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Dr. Scholls - - Suzanne, this might work

Posted by Carole C in NOLA on 2/16/02 at 14:15 (073911)

On impulse I stopped off at Walgreens to look at OTC arch supports this afternoon, and bought both kinds of Dr. Scholls arch supports. One was good and one was not so good.

GOOD: I put the $13 'Dr. Scholls Flexo Foam Arch Supports' in some of my old regular tie-up shoes. They are shorter than the whole foot, but I placed them as far back as they could go in the shoe. And guess what, Suzanne? If they are placed this way, the arch support hits my foot RIGHT on that rear arch spot that has bothered both of us!!!!!! WAHOO! LOL I took off the additional front metatarsal cushion as the package directions suggested for those who don't need it. I think that works best for me. Also, I get enough heel lift just from the arch support when it's placed far back like that, I think.

NOT SO GOOD: The $7 'Dr. Scholl's Cushioning Arch Supports' do not provide firm arch support, but provide more of a cushion with a hint of arch support. That's not good enough for me. Since the other ones have no cushion, I tried the 'bright idea' of putting the cushioning ones on top of the Flexo foam ones. Dumb idea! It just dampens the arch support. So, I will throw the Cushioning ones in my drawer of failed foot gizmos.

I don't know if either of these will work when I'm not sitting down typing, but these Flexo Foam ones feel very good right now. I walked out to the living room in them, and although they didn't feel as good as my custom orthotics, they just might be good enough because they address the main issue for me: firm rear arch support. I'll post a follow up report later.

Carole C

Re: To Carole C in Nola - dress orthotics

Donna SL on 2/16/02 at 16:07 (073924)

Carole,

Have you asked your Cped to make a pair of orthotics for dress/casual shoes? A smaller pair should be able to be made off the same cast. The correction, and support will still be there. Lots of people have one pair for dress, and one for athletic shoes. Also your current pair could be trimmed down a bit if you are having trouble putting them in other sneakers, etc..

Sometimes a second pair cost less than the first one, because the cast has been made already. Since you are doing so well with the current correction this may be easier, and less expensive in the long run than experimenting with various otc's. Also the custom one should last longer then the otc's. An orthotic should be able to be worn in many different shoes.

Donna

Re: To Carole C in Nola - dress orthotics

Carole C in NOLA on 2/16/02 at 18:42 (073929)

Donna, thanks for the ideas! You are right, I am doing quite well with the current correction, but I don't think they kept the cast and they kept no record of my visit at all. I'm pretty certain I'd be paying full price if I got more orthotics. I suppose that I could try to be re-cast by someone and to get a hard orthotic made.

As far as trimming down my orthotic, that's a great idea and I can try to broach that idea to one of the other CPeds at my CPed's office (I think she is not working regular hours now). The staff there did not suggest trimming down my orthotic when I was in there today and explained my desire to wear more normal looking shoes and asked them for suggestions of what to do next. It may not be possible to trim them, and here is the reason why:

http://www.geocities.com/CLCinNOLA/SASvsSAS.html

There's a huge size difference between the two shoes, and the smaller shoe is already quite big. From what Elliott said, the reason my orthotics are so large is because they were relatively cheap ($225). They are constructed of different materials, with foam on top and a prefabricated eva-like insole on the bottom.

I have been reading online that a lot of people get custom orthotics that would be equally well served by OTC orthotics. That is why I thought I'd try some, but you certainly do have a point!

Carole C

Re: To Carole C in Nola - dress orthotics

Donna SL on 2/16/02 at 21:34 (073952)

Hi Carole,

First of all I don't think the bigger shoe looks like a Sherman tank at all. You're just comparing it to the other shoe, so it seems big to you. To me they look like a nice trim casual shoe, and don't make your foot look big. I guess compared to my big fat white asics cross trainers they look great. They look like the men's Freetime, which are constructed better than the womens SAS, and just run a bit wider. There are plenty of women's shoes that look like that. I was considering the men's pair for myself. Is the shoe on your right foot a little tight?

I think the method your Cped might have used was a direct mold to foot to create the orthotics. I had called that company a while back to ask about their custom orthotic. It's made differently then a traditional orthotic with a plaster cast, so maybe that's why there isn't a mold. They are considered more of an accomadative orthotic, rather than functional. That may be the only method she is familiar with. If that's the case then it may be a good idea to go to someone else. Are there any pods that specialize in biomechanics in your area? You may just need an accomadative orthotic, but it can be made from a cast, so future pairs can be produced from it. A good pod, or cped should be able to make both functional, and accomadative ones.

Price has nothing to do with the size. Some doctors charge hundreds of dollars for big fat plaztazote, or other foam orthotics. Yet sometimes that's all that person can tolerate. You are paying for the time, and labor to construct them. The wholesale cost on a plastic, or graphite orthotic from a lab is cheap. The material itself is nothing special just harder. The average wholesale cost of a plastic, or graphite orthotic is around $60.00. The price is just inflated to the end user. Your Cped actually did all the labor herself rather than send them to a lab, so for all the time she spent with you plus constructing them was reasonable. She also got you mobile, and out of pain. She did an expensive job for a cheap price. I would talk to her about your concerns. Ask her if she can make trimmer ones for different needs. If not you'll need to go to someone else.

