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Custom Orthodics vs over the counter

Posted by Mike J on 4/01/02 at 18:50 (078218)

I bought the over the counter birkenstock orthodics about 4 months ago on the advice of a Dr. Today I saw a different dr about getting ESWT and he said before I go forward with it he wanted me to try custom orthodics. He said he uses a cast to take a mold and its very accurate and many times this will cure your pf when the standard premade orthodics do not. My question is has anyone heard of the custom orthodics having a night and day difference over the standard blue birkenstock orthodics?

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/01/02 at 20:06 (078220)

This is going to depend the function of your foot. How long have you had the pf . If there is excessive pronation in your gait custom orthosis may be helpful. IF you have had the problem for a real long time go for the ESWT it is a curative approach where as orthosis don't cure but relieve pain

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/01/02 at 22:43 (078222)

Mike, my custom orthotics have helped a lot in healing me. I don't know all there is to know about what's available out there, but nothing else that I tried (not even Birkenstocks) were anywhere near as helpful in healing my feet as my custom orthotics. I've never used the blue insert, but when my PF was bad I bought 5 pairs of Birkenstock sandals and clogs, both classic and Tatami high arch footbed. I can wear them, but they don't heal me like my custom orthotics do.

Some other people here have not had as good results as I have had with custom orthotics. But why not try them? You might find them to be very helpful.

Carole C

Re: Custom Orthodics vs over the counter

Julie on 4/02/02 at 00:28 (078225)

I have found custom orthotics very helpful: I think they were a major, possibly the major, contribution to my recovery from PF. The point is that they are made for YOUR feet, to correct any biomechanical faults in your gait. Once the fault - such as over-pronation - is addressed, the fascia has a better chance of healing. They are not simply 'arch supports', although they do also give support to the arch.

Of course, if you recover and then return to not wearing orthotics, the fault is still there and the problem may recur. I have assumed, perhaps incorrectly, that having had PF due at least partly to over-pronation, that I will need to use custom orthotics forever.

Re: Custom Orthodics vs over the counter

Richard, C.Ped on 4/02/02 at 09:38 (078248)

Hey Mike..
A custom orthosis is not really a 'cure' for PF. What it does is support the fascia in a proper way, thus relieving stress in the affected area. A custom orthosis is usually prescribed where there is a biomechanical abnormality, such as pes planus or pes cavus, as well as short heel cord and forefoot varus. An off the shelf insert cannot 'correct' (for lack of a better word) these conditions.

There are some pretty good off the shelf inserts out there, but if there are underlying conditions that are causing the pain, a custom orthosis would be the way to go...in my opinion. You have to get to the root of the problem. What is causing the pain? That takes a thorough examination. Make sure you find someone willing to take time with you. Always...of course...the device has to be made correctly in order to work.

Richard, C.Ped

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 16:36 (078271)

Hi

It is great that you are feeling good. Custom orthosis are made for feet that have abnormal function. Do you know if you had servere abnormal foot function such as pronation. Do you have any pain now. Do you have pain without the orthosis.

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 17:40 (078282)

Dr. Z, thank you for your interest!

In answer to your first question, I don't know if I have any abnormal foot function. I don't think that I do, or at least nothing too severe. I'm pretty sure I don't pronate severely. BG CPed who posts here wondered if maybe I had a subtle cavus foot after looking at photos of my feet, which I posted at

http://www.geocities.com/CLCinNOLA/pronate-supinate.html

but beyond that I don't really know. My Achilles tendon and other tendons and muscles have been very tight when I was in more pain but I am much better now.

Now I am mostly recovered and I am not normally wearing my orthotics any more. I have a little pain now but it is very minor, less than 1 one a scale of 1 to 10. If I begin to hurt more, stretching helps to lessen the pain. This is in regular shoes; I am not wearing my custom orthotics most of the time any more, because I'm so much better. However, if I'm doing something that I feel might strain my PF, such as standing on concrete lifting heavy boxes for a whole day, I wear my custom orthotics because I feel safer. I am still a little scared of tearing something in that sort of situation.

