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Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Posted by Arn on 6/08/01 at 21:50 (050303)

Hi,

Could there be a way from what I think is super sensitive arches and still use orthodics? I still need some more tests to rule out nerve damage, other then in my head that is. I know I'm going crazy!

When I wear these or if anything and it touches my arches they burn to a point I can't take it. Please read my post from earlier today for history. My pod casted while I was lying and sent the casts out to have done. I don't know where he had them done. Told me today to take them out if I have too.

http://www.xmission.com/~jbess/1F01-6-13(17-31).jpg
http://www.xmission.com/~jbess/2F01-6-13(17-32).jpg
http://www.xmission.com/~jbess/3F01-6-13(17-32).jpg

-Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 05:13 (050316)

Arn,

It's tough to look at orthotics without looking at your foot, but from the picture, they look like a semi rigid to rigid polypropylene plastic. This is usually too rigid of a material for a high-arched foot. Also just from the shape of the orthotic, there looks like a lot of intrisic valgus posting. Did the podiatrist tell you that you had a high degree of forefoot valgus? If it's not that severe, then these may be over-correcting you. Also the front shape of the orthotic shell doesn't seem natural. I don't see a cushioning top cover on them either which is important. An orthotic made out of a thinner more flexible plastic reinforced with an arch fill of a softer material, or one made out of a firm eva, or combo of some softer materials would be better. Look at this article on Cavus (high arched) feet. There's a section on orthotics for this foot type. They mention that the arch in the orthotic should not be too high, plus numerous other bits of info.

http://www.biomech.com/db_area/archives/2001/0101orthoses.55.bio.html

These orthotics are probably irritating the nerves in your foot, or may have caused some nerve entrapment,or severe fascia irritation from the restriction in motion they may be causing. High arched feet are usually rigid already. Also has anyone evaluated you for an ankle equinus (less than 10 degrees dorsiflexion)

I would stop wearing these orthotics, and just use supportive taping, along with a softer OTC orthotic to see if this resolves itself. Right now, an OTC orthotic without taping would make things worse. A thin firm rubber heel lift (1/8 to 1/4 inches) under the orthotic will help too. This will take some pressure off the arches. You may have to give this several weeks to months. It may take a while for the nerves to calm down. Have you tried vioxx instread of motrin? Also some type of PT may help (ART, myofascial release, electric stim, ultra sound, etc.) I don't recommend deep tissue massage though.

Also, I would try to find someone who knows how to prescribe an orthotic for a high-arched foot. If you could get someone to make it with a plaztizote top cover for now that would help too.

Donna

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Richard, C.Ped on 6/09/01 at 08:27 (050319)

Thanx for the pics Arn,
My feet hurt from just looking at what you are wearing. I am not a fan of the hard plastic orthotics.....as anyone here can tell you. The tend not to fit you foot as they should. Also, it is hard to interface them, or make them sit flat, in your shoe without adding extra posting and grinding it flat on the bottom. Many labs do not take the time to do this. Your orthotics are not flat on the bottom.

I would recommend a softer EVA or Ethyl Vinyl Acetate (a type of rubber) for an orthosis of your foot type. It molds better and fits so much better.

If you can find a pedorthist in your area, they would be able to add that extra posting, or bottom layer, of EVA or even cork (don't like that to much either) to the orthosis. That way it can fit better to your shoes. They can also cover the top of the orthosis with a softer material such as plastazote. I don't like the way the orthosis ends abruptly at the ball of your foot. I personally think it should be tapered in some way.

To find a pedorthist or C.ped in your area, click on my name (Richard Graham) at the top of the orthotic/shoes message board. That will take you to my web site. From there, scroll down to the links section and click on 'locate a c.ped'. Take time to read the site if you wish. I have a section on FAQs as well as a few questions to ask when being fitted for orthotics (still working on that one).

If you have any other questions, please feel free to ask. That is why we are here.

Good luck!
Richard, C.Ped

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Helene M on 6/09/01 at 10:41 (050328)

Arn,
I have cavus feet and I believe I have the same orthotics as you. Are they the hard plastic Langer 'Sporthotics'? They were my first pair of orthotics 10 years ago and they killed my arches. At that time, having no internet access and limited knowledge on PF/orthotics, I persisted with those torturous devices until I couldn't take the pain anymore. As Donna mentions, please read the article on the cavus foot and bring it with you if you see another pod.

Re: To Helene Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 12:46 (050335)

Hi Helene,

That's so funny. I thought they looked like my first pair of orthotics (torture devices) that I got around 9 years ago, and they were the Langer sports orthotics too! Does yours have a two part heel with a harder density material on the inside? That's a nice feature that's exclusive to Langer that is available on one of the sports models. It's a great device to help supinate us even more. ha ha. I still have them in my orthotics museum.

What were those pods thinking when they prescribed them?

PS I'll write you later.

Re: To Helene Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Helene M on 6/09/01 at 12:55 (050336)

Yes, those are the ones, Donna. I'll never have to buy an ice scraper again for those cold NY winters.

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 13:17 (050337)

Richard,

I think in Arn's case he's better off trashing them. Any type of posting (arch fill), no matter how soft, will only increase the rigidity of the shell. Also, that would increase the total contact in the shoe, which would really jamm them into his arches.

