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orthotics

Posted by ross on 8/06/01 at 23:15 (055722)

So far Ive tried two sets of orthotics-one pretty standard, and one inverted one with a high post. They both seem to make my right foot hurt more than without them. My pod has tinkered with them for months as I suffered. Should I give up on them completely? I find that icing and taping are the only things which help.

Re: orthotics

Richard, C.Ped on 8/07/01 at 08:20 (055740)

Hi Ross...how is Chandler, Monica, Rachael, Joey and Phoebe? Just kidding!! I'm sorry...I could not resist.

Anyway, first..what is your diagnosis? What type of foot do you have? Flat, high arch or pretty normal?

What type of material was used? Hard plastic? If so, did it have a soft cover on it?

Let me know..
Richard

Re: orthotics

ross on 8/07/01 at 12:31 (055783)

I've been diagnosed with pf and possibly some localized nerve entrapment but my doctor isn't sure about the nerve diagnosis. I have a high arch.

One set of orthotics seems to press on the area just forward of my heel causing pain. The other inverted one hurts my heel cause the ridge extends into the heel area of the orthotic. My heel isn't shaped like what the orthotic is shaped like in the heel. Both are hard plastic with spenco padding glued to the top. I think they suck cause I'm convinced they have done more harm then good.

Re: orthotics

donna SL on 8/07/01 at 14:52 (055811)

Hi Ross,

If you have a high arch, why did your doctor prescribe an inverted orthotic? The inverted orthotic technique is usually used for a person who has severe calcaneal pronation, and is more on the flat-footed side. That's rarely the case with a high arch. I can only guess that you may be supinating excessively, and are having some mid-stance pronation as a result, and your doctor may have misinterpreted your foot biomechanics.

Read this critical article
http://www.biomech.com/db_area/archives/2001/0101orthoses.55.bio.html

I'm pretty sure this is the web site. Their server seems to be down at the moment, so I can't try it. If not you can always go into http://www.biomech.com

and go into the archives, and do a search on cavus, and this article should come up. I think it was written in Jan 01.

I have high arches, and was diagnosed with nerve entrapment in the spring. I recommend that you stop wearing the orthotics immediately. They could cause, or increase any nerve entrapment in that area. Any deep heel cup, especially one made out of hard plastic, with an intrinsic medial post could possibly push on the lateral plantar nerve, and the branch called the Baxter's nerve, and make things worse. I had a similar pair made from a pod once, that caused pain like that, and possibly caused the nerve entrapment I was having. Also inverted orthotics will cause increased supination, which will cause additional strain on the fascia, nerves, etc., of a high arched foot.

A soft padded OTC like a spenco with a heel lift, and just taping my feet seemed to be the only thing that was comfortable, but I still needed intense therapy to assist in removing the nerve entrapment.

Even various soft prescription orthotics don't seem to be working to well with me lately, because to provide some stability there is always a trade-off, ie. deeper heel cup, putting the foot in neutral, etc., will cause some pressure on that area. My nerves were injured from the nerve entrapment, are are still sensitive, and need to heal. I'm going to request my pod pad that spot in the heel, and see if it will help. He already has gone to a softer material, altered the prescription, added a heel lift, etc. The only thing that worked for a while for me was a total plastizote orthotic, but after a while I couldn't tolerate it either, because it isn't very durable, and starts to feel too soft, and once it deforms doesn't really provide the control, and support I need.

Donna

Re: orthotics

Ed Davis, DPM on 8/07/01 at hrmin (055841)

The fact that taping helps generally means that orhtotics should also help if they are made correctly. Read the post by Donna SL-- it is right on the mark, particularly with the link she included. Perhaps you can print the article she linked and let your doc read it. It is a bit frustrating to read stuff like this because it should be common knowledge to all foot docs.
Ed

Re: Another Question Dr. Davis :)

D.Thomas on 8/08/01 at 18:03 (055968)

Dr. Davis,

You have seen my posts and answered a couple of times to which I am grateful. In relation to the article linked above I do not live too far away from Dr. Manoli (about four hours). You probably don't remember but I have extremely high arches and these new rigid orthotics are killing me. I would also probably have to pay some out of my own pocket to see him. Would you think Dr. Manoli would be worth a trip and expense compared to other foot doctors? Is he doing anything special that is rare with high arches?