When my PF was bad I wore my custom orthotics about 12 hours a day because they were really all I could wear except Birkenstocks. But the Birkenstocks did not seem to heal my PF like my custom orthotics. My custom orthotics seemed to cradle my feet in a position where the PF were not strained so much and provided considerable cushioning and protection for them. I feel like they held my foot in a position so that they could heal without the PF being accidently strained.

I don't feel I need my custom orthotics now that I am mostly healed. They do help to straighten out my gait, which is nice because I have a little residual clumsiness in my left leg due to minor effects of an old neurological problem. I've noticed that my knee pain that was supposed to be osteoarthritis, was less when I had PF(either due to the orthotics, or to the resting, I think). However, I am very overweight so that contributes and my plan is to lose weight. I've never had foot problems before this PF, which I believe was caused by repetitive injury in a poorly thought out new exercise regimen.

My custom orthotics were soft ones made of very thick foam on a layer of eva, and the C.Ped used a foam tray to make them right there, rather than sending them off to somewhere.

Hope this answers your questions.

Carole C

Re: PS - comments are welcome, Dr. Z and others! (nm)

Carole C in NOLA on 4/02/02 at 17:43 (078283)

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Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 17:53 (078285)

Hi

The reason that I asked you this was for the following reasons. How do we know if the orthosis healed your foot or was it time.

Just by looking at your feet and tying to picture your walking I am going to guess that you do how at least a moderate case of pronatin. Why do I say this . It appears that in the stance position your heels are everted so if I try to magnify this with you walking then there is excessive pronation. Then again I may be just looking at feet too much. My opinion is too wear your orthosis as much as possible.

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 18:06 (078288)

Dr. Z, thank you for your post! I appreciate and value your opinion.

Friday I am going to sea for a week (I'm an oceanographer) and I will wear my orthotics there because of the heavy work. When I return, I'll try to see a DPM for the first time and get a gait analysis so he can find out if I have overpronation or not. If I need to continue wearing orthotics, I will need smaller ones because I simply hate wearing huge orthotics in huge shoes like I have.

I hope I can find a DPM as good as the foot professionals on this board.

Carole C

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 18:14 (078290)

That's exciting . So where are you going

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 18:16 (078291)

I'll fly to Galveston Friday morning to get on the ship, and then the ship will take us across some of the deepest areas of the Gulf of Mexico. We'll be collecting measurements in deep water directly south of New Orleans, for the most part. Then the ship will take us back to Galveston (its home port) and I'll fly back to New Orleans.

Yes, I'm very excited about it! This is my idea of fun. :)

Carole C

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 18:19 (078293)

P.S., do you happen to know any good DPM's in the New Orleans area? I live in the New Orleans suburb of Metairie. Any tips on how to select one?

Carole C

Re: Custom Orthodics vs over the counter

Mike J on 4/02/02 at 19:01 (078295)

Thanks everyone for your comments on my post. I just talked to Dr Z over the phone today and got a different perspective on my pf. (funny how if you talk to three doctors you get three different opinions) My dilemma now is should I fork out the big bucks, see dr z and get the ESWT done or pay $400 and try the custom orthodics and wait to see if that helps.

Some people are saying they think the custom orthodics has cured them however may of the Doctors are saying it just helps the pain but the pf is still there. If I understand what I am being told the ESWT will actually cure the pf so I can use regular shoes and wont have to have orthodics. However, even if the custom orthodics helps I will still always have fp and always need to use the orthodics.

Does this sound right? If so any suggestions... I am going to give myself a day or two but want to make a decision very soon since I am desperate to get better, especially since spring is around the corner and I am a very avid golfer that loves to walk. (I've been using golf carts and am getting tired of it but I physically cannot walk 18 holes because of the pain)

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 19:44 (078296)

Mike, from what I've read here, sometimes it takes several ESWT treatments. It might be important to see if your insurance covers it since in the past that has been a problem for many. This is a much more expensive treatment than orthotics (which are not cheap either).

If it was me, I'd see a DPM and get a gait analysis and a thorough examination of my feet. I'd talk to him about the cause of my PF, and the alternatives for treatment, and I'd either follow his suggestions in the order suggested or else I'd start over with another DPM, another gait analysis, more talk, and so on. Find one that is both highly qualified and that you trust. There's a lot of money (maybe yours) that could be well spent or poorly spent depending on your decision.