Re: To Helene Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 13:23 (050338)

Helene,

I'll make sure to bring mine if I move to NY. I haven't seen snow in 10 years, except once when I visited Philly in 94.

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Arn on 6/09/01 at 18:37 (050352)

Donna,

Thanks for the great post! I don't know much about this stuff other then the pod told me that the place that he sends the cast's to does a real good job. I work with a guy that use to help make othodics and the first day I got them he trashed them. That got my thinking and I came to a conclusion that the poor pod is lost. Unfortunately he's the third I have been to here in Salt Lake City. I'm so frustrated with what seems to be bad medicine. I should of came here before I wasted my insurance coverage on these peace of junks! I should put pics up of the first set I got. I call them ice scrapers.

Anyway as I was saying I don't know much about this stuff and the pods have never told me what kind of feet I have. Other then I'm high arced with cavus. What is intrisic valgus posting? Well I will studying this on the web a bit. You know my pod just last Friday told my to stop wearing the ortodics. He is stumped with what I have. Don't know if you read my history or not. I have tried otc othodics and I can tell you if anything and I mean anything comes in contact with my arches I go crazy. Now because I have been wearing othodics that are bad for me I have pulled my fascia 2 time badly. And yep now I have heel spurs, but not that bad. I think in my case I have super sensitive nerve ending in my feet and that I have been mis-diagnosed.

What is forefoot valgus? Maybe my pod told me but in terms I could understand.

Also you said: The front shape of the orthotic shell doesn't seem natural. What the heck?

You know I might have a way to get some more made for me for free other then the shipping cost but I would have to use the castings that I have now. Do you think that it ok to use them? The guy at work has a friend that owes him a favor. He has already talked to him about it. This guys is a C.Ped and suposavly really knows his stuff.

Thanks for the link I will look it up.

Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Arn on 6/09/01 at 18:45 (050353)

Just as I'm finding out my orthodics are junk. I will print the many good posts here and the advice you have given me when I have my new pair made. Please read my reply to Donna because I feel what I have to say is covered there pretty much. Please reply on weather I can use my molds to have a new pair made. If not then I'm going to have to wait a while. I will try to go without these feet killers for a while. I have tried otc ones with no luck. Spenco's, etc.

Man I'm pissed! I was really counting on these things you know.

Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Arn on 6/09/01 at 18:48 (050354)

Helen,

I live in Salt Lake city and all I know about my orthodics is they were made in California and are a piece of junk. I really feel ripped! No pun intended but they have caused tears in my fascia.

Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 20:15 (050356)

Arn,

Even if an excellent lab was used, they are only as good as the prescription that the pod writes. Not everything can be seen from a negative cast. That's the cast the pod makes from wrapping the plaster around the foot. There are some things that would be only noticed through observation, and measurements, and these need to be included in the prescription to the lab. If there is an error in measurment in some forefoot condition for example, and the pod sends this to the lab, it will override what corrections the lab would have put in the cast.

Also, the podiatrist has to know what kind of materials to order for a high arched foot. They also need to be able to evaluate if the correction was done correctly. Even the most reputable labs make mistakes. Many podiatrist who prescribe orthotics do not have the biomechanical background to do so.

I have high arches, and have been through all this mess. I've got a lot of injuries, and nerve entrapment from the wrong orthotics, that I'm now recovering from. It's not an easy task to find someone who knows what they ase doing. I've been to way more than three. It's a lot of trial and error, and usually an expensive project. Try to do as much research as you can, and don't trust anyone so fast to make a pair of orthotics for you. The wrong ones can do more harm than good. They should be able to at least guarantee that the orthotics are comfortable. If not don't let them make them.

Orthotics should not hurt, or cause any additional problems. If they do there is something wrong, and they are causing injury. That's the easiest way for you to measure that they are not right. That's why I recommend you stop wearing those orthotics now. Ask someone to show you how to do low dye taping to take the pressure off the arches.

As for the cast they may, or may not be able to be used depending on how they were casted, and how they were corrected. From the looks of those orthotics, I would think not.

I wouldn't have anyone make an orthotic for you that is not being over seen by someone skilled in biomechanics, and can check these on your feet, and do necessary adjustments which is almost always needed. There are good and bad Cpeds, and podiatrist. I've had terrible orthotics made by both. I've had excellent cast taken by a podiatrist, but the orthotics were garbage. Recently I went to an orthotist/Cped, who made very nice looking orthotics, and was up to the minute on all the new materials, but his casting technique was very poor, and the correction he made was terrible, and the orthotics were useless. It's not easy to find the combination of all the skill sets needed to make a decent orthotic.

I still think the casting technique, and the correction is the most important thing. If you get that right, you can always try different materials made from that cast.

If you have a podiatry school in your area, call and see if they have an outpatient biomechanics clinic. Also, check major university hospitals. They usually have a prosthetic and orthotist department. They usually have orthotist who makes foot orthotics, and should be very skilled in this.