Not everybody can wear the same orthotic material. What works for one person, might be disatrous for another. I've had so called 'expensive' orthotics made out of graphite, and other plastic materials from some of the finest labs all constructed from the most meticulous cast, yet they killed me. I have a whole bag of them as a matter of fact. You might be able to tolerate some sort of plastic, but if not there are all different combinations of soft materials that when used together, can produce a slightly thinner orthotic with more strength ie. combinations of reinforced leather, cork, tri-lam, etc. There's also a material called pro-xp2 that looks, and feels like EVA, but doesn't bottom out. High stress areas can be reinforced with materials like liquid thermoknit. Orthotist, and some Cpeds are usually more familiar with this. These softer orthotics will still be somewhat bulkier then a plastic ones, but shouldn't be as bulky as what you have now.

Most softer orthotics are more bulky in general, but don't have to be huge. Your current orthotics should be able to be shortened, and narrowed a a little. If you want to go much thinner then sometimes softness has to be sacrificed. For a dress, or casual shoes you might be able to tolerate a semi-flexible plastic with a little poron, or eva arch fill for support. This will still give some control, yet have some flexiblity, and absorb shock. Also a thin 3/4 to full length top cover of something like 1/16' inch poron, or spenco could be put on for comfort. If you can tolerate the semi-flexible plastic like subortholene, or a thin co-polymer polypropylene combo, then I would recommend that, because they would be e more durable than soft materials, and give decent support, yet and still provide comfort.

If there is that great of a difference in the size of the current SAS shoes you have compared to other athletic shoes you plan to wear, and you want to continue wearing the SAS shoes for now then it may be a good idea to leave them alone so you have something to fall back on. But, maybe they can be trimmed a little in the length, and width to put in some other athletic shoes. A good orthotic though should be able to be transferred to other shoes, rather than making a hugh orthotic that requires a hugh shoe.

I think OTC's are great if you can wear them. It seem that most of the better ones on the market are made for a foot that pronates. Most have some type of increase on the medial side. If you don't have that problem then those otc's might actually be harmful. Most of the neutral ones I've seen so far provide little support, and mostly cushion. I have high arched feet, and haven't found an otc yet that works. I can't tolerate too much arch in an orthotic. If it's too high it actually restricts my motion, and causes me to supinate more, and is very uncomfortable.

For now you could give the Dr. Scholls a try. They may be all you need in a dress shoe, but if you need a bit more for a casual walking shoes don't drive yourself crazy trying different otc's. Most importantly it would be a good idea to get a biomechanical assessment from an expert, so you know what type of gait you really have. As BG cped mentioned in the past sometimes gaits are misdiagnosed, so try to find someone top notch.

Donna

Re: Donna, you know a LOT about orthotics!

Carole C in NOLA on 2/16/02 at 22:51 (073959)

No, the shoe on my right foot fits reasonably well but as well-fitting shoes go, it is on the very loose side, about as loose as a moccasin or slipper might fit.

Thanks for your very helpful and interesting posts! I'll address some of the things you are discussing.

The big newer SAS shoes are a men's SAS 'Time Out' shoe. They are just fine, except that my feet are in proportion to the rest of my body, and fit easily in my smaller older SAS shoes, so when I wear the big ones I look like a crossdressing Clarabelle the Clown. The fact that this didn't even bother me at first is a testimony to how awful PF pain can be. Now that I am no longer in agony, it bothers me.

You may very well be right about it being a direct mold rather than a cast. I just have no idea. The receipt said 'Orthofeet' but I wasn't able to find much info about their custom orthotics online. She had me sit and placed my foot in a box of some sort of goo (foam, maybe?), with straps to hold it in place and straight. There was some sort of plastic or Saran-wrap type stuff between my foot and the goo so that my foot didn't need to be washed afterwards. Then once it had set she gave the box to some others that work there, who fashioned the orthotic in the back room while she gave me various instructions about what to do and not do.

I'm perfectly happy with my orthotics. I just don't feel that I need to wear orthotics all the time now that my PF is nearly healed. I have worn Birkenstocks sometimes and this has not set me back. I know now not to do stupid things in my exercise program that injured my PF to begin with, so I feel that it may be possible to carefully transition out of the custom orthotics, and into 'regular' high quality shoes of some kind with arch support, remembering to push my feet less than I think I can rather than more.

I have never seen a DPM. It's difficult to know who might be top notch here near Metairie or Kenner, Louisiana (New Orleans suburbs). I have found the names of several online and in the yellow pages, but I have only lived here less than three years, and don't know anyone here with foot problems to ask. I will see if my rheumatologist knows of one when I go to see him on February 22nd. He was the one that sent me to my CPed, who is so great. Maybe he will know of a top notch DPM to send me to, or maybe not. He's a very good rheumatologist. Or, if I can ever see my CPed, maybe I could find out who she deals with the most. Or maybe somebody here on heelspurs.com knows of a top notch DPM in my area.

Yes, I thought my C.Ped. gave me a great price for my orthotic, and the information she gave me along with it was priceless. She spent 3-4 hours with me, telling me about a lot of the kinds of things we post about here at heelspurs.com and more, and she watched me walk, and examined my feet and I could tell she was doing everything humanly possible to help me. And, I needed it. I wasn't able to do much and was in a lot of pain, at the time.

