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Carol's ped. info

Posted by RACHAEL T. on 12/20/01 at 01:00 (067447)

Carol C - What info did you obtain from the ped. regarding the fit of your orthotics? I think I will consider an orthotic adjustment or new ones after Jan.'s dr. visit. Please advise any info or website regarding correctness in orthotics - in order to better educate & choose my next pair.

Re: Carol's ped. info

Carole C on 12/20/01 at 04:38 (067450)

I've only had my orthotics for ten days, and haven't seen anyone since they were made. My main information about them that I have is fact that I am in a lot less pain now than I was previously, and that I can definitely feel that I am healing now, to a much, much greater degree than I was with just Birkenstocks (which helped me, but only about half as much). Sorry I don't have anything more scientific/literate to report from websites and so on! I regard the heelspurs.com website as extremely helpful and I have read a lot here.

During my appointment when she was making the orthotics for me, she listened to my symptoms carefully and examined my feet, felt them thoroughly with her fingers, watched me walk, and so on. She selected the shoes to put the orthotic in. After the orthotics were made she watched me walk in them. She put white powder on them, put them in my new shoes and then put them on my feet, had me walk, and then carefully took them off my feet so she could see (from the pattern of the powder) the pattern of pressure on various parts of the orthotic that my foot was exerting. She made various adjustments and even completely remade one of the orthotics because she didn't like the pressures revealed to her by the powder.

She asked me about the fit at each step along the way once I was wearing them, and listened when I told her of various concerns I had (that my left heel was sliding outwards a little) and fixed that before I left. She asked me several times to check and see if the arch felt too high (but it never did, to me). I had my new orthotics on for over an hour during my appointment after they were finished, and when she thought they were done she asked me to walk outside in them for a while as well as inside on carpet and on hard floor. Even at that point my feet felt better with the orthotics on and walking around, than they did without the orthotics and sitting, believe it or not. I guess that's not very usual.

While she worked she talked to me about various aspects of fit that she was addressing like making sure my foot wasn't rolling one way or the other, the need (for me) to have my heel up a little to give some relief to my tendon pain, and that I had sufficient arch support since I have high arches. She told me a lot about how the parts of the foot interact with each other mechanically, and with the rest of my body, and what was going wrong to cause my particular foot problems. She asked me what kind of job I have, and how much walking I need to do at work and at home, and gave me her thoughts on all the issues we discuss here (like icing, rest, etc). She seems to have a sort of 'whole body' approach to foot problems. I am so new to this that I listened and tried to absorb it all, but all in all I pretty much let her do what she wanted to do and just told her how they felt each time she put them back on me to check.

She told me to wear them all day at work if I could, and then change to my Birks in the evenings. For some reason I didn't have any trouble doing this right from the start (but my orthotics are the foam type rather than the hard type). She said that it's not unusual to need an adjustment in two weeks, and then another one in four weeks, and so on, even if the orthotic was exactly right for me on the day it was made. She said that this is simple to do, and encouraged me to return for adjustment if/when I wasn't totally satisfied. When I left, I asked her assistant if I needed to return if they continued feeling great, and the assistant said no, but to return if they didn't.

It seems to me that a pedorthist could do all of this and still produce a custom orthotic that didn't work for me. It seems to me that to a very great extent, making orthotics is an art and one for which she has a gift. I hope I have answered your question because I'm not sure if I completely understand what kinds of things you want to know.

Carole C

Re: Carol's ped. info

RACHAEL T. on 12/20/01 at 07:32 (067454)

Oh Yes, you did answer my questions & I found your experience with the orthotics making quite informative.....& maybe a way in which for me to compare my future such appointment in seeing an ped. Thank you! & yes, you will walk Walmart one day & spend probably more money than you need to - but OH WHAT FUN! Hope you are smiling on that one!

Re: Carol's ped. info

Julie on 12/20/01 at 08:49 (067459)

Rachael, about a year ago, Richard CPed wrote a detailed description of the various ways in which orthotics can be made, and gave advice on what to look for when consulting a pedorthist. I tried to find it for you using the search facility, but it didn't turn up. Perhaps if Richard sees this and has a copy, he will re-post it. People found it very helpful at the time.