Also, whom ever is prescribing the orthotics doesn't necessarily have to be the one making them. What's important though is that they have the necessary equipment in their office to do spot adjustments. Someone interested in biomechanics will be able to do small things like heat spot the orthotic, do some grinding if necessary, put top covers on, etc., in their office, so they don't have to be sent back to a lab for every little minor change.

There is tons of information on forefoot valgus and other conditions on the web if you do a search. I think it means when the foot is in neutral the forefoot is in an everted position. Your met heads are bascially not even. In my most non technical terms the rearfoot to forefoot relationship is screwed up.

Here's a couple of definitions, but there is much more.

http://www.hhp.ufl.edu/ess/at/footankle/forefoot_valgus.htm
http://www.latrobe.edu.au/podiatry/Forefootvalgus.html

This article in podiatry today shows an orthotic made with a ff valgus correction vs one made without.

http://www.podiatrytoday.com/archive/pod_200012/pod_200012f1.html

I don't know what your foot condition is other than a high arched foot. You should get evaluated by someone who can give you a definate diagnosis, and see if you really needed orthotics in the first place. Once you heal, you may need nothing more than an accomadative device, and may be better off in the long run.

You should still have diagnostic test for nerve problems regardless.

Good luck!

Donna

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Julie on 6/10/01 at 01:21 (050373)

Donna, I've got to thank you and congratulate you on this masterly explanation. I'm sure it will be a huge help to Arn and to anyone else who is going through the same 'mess'. The complications and pitfalls take my breath away and make me feel I'm lucky to have my old familiar slightly flat over-pronating feet!

Re: Julie Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/10/01 at 09:20 (050385)

Hi Julie,

This 'mess' is making me wish for flat feet. It shouldn't be so complicated to get orthotics for high arches. I feel most practitioners have not taken the time and effort to study, and understand what's really needed for our foot type, and just try to take the easy way out. This is both frustrating and unacceptable.

It takes a little more creative thought, but can be done. They have to get it through their heads that you can't take an orthotic design, and materials that are used for a flatter foot, raise the arch, and slap it on a cavus foot. An entirely different approach is needed.

BG Cped for example, and his success with cavus feet proves that. My pod is starting to incorporate some the design features mentioned in the cavus foot article into my orthotics, and I feel we may be finally getting somewhere. He still has a lot to learn.

Re: Great reply Donna

Arn on 6/10/01 at 21:48 (050412)

Donna,

Another excellent reply! The information you have giving me is great! Along with the replys from others. The links are real helpful too. My pod did tell me that I was Valgus and explained it to me in layman terms. After looking at the article in the podiatry today shows an orthotic made with a ff valgus correction vs. one made without I think the pod did things right but don't know if he over corrected. He did do the alignment thing by locking in my ankle joint I do know. I remember thinking how can he get things aligned correctly while I'm lying down. What if my foot was tipping a bit forward or something. Anyway I will read up and I will take some time to find someone good. The guy at work suggested the VA hospital or the University of Utah hospital. Both along with the primary children's hospital have excellent othodic departments. The problem now is of course cash flow. The insurance won't let me have new ones made for I think 3 years? Might be one however. But I think like you mentioned in your reply that I might not need orthodics and I might be ok once healed up. Not sure at this point. Pod did diagnose my with valgus/cavus and has gone over what my feet are doing. Big toe curling under, small toes hammer toeing up etc.

At this point I have stopped using the orthodics. I tape the way Scott shows. Four straps on the bottom of my feet. I do know how to do the other one where 2 straps are placed from met 1 around the ankle to met 5 etc. but I can't feel any advantages to this and it takes allot more time and tape. The question I have as fare as strapping goes is how do I know that my foot is in the correct position while strapping. Seems like this is hard to accomplish if the I'm the person doing the strapping?

I think I need to post inconjuction to my question on foot alignment for strapping to make sure I'm doing it right.

Thanks so much,

Marty

Re: Great reply Donna

Julie on 6/11/01 at 01:05 (050416)

Arn, the only way to tell (about strapping) is to experiment and see how your foot feels when you stand and walk on it. It may take several tries, but you have to be the judge through experience. I have to dorsiflex my foot fully, and then apply the tape fairly tightly: it's then the right tension when I stand up. If I leave my foot in neutral, the tape is too tight when I stand up. Your foot would behave differently from mine, as you have a high arch. Experiment.

Re: Great reply Donna

Julie on 6/11/01 at 01:08 (050417)

Ah! I see that post was from Marty, not Arn (though it said it was from Arn, it was signed Marty - how's a poor girl to know?) So my reply was to Marty (if it was Marty) in which case the comment about the high arched foot may have been irrelevant.

Sorry for the frivolity in this post. I'm in a hurry - have to leave the house soon to catch a train for Paris. I'm away now for ten days, see you when I get back.

Re: Great reply Donna

Donna SL on 6/11/01 at 01:14 (050419)

Arn,

There's nothing wrong with casting while lying down. That's an excellent and preferred position. Especially on your back, so the legs can be aligned too. Sitting with the legs out on a chair with an extension is good also. This way the pod has a clear view of your feet He does have to know how to align your feet though, and hopefully he did this correctly. It sounds like the pod probably took a good cast, and it may, or may not have been corrected properly by the lab. Also, even if he did the proper measurements, your body, and feet may not be able to take a full correction, and he has to accomadate for that, and adjust the cast. He also has to take into account any equinus that you may have.