Re: Another Question Dr. Davis :)

Ed Davis, DPM on 8/08/01 at hrmin (055983)

I would like to believe that the orthotic requirements of the high arch foot are common knowledge in my profession and that all practitioners should thus be offering a similar level of service. It seems, that after reading a number of posts, that assumption is wrong. Again, it is a bit frustrating to me. If you have a good repoire with your local podiatrist, some patience and perserverance, you may be able to help educate him---doing yourself and other patients a service. If that does not work, the long drive may be worthwhile to get your feet to stop hurting.
Ed

Re: Another Question Dr. Davis :)

BG CPED on 8/11/01 at 21:18 (056375)

Dr Davis you are correct. I was co-author of that paper with Dr Manoli. Lack of knowledge regarding dx and tx of the cavus foot got us both frustrated. I saw approx 5 obvious and 4 subtle cavus pat last week alone. Of that number about 5 had 1 or more orthotics that were 'hard plastic or carbon, high arch, and actually had medial rf post.

Many of these pt also are wearing motion or pronation control running shoes due to somebody telling them 'you have a high arch, you need to suppoprt it' I recently had a pt with cmt. She walked on the outside border of her feet and would ruin a shoe in about 2 months. She had over 3 years been given several pair of UCB and AFO devices. Two of them actually had medial ff and rf post. She has several thousand dollars of orthotics in her closet and has worn all for a total of about 2 weeks, yet they keep making a variation.

That is an extreme example but it supports our belief that there is a large number of practitioners that are frankly ignorant in the treatment of the cavus foot. I think a simple explaination is that we are taught that flat feet are bad and high arch is good. The Army wont take flat feet, flat foot cops was an insult in the old days. Models have high arch feet, high arch is good.

So the common thinking is flat foot needs to be lifted and supported and high arch needs to be supported and held up, which is wrong. We are still working on the CFO device, it is done but the business/lawyer end is the hold up. I think you will find Dr Manoli a breath of fresh air. He is very easy to talk to and understands the cavus foot better than anyone.

Once we get the device to market we intend to have seminars to educate practitioners on the treatment AND indentification of cavus foot. And thanks to all that support the paper and link others to it

Re: D Thomas / Dr M anoli

Julie on 8/12/01 at 02:58 (056396)

Hi again, D Thomas

I don't think you need my input on this, but after reading Dr Ed's and BGCPed's posts, I can't resist saying that it would be worth a four-hour drive to see Dr Manoli. The help of a doctor who understands your foot type could be the ticket to recovery for you - I do hope so.

Make a weekend of it!

All the best, Julie

Re: D Thomas / Dr M anoli

Sandy Hendry on 8/13/01 at hrmin (056526)

I have stopped wearing my orthotics for 3 weeks and also had the practioner making the arch a lot higher (if that is what I am reading you are saying). My problem was it made my ankle joint unstable and I would get shooting pains on trying to raise onto my tiptoes. 3 weeks without orthotics and I can toe raise again with a lot more strength. I'm now wearing little sorbitol heel pads and of course have a bit more pain in the inside of my ankles and my heels but for me it seems less disturbing than feeling like my ankle may pop at any moment. What do you recommend? Try orthotics again or just use soft pads on inside of ankle? I've been off running for 8 months but really abused them in a 100k race last November. Do these things actually heel or are you stuck with them rest of your life?

Re: D Thomas / Dr M anoli

BG CPed on 8/13/01 at 06:44 (056532)

Without seeing you and your orthotics it is hard to tell. Common thought is if you fell inversion instability, that you are going to roll your ankle out can mean that the orthotic is too high in srch and or the correction is overdone. Also remember that the shoe will ad or subtract from the corrective force e.g. put it in a speery boat shoe it may not do that. Put it in a pronation control running shoe and it could cause instability. If you have confidence in the person that provided them take them back and ask for re-check. If not try something off shelf like SuperFeet

Re: D Thomas / Dr M anoli

sandy hendry on 8/13/01 at 19:15 (056642)

Thank you so much for your reply! I had the orthotics redone twice already and to no avail. He said that it was already low so I have lost confidence in the guy and am using OTC little rubber wedges. Ankle pain gone but tibialis posterior and plantar facitis is a little bit worse. I can't run but I can live with it walking and feel better off. (By the way I did start wearing flat soled shoes to minimize ankle instability and retinacular ankle pain) Anyway, a final question. My plan is to just keep trying to strengthen my arch muscles/TP with physio exercises and not to try rigid plastic orthotics again. (I didn't use anything for 33 years no problem and I am not very flat footed but I overpronate now, I think, because my TP is injured.) Does that sort of approach work many times or should I pursue this orthotics customization ad nauseum? Thanks again, Sandy.

