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Dr Davis/Hard Orthotics

Posted by john h on 7/27/01 at 10:05 (054474)

Dr Davis: as you know i have been critical of hard orthotics. when a past board member (yoko) emailed recently about her complete recovery from PF after 2 years of hardly being able to walk i asked her what she thought was the primary reason for her recovery. she informed me 'HARD ORTHOTICS'. so for those of you who may have been influenced by my post take heed there are two sides to every story. she now walks 18 holes of golf several times a week and runs a good distance each week and best of all HAS NO PAIN!

like all treatments some things will help one and be of no benefit to another. My first doctor an orthopedic surgeon specializing in foot and ankle surgery recommed soft orthotics. my second doctor a podiatrist recommed hard orthotics. i am now in semi rigid orthotics. many of us become very confused because each doctor has his own method of treating PF and they often differ drastically from doctor to doctor.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at hrmin (054485)

I don't think we can get rid of all of the confusion because medicine is not all science; it is, in part an art. I have proposed a flow chart for treatment on the doctors message board which I think could help by organizing and prioritizing all the information.
Ed

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 10:48 (054490)

my first podiatrist, who taught me nothing, also sold me $300 hard plastic orthotics. i wore them for three months and became drastically worse, and also felt PF developing in my until-then non-PF foot.
both my sports med. doc and the excellent orthotist i saw rated these hard plastic orthotics as 'junk,' and the orthotist said that hard orthotics should be prescribed only in rare cases, such as for very obese people and a few other conditions i don't recall now.
hard orthotics may well work for some, but my impression is that it's a very small number/percentage. it's just anecdotal of course, but the horror stories about hard plastic orthotics have filled this board for a very long time, and i believe yoko's success with them (and more power to her!) is the very first success story i've read. this is after 2+ years of a lot of reading.
nancy

Re: Dr Davis/Hard Orthotics

john h on 7/27/01 at 11:45 (054500)

nancy: yoko did say 'she thinks' hard orthotics were the major reason. i do not know if she ever tried any other kind which may have done the same thing. i do know she did all of the zillions of other things we have all tried. i am particularly interested in how much 'rest' she got and have asked her. she does work so i do not think she ever quit working.

Re: Dr Davis/Hard Orthotics

Julie on 7/27/01 at 12:00 (054505)

My orthotics are rigid. I knew I was taking a chance on them, after all I had read about them here, notably from Richard CPed, who is such a grand mine of information and good sense, but they were what my pod counselled, so I went along with it. They have been absolutely fine, and I am sure they have been an important factor in my healing: along with tape, Birkenstocks, relative rest, and - of course - yoga.

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 12:04 (054507)

hi john, i'll be interested to hear about yoko's rest too, as well as stretching. my little hard-orthotics diatribe was actually meant for dr. davis, in case he's interested. i think you're already very familiar with everything i said, eh?
nancy

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 12:09 (054508)

that's a mighty surprise, julie! are your rigid orthotics hard plastic? are they 3/4 or full length? how were you casted for them? mine are like nancy n's: good for ice-scraping, and that's it. i might as well have been walking concrete floors barefoot in them.
nancy

Re: Dr Davis/Hard Orthotics and Julie

Richard, C.Ped on 7/27/01 at 13:05 (054515)

I think what works for some people may not work for others. Motrin does not touch my headaches, but my wife wears by it. You get the point. The whole object is to properly support the plantar fascia as to relieve excess 'tugging'. If I think someone can handle rigid, I will make it for them. If they cant, I will do semi or soft. To me, it is not a 'one size fits all' thing. You have to know what you are doing. Those fly by night companies such as that Alzner stuff, it is all generic.

I like EVA. You guys know that. To me, you get a much better intimate fit to the foot than with carboplast or the other hard stuff. Now, if a physician writes for the hard stuff, I am not going to sit there and argue with them about it. But if they have never heard of or seen our style, I will gladly show them the benefits of EVA.

Julie, 'a grand mine of information and good sense???' I can't stop my wife from laughing. :-)

Richard, C.Ped

Re: Dr Davis/Hard Orthotics

Julie on 7/27/01 at 14:59 (054527)

I'm not sure what material they're made of, Nancy, but they are certainly hard. They're 3/4 length, with a strip of pleasant cushioning over them, which tapers off nicely a couple of inches beyond the plastic. They are comfortable, they feel as though they support my arches as they should, and have done so from day one. So I'm happy. I would guess, as my PF was never as acute as yours, or as that of so many others, that I am one of those Richard describes, who can 'handle rigid'. Lucky me. ?225 well spent, not thrown down the drain. But it could have been otherwise.

How were they casted? With me lying on my front, my feet hanging off the end of the table.

My first orthotics, 7-8 years ago, were the old ice-scrapers. They felt all right too - but didn't sto(They obviously weren't, because the new pair (which I've had for about 8 months now) feel quite different.)

Richard, your wife can laugh all she likes, but you know you are appreciated here. I meant it. I often feel that, with all the advice people give and get around here about 'what to do', that the importance of good footgear is sometimes overlooked. You supply the necessary corrective there - and you certainly are a mine of information about orthotics.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at 15:10 (054532)

Nancy:
Sorry to hear about your bad experience. Nevertheless, I have seen thousands of success stories with 'hard' orthotics with several hundred thousand being prescribed and successfully used every year.
Try not to let your personal experience unduly influence your opinion of something.
Ed

Re: Dr Davis/Hard Orthotics

Julie on 7/27/01 at 15:44 (054541)

Oh dear. A whole line disappeared from my orthotics post.

'They felt all right too - but didn't stop me getting PF. I probably wore them too long and should have checked every so often that they were still all right.' (They obviously weren't....etc etc.)

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 16:01 (054544)

Ed: i do try not to let my personal experience 'unduly' influence my opinion of something, thank you. like most other people, i sometimes succeed and sometimes don't.
my opinion of hard plastic orthotics, as i said, is based not only on my personal experience but that of countless others who have posted here in the past, plus the educated opinions of richard the pedorthist who has posted quite vehemently here on this subject earlier, my sports medicine doctor, and my well-experienced orthotist. so i do not feel unduly influenced.
i also said that no doubt hard plastic orthotics are right for some people. i just think that number is probably fewer than for other types of orthotics.
i would probably have to see some statistics based on studies in order to change my mind. i'm not confident that podiatrists always get full feedback on the effectiveness of the orthotics they prescribe. i for one never reported back to my initial podiatrist that the orthotics were lousy for me -- he couldn't have fixed them, and he made it clear that he wouldn't have been interested anyway.
i don't think i've ever told someone not to get hard orthotics, period. but if someone wanted to know my experience with them, and what i thought of them based on whatever other, perhaps minor knowledge i have of them, i came forth with that info., for whatever it's worth, and i'll continue to do that.
nancy