I was thinking if it's not costing you anything let that person make the orthotics for you that said there was no charge. You have nothing to lose. As long as you know that if they feel the least bit uncomfortable just trash them.

If the existing orthotics seem like they are contouring perfectly to your feet the arch is probably to high though. Ask the person who would be making them if they could do some additional medial expansion (standard to extra arch fill on the positive cast), before they repress the orthotics, and this may bring the arch down. They can also duplicate the original cast first, and alter the duplicate before repressing an orthotic off of them.

Have you tried talking to the pod about the pair he made, and told them they are no good for you? He should offer to make another pair that would work for you. He may have to alter the prescription, and should definately make a pair out of a more flexible material, and add a full length a top cover. If he's not willing to do this, or you've lost confidence in him then ask him to refund your money. Why should he keep payment for something that you can't wear, or is possibly causing harm. Show him the cavus foot article.

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Richard, C.Ped on 6/11/01 at 08:48 (050429)

Well, maybe. I have saved a few myself with this process. It depends on who does the procedure though. After he receives a new pair, yes, trash them. Or, use them as door stops, you can paint them, drill a whole in the heel and wear it as a necklace, dig in the garden with them, or my own personal idea.....window scapers in winter time.

Richard

Re: I did it now.

Arn/Marty ? on 6/11/01 at 09:45 (050439)

Julie,

Sorry about the confusion on the names. I knew that at some point I would do that. I officially sign stuff at work Marty but my nick is Arn, long story.

Sorry :)

Thanks for the advice on taping. Seems like I this point I can't get the tension right ends up loose.

-Arn/Marty

Ps. Sheesh seems like even my name is complicating.

Re: Julie Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Richard, C.Ped on 6/11/01 at 09:50 (050440)

Donna,
I agree, it should not be so complicated to make a correct orthosis for any foot type, cavus or planus. It is sad that so many people can not get the correct treatment. There are two other facilities here that I compete with. Looking at their orthotics compared to ours, you would not be able to tell we went to the same school. Make me angry.
Richard

Re: Great reply Donna

Arn/Marty on 6/11/01 at hrmin (050443)

Donna,

I have been thinking about this issue as well. The pod told me that he would be glad to make adjustments and send them back to the lab is needed. He told thins the day I got the orthodics. I will talk to him and see if we can work this out. You know at this point my feet feel so much better with just strapping that maybe I can heal up without them. My concern is the fore foot Valgus that I have. Maybe for now I can just worry about healing up and getting over this burning/numbness problem that I have. To make a long story short I remember the day it all started and for some reason if anything touches my arches they really react. Burning and numbness is the main this.

It's going to take a while to get my free pair made up because the guy I work with friend lives back east. I will have to send the casts to him and all that. If you could right me up in terms he will understand what I should have made I would really appreciate it. :) Material to use, how long etc.

I do know that my pod has talked to me on 3 different occasions about how as he put it to me my 'big toe is curling under and my little toes are starting to hammer toe up'. Does this coincide with my pics? I can post more pic's of orthodics/feet if that would help. I know that's not to practical though.

Thanks so much,

Arn/Marty

Ps. I thought I should put both names now that I confused Julie ..... oops

Re: Great reply Donna

Donna SL on 6/11/01 at 11:07 (050447)

Arn,

If your feet are feeling better without them, the orthotics are probably what's causing the problem. This is a good sign, that there is probably not permanent damage, and the nerves were just irritated. I don't think the pod should adjust the current pair of orthotics. The material looks too rigid for your feet. He would need to start all over. He needs to make a pair out of a more flexible material plus the other changes I mentioned in previous post. Show him all the info I gave you about checking for equinus, the cavus foot article, the materials I suggested in my first post, etc.

The terms I used in my previous post should be well understood by someone experienced in making orthotics.

You may just need a good supportive shoe, especially with some lateral support ie. neutral cross trainer with no medial post instead of running shoe, and a more accomadative orthotic. Watch out for some of NB top of the line cross trainers, they have a medial post in them. Look at asics, adidas, nike, etc. Also, have you checked the fit on your shoes? Maybe a bigger size, with a higher toe box would help hammer toes. You need to size up at least one to one and a half sizes in athletic shoes.

If you don't have any severe biomechanical problems, ie. severe supination, etc., you are probably better off without a functional orthotic.

I can't really tell much more from your orthotic pics. You would also need to be observed walking.

Also, The ART treatment I've been receiving not only helped my PF, and nerve entrapment, burning, numbness,etc., it also helped the structure of my foot. I'm not sure if this is because of the foot adjustments the chiropractor did in addition to the ART, or the ART itself relaxed all my tendons,and fascia. He worked on the entire foot, ankles,calves, etc. My toes are much straighter, and flatter now. Hope they stay that way. Maybe a couple of ART sessions would help you. You have nothing to lose.

Re: Oh no I have 4 pair of NB and I think you just explained why?

Arn on 6/11/01 at 15:40 (050465)

My NB 803's are the most expensive pair I have bought and I like them the least. My good old 658's were the best but have out life their usefulness.