I would like to talk to her about my options. She seems to be pretty hard to get hold of, though. I nearly had to stage a sit-in in her office to get her to show up for my original appointment with her. LOL But as you can tell, I think she is well worth the wait. I believe she could walk on water.

I am not sure the Dr. Scholls will work, at all. They are not perfect. I'm just hoping they will work well enough now that my feet are mostly healed. They would give me some options beyond Birkenstocks, maybe. The Dr. Scholls that feels best for me has the rear arch support that I need, but I am not getting any cushioning from it and I'm not sure my foot is in the best position. This is with the Dr. Scholls in my smaller SAS shoe in the photo, which has a regular hard flat non-orthotic non-cushioned insole in it.

I have some Nike Airs which I never wear, but I thought they might provide some cushion so I tried putting the Dr. Scholls in them. The feeling was totally different; I could hardly feel the arch support and it didn't feel good at all. So, the Nike Airs are gathering dust in the closet again and my Dr. Scholls are back in my smaller older SAS shoes. My plan is as always to try to push my feet to do less than I think they can take, so it will take some time but I'll let you know how it goes.

That was a very interesting post! You know a LOT about orthotics!

Carole C

Re: Carole C Nola- orthotics

Donna SL on 2/17/02 at 17:05 (074027)

Hi Carole,

You had me laughing, but I'm sure you don't look like Clarabell the clown.
Did you ever see the big black bulky Skechers the kids wear? That's the style. They may jut be a little long in lengtht. I would ask her why she sold you such a long pair. Do you have more than a thumbs width in them in front of the toes without the orthotics? Also how much room with the orthotics.

There is nothing wrong with going without orthotics either if you can. If you went your whole life without them, then probably after you heal you may be able to just wear good supportive shoes. My pods opinion has always been that unless you really need them they should just be temporary until the injury heals. He specializes in biomechanics, and his entire practice is mostly orthotics yet he feels there is no reason to be dependent on them if you can go without them. It's like when you have a back injury you don't have a person wearing a brace, or a cast on a broken leg once it heals, so there is no need to brace the foot if not necessary.

If you still feel you need orthotics for a while, or even forever then there's nothing wrong with wearing them. Probably the best thing would be to try to get another appointment with the Cped that made your first pair, and see if she can make them smaller in length, and width, so you could try them in other shoes. She seems pretty good. I've gone to pods that never even watched me walk, and prescribed orthotics. I also went to a pod who only did biomechanics, and even wrote a book on the subject, yet totally misdiagnosed my gait, and made a horrible pair of orthotics that caused injury. It's luck sometimes, and even a big-shot can make mistakes. If you have had success with this Cped I would stick with her, unless she is really not versatile.

Have you tried putting a thin piece of spenco, or other thin insole on top of the Dr.Scholls orthotic? If you need cushion just lay this right on top of the insert. It may, or may not work, but you could give it a try. Spenco sells the plain flat inserts for around $10.00, or try the cheapie ones first. Also the Cped place may be able to give you a piece of spenco if they have it. You could cut, and shape it to the shoe. Either 1/8th, or 1/16th should work, depending on how much room you have in the shoe. If that works then they could glue them on permanently.

Try to stay away from Nike air, or any shoe with too much heel cushion. They will pull on the fascia, and also make the foot/ankle more unstable. Most of the Nikes have very little support in general, as do most athletic shoes. I haven't had much success with any New Balance shoes either. The top of the line ones all contain some type of medial post, and their neutral ones are very mushy, except some of their outdoor/hiking shoes like the 751. Most of the New balance shoes actually caused me injury, because they rolled my feet out even more. Even the ones they claim to be for both supination, and pronation are no good, because the big medial post overrides the little one on the lateral side. Unless you have any severe biomechanical problems you are better off staying in a good supportive neurtral shoe like the SAS, or a neutral supportive cross-trainer for every day walking. Their hard to find too. Once you find out your gait pattern, it should help in selecting shoes. It's not a bad idea to have the cped watch you walk in the shoes you select either. I brought my pod tons of shoes so he could observe me in them. I'm getting better at selecting them on my own now, but sometimes you need an alternative viewpoint.

I couldn't find info on orthofeet on the web, other than their address, That's why I had called them to find out about the orthotic. I found their address when I did a search on the biomechanics on-line web site. http://www.biomech.com/

They have some interesting articles in their archives on orthotics, biomechanics etc. Also this is the article that BG cped wrote in biomechanics magazine.

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

You can also find it by doing a search on 'CAVUS' in the archives section.
It's so hard to tell by a picture of you standing if you have a cavus (high arched foot) I was trying to figure out what type of foot/gait you have, but you really need to be observed while walking, and in person. It's a shame you can't do a video of you walking. Also a non-wt bearing pic would show the arch. It appears from the rear view picture that your right foot is slightly everted (going in at the ankle), and the left one is a litte supinated, but in one of the front view pictures it looks like your left foot is everting also. It's almost impossible to really tell from a picture, because you could just be standing certain ways. From the pics though it doesn't appear that you have anything really severe wrong with your feet. They seem to be in the normal range.

Keep me posted on what you try.

Donna

Re: Carole C Nola- orthotics

Carole C in NOLA on 2/17/02 at 18:03 (074042)

Aha! I am one step ahead, Donna. I did a search yesterday on your handle, because your posts in this thread were interesting. While reading some but not all previous posts of yours, I came across that article that BG CPed wrote, and read it and saved it as one of my favorites. I think maybe I have a subtle cavus foot too, though I'm not sure either.