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at hrmin (054560)

You are probably right about the numbers of 'hard' orthotics dispensed are fewer than others. I am assuming that you consider hard orthotics to be the translucent plastic variety. Rohadur was a red translucent plastic made by Rohm & Haas (unsure of spelling) of Germany that was imported until the late 1980's. It was replaced by a similar material known as Polydur with similar characteristics. Polypropylene is an opaque plastic used to make 'semi-rigid' orthotics, so-called 'sport' orthotics and is less rigid than rohadur. The thickness of polypropylene usually determines the degree of flexibility. I generally use carbon-graphite or carbon-graphite-fiberglass composites (Superglass by Northwest Podiatric Lab of Blaine, WA). These composites are available in a range of flexibilities, from fairly flexible to rigid. The decision as to the degree of flex is based on the weight of the patient, activity level and the need for support. Richard will be sending me some samples of his EVA orthotics to look at. EVA comes in a range of flex such that there is some EVA that is more rigid than the graphite composites and visa versa.

The important point here is that hardness or rigidity is relative. I don't think in terms of rigid vs. soft orthotics (it is a continuum), only in terms of what the patient needs.
Ed

Re: Dr Davis/Hard Orthotics

john h on 7/27/01 at 18:37 (054566)

julie: your description of hard orthotics makes me want to get a date with them: 'pleasant cushioning' 'comfortable' ' tapers off nicely'. you should have been a car saleslady.

Re: Dr Davis/Hard Orthotics

Nancy N on 7/27/01 at 18:53 (054570)

I was told by my pedorthist that my 'ice scrapers' were made of polypropylene, and I have a hard time believing that they're only semi-rigid. They sure never flexed so much as a micron for me. Like I said, they are only useful anymore when there's frost on my windsheild in the morning. I'm not saying you're wrong, just that I'm mighty surprised at this idea.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at hrmin (054573)

The thickness of polypropylene determines the flex so yours must be made of fairly thick polypro. The problem with thick polypro is thick edges and shoe fit although the edges can be ground thin. I don't know why you were provided with such a device. The carbon-graphite we use ranges from about 1.1 mm to 1.5 mm in thickness with our average device being about 1.2 mm thick. This leaves room for a soft top cover made of EVA or other materials.

A lot of people are on this forum because their treatment was not successful and they are looking for something better. I am somewhat surprised that you are surprised because the stuff I am talking about is fairly standard; in other words, it is a standard of care that is widely used. That is why I am supporting the concept of flow charting plantar fasciitis treatment--showing treatment pathways based on current teatment concepts.
Ed

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 21:56 (054584)

Ed, i think i have the same kind of orthotics that nancy n is posting about. mine are opaque white plastic, thick, and hard as a rock -- you could literally take a hammer to them and not make a dent. there is zero give, zero flexibility, and no cushioning of any kind on top. there is a thick and dramatic drop-off at the 3/4 mark.
maybe this all boils down to semantics. if the term hard orthotics actually refers to a continuum, with different amounts of flexibility, etc., then mine are at the far extreme of hardness and rigidity, a type that probably accounts for only a percentage of what you consider hard orthotics. i honestly don't think you'd hold these in high regard if you saw them! from your posts on this board, i get the impression that you're far more professional, involved, and truly interested in helping your patients than the podiatrist who sold me my ice scrapers. and i think your efforts to get a handle on the big picture of pf treatment are much needed.
nancy s

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 22:02 (054585)

john, i think you deserve that date with julie's orthotics. hers don't sound bad at all.
ladies, heed john's words: men like cushioning!

Re: Dr Davis/Hard Orthotics

JudyS on 7/27/01 at 22:09 (054586)

Nancy - those are the ones my husband (you remember him, don't you? :) )
has......and he loves them. They took care of his PF and his TTS. He's a happy little camper.....and runner.
welcome back!

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 22:23 (054588)

oh my, judy, you never told me! would he like me to send him mine for when his wear out? oh never mind -- they won't wear out, trust me.
since they worked for him, have you tried some?

(yes, of course i remember that handsome devil!)

Re: Dr Davis/Hard Orthotics

Glenn X on 7/27/01 at hrmin (054594)

Nancy: I have these very same orthotics, though mine have a thin covering of some blue, smooth synthetic material on the platform. Also the word 'Sport' is printed on the blue.

I've worn mine for 20 months now. They don't yet feel comfortable, but then I've been shuffling along on crutches the whole time and haven't really strode into them. I think if I could step naturally they'd work better. My chief concern is that these may be harsh on the fat pads of my feet. My left good foot often feels gouged. I also often feel they are overly 'hard' but have noticed I feel this less when my calves are flexible. I have learned this is an important signal: Hard orthotics feel harder when we are insufficiently flexible.

I did take a file to the underside at the 3/4 edge that rests on my shoe. Removed maybe 1/16 to 3/32 of plastic. Took a LOT of filing, but the ball of my foot no longer hangs over the edge quite so much, though still a bit.

Inside my shoe I removed the insert that came with and replaced it with a Spenco blue rubbery-material full cushion (forget the name). It's maybe an eighth of an inch thick. The orthotic goes on top of this.

I have on occasion tried the reverse; placing the orthotic in the shoe and the blue full-shoe cushion on top of the orthotic. Since my orthotic has a shallow heel platform (not much cup) I can get away with it, but I can't say it works any better, and don't do it any more (and don't really suggest it).

Even socks can make a difference. As hard as my orthotics are, I find thin socks more comfortable than thick socks. The latter seem to generate more sideways friction. otherwise tenderizing my foot.

I am not yet sure I am using the right shoe with these orthotics (Rockport ProWalkers), which is yet another variable.

Bottom line, I agree on the importance of FIRM arch support, but don't think mine are right. I've toughed through them, but am eagerly looking forward to a fresh opinion next week.

All in all there's a lot to consider in getting proper arch support. I am not there yet, and can well appreciate your lack of enthusiasm for your 3/4 white tools for torment.