I do believe there a reason my arches are so sensitive ant that probably my next course of action at this point. I don't like being on Neurontin at all because it's probably just masking the problem. This however could be a long road haul. At this point who's really know what my feet are freaking out.

-Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 05:13 (050316)

Arn,

It's tough to look at orthotics without looking at your foot, but from the picture, they look like a semi rigid to rigid polypropylene plastic. This is usually too rigid of a material for a high-arched foot. Also just from the shape of the orthotic, there looks like a lot of intrisic valgus posting. Did the podiatrist tell you that you had a high degree of forefoot valgus? If it's not that severe, then these may be over-correcting you. Also the front shape of the orthotic shell doesn't seem natural. I don't see a cushioning top cover on them either which is important. An orthotic made out of a thinner more flexible plastic reinforced with an arch fill of a softer material, or one made out of a firm eva, or combo of some softer materials would be better. Look at this article on Cavus (high arched) feet. There's a section on orthotics for this foot type. They mention that the arch in the orthotic should not be too high, plus numerous other bits of info.

http://www.biomech.com/db_area/archives/2001/0101orthoses.55.bio.html

These orthotics are probably irritating the nerves in your foot, or may have caused some nerve entrapment,or severe fascia irritation from the restriction in motion they may be causing. High arched feet are usually rigid already. Also has anyone evaluated you for an ankle equinus (less than 10 degrees dorsiflexion)

I would stop wearing these orthotics, and just use supportive taping, along with a softer OTC orthotic to see if this resolves itself. Right now, an OTC orthotic without taping would make things worse. A thin firm rubber heel lift (1/8 to 1/4 inches) under the orthotic will help too. This will take some pressure off the arches. You may have to give this several weeks to months. It may take a while for the nerves to calm down. Have you tried vioxx instread of motrin? Also some type of PT may help (ART, myofascial release, electric stim, ultra sound, etc.) I don't recommend deep tissue massage though.

Also, I would try to find someone who knows how to prescribe an orthotic for a high-arched foot. If you could get someone to make it with a plaztizote top cover for now that would help too.

Donna

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Richard, C.Ped on 6/09/01 at 08:27 (050319)

Thanx for the pics Arn,
My feet hurt from just looking at what you are wearing. I am not a fan of the hard plastic orthotics.....as anyone here can tell you. The tend not to fit you foot as they should. Also, it is hard to interface them, or make them sit flat, in your shoe without adding extra posting and grinding it flat on the bottom. Many labs do not take the time to do this. Your orthotics are not flat on the bottom.

I would recommend a softer EVA or Ethyl Vinyl Acetate (a type of rubber) for an orthosis of your foot type. It molds better and fits so much better.

If you can find a pedorthist in your area, they would be able to add that extra posting, or bottom layer, of EVA or even cork (don't like that to much either) to the orthosis. That way it can fit better to your shoes. They can also cover the top of the orthosis with a softer material such as plastazote. I don't like the way the orthosis ends abruptly at the ball of your foot. I personally think it should be tapered in some way.

To find a pedorthist or C.ped in your area, click on my name (Richard Graham) at the top of the orthotic/shoes message board. That will take you to my web site. From there, scroll down to the links section and click on 'locate a c.ped'. Take time to read the site if you wish. I have a section on FAQs as well as a few questions to ask when being fitted for orthotics (still working on that one).

If you have any other questions, please feel free to ask. That is why we are here.

Good luck!
Richard, C.Ped

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Helene M on 6/09/01 at 10:41 (050328)

Arn,
I have cavus feet and I believe I have the same orthotics as you. Are they the hard plastic Langer 'Sporthotics'? They were my first pair of orthotics 10 years ago and they killed my arches. At that time, having no internet access and limited knowledge on PF/orthotics, I persisted with those torturous devices until I couldn't take the pain anymore. As Donna mentions, please read the article on the cavus foot and bring it with you if you see another pod.

Re: To Helene Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 12:46 (050335)

Hi Helene,

That's so funny. I thought they looked like my first pair of orthotics (torture devices) that I got around 9 years ago, and they were the Langer sports orthotics too! Does yours have a two part heel with a harder density material on the inside? That's a nice feature that's exclusive to Langer that is available on one of the sports models. It's a great device to help supinate us even more. ha ha. I still have them in my orthotics museum.

What were those pods thinking when they prescribed them?

PS I'll write you later.

Re: To Helene Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Helene M on 6/09/01 at 12:55 (050336)

Yes, those are the ones, Donna. I'll never have to buy an ice scraper again for those cold NY winters.

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 13:17 (050337)

Richard,

I think in Arn's case he's better off trashing them. Any type of posting (arch fill), no matter how soft, will only increase the rigidity of the shell. Also, that would increase the total contact in the shoe, which would really jamm them into his arches.

Re: To Helene Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 13:23 (050338)

Helene,

I'll make sure to bring mine if I move to NY. I haven't seen snow in 10 years, except once when I visited Philly in 94.

