/09/01 at 07:41 (047131)

Well Marjorie - your call - you've had two doctors and one non doctor tell you to get evaluated - you disagree.

It has absolutely nothing to do with 'being healthy' or taking care of yourself.

Your body - your decision.

Re: ongoing numbness with new orthotics

LisaCO on 5/09/01 at 10:47 (047156)

Yes, I can relate to what you describe! You say that you have scoliosis--is the curve limited only to the lower back? I have a full, but mild, curve too. I get nerve impingement on the lower curve (sciatic) and on the upper curve. My upper body symptoms are exactly what yours are--numbness and tingling in the ring and pinky fingers, and overall weakness. I drop things a lot--only plastic tumblers for me when I am having trouble. It does sometimes progress to an intense, unremitting burning pain from armpit to fingertip if I do not get to the chiropractor in time. I haven't really seen much numbness in my feet, but I do tend to drag them.

I did not have a diagnosis on my back until recently--after I had a rather severe subluxation a couple of years ago. I had just begun treatment for heelspurs, and had been wearing new orthotics for a few months. I was seeing a podiatrist, and then sought out a chiropractor. I have had 3 more podiatrists since then, and have had an evaluation by an orthopedic surgeon (for my back) as well, but am still with the same chiro. He treats my symptoms as they arise, but has told me not to expect significant improvement until I can get my feet working well again. I can certainly see how adjusting your gait can cause a cascade of neurological symptoms up an already-curved spine! Does your PT treat the symptoms you are developing?

I was willing to believe that some pain would have to be associated with the breaking in custom orthotics, and it has cost me too much. Because of the first pair, I will probably need treatment for my back for a long time to come. I have new spurs on my Achilles tendons as a result of the damage from the second pair. By the time I got to Pod #3, I wouldn't even discuss the issue anymore. But I have had sucess with Birkenstock. I bought my first pair of Birks a year ago, and they felt great from the first step. They are all I wear now.

I think you are on the right track here. Go with the taping, or whatever relieves the stress on the fascia the best for you. A regular poster here (Julie) has had lots of good things to say about taping. If you want to pursue the custom orthotics further, maybe you should start over with a c.ped. that has more fabrication options available to them. That's what I am planning to do...

Re: ongoing numbness with new orthotics

Dr. Zuckerman on 5/09/01 at 10:54 (047157)

I totally agree that a complete history and physical examination needs to be done considering the numbness in your hands. I am sure you will do this. With regard to the orthosis I would make sure that the extension isn't too thick and that the end of the orthosis isn't too steep a cut off.
The end can be beveled . Have the person making the orthosis correct the bevel at the time of your visit and then walk around in the office.

We have some excellent orthosis clincian on the insert/orthosis board I would also run this by them Richard is a master

Re: ongoing numbness with new orthotics

Marjorie R. on 5/09/01 at 11:24 (047168)

Lisa,

I have a normal to slight curvature with no orthotics (according to a doctor and chiro I've seen), and when in the new orthotics, I see a big indent in the lower back and a slight one at the top. The symptoms (numbness and curvature) have gone away in a few days after stopping the breaking in of the new orthotics. The tingling in the two end fingers is important to resolve because of a major nerve below the neck. A friend of mine had a prob with it last summer, for which he saw numerous doctors, most recommending immediate, drastic surgery. He sought alternative remedies (chiro, different strengthening tech.) and it's disappeared.

As for the pt, she hasn't treated these new symptoms and I haven't asked her to. So far, when I stop the orthotics, the symptoms have disappeared.

Dr. Z,

thank you. I will talk to the pt about beveling. It's interesting how a slight change in the footbed can affect the body, from beveling to the arch angle!

Re: ongoing numbness with new orthotics

Dr. Zuckerman on 5/08/01 at 10:55 (047029)

Where does the orthosis end . Do you have an extension on the orthosis?

Re: ongoing numbness with new orthotics

wendyn on 5/08/01 at 13:47 (047056)

marjorie - there is no way that the orthotics are causing problems with your hands. You need to have an evaluation to make sure there is nothing else going on in your body. You could have some impinged nerves - or you could have a systemic problem. Have you mentioned the numb fingers to your doctor?

Re: ongoing numbness with new orthotics

Dr. David S. Wander on 5/08/01 at 14:01 (047057)

If you are also having numbness in your hands, I certainly would not be blaming the orthoses that were fabricated. If there is some numbness in the foot that only occurs with the orthoses, there must be some impingement on the nerve while you are wearing the orthoses. However, if you are also having numbness in your hands or fingers I would have a thorough evaluation by your internist as soon as possible.

Re: ongoing numbness with new orthotics

Marjorie R. on 5/09/01 at 07:11 (047127)

The orthosis ends below the ball of my foot but the fabric continues along the full length of my foot.