Re: Dr Davis/Hard Orthotics

nancy s. on 7/28/01 at 00:28 (054596)

glenn, it sounds like you've had a tough go of it, and i hope your fresh opinion next week brings you some new light at the end of tunnel.
twenty months seems a long time in orthotics that don't feel right -- though that filing down at the 3/4 mark was a good idea and i'll bet has saved you further problems.
you know, i worry about the fat pads also. they never in my life felt tender before, but they do now -- both of them, not just my pf foot. after 2+ years of pf and various other tendonitises, i consider myself about 90% better; but that last 10% i feel mostly all over the heel bottoms, as if the fat pads are too thin and are slowly breaking down. scary, isn't it? i have two pairs of softer-footbed birks on the way from germany as a result, and i also finally bought a pair of thorlo socks, which people have been raving about forever on this board and i just let it go by. like you, i preferred thinner socks, but i've been amazed at how wonderful these thorlos feel! they aren't thick all over -- they just have extra padding at the heel, and for me so far that's improved the tender fat pads quite a bit. have you tried them?
i think you're right that the right arch support is key. i'm lucky that birks work so well that way for me. i did get a much better pair of orthotics made last fall, but i don't wear them that much. i have normal arches until i stand -- then they flatten out like pancakes. i haven't been able to break in the orthotics enough to keep my arches from aching. i really should go back to the orthotist and have more adjustments made -- but i think my weakness for birks has made me reluctant!
again, best of luck at your appointment next week.
nancy

Re: Orthotics and Thorlos

Julie on 7/28/01 at 01:57 (054603)

Great minds, Nancy - when I read Glenn's post I immediately wanted to suggest he try Thorlos, but mindful of the 'read all messages before posting' rule, I continued reading, and there was yours.

Glenn, I really think you'd like them. As Nancy says, the extra padding in the heel makes them very comfortable, but to my mind, the best thing about them is that they FIT. They seem to 'contain' the feet - I don't know how else to describe it. The label claims that they offer extra support, and I think that's true.

I know John's going to accuse me of sounding like a car saleslady again, but your feet (or at least my feet) feel so pleasantly cushioned in them that I wear them most of the time now, outdoors. I thought I was buying them mainly for mountain walking, but they're just as helpful on hot London pavements.

There are many styles and weights. I've got the Light Hiking ones, which I think are the thinnest, and they're just right for what I need.

Nancy, I thought you were happy with your latest orthotics. Don't you think it's maybe time to get those adjustments made? Once they're really right, they should be even better for your feet than Birks.

Re: More about my orthotics

Julie on 7/28/01 at 02:13 (054604)

My first orthotics were made of Rohadur (so they must have been made even longer ago than I remembered) and were totally rigid. They broke! - and were replaced by Polydur.

I'm not sure about my present ones. They're a very dark grey-black, which I assume must be carbon-graphite. They don't appear to flex at all - I'm afraid of breaking them if I try bending them with any more force than I've dared to - so I guess they are at the rigid end of the continuum. The (black leather-like) covering has a springy feel (very pleasant, John! - you can have a date with them any time) and it extends an inch and a half beyond the hard material. And it tapers, so that I feel no 'edge' .

They were made by C-One Orthotics. Do you know them, Ed? They're somewhere in the States. My pod thinks the Americans do things better, and who am I to argue? Still American through and through, after 40 years in England.

Re: More about my orthotics

Julie on 7/28/01 at 02:14 (054605)

I forgot to say - the postings are bright red.

Re: Dr Davis/Hard Orthotics

Donna SL on 7/28/01 at 06:08 (054617)

Dr. Davis

I'm sure Nancy is not the only person who has had problems with hard orthotics, but I think that is only part of the cause of orthotic failure.

Many people have received uncomfortable orthotics, but in many cases it's not only because of the type of material that is used , but errors in the prescription, or not considering the proper orthotic for a certain foot type. There are so many factors as you know that go into creating an orthotic. If anything is off along the chain of creating them from poor casting technique, incorrect, or no gait analysis, poor lab corrections, sloppy workmanship, etc., then the orthotic can sometimes have devastating effects, and cause much pain, and possible injury. You seem very ethical and knowledgeable about orthotics, but there are many professionals that are prescribing them that aren't.

Many podiatrist, and other orthotic prescribing practitioners have a poor knowledge of biomechanics. Even if they manage to take a proper cast,
may not have assessed the individual properly to write the correct prescription. There are many things to consider besides taking a cast of the foot, and sending it off to the lab to have an orthotic fabricated. If the person prescribing them doesn't have the proper knowledge to assess the orthotic once it's produced, and make the necessary adjustments, etc., they may just tell the person they need to get used to them, and that's when problems occur. I have had many experiences throughout the years where that happened. A lot of podiatrist never even watched me walk before, or after I received the orthotic.

There are so many practitioners that blindly prescribe the old standard 3-4 mm polypro, for every foot type. I have rigid high arches, and supinate, and one of the first orthotics that was prescribed for me was the rigid Langer sport orthotic with the anti-pronation heel, with no cushioned top cover. The orthotic prescription didn't even come near what I needed in a correction. This is just one example of many disasters I have incurred. Most of the orthotics were too painful to wear at all, but it seemed once the podiatrist dispensed them, and had my money they weren't really interested in fixing them. If the same thing happened today I would demand a refund. I finally found one podiatrist to make a pair I could tolerate, but he unfortunately moved out of the city. I think if someone is going to prescribe orthotics they should have a decent biomechanic background, minimum equipment in their office to spot adjust them if necessary (which so many don't), etc..

I'm not against using plastic orthotics in certain cases if they can be tolerated, and realize you can adjust the flexibility by using certain thickness. I had a nice pair made years ago out of a thin flexible polypro blend, with a poron arch fill that were somewhat comfortable, for my high arched feet. I went to another podiatrist to get my current pair refurbished, and he convinced me that I needed a new pair, because the current pair were so bad for my foot type, etc.. He said it was critical to wear, and get used to his orthotics, or I would have serious problems as I got older, and that's when I developed numerous problems. They were made of a more rigid poly pro, and caused much pain, and many injuries which I'm still recovering from. I still can't wear my old ones since then. Part of the problem may have been because the density of the polypro was too thick, but later on I found out the prescription was totally wrong for my foot type too. In addition, the footwear he suggested I use was incorrect.

I think the wrong prescription can have a worst effect then the material used, but the material is still an important consideration. For example 3 mm polypro may be great for a normal to flat footed person engaged in certain activities, but can be very rigid for a cavus foot. They usually need a very flexible plastic, or one made out of the many softer materials that are available on the market. Also, EVA may be great in certain cases, but in others an EVA orthotic depending on the density may have little, or no benefit for someone who requires a more rigid device, and can also cause harm if for example it was too soft, or the prescription was wrong. I had one pair made out of EVA that were horrible, and another pair that was ok. There are some densities of EVA that are hard as a rock, and more uncomfortable than plastic, and a person could be enjoying a thinner less bulky device. Also, sometimes you can get away with not having as precise of a prescription with a softer EVA, and have a larger margin of error which in some cases may not be a good thing. In other cases EVA, or similar materials, or various combinations of softer materials may be the only choice, if that's all the person can tolerate. I'm also aware of Northwest labs that use the fiberglass orthotics which are supposed to be very nice, and thin, but I've been told they are almost impossible to adjust, so I think they are good once you have the prescription worked out for that individual.