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Arn on 6/09/01 at 18:37 (050352)

Donna,

Thanks for the great post! I don't know much about this stuff other then the pod told me that the place that he sends the cast's to does a real good job. I work with a guy that use to help make othodics and the first day I got them he trashed them. That got my thinking and I came to a conclusion that the poor pod is lost. Unfortunately he's the third I have been to here in Salt Lake City. I'm so frustrated with what seems to be bad medicine. I should of came here before I wasted my insurance coverage on these peace of junks! I should put pics up of the first set I got. I call them ice scrapers.

Anyway as I was saying I don't know much about this stuff and the pods have never told me what kind of feet I have. Other then I'm high arced with cavus. What is intrisic valgus posting? Well I will studying this on the web a bit. You know my pod just last Friday told my to stop wearing the ortodics. He is stumped with what I have. Don't know if you read my history or not. I have tried otc othodics and I can tell you if anything and I mean anything comes in contact with my arches I go crazy. Now because I have been wearing othodics that are bad for me I have pulled my fascia 2 time badly. And yep now I have heel spurs, but not that bad. I think in my case I have super sensitive nerve ending in my feet and that I have been mis-diagnosed.

What is forefoot valgus? Maybe my pod told me but in terms I could understand.

Also you said: The front shape of the orthotic shell doesn't seem natural. What the heck?

You know I might have a way to get some more made for me for free other then the shipping cost but I would have to use the castings that I have now. Do you think that it ok to use them? The guy at work has a friend that owes him a favor. He has already talked to him about it. This guys is a C.Ped and suposavly really knows his stuff.

Thanks for the link I will look it up.

Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Arn on 6/09/01 at 18:45 (050353)

Just as I'm finding out my orthodics are junk. I will print the many good posts here and the advice you have given me when I have my new pair made. Please read my reply to Donna because I feel what I have to say is covered there pretty much. Please reply on weather I can use my molds to have a new pair made. If not then I'm going to have to wait a while. I will try to go without these feet killers for a while. I have tried otc ones with no luck. Spenco's, etc.

Man I'm pissed! I was really counting on these things you know.

Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Arn on 6/09/01 at 18:48 (050354)

Helen,

I live in Salt Lake city and all I know about my orthodics is they were made in California and are a piece of junk. I really feel ripped! No pun intended but they have caused tears in my fascia.

Arn

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/09/01 at 20:15 (050356)

Arn,

Even if an excellent lab was used, they are only as good as the prescription that the pod writes. Not everything can be seen from a negative cast. That's the cast the pod makes from wrapping the plaster around the foot. There are some things that would be only noticed through observation, and measurements, and these need to be included in the prescription to the lab. If there is an error in measurment in some forefoot condition for example, and the pod sends this to the lab, it will override what corrections the lab would have put in the cast.

Also, the podiatrist has to know what kind of materials to order for a high arched foot. They also need to be able to evaluate if the correction was done correctly. Even the most reputable labs make mistakes. Many podiatrist who prescribe orthotics do not have the biomechanical background to do so.

I have high arches, and have been through all this mess. I've got a lot of injuries, and nerve entrapment from the wrong orthotics, that I'm now recovering from. It's not an easy task to find someone who knows what they ase doing. I've been to way more than three. It's a lot of trial and error, and usually an expensive project. Try to do as much research as you can, and don't trust anyone so fast to make a pair of orthotics for you. The wrong ones can do more harm than good. They should be able to at least guarantee that the orthotics are comfortable. If not don't let them make them.

Orthotics should not hurt, or cause any additional problems. If they do there is something wrong, and they are causing injury. That's the easiest way for you to measure that they are not right. That's why I recommend you stop wearing those orthotics now. Ask someone to show you how to do low dye taping to take the pressure off the arches.

As for the cast they may, or may not be able to be used depending on how they were casted, and how they were corrected. From the looks of those orthotics, I would think not.

I wouldn't have anyone make an orthotic for you that is not being over seen by someone skilled in biomechanics, and can check these on your feet, and do necessary adjustments which is almost always needed. There are good and bad Cpeds, and podiatrist. I've had terrible orthotics made by both. I've had excellent cast taken by a podiatrist, but the orthotics were garbage. Recently I went to an orthotist/Cped, who made very nice looking orthotics, and was up to the minute on all the new materials, but his casting technique was very poor, and the correction he made was terrible, and the orthotics were useless. It's not easy to find the combination of all the skill sets needed to make a decent orthotic.

I still think the casting technique, and the correction is the most important thing. If you get that right, you can always try different materials made from that cast.

If you have a podiatry school in your area, call and see if they have an outpatient biomechanics clinic. Also, check major university hospitals. They usually have a prosthetic and orthotist department. They usually have orthotist who makes foot orthotics, and should be very skilled in this.

Also, whom ever is prescribing the orthotics doesn't necessarily have to be the one making them. What's important though is that they have the necessary equipment in their office to do spot adjustments. Someone interested in biomechanics will be able to do small things like heat spot the orthotic, do some grinding if necessary, put top covers on, etc., in their office, so they don't have to be sent back to a lab for every little minor change.

There is tons of information on forefoot valgus and other conditions on the web if you do a search. I think it means when the foot is in neutral the forefoot is in an everted position. Your met heads are bascially not even. In my most non technical terms the rearfoot to forefoot relationship is screwed up.