With the orthotics, I have only maybe 1/4' to 3/8' at the end of the shoes, just the right amount so that when I stand my toes don't quite hit the end but almost. Everything is a nice, snug, fit. Without the orthotics I have maybe an inch and a half at the end of the shoes. I guess the difference is probably due to the thickness of the orthotic, so all of the volume inside the shoe is taken up.

I wish I could do a video of me walking too. I am taking these photos with a webcam, so maybe there is some way to do that. I have never done it, though. I have photos of my arch both weight bearing and non weight bearing, here:

http://www.geocities.com/CLCinNOLA/footarch.html

My feet look dirty in the photo but it's just the lighting which is practically non-existent at this end of the room. Anyway, I agree that I do not have much that is very wrong with my feet. I would very much like to ditch the orthotics as soon as my feet can handle that, and go for a pair of good supportive shoes. The problem is that most shoes don't seem to be that supportive, so I need to find out what kinds are supportive in ways that won't be harmful to my feet.

It seems to me that right now, if I were to start wearing supportive shoes more, I would be better off if they gave me considerable arch support too. I think I will need arch support for quite a while after I stop needing my orthotics. If the arch support is far enough back, apparently I don't need the heel lifts (my mistake, oops). At least that was what I learned from the Dr. Scholls. The far rear arch support actually lifts my heel a bit, which is enough really.

I agree with your pod that for me this should be temporary, if possible. If it's not possible, I'm sure my feet will let me know. As always I try to approach anything like this with caution.

Carole C

Re: Carole C Nola- orthotics

Donna SL on 2/17/02 at 19:36 (074061)

Carole,

You're arch, and foot looks pretty normal too me. From the pictures it looks just right. It's not nearly as high as mine. I remember a PT said my arch is so high a little mouse could run under it. I've seen higher arches than mine though. If you decide to stay with orthotics it would probably be better to stick with accomodative ones to maybe unload some pressure points only if they are bothering you. Do you have any pain under the first big toe joint? You're first ray may be a little dropped, but it's hard to tell from a picture. You can always get a little dancer's pad for that if it ever hurts in that area, or a first ray cut out in the orthotic, but sometimes you have to be careful because if your arch collapses on wt bearing it could cause the forefoot to pronate. An intrinsic forefoot post built into an orthotic to level the mets would work too, but with any of these methods the orthotic has to be properly balanced, or they may cause other problems. That's why if you don't have any severe discomfort it's better not to start with all this stuff, and you're right in trying to go without them. Sometimes trying to put the foot in a perfectly neutral position can cause all kinds of problems. There's been a lot of controversy lately on the Rooterian theory. Most people don't walk in neutral, and have no pain.

Have you tried ART - Active release technique? I've mentioned it in the past on the board. It's incredible. This would help loosen up the tight tissue in the fascia, and the surrounding tissues , so you could heal faster. I even noticed with my bad feet that I can take more give in a shoe as they get better, as long as they aren't too sinky in the heel, and have good lateral support. And I've had severe problems not only with rigid high-arched feet, but also TTS, and PF, and back problems. The ART even helped the pain under my first ray which is dropped also, by working on other muscles and tendons in the foot, and legs. I may still end up needing an accomodative orthotic to be more comfortable, but I'm waiting a while to see if I can continue to improve without them. It seems the intrinsic muscles in my feet are getting stronger since I haven't been wearing orthotics, but I couldn't have done it without all the therapy I had. This site would help you find an ART practitioner in your area if you ever want to try it.

http://www.activerelease.com/

Walking shoes should have around a thumbs width in front of the toe. I guess that's around an inch. You could probably have the orthotics cut down a bit, and they won't slide in the SAS, but other shoes should have around the same bit of room in front to the shoe. Also make sure the shoes you select has a decent lift in the heel, and little torque in the midfoot, yet has a flexible forefoot. This will take stress off the fascia. Have you ever tried putting a little 1/16' firm heel lift in any of your shoes without anything else? This may help more than arch support. Did the Cped assess your range of motion in your ankles? I haven't looked at the SAS lately, but I'm wondering if they have enough support on their own. Did you every try them without the orthotic? They may be a little big though without the orthotic.

Donna

Re: Carole C Nola- orthotics

Carole C in NOLA on 2/17/02 at 21:04 (074069)

Nope, I never get any pain under the first joint (or any joint) of the big toe, and I think/suspect that I don't need it raised and that if it was raised by me it would set my whole foot 'off kilter'. It feels best down low relative to my heel and relative to my arch.

Thanks for the ART link. I don't know anything about it, so it will be interesting to read about it.

I have some gel heel lifts that are about 1/8' which I got before I was diagnosed. They did help, but not enough at that point. I almost could not walk without them, at the time. Maybe they would work better now that I'm almost healed.

Yes, the Cped and the rheumatologist both looked at my range of motion in my ankles. At the time, I was in agony and my C.Ped said things like 'My, you're so tight!' referring to all the tendons and muscles which felt like fire from my feet up through my lower leg and were hurting and felt short. Much of my pain was from the tendon(s) in my lower leg, and that is why I think Birkenstocks are not ideal for me, because of their very low position for the heel.