Carole C

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 20:21 (078297)

Dr. Z,

You say that orthoses don't cure but relieve pain, but that ESWT cures.

Would you then recommend ESWT for someone who had PF but who no longer feels any pain, due to the diligent use of orthotics, stretching, icing, rest, and so on in previous months while they were experiencing pain?

From what you are saying, it is not clear to me if you are recommending use of ESWT on someone with no pain or complaint at all.

Carole C

Re: How do we know if it was the orthosis that healed my foot or was it time.....

Carole C in NOLA on 4/02/02 at 20:25 (078298)

I don't think we KNOW anything for any given individual. However, consider this:

Each time I didn't wear my custom orthotics, and wore normal shoes without orthotics or went barefoot, I felt a tearing feeling in my plantar fascia and that resulted in more pain for days. This happened a number of times, until I 'got the hang of it'. For me, recovering from PF meant not re-injuring my plantar fascia in this way for about two months so that they could heal.

Carole C

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 20:29 (078299)

ESWT is for PAINFUL chronic proximal insertional plantar fasciitis with or
without a heel spur. The person has tried other conservative treatments such as stretching, physical therapy , heel pads, orthosis, casting, nsaid
The pain has been present for a period of at least six months and last by not least they can afford the cost of ESWT

Re: Custom Orthotics and ESWT - question for Dr Z

Julie on 4/03/02 at 02:36 (078312)

I'd like to set out my understanding of orthotics and ESWT so that you can put me right if I have misunderstood anything.

This is my understanding of custom orthotics. They correct abnormal foot function, such as over-pronation, normalizing one's gait and taking the strain off the plantar fascia, thus allowing it to heal. The inflammation goes, and so the associated pain goes. (I would say that this constitutes healing, not simply 'pain relief', as we get from, say, pain medication.)

However, I would assume that if we stop wearing orthotics once the fascia has healed we are painfree, the functional abnormality will return, and we risk a recurrence of plantar fasciitis.

My understanding of ESWT (learned from you - thank you!) is that it initiates the healing process by stimulating blood flow to the area, so that in the many successful cases, the PF goes.

However, if the root cause of the PF was abnormal foot function, and if this has not been addressed with custom orthotics, isn't there the same risk of PF returning, even after successful ESWT treatment?

Or are you saying, when you say that ESWT cures PF, that it can correct abnormal foot function (or deal with any of the other root causes of PF)?

I am not asking these questions to challenge you - I hope you realize that. But I have found this thread somewhat confusing. Mike believes he needs to make an either/or decision between custom orthotics and ESWT, but I can't see that the two are mutually exclusive. Surely if he needs custom orthotics, as recommended by his doctor, he needs them whether or not he decides for ESWT?

Re: Custom Orthotics and ESWT - question for Dr Z

Dr. Zuckerman on 4/03/02 at 07:11 (078318)

Hi

You never challenge me in anyway. Ok ESWT micro- injures the plantar that is damaged. at the heel insertin. If it damaged to the point of no healing which means there is no micro circulation to the fibers of the plantar fascia at the insertion then it is never going to heal without either surgery or ESWT. It is very subjective when the doctor determines that it won't heal

This is why the doctor will exhaust all treatment before surgery because of has complications. With ESWT you can go ahead before all treatments are exhausted due to the lack of complications. but conservative treatment should be attempted at this time

So how do orthosis heal the problem. If the damage is not beyond the body's ability to repair then they can heal or reduce the pain if there is a biomechanical problem

The main bimechanical function that you are addrsssing is abnormal excessive pronation that is caused from a compensation from the body's movement during the gait cycle. For example tight achilles, short leg.
midtarsal abnormal function.

It in my opinion that excessive pronation contribute to the pf if prsent but doesn't cause the problem. I have seen many many patients with abormal excessive pronation and after an x-ray is taken have heel spurs and no pain at all.

Plantar fasciitis is a repetitive motion-traction injury that may or may not heal and can or can't be helped with orthosis even if there is a biomechanical functional problems. The podiatrist can help to determine if the patient does have excessive pronation but the sucess will depend on just how bad the micotrauma is to the plantar fascia and how long it is has been there.