Here's a couple of definitions, but there is much more.

http://www.hhp.ufl.edu/ess/at/footankle/forefoot_valgus.htm
http://www.latrobe.edu.au/podiatry/Forefootvalgus.html

This article in podiatry today shows an orthotic made with a ff valgus correction vs one made without.

http://www.podiatrytoday.com/archive/pod_200012/pod_200012f1.html

I don't know what your foot condition is other than a high arched foot. You should get evaluated by someone who can give you a definate diagnosis, and see if you really needed orthotics in the first place. Once you heal, you may need nothing more than an accomadative device, and may be better off in the long run.

You should still have diagnostic test for nerve problems regardless.

Good luck!

Donna

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Julie on 6/10/01 at 01:21 (050373)

Donna, I've got to thank you and congratulate you on this masterly explanation. I'm sure it will be a huge help to Arn and to anyone else who is going through the same 'mess'. The complications and pitfalls take my breath away and make me feel I'm lucky to have my old familiar slightly flat over-pronating feet!

Re: Julie Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Donna SL on 6/10/01 at 09:20 (050385)

Hi Julie,

This 'mess' is making me wish for flat feet. It shouldn't be so complicated to get orthotics for high arches. I feel most practitioners have not taken the time and effort to study, and understand what's really needed for our foot type, and just try to take the easy way out. This is both frustrating and unacceptable.

It takes a little more creative thought, but can be done. They have to get it through their heads that you can't take an orthotic design, and materials that are used for a flatter foot, raise the arch, and slap it on a cavus foot. An entirely different approach is needed.

BG Cped for example, and his success with cavus feet proves that. My pod is starting to incorporate some the design features mentioned in the cavus foot article into my orthotics, and I feel we may be finally getting somewhere. He still has a lot to learn.

Re: Great reply Donna

Arn on 6/10/01 at 21:48 (050412)

Donna,

Another excellent reply! The information you have giving me is great! Along with the replys from others. The links are real helpful too. My pod did tell me that I was Valgus and explained it to me in layman terms. After looking at the article in the podiatry today shows an orthotic made with a ff valgus correction vs. one made without I think the pod did things right but don't know if he over corrected. He did do the alignment thing by locking in my ankle joint I do know. I remember thinking how can he get things aligned correctly while I'm lying down. What if my foot was tipping a bit forward or something. Anyway I will read up and I will take some time to find someone good. The guy at work suggested the VA hospital or the University of Utah hospital. Both along with the primary children's hospital have excellent othodic departments. The problem now is of course cash flow. The insurance won't let me have new ones made for I think 3 years? Might be one however. But I think like you mentioned in your reply that I might not need orthodics and I might be ok once healed up. Not sure at this point. Pod did diagnose my with valgus/cavus and has gone over what my feet are doing. Big toe curling under, small toes hammer toeing up etc.

At this point I have stopped using the orthodics. I tape the way Scott shows. Four straps on the bottom of my feet. I do know how to do the other one where 2 straps are placed from met 1 around the ankle to met 5 etc. but I can't feel any advantages to this and it takes allot more time and tape. The question I have as fare as strapping goes is how do I know that my foot is in the correct position while strapping. Seems like this is hard to accomplish if the I'm the person doing the strapping?

I think I need to post inconjuction to my question on foot alignment for strapping to make sure I'm doing it right.

Thanks so much,

Marty

Re: Great reply Donna

Julie on 6/11/01 at 01:05 (050416)

Arn, the only way to tell (about strapping) is to experiment and see how your foot feels when you stand and walk on it. It may take several tries, but you have to be the judge through experience. I have to dorsiflex my foot fully, and then apply the tape fairly tightly: it's then the right tension when I stand up. If I leave my foot in neutral, the tape is too tight when I stand up. Your foot would behave differently from mine, as you have a high arch. Experiment.

Re: Great reply Donna

Julie on 6/11/01 at 01:08 (050417)

Ah! I see that post was from Marty, not Arn (though it said it was from Arn, it was signed Marty - how's a poor girl to know?) So my reply was to Marty (if it was Marty) in which case the comment about the high arched foot may have been irrelevant.

Sorry for the frivolity in this post. I'm in a hurry - have to leave the house soon to catch a train for Paris. I'm away now for ten days, see you when I get back.

Re: Great reply Donna

Donna SL on 6/11/01 at 01:14 (050419)

Arn,

There's nothing wrong with casting while lying down. That's an excellent and preferred position. Especially on your back, so the legs can be aligned too. Sitting with the legs out on a chair with an extension is good also. This way the pod has a clear view of your feet He does have to know how to align your feet though, and hopefully he did this correctly. It sounds like the pod probably took a good cast, and it may, or may not have been corrected properly by the lab. Also, even if he did the proper measurements, your body, and feet may not be able to take a full correction, and he has to accomadate for that, and adjust the cast. He also has to take into account any equinus that you may have.

I was thinking if it's not costing you anything let that person make the orthotics for you that said there was no charge. You have nothing to lose. As long as you know that if they feel the least bit uncomfortable just trash them.