The larger SAS is way too big to have any support without the orthotic, but with the orthotic it has a LOT of support... much of the size that you see in it is due to the fact that every aspect of the shoe has a lot of cushioning. Besides, if I'm wearing my Clarabelle shoes I might as well put the orthotic in them. LOL

The smaller SAS shoe is probably getting too old. My Easy Spirits and Nike Airs are in the 'never to be worn again' corner of my closet along with the horrible sandals that contributed to my PF to begin with. I'd really like to wear some sort of normal looking tie-up shoe, so I will probably have to go buy another shoe at some point. Something with good lateral support, and with something more than a flat footbed, at least to start with, would be ideal. Maybe the Dr. Scholls or heel pads, but even better maybe something built into the shoe.

Thanks again for your insights, Donna.....

Carole C

Re: To Carole C in Nola - dress orthotics

Donna SL on 2/16/02 at 16:07 (073924)

Carole,

Have you asked your Cped to make a pair of orthotics for dress/casual shoes? A smaller pair should be able to be made off the same cast. The correction, and support will still be there. Lots of people have one pair for dress, and one for athletic shoes. Also your current pair could be trimmed down a bit if you are having trouble putting them in other sneakers, etc..

Sometimes a second pair cost less than the first one, because the cast has been made already. Since you are doing so well with the current correction this may be easier, and less expensive in the long run than experimenting with various otc's. Also the custom one should last longer then the otc's. An orthotic should be able to be worn in many different shoes.

Donna

Re: To Carole C in Nola - dress orthotics

Carole C in NOLA on 2/16/02 at 18:42 (073929)

Donna, thanks for the ideas! You are right, I am doing quite well with the current correction, but I don't think they kept the cast and they kept no record of my visit at all. I'm pretty certain I'd be paying full price if I got more orthotics. I suppose that I could try to be re-cast by someone and to get a hard orthotic made.

As far as trimming down my orthotic, that's a great idea and I can try to broach that idea to one of the other CPeds at my CPed's office (I think she is not working regular hours now). The staff there did not suggest trimming down my orthotic when I was in there today and explained my desire to wear more normal looking shoes and asked them for suggestions of what to do next. It may not be possible to trim them, and here is the reason why:

http://www.geocities.com/CLCinNOLA/SASvsSAS.html

There's a huge size difference between the two shoes, and the smaller shoe is already quite big. From what Elliott said, the reason my orthotics are so large is because they were relatively cheap ($225). They are constructed of different materials, with foam on top and a prefabricated eva-like insole on the bottom.

I have been reading online that a lot of people get custom orthotics that would be equally well served by OTC orthotics. That is why I thought I'd try some, but you certainly do have a point!

Carole C

Re: To Carole C in Nola - dress orthotics

Donna SL on 2/16/02 at 21:34 (073952)

Hi Carole,

First of all I don't think the bigger shoe looks like a Sherman tank at all. You're just comparing it to the other shoe, so it seems big to you. To me they look like a nice trim casual shoe, and don't make your foot look big. I guess compared to my big fat white asics cross trainers they look great. They look like the men's Freetime, which are constructed better than the womens SAS, and just run a bit wider. There are plenty of women's shoes that look like that. I was considering the men's pair for myself. Is the shoe on your right foot a little tight?

I think the method your Cped might have used was a direct mold to foot to create the orthotics. I had called that company a while back to ask about their custom orthotic. It's made differently then a traditional orthotic with a plaster cast, so maybe that's why there isn't a mold. They are considered more of an accomadative orthotic, rather than functional. That may be the only method she is familiar with. If that's the case then it may be a good idea to go to someone else. Are there any pods that specialize in biomechanics in your area? You may just need an accomadative orthotic, but it can be made from a cast, so future pairs can be produced from it. A good pod, or cped should be able to make both functional, and accomadative ones.

Price has nothing to do with the size. Some doctors charge hundreds of dollars for big fat plaztazote, or other foam orthotics. Yet sometimes that's all that person can tolerate. You are paying for the time, and labor to construct them. The wholesale cost on a plastic, or graphite orthotic from a lab is cheap. The material itself is nothing special just harder. The average wholesale cost of a plastic, or graphite orthotic is around $60.00. The price is just inflated to the end user. Your Cped actually did all the labor herself rather than send them to a lab, so for all the time she spent with you plus constructing them was reasonable. She also got you mobile, and out of pain. She did an expensive job for a cheap price. I would talk to her about your concerns. Ask her if she can make trimmer ones for different needs. If not you'll need to go to someone else.

Not everybody can wear the same orthotic material. What works for one person, might be disatrous for another. I've had so called 'expensive' orthotics made out of graphite, and other plastic materials from some of the finest labs all constructed from the most meticulous cast, yet they killed me. I have a whole bag of them as a matter of fact. You might be able to tolerate some sort of plastic, but if not there are all different combinations of soft materials that when used together, can produce a slightly thinner orthotic with more strength ie. combinations of reinforced leather, cork, tri-lam, etc. There's also a material called pro-xp2 that looks, and feels like EVA, but doesn't bottom out. High stress areas can be reinforced with materials like liquid thermoknit. Orthotist, and some Cpeds are usually more familiar with this. These softer orthotics will still be somewhat bulkier then a plastic ones, but shouldn't be as bulky as what you have now.