I can understand why so many people are frustrated with hard orthotics, or otherwise, because they unfortunately came across the wrong person to
produce them. I now have a good podiatrist who is extremely knowledgeable about biomechanics, and produces his own orthotics, but I had years of bad experiences before I found him. He seems to be an exception to the norm.

I'm sure for the thousands of very successful orthotics out there made of hard plastic, or otherwise, there is an equal number if not more of
unsuccessful ones produced.

Donna

Re: Dr Davis/Hard Orthotics

john h on 7/28/01 at 09:09 (054621)

my custom hard orthotics were 3/4 length with a pad that went the full lenth of the shoe attached to top. they were blue and had a very very hard multi layered rubber compound as a heel. you wold not be able to bend them in a vise. i have forgotten their name but they are one the larger makers of orthotics in the U.S. they were fitted with me laying prone on my back while the cast was made. they were ordered my on my first visit to poditrist. the doctor did not watch me walk and took x-rays (no spur). he wanted to give me a shot but i declined. seems to me that he might have tried some of the other treatments before immediately placing an uneducated me in orthotics hard or soft.

Re: flow chart

Scott R on 7/28/01 at 09:12 (054623)

Dr. Davis, please post or send me a copy of the flow chart.

Re: Dr Davis/Hard Orthotics

john h on 7/28/01 at 09:17 (054624)

consider this: if you have been walking without orthotics for 50 years or so and you suddenly completly change the way your feet strike the ground your body has some major adjustments to make. there are many bones in your feet and along with the changes in tension on muscles,tendons,etc there would seem to be the possibility of real damage if one did not need orthotics or were prescribed orthotics that were not properly fitted. there are many people who need orthotics and there are probably many people who have suffered damage because they were placed in orthotics needlessly or improperly. as patients we are at the mercy of our health providers because we do not know a good orthotic from a bad one and whether we need one or not.

Re: Thorlos

Glenn X on 7/28/01 at hrmin (054630)

Nancy: Thanks for your thoughts. Based on Your's and Julie's recomendation I'll order Thorlos today.

There was a time before I re-injured myself that I accustomed myself to orthotics. They really got comfortable. Took a few months to get there though. These were not the white one's I talk about in my earlier message, but a more giving pair, 3/4 with a cushiony cover that extended to the toe. The reddish color mentioned earler in this thread. I should have never switched.

The less I use my feet, the less able they are to do their job. This is one of the reasons I believe orthotics are important for treating PF. They take stresses off the feet, help them rest even as they do their work. I haven't tried the Birks but if they help your fascia rest, maybe they're doing what's needed?

Re: More about my orthotics

Ed Davis, DPM on 7/28/01 at hrmin (054632)

Thank you for your comments. I am not familiar with that orthotic lab.
Ed

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/28/01 at hrmin (054633)

Donna:
Your post is excellent--the problem IS in the prescription, not so much the materials themselves. Podiatrists get excellent training in biomechanics but, unfortunately, many fail to practice that art to the full extent of their knowledge. Why?--- Cannot say for sure but time and financial pressures may be a factor, sometimes laziness, sometimes over confidence in surgery with insufficient respect for the value of conservative treatments.

Each orthotic prescription should be unique as to the design, including flexibility or rigidity. Softer flexes are more forgiving so that a prescription that is 'off' may still be useable but may not have the therapeutic effect desired. The important thing to remember about 'rigid' orthotics is that they are unforgiving, that is, any imperfections may hurt and deficits in the prescription can cause problems.
Ed

Re: flow chart

Ed Davis, DPM on 7/28/01 at hrmin (054634)

Scott:
It has not been written yet. I will see if one is presented at the our meeting in a couple of weeks. If not, I will come up with a rough draft to send to the other contributors on this site. I think it will probably take a couple months to do a really good job on it; we will need to get a concensus in a number of areas so we will have something that works for as many people as possible.
Ed

Re: flow chart

Scott R on 7/28/01 at 13:06 (054641)

Oh, I had mis-read one of your posts yesterday.

Re: Getting them made by same person who casts them... Helped me.

Beverly on 7/28/01 at 14:35 (054645)

My orthodics are soft, and they are my 4th attempt and the only set to give me some relief. Each of my past sets were made out of a different type of material even though they were all labeled 'soft,' and they were cast in a variety of ways.

I like my current set so much (full length), I just got a second set made in 3/4 with more arch support for sandals that will accomodate orthodics... didn't want to look like a total dork with orthodic cushion showing through my toes! Also, I've found some of my shoes need more arch support than others.

What made this set different? One is that they were cast by the same people who made them... not sent off to a lab somewhere. I got very lucky, because the owner uses senior citizen lab guys who have been making orthodics for years and years. It gives me much peace of mind to know mine were made by someone who was making orthodics when I was still in grade school!

None of the doctors I saw wanted me in hard orthodics. They all either reccommended soft or semi-rigid. But I have learned that even among 'soft' there are a variety of different materials. The ones I have now are stronger than my previous pairs. I think they are made of crepe (but not sure) and they have a metarsal support that I especially like. These were made with me standing in the foam box (a source of contreversey I know), but I like them.

They have helped my ankles more than my feet but considering that I have PF, AT, and PTT, to get some relief and my ankles feeling fairly decent most days, feels like progress. I still have a ways to go on the feet.
Beverly

Re: Thorlos

Glenn X on 7/29/01 at hrmin (054687)

John H: Thanks for the point to http://www.thesockcompany.com . Got the Thorlos Light Hikers for $9.60 a pair. They were $12.00 at REI, an otherwise fine sporting/outdoors-goods web site.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/29/01 at hrmin (054695)

John-
That is why we thoroughly train and license professionals to make sure that people get the right treatment. The system is far from perfect. Quality providers are also hurt when they have to deal with patients who have become cynical or suspicious because they had bad experiences.
Ed

Re: Getting them made by same person who casts them... Helped me.

Ed Davis, DPM on 7/29/01 at hrmin (054697)

Most podiatrists are trained to make orthotics in school. It really helps to understand their manufacture when doing a prescription. Different casting or molding methods are better for different types of foot problems. There is some controversy but I encourage the residents I train to take a flexible approach--learn all methods and know their strengths and weaknesses.

Most practitioners limit the number of labs they work with because they need to become very familiar with the way certain labs interpret their prescriptions and vice versa. One of my labs, Northwest Labs of Blaine, Wa (they also make Superfeet pre-fabs) has been working with me since about 1985. We often talk over the phone to discuss a prescription--they know my prescribing habits well and I know their production methods...
A few years ago, at the height of the managed care 'craze,' a large orthtoic lab came to town and attempted to sign my colleagues and myself up as a 'buying group' in order to obtain volume discounts. I refused due to the good working relationship I had with my current labs. A few colleagues tried them out but soon went back to their preferred labs.
Ed

Re: Thorlos

Julie on 7/29/01 at 13:56 (054701)

You're so lucky! The Light Hikers cost ?11 here (that's 11 pounds sterling): I suppose about $16).