If the existing orthotics seem like they are contouring perfectly to your feet the arch is probably to high though. Ask the person who would be making them if they could do some additional medial expansion (standard to extra arch fill on the positive cast), before they repress the orthotics, and this may bring the arch down. They can also duplicate the original cast first, and alter the duplicate before repressing an orthotic off of them.

Have you tried talking to the pod about the pair he made, and told them they are no good for you? He should offer to make another pair that would work for you. He may have to alter the prescription, and should definately make a pair out of a more flexible material, and add a full length a top cover. If he's not willing to do this, or you've lost confidence in him then ask him to refund your money. Why should he keep payment for something that you can't wear, or is possibly causing harm. Show him the cavus foot article.

Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Richard, C.Ped on 6/11/01 at 08:48 (050429)

Well, maybe. I have saved a few myself with this process. It depends on who does the procedure though. After he receives a new pair, yes, trash them. Or, use them as door stops, you can paint them, drill a whole in the heel and wear it as a necklace, dig in the garden with them, or my own personal idea.....window scapers in winter time.

Richard

Re: I did it now.

Arn/Marty ? on 6/11/01 at 09:45 (050439)

Julie,

Sorry about the confusion on the names. I knew that at some point I would do that. I officially sign stuff at work Marty but my nick is Arn, long story.

Sorry :)

Thanks for the advice on taping. Seems like I this point I can't get the tension right ends up loose.

-Arn/Marty

Ps. Sheesh seems like even my name is complicating.

Re: Julie Re: Pic's of my Orthodics and please read post from earlier today for history. Kinda long

Richard, C.Ped on 6/11/01 at 09:50 (050440)

Donna,
I agree, it should not be so complicated to make a correct orthosis for any foot type, cavus or planus. It is sad that so many people can not get the correct treatment. There are two other facilities here that I compete with. Looking at their orthotics compared to ours, you would not be able to tell we went to the same school. Make me angry.
Richard

Re: Great reply Donna

Arn/Marty on 6/11/01 at hrmin (050443)

Donna,

I have been thinking about this issue as well. The pod told me that he would be glad to make adjustments and send them back to the lab is needed. He told thins the day I got the orthodics. I will talk to him and see if we can work this out. You know at this point my feet feel so much better with just strapping that maybe I can heal up without them. My concern is the fore foot Valgus that I have. Maybe for now I can just worry about healing up and getting over this burning/numbness problem that I have. To make a long story short I remember the day it all started and for some reason if anything touches my arches they really react. Burning and numbness is the main this.

It's going to take a while to get my free pair made up because the guy I work with friend lives back east. I will have to send the casts to him and all that. If you could right me up in terms he will understand what I should have made I would really appreciate it. :) Material to use, how long etc.

I do know that my pod has talked to me on 3 different occasions about how as he put it to me my 'big toe is curling under and my little toes are starting to hammer toe up'. Does this coincide with my pics? I can post more pic's of orthodics/feet if that would help. I know that's not to practical though.

Thanks so much,

Arn/Marty

Ps. I thought I should put both names now that I confused Julie ..... oops

Re: Great reply Donna

Donna SL on 6/11/01 at 11:07 (050447)

Arn,

If your feet are feeling better without them, the orthotics are probably what's causing the problem. This is a good sign, that there is probably not permanent damage, and the nerves were just irritated. I don't think the pod should adjust the current pair of orthotics. The material looks too rigid for your feet. He would need to start all over. He needs to make a pair out of a more flexible material plus the other changes I mentioned in previous post. Show him all the info I gave you about checking for equinus, the cavus foot article, the materials I suggested in my first post, etc.

The terms I used in my previous post should be well understood by someone experienced in making orthotics.

You may just need a good supportive shoe, especially with some lateral support ie. neutral cross trainer with no medial post instead of running shoe, and a more accomadative orthotic. Watch out for some of NB top of the line cross trainers, they have a medial post in them. Look at asics, adidas, nike, etc. Also, have you checked the fit on your shoes? Maybe a bigger size, with a higher toe box would help hammer toes. You need to size up at least one to one and a half sizes in athletic shoes.

If you don't have any severe biomechanical problems, ie. severe supination, etc., you are probably better off without a functional orthotic.

I can't really tell much more from your orthotic pics. You would also need to be observed walking.

Also, The ART treatment I've been receiving not only helped my PF, and nerve entrapment, burning, numbness,etc., it also helped the structure of my foot. I'm not sure if this is because of the foot adjustments the chiropractor did in addition to the ART, or the ART itself relaxed all my tendons,and fascia. He worked on the entire foot, ankles,calves, etc. My toes are much straighter, and flatter now. Hope they stay that way. Maybe a couple of ART sessions would help you. You have nothing to lose.

Re: Oh no I have 4 pair of NB and I think you just explained why?

Arn on 6/11/01 at 15:40 (050465)

My NB 803's are the most expensive pair I have bought and I like them the least. My good old 658's were the best but have out life their usefulness.

I do believe there a reason my arches are so sensitive ant that probably my next course of action at this point. I don't like being on Neurontin at all because it's probably just masking the problem. This however could be a long road haul. At this point who's really know what my feet are freaking out.

-Arn