Most softer orthotics are more bulky in general, but don't have to be huge. Your current orthotics should be able to be shortened, and narrowed a a little. If you want to go much thinner then sometimes softness has to be sacrificed. For a dress, or casual shoes you might be able to tolerate a semi-flexible plastic with a little poron, or eva arch fill for support. This will still give some control, yet have some flexiblity, and absorb shock. Also a thin 3/4 to full length top cover of something like 1/16' inch poron, or spenco could be put on for comfort. If you can tolerate the semi-flexible plastic like subortholene, or a thin co-polymer polypropylene combo, then I would recommend that, because they would be e more durable than soft materials, and give decent support, yet and still provide comfort.

If there is that great of a difference in the size of the current SAS shoes you have compared to other athletic shoes you plan to wear, and you want to continue wearing the SAS shoes for now then it may be a good idea to leave them alone so you have something to fall back on. But, maybe they can be trimmed a little in the length, and width to put in some other athletic shoes. A good orthotic though should be able to be transferred to other shoes, rather than making a hugh orthotic that requires a hugh shoe.

I think OTC's are great if you can wear them. It seem that most of the better ones on the market are made for a foot that pronates. Most have some type of increase on the medial side. If you don't have that problem then those otc's might actually be harmful. Most of the neutral ones I've seen so far provide little support, and mostly cushion. I have high arched feet, and haven't found an otc yet that works. I can't tolerate too much arch in an orthotic. If it's too high it actually restricts my motion, and causes me to supinate more, and is very uncomfortable.

For now you could give the Dr. Scholls a try. They may be all you need in a dress shoe, but if you need a bit more for a casual walking shoes don't drive yourself crazy trying different otc's. Most importantly it would be a good idea to get a biomechanical assessment from an expert, so you know what type of gait you really have. As BG cped mentioned in the past sometimes gaits are misdiagnosed, so try to find someone top notch.

Donna

Re: Donna, you know a LOT about orthotics!

Carole C in NOLA on 2/16/02 at 22:51 (073959)

No, the shoe on my right foot fits reasonably well but as well-fitting shoes go, it is on the very loose side, about as loose as a moccasin or slipper might fit.

Thanks for your very helpful and interesting posts! I'll address some of the things you are discussing.

The big newer SAS shoes are a men's SAS 'Time Out' shoe. They are just fine, except that my feet are in proportion to the rest of my body, and fit easily in my smaller older SAS shoes, so when I wear the big ones I look like a crossdressing Clarabelle the Clown. The fact that this didn't even bother me at first is a testimony to how awful PF pain can be. Now that I am no longer in agony, it bothers me.

You may very well be right about it being a direct mold rather than a cast. I just have no idea. The receipt said 'Orthofeet' but I wasn't able to find much info about their custom orthotics online. She had me sit and placed my foot in a box of some sort of goo (foam, maybe?), with straps to hold it in place and straight. There was some sort of plastic or Saran-wrap type stuff between my foot and the goo so that my foot didn't need to be washed afterwards. Then once it had set she gave the box to some others that work there, who fashioned the orthotic in the back room while she gave me various instructions about what to do and not do.

I'm perfectly happy with my orthotics. I just don't feel that I need to wear orthotics all the time now that my PF is nearly healed. I have worn Birkenstocks sometimes and this has not set me back. I know now not to do stupid things in my exercise program that injured my PF to begin with, so I feel that it may be possible to carefully transition out of the custom orthotics, and into 'regular' high quality shoes of some kind with arch support, remembering to push my feet less than I think I can rather than more.

I have never seen a DPM. It's difficult to know who might be top notch here near Metairie or Kenner, Louisiana (New Orleans suburbs). I have found the names of several online and in the yellow pages, but I have only lived here less than three years, and don't know anyone here with foot problems to ask. I will see if my rheumatologist knows of one when I go to see him on February 22nd. He was the one that sent me to my CPed, who is so great. Maybe he will know of a top notch DPM to send me to, or maybe not. He's a very good rheumatologist. Or, if I can ever see my CPed, maybe I could find out who she deals with the most. Or maybe somebody here on heelspurs.com knows of a top notch DPM in my area.

Yes, I thought my C.Ped. gave me a great price for my orthotic, and the information she gave me along with it was priceless. She spent 3-4 hours with me, telling me about a lot of the kinds of things we post about here at heelspurs.com and more, and she watched me walk, and examined my feet and I could tell she was doing everything humanly possible to help me. And, I needed it. I wasn't able to do much and was in a lot of pain, at the time.

I would like to talk to her about my options. She seems to be pretty hard to get hold of, though. I nearly had to stage a sit-in in her office to get her to show up for my original appointment with her. LOL But as you can tell, I think she is well worth the wait. I believe she could walk on water.

I am not sure the Dr. Scholls will work, at all. They are not perfect. I'm just hoping they will work well enough now that my feet are mostly healed. They would give me some options beyond Birkenstocks, maybe. The Dr. Scholls that feels best for me has the rear arch support that I need, but I am not getting any cushioning from it and I'm not sure my foot is in the best position. This is with the Dr. Scholls in my smaller SAS shoe in the photo, which has a regular hard flat non-orthotic non-cushioned insole in it.