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at hrmin (054485)

I don't think we can get rid of all of the confusion because medicine is not all science; it is, in part an art. I have proposed a flow chart for treatment on the doctors message board which I think could help by organizing and prioritizing all the information.
Ed

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 10:48 (054490)

my first podiatrist, who taught me nothing, also sold me $300 hard plastic orthotics. i wore them for three months and became drastically worse, and also felt PF developing in my until-then non-PF foot.
both my sports med. doc and the excellent orthotist i saw rated these hard plastic orthotics as 'junk,' and the orthotist said that hard orthotics should be prescribed only in rare cases, such as for very obese people and a few other conditions i don't recall now.
hard orthotics may well work for some, but my impression is that it's a very small number/percentage. it's just anecdotal of course, but the horror stories about hard plastic orthotics have filled this board for a very long time, and i believe yoko's success with them (and more power to her!) is the very first success story i've read. this is after 2+ years of a lot of reading.
nancy

Re: Dr Davis/Hard Orthotics

john h on 7/27/01 at 11:45 (054500)

nancy: yoko did say 'she thinks' hard orthotics were the major reason. i do not know if she ever tried any other kind which may have done the same thing. i do know she did all of the zillions of other things we have all tried. i am particularly interested in how much 'rest' she got and have asked her. she does work so i do not think she ever quit working.

Re: Dr Davis/Hard Orthotics

Julie on 7/27/01 at 12:00 (054505)

My orthotics are rigid. I knew I was taking a chance on them, after all I had read about them here, notably from Richard CPed, who is such a grand mine of information and good sense, but they were what my pod counselled, so I went along with it. They have been absolutely fine, and I am sure they have been an important factor in my healing: along with tape, Birkenstocks, relative rest, and - of course - yoga.

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 12:04 (054507)

hi john, i'll be interested to hear about yoko's rest too, as well as stretching. my little hard-orthotics diatribe was actually meant for dr. davis, in case he's interested. i think you're already very familiar with everything i said, eh?
nancy

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 12:09 (054508)

that's a mighty surprise, julie! are your rigid orthotics hard plastic? are they 3/4 or full length? how were you casted for them? mine are like nancy n's: good for ice-scraping, and that's it. i might as well have been walking concrete floors barefoot in them.
nancy

Re: Dr Davis/Hard Orthotics and Julie

Richard, C.Ped on 7/27/01 at 13:05 (054515)

I think what works for some people may not work for others. Motrin does not touch my headaches, but my wife wears by it. You get the point. The whole object is to properly support the plantar fascia as to relieve excess 'tugging'. If I think someone can handle rigid, I will make it for them. If they cant, I will do semi or soft. To me, it is not a 'one size fits all' thing. You have to know what you are doing. Those fly by night companies such as that Alzner stuff, it is all generic.

I like EVA. You guys know that. To me, you get a much better intimate fit to the foot than with carboplast or the other hard stuff. Now, if a physician writes for the hard stuff, I am not going to sit there and argue with them about it. But if they have never heard of or seen our style, I will gladly show them the benefits of EVA.

Julie, 'a grand mine of information and good sense???' I can't stop my wife from laughing. :-)

Richard, C.Ped

Re: Dr Davis/Hard Orthotics

Julie on 7/27/01 at 14:59 (054527)

I'm not sure what material they're made of, Nancy, but they are certainly hard. They're 3/4 length, with a strip of pleasant cushioning over them, which tapers off nicely a couple of inches beyond the plastic. They are comfortable, they feel as though they support my arches as they should, and have done so from day one. So I'm happy. I would guess, as my PF was never as acute as yours, or as that of so many others, that I am one of those Richard describes, who can 'handle rigid'. Lucky me. ?225 well spent, not thrown down the drain. But it could have been otherwise.

How were they casted? With me lying on my front, my feet hanging off the end of the table.

My first orthotics, 7-8 years ago, were the old ice-scrapers. They felt all right too - but didn't sto(They obviously weren't, because the new pair (which I've had for about 8 months now) feel quite different.)

Richard, your wife can laugh all she likes, but you know you are appreciated here. I meant it. I often feel that, with all the advice people give and get around here about 'what to do', that the importance of good footgear is sometimes overlooked. You supply the necessary corrective there - and you certainly are a mine of information about orthotics.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at 15:10 (054532)

Nancy:
Sorry to hear about your bad experience. Nevertheless, I have seen thousands of success stories with 'hard' orthotics with several hundred thousand being prescribed and successfully used every year.
Try not to let your personal experience unduly influence your opinion of something.
Ed

Re: Dr Davis/Hard Orthotics

Julie on 7/27/01 at 15:44 (054541)

Oh dear. A whole line disappeared from my orthotics post.

'They felt all right too - but didn't stop me getting PF. I probably wore them too long and should have checked every so often that they were still all right.' (They obviously weren't....etc etc.)

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 16:01 (054544)

Ed: i do try not to let my personal experience 'unduly' influence my opinion of something, thank you. like most other people, i sometimes succeed and sometimes don't.
my opinion of hard plastic orthotics, as i said, is based not only on my personal experience but that of countless others who have posted here in the past, plus the educated opinions of richard the pedorthist who has posted quite vehemently here on this subject earlier, my sports medicine doctor, and my well-experienced orthotist. so i do not feel unduly influenced.
i also said that no doubt hard plastic orthotics are right for some people. i just think that number is probably fewer than for other types of orthotics.
i would probably have to see some statistics based on studies in order to change my mind. i'm not confident that podiatrists always get full feedback on the effectiveness of the orthotics they prescribe. i for one never reported back to my initial podiatrist that the orthotics were lousy for me -- he couldn't have fixed them, and he made it clear that he wouldn't have been interested anyway.
i don't think i've ever told someone not to get hard orthotics, period. but if someone wanted to know my experience with them, and what i thought of them based on whatever other, perhaps minor knowledge i have of them, i came forth with that info., for whatever it's worth, and i'll continue to do that.
nancy

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at hrmin (054560)

You are probably right about the numbers of 'hard' orthotics dispensed are fewer than others. I am assuming that you consider hard orthotics to be the translucent plastic variety. Rohadur was a red translucent plastic made by Rohm & Haas (unsure of spelling) of Germany that was imported until the late 1980's. It was replaced by a similar material known as Polydur with similar characteristics. Polypropylene is an opaque plastic used to make 'semi-rigid' orthotics, so-called 'sport' orthotics and is less rigid than rohadur. The thickness of polypropylene usually determines the degree of flexibility. I generally use carbon-graphite or carbon-graphite-fiberglass composites (Superglass by Northwest Podiatric Lab of Blaine, WA). These composites are available in a range of flexibilities, from fairly flexible to rigid. The decision as to the degree of flex is based on the weight of the patient, activity level and the need for support. Richard will be sending me some samples of his EVA orthotics to look at. EVA comes in a range of flex such that there is some EVA that is more rigid than the graphite composites and visa versa.