I hope that I haven't confused this anymore is so I will try again

So in summary

1. orthosis can heal the pf depending on the biomechanical examine and the degree of damage to the pf
2. Many people have abnormal foot function and heel spurs and no pain
4. Orthosis can prevent pf with people with biomechinical faults.
5. Orthosis hecome very popular with runner's in the 1970's
6 If there is no circulation to the fibers of the pf much like a mal or non union in bone then the only treatment that will cure the problem is either ESWT or surgery.

Re: Custom Orthotics and ESWT - question for Dr Z

Mike J on 4/03/02 at 08:28 (078332)

Thank you everyone for adding to this thread with your questions and thank you Dr Z for answering the questions. This has been extremely eductional and helpful for me. It now sounds like the million dollar question is... 'Is my foot damaged enough where there is no circulation to the micro fibers?' If so then i will need ESWT, if not then custom orthodics should do the trick.

I guess the even bigger question is how do you tell if there is curculation to the fibers or not? Can you tell by the pain level or how you have progressed (or in my case declined) over the months? When I talked to you Dr Z you said you thought I had a tair in my PF since on a few occasions it hurt so bad it took me almost an hour of stretching in the morning before I could even tollerate the pain of my first step. Does a tear mean you have no circulation to the fibers?

Thanks again for your help.

Re: There is a continuation of this thread by Dr. Z on the ESWT board entitled "ORTHOSIS". (eom)

Suzanne D on 4/03/02 at 12:17 (078359)

.

Re: Custom Orthotics and ESWT - question for Dr Z

Dr. Zuckerman on 4/03/02 at 18:49 (078389)

Either you have no micro-circulation or very little . The fact that you have pain on palpation and it hurts pretty bad is a very good indicator that there is a tear. If the x-ray shows calificaton and there is pain that is another indicator. It really is a diagnosis that a doctor can make with a good physical palpation of the area.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Julie on 4/04/02 at 00:38 (078454)

Thank you very much for your detailed reply. This is the first time it has been explained (or at least the first time I've seen it explained) that there is a stage at which PF cannot be resolved with conservative treatment (i.e. when there is no blood circulation to the fibers) and will not heal without surgery or ESWT. That is extremely interesting (even allowing for other variables, such as the fact that so many PF sufferers cannot easily change their work or their life style).

Could you now elaborate a little more on abnormal pronation and orthotics, please?

You said that you don't consider abnormal pronation a cause of PF, but simply a contribution to it. I don't really see the difference: if over-pronation puts a strain on the fascia, doesn't that constitute a 'cause'? You said that you've examined many over-pronators who don't display symptoms of PF or spurs, but you also say that PF is a repetitive motion injury. Doesn't this mean that after a certain unspecified number of repetitions (however many millions over 30, 40, 50 or 60 years) over-pronation is likely to 'cause' PF? Perhaps the asymptomatic folks just haven't got a PF problem YET?

I've been a (moderately) abnormal pronator all my life, but didn't develop PF until I was 65. I have custom orthotics and I am quite sure they have helped me: my PF began to improve markedly as soon as I got them, though of course time and other conservative measures must also have helped. I've been pain free, except for the odd twinge, for over a year. I continue to wear the orthotics, or Birkenstocks, because I assume that the predisposing factors that gave me PF in the first place have not gone away, that once an over-pronator always an over-pronator, and that therefore if I stop wearing the orthotics I risk a recurrence of PF.

Am I right or wrong? Am I being sensible or over-cautious?

(I should say that I'm happy and totally comfortable with my orthotics and the shoes I wear them in, and with Birkenstocks, and, having finally got my footgear sorted out I have no intention or desire to change. In other words, I'm just asking for your view on the question, not for your approval to switch to stilettos and winkle-pickers.)

Thanks for your time. I'm very sorry to hear (on another thread) that your feet hurt! PF must be a podiatrist's occupational disease - my pod gets it too.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Dr. Zuckerman on 4/04/02 at 01:11 (078458)

Lets see. Your life style is very important . If you are an over pronator and really don't stand alot or stand on hard cement or if you are a runner or plays tennis then generally speaking the over pronation isn't going to be a major factor.

I really don't think that there have been any controlled studies showing that you are more prone to pf if you are an over pronator but I would have to agree that over pronation could make you more prone to pf.