I have some Nike Airs which I never wear, but I thought they might provide some cushion so I tried putting the Dr. Scholls in them. The feeling was totally different; I could hardly feel the arch support and it didn't feel good at all. So, the Nike Airs are gathering dust in the closet again and my Dr. Scholls are back in my smaller older SAS shoes. My plan is as always to try to push my feet to do less than I think they can take, so it will take some time but I'll let you know how it goes.

That was a very interesting post! You know a LOT about orthotics!

Carole C

Re: Carole C Nola- orthotics

Donna SL on 2/17/02 at 17:05 (074027)

Hi Carole,

You had me laughing, but I'm sure you don't look like Clarabell the clown.
Did you ever see the big black bulky Skechers the kids wear? That's the style. They may jut be a little long in lengtht. I would ask her why she sold you such a long pair. Do you have more than a thumbs width in them in front of the toes without the orthotics? Also how much room with the orthotics.

There is nothing wrong with going without orthotics either if you can. If you went your whole life without them, then probably after you heal you may be able to just wear good supportive shoes. My pods opinion has always been that unless you really need them they should just be temporary until the injury heals. He specializes in biomechanics, and his entire practice is mostly orthotics yet he feels there is no reason to be dependent on them if you can go without them. It's like when you have a back injury you don't have a person wearing a brace, or a cast on a broken leg once it heals, so there is no need to brace the foot if not necessary.

If you still feel you need orthotics for a while, or even forever then there's nothing wrong with wearing them. Probably the best thing would be to try to get another appointment with the Cped that made your first pair, and see if she can make them smaller in length, and width, so you could try them in other shoes. She seems pretty good. I've gone to pods that never even watched me walk, and prescribed orthotics. I also went to a pod who only did biomechanics, and even wrote a book on the subject, yet totally misdiagnosed my gait, and made a horrible pair of orthotics that caused injury. It's luck sometimes, and even a big-shot can make mistakes. If you have had success with this Cped I would stick with her, unless she is really not versatile.

Have you tried putting a thin piece of spenco, or other thin insole on top of the Dr.Scholls orthotic? If you need cushion just lay this right on top of the insert. It may, or may not work, but you could give it a try. Spenco sells the plain flat inserts for around $10.00, or try the cheapie ones first. Also the Cped place may be able to give you a piece of spenco if they have it. You could cut, and shape it to the shoe. Either 1/8th, or 1/16th should work, depending on how much room you have in the shoe. If that works then they could glue them on permanently.

Try to stay away from Nike air, or any shoe with too much heel cushion. They will pull on the fascia, and also make the foot/ankle more unstable. Most of the Nikes have very little support in general, as do most athletic shoes. I haven't had much success with any New Balance shoes either. The top of the line ones all contain some type of medial post, and their neutral ones are very mushy, except some of their outdoor/hiking shoes like the 751. Most of the New balance shoes actually caused me injury, because they rolled my feet out even more. Even the ones they claim to be for both supination, and pronation are no good, because the big medial post overrides the little one on the lateral side. Unless you have any severe biomechanical problems you are better off staying in a good supportive neurtral shoe like the SAS, or a neutral supportive cross-trainer for every day walking. Their hard to find too. Once you find out your gait pattern, it should help in selecting shoes. It's not a bad idea to have the cped watch you walk in the shoes you select either. I brought my pod tons of shoes so he could observe me in them. I'm getting better at selecting them on my own now, but sometimes you need an alternative viewpoint.

I couldn't find info on orthofeet on the web, other than their address, That's why I had called them to find out about the orthotic. I found their address when I did a search on the biomechanics on-line web site. http://www.biomech.com/

They have some interesting articles in their archives on orthotics, biomechanics etc. Also this is the article that BG cped wrote in biomechanics magazine.

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

You can also find it by doing a search on 'CAVUS' in the archives section.
It's so hard to tell by a picture of you standing if you have a cavus (high arched foot) I was trying to figure out what type of foot/gait you have, but you really need to be observed while walking, and in person. It's a shame you can't do a video of you walking. Also a non-wt bearing pic would show the arch. It appears from the rear view picture that your right foot is slightly everted (going in at the ankle), and the left one is a litte supinated, but in one of the front view pictures it looks like your left foot is everting also. It's almost impossible to really tell from a picture, because you could just be standing certain ways. From the pics though it doesn't appear that you have anything really severe wrong with your feet. They seem to be in the normal range.

Keep me posted on what you try.

Donna

Re: Carole C Nola- orthotics

Carole C in NOLA on 2/17/02 at 18:03 (074042)

Aha! I am one step ahead, Donna. I did a search yesterday on your handle, because your posts in this thread were interesting. While reading some but not all previous posts of yours, I came across that article that BG CPed wrote, and read it and saved it as one of my favorites. I think maybe I have a subtle cavus foot too, though I'm not sure either.

With the orthotics, I have only maybe 1/4' to 3/8' at the end of the shoes, just the right amount so that when I stand my toes don't quite hit the end but almost. Everything is a nice, snug, fit. Without the orthotics I have maybe an inch and a half at the end of the shoes. I guess the difference is probably due to the thickness of the orthotic, so all of the volume inside the shoe is taken up.