The important point here is that hardness or rigidity is relative. I don't think in terms of rigid vs. soft orthotics (it is a continuum), only in terms of what the patient needs.
Ed

Re: Dr Davis/Hard Orthotics

john h on 7/27/01 at 18:37 (054566)

julie: your description of hard orthotics makes me want to get a date with them: 'pleasant cushioning' 'comfortable' ' tapers off nicely'. you should have been a car saleslady.

Re: Dr Davis/Hard Orthotics

Nancy N on 7/27/01 at 18:53 (054570)

I was told by my pedorthist that my 'ice scrapers' were made of polypropylene, and I have a hard time believing that they're only semi-rigid. They sure never flexed so much as a micron for me. Like I said, they are only useful anymore when there's frost on my windsheild in the morning. I'm not saying you're wrong, just that I'm mighty surprised at this idea.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/27/01 at hrmin (054573)

The thickness of polypropylene determines the flex so yours must be made of fairly thick polypro. The problem with thick polypro is thick edges and shoe fit although the edges can be ground thin. I don't know why you were provided with such a device. The carbon-graphite we use ranges from about 1.1 mm to 1.5 mm in thickness with our average device being about 1.2 mm thick. This leaves room for a soft top cover made of EVA or other materials.

A lot of people are on this forum because their treatment was not successful and they are looking for something better. I am somewhat surprised that you are surprised because the stuff I am talking about is fairly standard; in other words, it is a standard of care that is widely used. That is why I am supporting the concept of flow charting plantar fasciitis treatment--showing treatment pathways based on current teatment concepts.
Ed

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 21:56 (054584)

Ed, i think i have the same kind of orthotics that nancy n is posting about. mine are opaque white plastic, thick, and hard as a rock -- you could literally take a hammer to them and not make a dent. there is zero give, zero flexibility, and no cushioning of any kind on top. there is a thick and dramatic drop-off at the 3/4 mark.
maybe this all boils down to semantics. if the term hard orthotics actually refers to a continuum, with different amounts of flexibility, etc., then mine are at the far extreme of hardness and rigidity, a type that probably accounts for only a percentage of what you consider hard orthotics. i honestly don't think you'd hold these in high regard if you saw them! from your posts on this board, i get the impression that you're far more professional, involved, and truly interested in helping your patients than the podiatrist who sold me my ice scrapers. and i think your efforts to get a handle on the big picture of pf treatment are much needed.
nancy s

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 22:02 (054585)

john, i think you deserve that date with julie's orthotics. hers don't sound bad at all.
ladies, heed john's words: men like cushioning!

Re: Dr Davis/Hard Orthotics

JudyS on 7/27/01 at 22:09 (054586)

Nancy - those are the ones my husband (you remember him, don't you? :) )
has......and he loves them. They took care of his PF and his TTS. He's a happy little camper.....and runner.
welcome back!

Re: Dr Davis/Hard Orthotics

nancy s. on 7/27/01 at 22:23 (054588)

oh my, judy, you never told me! would he like me to send him mine for when his wear out? oh never mind -- they won't wear out, trust me.
since they worked for him, have you tried some?

(yes, of course i remember that handsome devil!)

Re: Dr Davis/Hard Orthotics

Glenn X on 7/27/01 at hrmin (054594)

Nancy: I have these very same orthotics, though mine have a thin covering of some blue, smooth synthetic material on the platform. Also the word 'Sport' is printed on the blue.

I've worn mine for 20 months now. They don't yet feel comfortable, but then I've been shuffling along on crutches the whole time and haven't really strode into them. I think if I could step naturally they'd work better. My chief concern is that these may be harsh on the fat pads of my feet. My left good foot often feels gouged. I also often feel they are overly 'hard' but have noticed I feel this less when my calves are flexible. I have learned this is an important signal: Hard orthotics feel harder when we are insufficiently flexible.

I did take a file to the underside at the 3/4 edge that rests on my shoe. Removed maybe 1/16 to 3/32 of plastic. Took a LOT of filing, but the ball of my foot no longer hangs over the edge quite so much, though still a bit.

Inside my shoe I removed the insert that came with and replaced it with a Spenco blue rubbery-material full cushion (forget the name). It's maybe an eighth of an inch thick. The orthotic goes on top of this.

I have on occasion tried the reverse; placing the orthotic in the shoe and the blue full-shoe cushion on top of the orthotic. Since my orthotic has a shallow heel platform (not much cup) I can get away with it, but I can't say it works any better, and don't do it any more (and don't really suggest it).

Even socks can make a difference. As hard as my orthotics are, I find thin socks more comfortable than thick socks. The latter seem to generate more sideways friction. otherwise tenderizing my foot.

I am not yet sure I am using the right shoe with these orthotics (Rockport ProWalkers), which is yet another variable.

Bottom line, I agree on the importance of FIRM arch support, but don't think mine are right. I've toughed through them, but am eagerly looking forward to a fresh opinion next week.

All in all there's a lot to consider in getting proper arch support. I am not there yet, and can well appreciate your lack of enthusiasm for your 3/4 white tools for torment.

Re: Dr Davis/Hard Orthotics

nancy s. on 7/28/01 at 00:28 (054596)

glenn, it sounds like you've had a tough go of it, and i hope your fresh opinion next week brings you some new light at the end of tunnel.
twenty months seems a long time in orthotics that don't feel right -- though that filing down at the 3/4 mark was a good idea and i'll bet has saved you further problems.
you know, i worry about the fat pads also. they never in my life felt tender before, but they do now -- both of them, not just my pf foot. after 2+ years of pf and various other tendonitises, i consider myself about 90% better; but that last 10% i feel mostly all over the heel bottoms, as if the fat pads are too thin and are slowly breaking down. scary, isn't it? i have two pairs of softer-footbed birks on the way from germany as a result, and i also finally bought a pair of thorlo socks, which people have been raving about forever on this board and i just let it go by. like you, i preferred thinner socks, but i've been amazed at how wonderful these thorlos feel! they aren't thick all over -- they just have extra padding at the heel, and for me so far that's improved the tender fat pads quite a bit. have you tried them?
i think you're right that the right arch support is key. i'm lucky that birks work so well that way for me. i did get a much better pair of orthotics made last fall, but i don't wear them that much. i have normal arches until i stand -- then they flatten out like pancakes. i haven't been able to break in the orthotics enough to keep my arches from aching. i really should go back to the orthotist and have more adjustments made -- but i think my weakness for birks has made me reluctant!
again, best of luck at your appointment next week.
nancy

Re: Orthotics and Thorlos

Julie on 7/28/01 at 01:57 (054603)

Great minds, Nancy - when I read Glenn's post I immediately wanted to suggest he try Thorlos, but mindful of the 'read all messages before posting' rule, I continued reading, and there was yours.