Re: Carol's ped. info

Carole C on 12/20/01 at 11:35 (067479)

YES!!! That is what I want. Whoever would have thought going to Walmart could be anybody's dream? LOL

Carole C

Re: Is this it?

Carole C on 12/20/01 at 11:45 (067480)

(Julie, I found this interesting post by Richard in the archives. Is this it? Carole C)

Re: Judy View Thread
Posted by Richard, C.Ped on 7/27/00 at 14:34

Hi Judy,
I don't mind questions at all because I enjoy sharing information. Fourth pair or inserts...huh? Wow. I, personally, prefer the foam box semi-weight bearing casting method. There are different computer pad thingies that I do NOT like at all. Some raise sensors that shape to your foot. The problem is that there are not enough sensors to get every detain of your foot. I have never heard of Footmaxx, so I can not comment on that.
My experience has taught me that there are many, many (did I say many?) orthotic manufacturers that do not properly interface the orthotic to the shoe. Many people are still stuck in the 'dark ages' of orthotic fabrication. They still swear by and use the hard plastic 'window scrapers' (great for winter use :-)). They are very ridgid and do not provide proper cushion. The way impressions of your feet are taken play a major factor as well. I have learned that the best impressions are taken in a sitting position or semi-weight bearing position. Never stand in the foam box. This causes the foam or any other impression material to 'bottom out'. This will not give you proper arch support.

I have seen some funky orthotics come in my door which leave me scratching my head wondering what was being treated. Most of the time, with my PF patients, I do use ridgid material. It depends on what the physician suggests as well. When I use the rigid material, most of my PF patients have had extreme relief in 2-3 weeks. Now, this all depends of the severity of the PF. The material I use is a rubber material called ethel vinyl acetate or EVA for short. The material is measured by durometers. That tell you how dense the material is. I use a 60 durometer EVA for PF. For diabetics, I use a less dense EVA. Usually a 40 durometer. The EVA is for posting. The shell of the orthotic is usually a softer EVA.

Make sure of these things:
1. Your orthotics sit flat within your shoes. If they 'cup' when you press your index finger in the center, they need to be adjusted. The cupping causes pain and discomfort, usually on the lateral side. Most places, depending on their policy, will adjust your orthotic. Along the same lines, make sure your orthotic are flat on the bottom, not rounded.

2. Some people require a 'breaking in period' with new orthotics. Wear them for about an hour the first day. When your feet start to feel tired, take the inserts out, and put the inserts that came with the shoes back in. Go a little longer the next day, and so on.

3. Ask you physician or pedorthist what material your inserts will be made out of. Ask to see a sample. Look for a well defined arch and heel cup.

4. Wear your orthotics (and shoes of course) every time your feet touch the floor. I have ankle pain every morning after playing volleyball. If I do not put my feet in my shoes with my inserts...well, let's just say, ouch. The same goes for PF, and other sports type injuries.

5. If the arch area seems to 'high' and is causing pain, even after the 'break in period', ask the physician or pedorthist if the inserts can be adjusted. That is one of the problems with sending out to have inserts made. Adjustments can not be made right then and there. You have to wait for them to be shipped to and fro. Find someone who can do adjustments in the office. That way, you can try them on again, and if adjustments are needed, it can be done on the spot.

I know I tend to ramble, so, I hope I answered your question. If not, please let me know. I also hope that I spelled everything correctly. If not, I'm sorry.
Good luck!
Richard Graham, C.Ped, O.S.T.

Re: Carol's ped. info

nancy s. on 12/20/01 at 13:56 (067486)

here's one that richard posted to me a year ago october 20, and it was Very Helpful to me. i don't know if this is the one julie was remembering, but i've copied it and will paste it here:

Re: CUSTOM ORTHOTICS: My opinion and disagreement (long) View Thread
Posted by Richard C.Ped on 10/20/00 at 08:32
Hi Nancy. Yes, it is an old topic, but a great refresher. It will be an asset to anyone new to the board who does not know about the search function. First, my disagreement. I also have to begin this by saying to Lynn that I mean no disrespect by any means:-). I have to disagree with Lynn about her opinion of the foam box casting system. I use this system on all my patients, if applicable, with great success. She mentioned that you can not hold the foot and ankle in sub-talor neutral while taking the weight bearing impression. I take a semi-weight bearing impression, after location sub-talor neutral, while the patient is sitting. I take the impression by holding the foot in neutral with my index finger and thumb on my left hand, while pushing with the palm of my left hand on the forefoot. I push down on the knee with my right. I do this slowly, constantly making sure that the foot is in neutral. Standing in a foam box does not give the proper impression needed. Certified Pedorthists are properly trained in taking foam impressions, as well as many other ways. I strongly believe that the foam box (IF USED CORRECTLY) will give one of the best impressions of the foot needed to make a cast. There are many other ways such as: wax, sand and wax, and bi-valve casting. I prefer the foam box. Again, I promise I mean no disrespect to Lynn at all. I know that it works if the person knows what he/she is doing.
Nancy, if someone came to me with a history such as yours, I would recommend using a soft orthotic at first, at full price (hopefully insurance will pay). This will allow your feet to get used to the support. After a couple of weeks or so, when you think you are ready for a slightly harder insert, I would grind the soft posting off and add semi-ridgid material, for about $5 (only to cover cost of the material). After you become comfortable with that, I would grind again then add a more ridgid material(not that hard plastic junk) for the same price. Adjusting the inserts to your shoes can be an ongoing process. This is where the customer service issue kicks in. If the person who makes your inserts is not willing to work with you on adjustments, well, you know what to do. Please do not be afraid to ask them questions. If they give you information you do not understand, ask me or the docs. I am sure they will be as happy to help you as I am. Ask to view samples of their work. That way you can see what materials will be used. Make sure that the insets are properly interfaced or 'sitting flat' with your shoes/boots. This is SO important. With the insert in the shoe/boot, push down just behind the arch toward the heel with your index finger. If the insert 'bows up' at the edges, it is not interfaced with the shoe. Have them adjust it on the spot until it is right. So many places will not take the time to do this. Make sure the inserts are flat on the bottom. Rounded inserts will certainly 'bow'. If it does not fit, it will not work. If you have any questions, please do not hesitate to ask either by posting or e-mail.
Richard, Certified Pedorthist

30907

Re: Carole and Nancy and Rachael

Julie on 12/20/01 at 16:06 (067493)

Carole and Nancy, thanks: I remember both of these good posts of Richard's, but couldn't find them. Well done.

Rachael, I hope these are helpful!

Re: Carol's ped. info

Carole C on 12/20/01 at 04:38 (067450)

I've only had my orthotics for ten days, and haven't seen anyone since they were made. My main information about them that I have is fact that I am in a lot less pain now than I was previously, and that I can definitely feel that I am healing now, to a much, much greater degree than I was with just Birkenstocks (which helped me, but only about half as much). Sorry I don't have anything more scientific/literate to report from websites and so on! I regard the heelspurs.com website as extremely helpful and I have read a lot here.

During my appointment when she was making the orthotics for me, she listened to my symptoms carefully and examined my feet, felt them thoroughly with her fingers, watched me walk, and so on. She selected the shoes to put the orthotic in. After the orthotics were made she watched me walk in them. She put white powder on them, put them in my new shoes and then put them on my feet, had me walk, and then carefully took them off my feet so she could see (from the pattern of the powder) the pattern of pressure on various parts of the orthotic that my foot was exerting. She made various adjustments and even completely remade one of the orthotics because she didn't like the pressures revealed to her by the powder.

She asked me about the fit at each step along the way once I was wearing them, and listened when I told her of various concerns I had (that my left heel was sliding outwards a little) and fixed that before I left. She asked me several times to check and see if the arch felt too high (but it never did, to me). I had my new orthotics on for over an hour during my appointment after they were finished, and when she thought they were done she asked me to walk outside in them for a while as well as inside on carpet and on hard floor. Even at that point my feet felt better with the orthotics on and walking around, than they did without the orthotics and sitting, believe it or not. I guess that's not very usual.

While she worked she talked to me about various aspects of fit that she was addressing like making sure my foot wasn't rolling one way or the other, the need (for me) to have my heel up a little to give some relief to my tendon pain, and that I had sufficient arch support since I have high arches. She told me a lot about how the parts of the foot interact with each other mechanically, and with the rest of my body, and what was going wrong to cause my particular foot problems. She asked me what kind of job I have, and how much walking I need to do at work and at home, and gave me her thoughts on all the issues we discuss here (like icing, rest, etc). She seems to have a sort of 'whole body' approach to foot problems. I am so new to this that I listened and tried to absorb it all, but all in all I pretty much let her do what she wanted to do and just told her how they felt each time she put them back on me to check.