I wish I could do a video of me walking too. I am taking these photos with a webcam, so maybe there is some way to do that. I have never done it, though. I have photos of my arch both weight bearing and non weight bearing, here:

http://www.geocities.com/CLCinNOLA/footarch.html

My feet look dirty in the photo but it's just the lighting which is practically non-existent at this end of the room. Anyway, I agree that I do not have much that is very wrong with my feet. I would very much like to ditch the orthotics as soon as my feet can handle that, and go for a pair of good supportive shoes. The problem is that most shoes don't seem to be that supportive, so I need to find out what kinds are supportive in ways that won't be harmful to my feet.

It seems to me that right now, if I were to start wearing supportive shoes more, I would be better off if they gave me considerable arch support too. I think I will need arch support for quite a while after I stop needing my orthotics. If the arch support is far enough back, apparently I don't need the heel lifts (my mistake, oops). At least that was what I learned from the Dr. Scholls. The far rear arch support actually lifts my heel a bit, which is enough really.

I agree with your pod that for me this should be temporary, if possible. If it's not possible, I'm sure my feet will let me know. As always I try to approach anything like this with caution.

Carole C

Re: Carole C Nola- orthotics

Donna SL on 2/17/02 at 19:36 (074061)

Carole,

You're arch, and foot looks pretty normal too me. From the pictures it looks just right. It's not nearly as high as mine. I remember a PT said my arch is so high a little mouse could run under it. I've seen higher arches than mine though. If you decide to stay with orthotics it would probably be better to stick with accomodative ones to maybe unload some pressure points only if they are bothering you. Do you have any pain under the first big toe joint? You're first ray may be a little dropped, but it's hard to tell from a picture. You can always get a little dancer's pad for that if it ever hurts in that area, or a first ray cut out in the orthotic, but sometimes you have to be careful because if your arch collapses on wt bearing it could cause the forefoot to pronate. An intrinsic forefoot post built into an orthotic to level the mets would work too, but with any of these methods the orthotic has to be properly balanced, or they may cause other problems. That's why if you don't have any severe discomfort it's better not to start with all this stuff, and you're right in trying to go without them. Sometimes trying to put the foot in a perfectly neutral position can cause all kinds of problems. There's been a lot of controversy lately on the Rooterian theory. Most people don't walk in neutral, and have no pain.

Have you tried ART - Active release technique? I've mentioned it in the past on the board. It's incredible. This would help loosen up the tight tissue in the fascia, and the surrounding tissues , so you could heal faster. I even noticed with my bad feet that I can take more give in a shoe as they get better, as long as they aren't too sinky in the heel, and have good lateral support. And I've had severe problems not only with rigid high-arched feet, but also TTS, and PF, and back problems. The ART even helped the pain under my first ray which is dropped also, by working on other muscles and tendons in the foot, and legs. I may still end up needing an accomodative orthotic to be more comfortable, but I'm waiting a while to see if I can continue to improve without them. It seems the intrinsic muscles in my feet are getting stronger since I haven't been wearing orthotics, but I couldn't have done it without all the therapy I had. This site would help you find an ART practitioner in your area if you ever want to try it.

http://www.activerelease.com/

Walking shoes should have around a thumbs width in front of the toe. I guess that's around an inch. You could probably have the orthotics cut down a bit, and they won't slide in the SAS, but other shoes should have around the same bit of room in front to the shoe. Also make sure the shoes you select has a decent lift in the heel, and little torque in the midfoot, yet has a flexible forefoot. This will take stress off the fascia. Have you ever tried putting a little 1/16' firm heel lift in any of your shoes without anything else? This may help more than arch support. Did the Cped assess your range of motion in your ankles? I haven't looked at the SAS lately, but I'm wondering if they have enough support on their own. Did you every try them without the orthotic? They may be a little big though without the orthotic.

Donna

Re: Carole C Nola- orthotics

Carole C in NOLA on 2/17/02 at 21:04 (074069)

Nope, I never get any pain under the first joint (or any joint) of the big toe, and I think/suspect that I don't need it raised and that if it was raised by me it would set my whole foot 'off kilter'. It feels best down low relative to my heel and relative to my arch.

Thanks for the ART link. I don't know anything about it, so it will be interesting to read about it.

I have some gel heel lifts that are about 1/8' which I got before I was diagnosed. They did help, but not enough at that point. I almost could not walk without them, at the time. Maybe they would work better now that I'm almost healed.

Yes, the Cped and the rheumatologist both looked at my range of motion in my ankles. At the time, I was in agony and my C.Ped said things like 'My, you're so tight!' referring to all the tendons and muscles which felt like fire from my feet up through my lower leg and were hurting and felt short. Much of my pain was from the tendon(s) in my lower leg, and that is why I think Birkenstocks are not ideal for me, because of their very low position for the heel.

The larger SAS is way too big to have any support without the orthotic, but with the orthotic it has a LOT of support... much of the size that you see in it is due to the fact that every aspect of the shoe has a lot of cushioning. Besides, if I'm wearing my Clarabelle shoes I might as well put the orthotic in them. LOL

The smaller SAS shoe is probably getting too old. My Easy Spirits and Nike Airs are in the 'never to be worn again' corner of my closet along with the horrible sandals that contributed to my PF to begin with. I'd really like to wear some sort of normal looking tie-up shoe, so I will probably have to go buy another shoe at some point. Something with good lateral support, and with something more than a flat footbed, at least to start with, would be ideal. Maybe the Dr. Scholls or heel pads, but even better maybe something built into the shoe.

Thanks again for your insights, Donna.....

Carole C