Glenn, I really think you'd like them. As Nancy says, the extra padding in the heel makes them very comfortable, but to my mind, the best thing about them is that they FIT. They seem to 'contain' the feet - I don't know how else to describe it. The label claims that they offer extra support, and I think that's true.

I know John's going to accuse me of sounding like a car saleslady again, but your feet (or at least my feet) feel so pleasantly cushioned in them that I wear them most of the time now, outdoors. I thought I was buying them mainly for mountain walking, but they're just as helpful on hot London pavements.

There are many styles and weights. I've got the Light Hiking ones, which I think are the thinnest, and they're just right for what I need.

Nancy, I thought you were happy with your latest orthotics. Don't you think it's maybe time to get those adjustments made? Once they're really right, they should be even better for your feet than Birks.

Re: More about my orthotics

Julie on 7/28/01 at 02:13 (054604)

My first orthotics were made of Rohadur (so they must have been made even longer ago than I remembered) and were totally rigid. They broke! - and were replaced by Polydur.

I'm not sure about my present ones. They're a very dark grey-black, which I assume must be carbon-graphite. They don't appear to flex at all - I'm afraid of breaking them if I try bending them with any more force than I've dared to - so I guess they are at the rigid end of the continuum. The (black leather-like) covering has a springy feel (very pleasant, John! - you can have a date with them any time) and it extends an inch and a half beyond the hard material. And it tapers, so that I feel no 'edge' .

They were made by C-One Orthotics. Do you know them, Ed? They're somewhere in the States. My pod thinks the Americans do things better, and who am I to argue? Still American through and through, after 40 years in England.

Re: More about my orthotics

Julie on 7/28/01 at 02:14 (054605)

I forgot to say - the postings are bright red.

Re: Dr Davis/Hard Orthotics

Donna SL on 7/28/01 at 06:08 (054617)

Dr. Davis

I'm sure Nancy is not the only person who has had problems with hard orthotics, but I think that is only part of the cause of orthotic failure.

Many people have received uncomfortable orthotics, but in many cases it's not only because of the type of material that is used , but errors in the prescription, or not considering the proper orthotic for a certain foot type. There are so many factors as you know that go into creating an orthotic. If anything is off along the chain of creating them from poor casting technique, incorrect, or no gait analysis, poor lab corrections, sloppy workmanship, etc., then the orthotic can sometimes have devastating effects, and cause much pain, and possible injury. You seem very ethical and knowledgeable about orthotics, but there are many professionals that are prescribing them that aren't.

Many podiatrist, and other orthotic prescribing practitioners have a poor knowledge of biomechanics. Even if they manage to take a proper cast,
may not have assessed the individual properly to write the correct prescription. There are many things to consider besides taking a cast of the foot, and sending it off to the lab to have an orthotic fabricated. If the person prescribing them doesn't have the proper knowledge to assess the orthotic once it's produced, and make the necessary adjustments, etc., they may just tell the person they need to get used to them, and that's when problems occur. I have had many experiences throughout the years where that happened. A lot of podiatrist never even watched me walk before, or after I received the orthotic.

There are so many practitioners that blindly prescribe the old standard 3-4 mm polypro, for every foot type. I have rigid high arches, and supinate, and one of the first orthotics that was prescribed for me was the rigid Langer sport orthotic with the anti-pronation heel, with no cushioned top cover. The orthotic prescription didn't even come near what I needed in a correction. This is just one example of many disasters I have incurred. Most of the orthotics were too painful to wear at all, but it seemed once the podiatrist dispensed them, and had my money they weren't really interested in fixing them. If the same thing happened today I would demand a refund. I finally found one podiatrist to make a pair I could tolerate, but he unfortunately moved out of the city. I think if someone is going to prescribe orthotics they should have a decent biomechanic background, minimum equipment in their office to spot adjust them if necessary (which so many don't), etc..

I'm not against using plastic orthotics in certain cases if they can be tolerated, and realize you can adjust the flexibility by using certain thickness. I had a nice pair made years ago out of a thin flexible polypro blend, with a poron arch fill that were somewhat comfortable, for my high arched feet. I went to another podiatrist to get my current pair refurbished, and he convinced me that I needed a new pair, because the current pair were so bad for my foot type, etc.. He said it was critical to wear, and get used to his orthotics, or I would have serious problems as I got older, and that's when I developed numerous problems. They were made of a more rigid poly pro, and caused much pain, and many injuries which I'm still recovering from. I still can't wear my old ones since then. Part of the problem may have been because the density of the polypro was too thick, but later on I found out the prescription was totally wrong for my foot type too. In addition, the footwear he suggested I use was incorrect.

I think the wrong prescription can have a worst effect then the material used, but the material is still an important consideration. For example 3 mm polypro may be great for a normal to flat footed person engaged in certain activities, but can be very rigid for a cavus foot. They usually need a very flexible plastic, or one made out of the many softer materials that are available on the market. Also, EVA may be great in certain cases, but in others an EVA orthotic depending on the density may have little, or no benefit for someone who requires a more rigid device, and can also cause harm if for example it was too soft, or the prescription was wrong. I had one pair made out of EVA that were horrible, and another pair that was ok. There are some densities of EVA that are hard as a rock, and more uncomfortable than plastic, and a person could be enjoying a thinner less bulky device. Also, sometimes you can get away with not having as precise of a prescription with a softer EVA, and have a larger margin of error which in some cases may not be a good thing. In other cases EVA, or similar materials, or various combinations of softer materials may be the only choice, if that's all the person can tolerate. I'm also aware of Northwest labs that use the fiberglass orthotics which are supposed to be very nice, and thin, but I've been told they are almost impossible to adjust, so I think they are good once you have the prescription worked out for that individual.

I can understand why so many people are frustrated with hard orthotics, or otherwise, because they unfortunately came across the wrong person to
produce them. I now have a good podiatrist who is extremely knowledgeable about biomechanics, and produces his own orthotics, but I had years of bad experiences before I found him. He seems to be an exception to the norm.

I'm sure for the thousands of very successful orthotics out there made of hard plastic, or otherwise, there is an equal number if not more of
unsuccessful ones produced.