Re: ongoing numbness with new orthotics

Marjorie R. on 5/09/01 at 07:25 (047129)

My pt agrees that if I have numbness in my hands when wearing the orthoses, I should see an internist.

I entirely disagree. The numbness and tingling in both the outside toes and outside fingers occur ONLY when I'm breaking in new orthoses and it seems plain to me that the heel counter or something about the orthoses is throwing off my entire posture enough to irritate not only the sciatica (because it occurs when I sit on my sitting bones during the breaking in period) and a nerve higher up below the neck, which affects the outside fingers. (In fact, when I looked at my posture in the mirror while naked and using the new orthoses, my lower back has an extreme curvature, something that is not there otherwise.)

I am an extremely healthy eater, I do yoga and swim regularly, which is to say that I'm muscular and flexible. But besides that, the probs only occur when I'm breaking in new orthoses and go away when I return to only taping and have never occured in my life until the times when I've been breaking in new orthoses over the past 4 months.

So, they need to get it right and they're trying, but maybe they won't. My pt says now she'll remove the 'heel correction' entirely to see if that does it.

I was wondering if any of you have seen this before and how it was resolved, though perhaps it would be of no use to me because each of us (and our feet) is unique. I just thought it good to ask.
Thanks.

Re: ongoing numbness with new orthotics

wendyn on 5/09/01 at 07:41 (047131)

Well Marjorie - your call - you've had two doctors and one non doctor tell you to get evaluated - you disagree.

It has absolutely nothing to do with 'being healthy' or taking care of yourself.

Your body - your decision.

Re: ongoing numbness with new orthotics

LisaCO on 5/09/01 at 10:47 (047156)

Yes, I can relate to what you describe! You say that you have scoliosis--is the curve limited only to the lower back? I have a full, but mild, curve too. I get nerve impingement on the lower curve (sciatic) and on the upper curve. My upper body symptoms are exactly what yours are--numbness and tingling in the ring and pinky fingers, and overall weakness. I drop things a lot--only plastic tumblers for me when I am having trouble. It does sometimes progress to an intense, unremitting burning pain from armpit to fingertip if I do not get to the chiropractor in time. I haven't really seen much numbness in my feet, but I do tend to drag them.

I did not have a diagnosis on my back until recently--after I had a rather severe subluxation a couple of years ago. I had just begun treatment for heelspurs, and had been wearing new orthotics for a few months. I was seeing a podiatrist, and then sought out a chiropractor. I have had 3 more podiatrists since then, and have had an evaluation by an orthopedic surgeon (for my back) as well, but am still with the same chiro. He treats my symptoms as they arise, but has told me not to expect significant improvement until I can get my feet working well again. I can certainly see how adjusting your gait can cause a cascade of neurological symptoms up an already-curved spine! Does your PT treat the symptoms you are developing?

I was willing to believe that some pain would have to be associated with the breaking in custom orthotics, and it has cost me too much. Because of the first pair, I will probably need treatment for my back for a long time to come. I have new spurs on my Achilles tendons as a result of the damage from the second pair. By the time I got to Pod #3, I wouldn't even discuss the issue anymore. But I have had sucess with Birkenstock. I bought my first pair of Birks a year ago, and they felt great from the first step. They are all I wear now.

I think you are on the right track here. Go with the taping, or whatever relieves the stress on the fascia the best for you. A regular poster here (Julie) has had lots of good things to say about taping. If you want to pursue the custom orthotics further, maybe you should start over with a c.ped. that has more fabrication options available to them. That's what I am planning to do...

Re: ongoing numbness with new orthotics

Dr. Zuckerman on 5/09/01 at 10:54 (047157)

I totally agree that a complete history and physical examination needs to be done considering the numbness in your hands. I am sure you will do this. With regard to the orthosis I would make sure that the extension isn't too thick and that the end of the orthosis isn't too steep a cut off.
The end can be beveled . Have the person making the orthosis correct the bevel at the time of your visit and then walk around in the office.

We have some excellent orthosis clincian on the insert/orthosis board I would also run this by them Richard is a master

Re: ongoing numbness with new orthotics

Marjorie R. on 5/09/01 at 11:24 (047168)

Lisa,

I have a normal to slight curvature with no orthotics (according to a doctor and chiro I've seen), and when in the new orthotics, I see a big indent in the lower back and a slight one at the top. The symptoms (numbness and curvature) have gone away in a few days after stopping the breaking in of the new orthotics. The tingling in the two end fingers is important to resolve because of a major nerve below the neck. A friend of mine had a prob with it last summer, for which he saw numerous doctors, most recommending immediate, drastic surgery. He sought alternative remedies (chiro, different strengthening tech.) and it's disappeared.

As for the pt, she hasn't treated these new symptoms and I haven't asked her to. So far, when I stop the orthotics, the symptoms have disappeared.

Dr. Z,

thank you. I will talk to the pt about beveling. It's interesting how a slight change in the footbed can affect the body, from beveling to the arch angle!