She told me to wear them all day at work if I could, and then change to my Birks in the evenings. For some reason I didn't have any trouble doing this right from the start (but my orthotics are the foam type rather than the hard type). She said that it's not unusual to need an adjustment in two weeks, and then another one in four weeks, and so on, even if the orthotic was exactly right for me on the day it was made. She said that this is simple to do, and encouraged me to return for adjustment if/when I wasn't totally satisfied. When I left, I asked her assistant if I needed to return if they continued feeling great, and the assistant said no, but to return if they didn't.

It seems to me that a pedorthist could do all of this and still produce a custom orthotic that didn't work for me. It seems to me that to a very great extent, making orthotics is an art and one for which she has a gift. I hope I have answered your question because I'm not sure if I completely understand what kinds of things you want to know.

Carole C

Re: Carol's ped. info

RACHAEL T. on 12/20/01 at 07:32 (067454)

Oh Yes, you did answer my questions & I found your experience with the orthotics making quite informative.....& maybe a way in which for me to compare my future such appointment in seeing an ped. Thank you! & yes, you will walk Walmart one day & spend probably more money than you need to - but OH WHAT FUN! Hope you are smiling on that one!

Re: Carol's ped. info

Julie on 12/20/01 at 08:49 (067459)

Rachael, about a year ago, Richard CPed wrote a detailed description of the various ways in which orthotics can be made, and gave advice on what to look for when consulting a pedorthist. I tried to find it for you using the search facility, but it didn't turn up. Perhaps if Richard sees this and has a copy, he will re-post it. People found it very helpful at the time.

Re: Carol's ped. info

Carole C on 12/20/01 at 11:35 (067479)

YES!!! That is what I want. Whoever would have thought going to Walmart could be anybody's dream? LOL

Carole C

Re: Is this it?

Carole C on 12/20/01 at 11:45 (067480)

(Julie, I found this interesting post by Richard in the archives. Is this it? Carole C)

Re: Judy View Thread
Posted by Richard, C.Ped on 7/27/00 at 14:34

Hi Judy,
I don't mind questions at all because I enjoy sharing information. Fourth pair or inserts...huh? Wow. I, personally, prefer the foam box semi-weight bearing casting method. There are different computer pad thingies that I do NOT like at all. Some raise sensors that shape to your foot. The problem is that there are not enough sensors to get every detain of your foot. I have never heard of Footmaxx, so I can not comment on that.
My experience has taught me that there are many, many (did I say many?) orthotic manufacturers that do not properly interface the orthotic to the shoe. Many people are still stuck in the 'dark ages' of orthotic fabrication. They still swear by and use the hard plastic 'window scrapers' (great for winter use :-)). They are very ridgid and do not provide proper cushion. The way impressions of your feet are taken play a major factor as well. I have learned that the best impressions are taken in a sitting position or semi-weight bearing position. Never stand in the foam box. This causes the foam or any other impression material to 'bottom out'. This will not give you proper arch support.

I have seen some funky orthotics come in my door which leave me scratching my head wondering what was being treated. Most of the time, with my PF patients, I do use ridgid material. It depends on what the physician suggests as well. When I use the rigid material, most of my PF patients have had extreme relief in 2-3 weeks. Now, this all depends of the severity of the PF. The material I use is a rubber material called ethel vinyl acetate or EVA for short. The material is measured by durometers. That tell you how dense the material is. I use a 60 durometer EVA for PF. For diabetics, I use a less dense EVA. Usually a 40 durometer. The EVA is for posting. The shell of the orthotic is usually a softer EVA.

Make sure of these things:
1. Your orthotics sit flat within your shoes. If they 'cup' when you press your index finger in the center, they need to be adjusted. The cupping causes pain and discomfort, usually on the lateral side. Most places, depending on their policy, will adjust your orthotic. Along the same lines, make sure your orthotic are flat on the bottom, not rounded.

