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Question for the CPeds

Posted by Carmel M on 9/06/01 at 13:33 (059237)

I've had PF for over two years, am wearing custom orthotics, have gone through all the treatment options (ice, stretching, rest, cort shots) and will start PT next week. I also just ordered the night splint and am waiting for it to come in.

I fear I am developing peroneal tendonitis because I have more pain on the edge on my heel than I do at the plantar fascia insertion point on the bottom of the heel.

Would I benefit from seeing a Pedorthist, and would it be appropriate for me to ask my doctor for a referral? I spoke to the lady in the office of the pedorthist and she said to see the pedorthist is by referral from the Pod.

Is the peroneal tendonitis caused by improper orthotics? I think maybe the PF insertional pain is getting better but now the other areas of my heel hurt. Maybe it's time for new orthotics or a gait analysis to determine the cause of the new pain?

Thanks for your help.
Carmel

Re: Question for the CPeds

BG CPed on 9/06/01 at 21:10 (059309)

That depends on the area that hurts. If you have a true cavus foot and your orthotics are posted into varus that can definatly cause peroneal issues. Make sure that the pain is not from the rim or edge of the heel cup. Sometimes the edge is sharp or the heel cup has been narrowed for control. If that is over done or combined with medial post (thicker under arch side of heel) that can cause it to hurt.

Look for a red mark along the edge of heel along the rim of the orthotic. If it is peroneal it will hurt usually a little higher right below your outside ankle bone, usually if you push on it or turn your feet outside (lift arch higher)that puts a pull on it. Usually peroneal tendonitis in a cavus foot will sometimes feel better without shoes or with flat type shoes. If you ad the orthotic to a shoe with extra medial support like many running shoes that can flare up peroneal.

Re: Question for the CPeds

Carmel on 9/06/01 at 21:29 (059315)

Thanks for your response. After reading your post, I'm not sure if it is the peroneal tendon causing problems. I don't know...I'm so confused! The pain is along the edge of my heel but not just the outside. The back edge and the inside edge hurts too. Which doesn't sound like peroneal tendonitis or achilles tendonitis (which is what my Pod thought.) I'm hoping to get some answers from the Physical Therapist also.

I wonder too if I'm not in the wrong kind of shoe. I've had the NB 655 for approx. 3 months. Also I've never taken out the insole, I just put my orthotic on top of the one that comes in the shoe. Probably not a good thing to do?

Thanks for the help.
Carmel

Re: Question for the CPeds

Richard, C.Ped on 9/07/01 at 08:21 (059351)

Take the insole out of the shoe, then put the orthosis in. Let us know how that feels.
Richard

Re: Question for the CPeds

Carmel M on 9/07/01 at 15:40 (059404)

So far it feels good, more stable in the heel area. I think the added height of the orthotic on top of the insole was causing my heel to slip around too much in the shoe.

Thanks.
Carmel

Re: Question for the CPeds

BG CPed on 9/06/01 at 21:10 (059309)

That depends on the area that hurts. If you have a true cavus foot and your orthotics are posted into varus that can definatly cause peroneal issues. Make sure that the pain is not from the rim or edge of the heel cup. Sometimes the edge is sharp or the heel cup has been narrowed for control. If that is over done or combined with medial post (thicker under arch side of heel) that can cause it to hurt.

Look for a red mark along the edge of heel along the rim of the orthotic. If it is peroneal it will hurt usually a little higher right below your outside ankle bone, usually if you push on it or turn your feet outside (lift arch higher)that puts a pull on it. Usually peroneal tendonitis in a cavus foot will sometimes feel better without shoes or with flat type shoes. If you ad the orthotic to a shoe with extra medial support like many running shoes that can flare up peroneal.

Re: Question for the CPeds

Carmel on 9/06/01 at 21:29 (059315)

Thanks for your response. After reading your post, I'm not sure if it is the peroneal tendon causing problems. I don't know...I'm so confused! The pain is along the edge of my heel but not just the outside. The back edge and the inside edge hurts too. Which doesn't sound like peroneal tendonitis or achilles tendonitis (which is what my Pod thought.) I'm hoping to get some answers from the Physical Therapist also.

I wonder too if I'm not in the wrong kind of shoe. I've had the NB 655 for approx. 3 months. Also I've never taken out the insole, I just put my orthotic on top of the one that comes in the shoe. Probably not a good thing to do?

Thanks for the help.
Carmel

Re: Question for the CPeds

Richard, C.Ped on 9/07/01 at 08:21 (059351)

Take the insole out of the shoe, then put the orthosis in. Let us know how that feels.
Richard

Re: Question for the CPeds

Carmel M on 9/07/01 at 15:40 (059404)

So far it feels good, more stable in the heel area. I think the added height of the orthotic on top of the insole was causing my heel to slip around too much in the shoe.

Thanks.
Carmel