Donna

Re: Dr Davis/Hard Orthotics

john h on 7/28/01 at 09:09 (054621)

my custom hard orthotics were 3/4 length with a pad that went the full lenth of the shoe attached to top. they were blue and had a very very hard multi layered rubber compound as a heel. you wold not be able to bend them in a vise. i have forgotten their name but they are one the larger makers of orthotics in the U.S. they were fitted with me laying prone on my back while the cast was made. they were ordered my on my first visit to poditrist. the doctor did not watch me walk and took x-rays (no spur). he wanted to give me a shot but i declined. seems to me that he might have tried some of the other treatments before immediately placing an uneducated me in orthotics hard or soft.

Re: flow chart

Scott R on 7/28/01 at 09:12 (054623)

Dr. Davis, please post or send me a copy of the flow chart.

Re: Dr Davis/Hard Orthotics

john h on 7/28/01 at 09:17 (054624)

consider this: if you have been walking without orthotics for 50 years or so and you suddenly completly change the way your feet strike the ground your body has some major adjustments to make. there are many bones in your feet and along with the changes in tension on muscles,tendons,etc there would seem to be the possibility of real damage if one did not need orthotics or were prescribed orthotics that were not properly fitted. there are many people who need orthotics and there are probably many people who have suffered damage because they were placed in orthotics needlessly or improperly. as patients we are at the mercy of our health providers because we do not know a good orthotic from a bad one and whether we need one or not.

Re: Thorlos

Glenn X on 7/28/01 at hrmin (054630)

Nancy: Thanks for your thoughts. Based on Your's and Julie's recomendation I'll order Thorlos today.

There was a time before I re-injured myself that I accustomed myself to orthotics. They really got comfortable. Took a few months to get there though. These were not the white one's I talk about in my earlier message, but a more giving pair, 3/4 with a cushiony cover that extended to the toe. The reddish color mentioned earler in this thread. I should have never switched.

The less I use my feet, the less able they are to do their job. This is one of the reasons I believe orthotics are important for treating PF. They take stresses off the feet, help them rest even as they do their work. I haven't tried the Birks but if they help your fascia rest, maybe they're doing what's needed?

Re: More about my orthotics

Ed Davis, DPM on 7/28/01 at hrmin (054632)

Thank you for your comments. I am not familiar with that orthotic lab.
Ed

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/28/01 at hrmin (054633)

Donna:
Your post is excellent--the problem IS in the prescription, not so much the materials themselves. Podiatrists get excellent training in biomechanics but, unfortunately, many fail to practice that art to the full extent of their knowledge. Why?--- Cannot say for sure but time and financial pressures may be a factor, sometimes laziness, sometimes over confidence in surgery with insufficient respect for the value of conservative treatments.

Each orthotic prescription should be unique as to the design, including flexibility or rigidity. Softer flexes are more forgiving so that a prescription that is 'off' may still be useable but may not have the therapeutic effect desired. The important thing to remember about 'rigid' orthotics is that they are unforgiving, that is, any imperfections may hurt and deficits in the prescription can cause problems.
Ed

Re: flow chart

Ed Davis, DPM on 7/28/01 at hrmin (054634)

Scott:
It has not been written yet. I will see if one is presented at the our meeting in a couple of weeks. If not, I will come up with a rough draft to send to the other contributors on this site. I think it will probably take a couple months to do a really good job on it; we will need to get a concensus in a number of areas so we will have something that works for as many people as possible.
Ed

Re: flow chart

Scott R on 7/28/01 at 13:06 (054641)

Oh, I had mis-read one of your posts yesterday.

Re: Getting them made by same person who casts them... Helped me.

Beverly on 7/28/01 at 14:35 (054645)

My orthodics are soft, and they are my 4th attempt and the only set to give me some relief. Each of my past sets were made out of a different type of material even though they were all labeled 'soft,' and they were cast in a variety of ways.

I like my current set so much (full length), I just got a second set made in 3/4 with more arch support for sandals that will accomodate orthodics... didn't want to look like a total dork with orthodic cushion showing through my toes! Also, I've found some of my shoes need more arch support than others.

What made this set different? One is that they were cast by the same people who made them... not sent off to a lab somewhere. I got very lucky, because the owner uses senior citizen lab guys who have been making orthodics for years and years. It gives me much peace of mind to know mine were made by someone who was making orthodics when I was still in grade school!

None of the doctors I saw wanted me in hard orthodics. They all either reccommended soft or semi-rigid. But I have learned that even among 'soft' there are a variety of different materials. The ones I have now are stronger than my previous pairs. I think they are made of crepe (but not sure) and they have a metarsal support that I especially like. These were made with me standing in the foam box (a source of contreversey I know), but I like them.

They have helped my ankles more than my feet but considering that I have PF, AT, and PTT, to get some relief and my ankles feeling fairly decent most days, feels like progress. I still have a ways to go on the feet.
Beverly

Re: Thorlos

Glenn X on 7/29/01 at hrmin (054687)

John H: Thanks for the point to http://www.thesockcompany.com . Got the Thorlos Light Hikers for $9.60 a pair. They were $12.00 at REI, an otherwise fine sporting/outdoors-goods web site.

Re: Dr Davis/Hard Orthotics

Ed Davis, DPM on 7/29/01 at hrmin (054695)

John-
That is why we thoroughly train and license professionals to make sure that people get the right treatment. The system is far from perfect. Quality providers are also hurt when they have to deal with patients who have become cynical or suspicious because they had bad experiences.
Ed

Re: Getting them made by same person who casts them... Helped me.

Ed Davis, DPM on 7/29/01 at hrmin (054697)

Most podiatrists are trained to make orthotics in school. It really helps to understand their manufacture when doing a prescription. Different casting or molding methods are better for different types of foot problems. There is some controversy but I encourage the residents I train to take a flexible approach--learn all methods and know their strengths and weaknesses.

Most practitioners limit the number of labs they work with because they need to become very familiar with the way certain labs interpret their prescriptions and vice versa. One of my labs, Northwest Labs of Blaine, Wa (they also make Superfeet pre-fabs) has been working with me since about 1985. We often talk over the phone to discuss a prescription--they know my prescribing habits well and I know their production methods...
A few years ago, at the height of the managed care 'craze,' a large orthtoic lab came to town and attempted to sign my colleagues and myself up as a 'buying group' in order to obtain volume discounts. I refused due to the good working relationship I had with my current labs. A few colleagues tried them out but soon went back to their preferred labs.
Ed

Re: Thorlos

Julie on 7/29/01 at 13:56 (054701)

You're so lucky! The Light Hikers cost ?11 here (that's 11 pounds sterling): I suppose about $16).