Re: orthotics

Richard, C.Ped on 8/07/01 at 08:20 (055740)

Hi Ross...how is Chandler, Monica, Rachael, Joey and Phoebe? Just kidding!! I'm sorry...I could not resist.

Anyway, first..what is your diagnosis? What type of foot do you have? Flat, high arch or pretty normal?

What type of material was used? Hard plastic? If so, did it have a soft cover on it?

Let me know..
Richard

Re: orthotics

ross on 8/07/01 at 12:31 (055783)

I've been diagnosed with pf and possibly some localized nerve entrapment but my doctor isn't sure about the nerve diagnosis. I have a high arch.

One set of orthotics seems to press on the area just forward of my heel causing pain. The other inverted one hurts my heel cause the ridge extends into the heel area of the orthotic. My heel isn't shaped like what the orthotic is shaped like in the heel. Both are hard plastic with spenco padding glued to the top. I think they suck cause I'm convinced they have done more harm then good.

Re: orthotics

donna SL on 8/07/01 at 14:52 (055811)

Hi Ross,

If you have a high arch, why did your doctor prescribe an inverted orthotic? The inverted orthotic technique is usually used for a person who has severe calcaneal pronation, and is more on the flat-footed side. That's rarely the case with a high arch. I can only guess that you may be supinating excessively, and are having some mid-stance pronation as a result, and your doctor may have misinterpreted your foot biomechanics.

Read this critical article
http://www.biomech.com/db_area/archives/2001/0101orthoses.55.bio.html

I'm pretty sure this is the web site. Their server seems to be down at the moment, so I can't try it. If not you can always go into http://www.biomech.com

and go into the archives, and do a search on cavus, and this article should come up. I think it was written in Jan 01.

I have high arches, and was diagnosed with nerve entrapment in the spring. I recommend that you stop wearing the orthotics immediately. They could cause, or increase any nerve entrapment in that area. Any deep heel cup, especially one made out of hard plastic, with an intrinsic medial post could possibly push on the lateral plantar nerve, and the branch called the Baxter's nerve, and make things worse. I had a similar pair made from a pod once, that caused pain like that, and possibly caused the nerve entrapment I was having. Also inverted orthotics will cause increased supination, which will cause additional strain on the fascia, nerves, etc., of a high arched foot.

A soft padded OTC like a spenco with a heel lift, and just taping my feet seemed to be the only thing that was comfortable, but I still needed intense therapy to assist in removing the nerve entrapment.

Even various soft prescription orthotics don't seem to be working to well with me lately, because to provide some stability there is always a trade-off, ie. deeper heel cup, putting the foot in neutral, etc., will cause some pressure on that area. My nerves were injured from the nerve entrapment, are are still sensitive, and need to heal. I'm going to request my pod pad that spot in the heel, and see if it will help. He already has gone to a softer material, altered the prescription, added a heel lift, etc. The only thing that worked for a while for me was a total plastizote orthotic, but after a while I couldn't tolerate it either, because it isn't very durable, and starts to feel too soft, and once it deforms doesn't really provide the control, and support I need.

Donna

Re: orthotics

Ed Davis, DPM on 8/07/01 at hrmin (055841)

The fact that taping helps generally means that orhtotics should also help if they are made correctly. Read the post by Donna SL-- it is right on the mark, particularly with the link she included. Perhaps you can print the article she linked and let your doc read it. It is a bit frustrating to read stuff like this because it should be common knowledge to all foot docs.
Ed

Re: Another Question Dr. Davis :)

D.Thomas on 8/08/01 at 18:03 (055968)

Dr. Davis,

You have seen my posts and answered a couple of times to which I am grateful. In relation to the article linked above I do not live too far away from Dr. Manoli (about four hours). You probably don't remember but I have extremely high arches and these new rigid orthotics are killing me. I would also probably have to pay some out of my own pocket to see him. Would you think Dr. Manoli would be worth a trip and expense compared to other foot doctors? Is he doing anything special that is rare with high arches?