2. Some people require a 'breaking in period' with new orthotics. Wear them for about an hour the first day. When your feet start to feel tired, take the inserts out, and put the inserts that came with the shoes back in. Go a little longer the next day, and so on.

3. Ask you physician or pedorthist what material your inserts will be made out of. Ask to see a sample. Look for a well defined arch and heel cup.

4. Wear your orthotics (and shoes of course) every time your feet touch the floor. I have ankle pain every morning after playing volleyball. If I do not put my feet in my shoes with my inserts...well, let's just say, ouch. The same goes for PF, and other sports type injuries.

5. If the arch area seems to 'high' and is causing pain, even after the 'break in period', ask the physician or pedorthist if the inserts can be adjusted. That is one of the problems with sending out to have inserts made. Adjustments can not be made right then and there. You have to wait for them to be shipped to and fro. Find someone who can do adjustments in the office. That way, you can try them on again, and if adjustments are needed, it can be done on the spot.

I know I tend to ramble, so, I hope I answered your question. If not, please let me know. I also hope that I spelled everything correctly. If not, I'm sorry.
Good luck!
Richard Graham, C.Ped, O.S.T.

Re: Carol's ped. info

nancy s. on 12/20/01 at 13:56 (067486)

here's one that richard posted to me a year ago october 20, and it was Very Helpful to me. i don't know if this is the one julie was remembering, but i've copied it and will paste it here:

Re: CUSTOM ORTHOTICS: My opinion and disagreement (long) View Thread
Posted by Richard C.Ped on 10/20/00 at 08:32
Hi Nancy. Yes, it is an old topic, but a great refresher. It will be an asset to anyone new to the board who does not know about the search function. First, my disagreement. I also have to begin this by saying to Lynn that I mean no disrespect by any means:-). I have to disagree with Lynn about her opinion of the foam box casting system. I use this system on all my patients, if applicable, with great success. She mentioned that you can not hold the foot and ankle in sub-talor neutral while taking the weight bearing impression. I take a semi-weight bearing impression, after location sub-talor neutral, while the patient is sitting. I take the impression by holding the foot in neutral with my index finger and thumb on my left hand, while pushing with the palm of my left hand on the forefoot. I push down on the knee with my right. I do this slowly, constantly making sure that the foot is in neutral. Standing in a foam box does not give the proper impression needed. Certified Pedorthists are properly trained in taking foam impressions, as well as many other ways. I strongly believe that the foam box (IF USED CORRECTLY) will give one of the best impressions of the foot needed to make a cast. There are many other ways such as: wax, sand and wax, and bi-valve casting. I prefer the foam box. Again, I promise I mean no disrespect to Lynn at all. I know that it works if the person knows what he/she is doing.
Nancy, if someone came to me with a history such as yours, I would recommend using a soft orthotic at first, at full price (hopefully insurance will pay). This will allow your feet to get used to the support. After a couple of weeks or so, when you think you are ready for a slightly harder insert, I would grind the soft posting off and add semi-ridgid material, for about $5 (only to cover cost of the material). After you become comfortable with that, I would grind again then add a more ridgid material(not that hard plastic junk) for the same price. Adjusting the inserts to your shoes can be an ongoing process. This is where the customer service issue kicks in. If the person who makes your inserts is not willing to work with you on adjustments, well, you know what to do. Please do not be afraid to ask them questions. If they give you information you do not understand, ask me or the docs. I am sure they will be as happy to help you as I am. Ask to view samples of their work. That way you can see what materials will be used. Make sure that the insets are properly interfaced or 'sitting flat' with your shoes/boots. This is SO important. With the insert in the shoe/boot, push down just behind the arch toward the heel with your index finger. If the insert 'bows up' at the edges, it is not interfaced with the shoe. Have them adjust it on the spot until it is right. So many places will not take the time to do this. Make sure the inserts are flat on the bottom. Rounded inserts will certainly 'bow'. If it does not fit, it will not work. If you have any questions, please do not hesitate to ask either by posting or e-mail.
Richard, Certified Pedorthist

30907

Re: Carole and Nancy and Rachael

Julie on 12/20/01 at 16:06 (067493)

Carole and Nancy, thanks: I remember both of these good posts of Richard's, but couldn't find them. Well done.

Rachael, I hope these are helpful!