Re: Another Question Dr. Davis :)

Ed Davis, DPM on 8/08/01 at hrmin (055983)

I would like to believe that the orthotic requirements of the high arch foot are common knowledge in my profession and that all practitioners should thus be offering a similar level of service. It seems, that after reading a number of posts, that assumption is wrong. Again, it is a bit frustrating to me. If you have a good repoire with your local podiatrist, some patience and perserverance, you may be able to help educate him---doing yourself and other patients a service. If that does not work, the long drive may be worthwhile to get your feet to stop hurting.
Ed

Re: Another Question Dr. Davis :)

BG CPED on 8/11/01 at 21:18 (056375)

Dr Davis you are correct. I was co-author of that paper with Dr Manoli. Lack of knowledge regarding dx and tx of the cavus foot got us both frustrated. I saw approx 5 obvious and 4 subtle cavus pat last week alone. Of that number about 5 had 1 or more orthotics that were 'hard plastic or carbon, high arch, and actually had medial rf post.

Many of these pt also are wearing motion or pronation control running shoes due to somebody telling them 'you have a high arch, you need to suppoprt it' I recently had a pt with cmt. She walked on the outside border of her feet and would ruin a shoe in about 2 months. She had over 3 years been given several pair of UCB and AFO devices. Two of them actually had medial ff and rf post. She has several thousand dollars of orthotics in her closet and has worn all for a total of about 2 weeks, yet they keep making a variation.

That is an extreme example but it supports our belief that there is a large number of practitioners that are frankly ignorant in the treatment of the cavus foot. I think a simple explaination is that we are taught that flat feet are bad and high arch is good. The Army wont take flat feet, flat foot cops was an insult in the old days. Models have high arch feet, high arch is good.

So the common thinking is flat foot needs to be lifted and supported and high arch needs to be supported and held up, which is wrong. We are still working on the CFO device, it is done but the business/lawyer end is the hold up. I think you will find Dr Manoli a breath of fresh air. He is very easy to talk to and understands the cavus foot better than anyone.

Once we get the device to market we intend to have seminars to educate practitioners on the treatment AND indentification of cavus foot. And thanks to all that support the paper and link others to it

Re: D Thomas / Dr M anoli

Julie on 8/12/01 at 02:58 (056396)

Hi again, D Thomas

I don't think you need my input on this, but after reading Dr Ed's and BGCPed's posts, I can't resist saying that it would be worth a four-hour drive to see Dr Manoli. The help of a doctor who understands your foot type could be the ticket to recovery for you - I do hope so.

Make a weekend of it!

All the best, Julie

Re: D Thomas / Dr M anoli

Sandy Hendry on 8/13/01 at hrmin (056526)

I have stopped wearing my orthotics for 3 weeks and also had the practioner making the arch a lot higher (if that is what I am reading you are saying). My problem was it made my ankle joint unstable and I would get shooting pains on trying to raise onto my tiptoes. 3 weeks without orthotics and I can toe raise again with a lot more strength. I'm now wearing little sorbitol heel pads and of course have a bit more pain in the inside of my ankles and my heels but for me it seems less disturbing than feeling like my ankle may pop at any moment. What do you recommend? Try orthotics again or just use soft pads on inside of ankle? I've been off running for 8 months but really abused them in a 100k race last November. Do these things actually heel or are you stuck with them rest of your life?

Re: D Thomas / Dr M anoli

BG CPed on 8/13/01 at 06:44 (056532)

Without seeing you and your orthotics it is hard to tell. Common thought is if you fell inversion instability, that you are going to roll your ankle out can mean that the orthotic is too high in srch and or the correction is overdone. Also remember that the shoe will ad or subtract from the corrective force e.g. put it in a speery boat shoe it may not do that. Put it in a pronation control running shoe and it could cause instability. If you have confidence in the person that provided them take them back and ask for re-check. If not try something off shelf like SuperFeet

Re: D Thomas / Dr M anoli

sandy hendry on 8/13/01 at 19:15 (056642)

Thank you so much for your reply! I had the orthotics redone twice already and to no avail. He said that it was already low so I have lost confidence in the guy and am using OTC little rubber wedges. Ankle pain gone but tibialis posterior and plantar facitis is a little bit worse. I can't run but I can live with it walking and feel better off. (By the way I did start wearing flat soled shoes to minimize ankle instability and retinacular ankle pain) Anyway, a final question. My plan is to just keep trying to strengthen my arch muscles/TP with physio exercises and not to try rigid plastic orthotics again. (I didn't use anything for 33 years no problem and I am not very flat footed but I overpronate now, I think, because my TP is injured.) Does that sort of approach work many times or should I pursue this orthotics customization ad nauseum? Thanks again, Sandy.