So what I am saying is that without repetitive motion you won't have pf
you can have pf with over pronation but without repetiive motion you won't have pf

Now to complicate this even more. An orthosis won't function or control over pronation unless it is in a proper shoe and worn everyday.

Very difficult to wear the proper shoes and your orthosis every day.
Can be done but difficult. I have patients every day that stop and start their orthois wearing. Once the pf is gone they stop the orthosis. Some will go for years without the orthosis before the pf return. Is this proof that the pf came back due to not wearing the orthosis . I believe no because they stopped for years but then they either started a new type of job whick required standing or started a new excercise program.

So for you keep wearing the orthosis.. And yes once an over pronator always To be continued tommorrow.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Carole C in NOLA on 4/04/02 at 05:27 (078459)

Whatever abnormal or normal gait I have, I did not have the slightest foot problem either until I reached 53, Julie.

From what Dr. Z has already said in this thread, my views on this are not correct and the views he has already expressed are identical those you express; that in other words people like you and I that were helped by orthotics during PF should wear orthotics for life.

My take on the situation (with which Dr. Z has already expressed disagreement, I believe, and which disagreement has caused me to question my thoughts on this) is that the orthotic helped more in functioning almost as a splint or cast does for a broken arm; it kept my foot in a position where the plantar fascia and various tendons were not overly stretched or strained during walking, so they could heal. My orthotics also corrected my gait, which I feel was not much of a correction and not nearly as important in my recovery as the way they cradled my foot firmly, giving it just the right support and limiting the range of motion inside the shoe during healing.

While healing, going without my orthotics for a day set me back days or weeks in my recovery (such as on January 8th when I took a chance and went without them for most of a day, and had a major setback). They played a big role in my recovery which I do not feel was solely due to rest. Now that I am just about entirely healed, I'm quite comfortable without orthotics as long as I'm not expecting any major strain of my PF. I go about my daily life and work on building up my strength and walking more without my orthotics and with as little pain as when I wear my orthotics. Once I'm completely healed and have been so for some time, I would expect to be able to deal with more strain on my PF than I can now. Just like with a broken arm or other healing tissue.

Previously injured tissues may be more likely to fail under stress. However, if they recover sufficiently that they do not, one would not require further treatment and the podiatrist would not know about it, it seems to me. All the preceding verbiage in the past few paragraphs is what I had been thinking, derived from my own experiences with orthotics, and what I am now questioning because of Dr. Z's post.

Carole C

Re: Custom Orthotics and over-pronation - another question for Dr Z

Carole C in NOLA on 4/04/02 at 05:32 (078460)

Oh! OK! That explains it... the missing factor for the first half century of my life was the type of repetitive motion that strained my feet and achilles tendon so much.

Right before I got PF I did some really dumb things on my recumbent bike, involving repetitive straining of these tissues, that I will not be doing again for the next fifty years at least.

I didn't see this post yet when I posted my other post just below. Sorry!

Carole C

Re: Custom Orthotics and over-pronation - another question for Dr Z

Dr. Zuckerman on 4/04/02 at 07:21 (078462)

Pronation is a three plane motion. The limiting of motion in your shoe and preventing overstretching of the muscles in your foot is part of excessive pronation. Excessive pronation isn't a simple type of motion.

I know what you are saying about the crading and splinting. that too can happen with orthosis, but is it the control of abnormal motion which then allows the foot muscles to function at the right time during the gait cycle.

Yes it still could of been the splinting, so over the counter semi- custom, semi rigid orthosis can provide splinging .

So long as your othosis are comfortable wear them. They should be checked once per year to make sure the posts are not worn down

Bimoechanicl analysis and manufactoring of orthosis is very complex and is both an art and a science. There ar so many motions in the human foot that are altered with different type of orthosis.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Julie on 4/04/02 at 10:33 (078479)

Hi Carole

This has been a useful discussion, hasn't it?

To ruminate on one of your points: I don't think the broken arm analogy was useful. Once a broken bone has healed it is forever healed, unless you keep repeatedly doing the same thing to it that broke it in the first place: that's unlikely, but if you do, it will probably break again. With a plantar fascia that is no longer supported by orthosis, we're talking about an injured tissue that healed, but that is now being repeatedly stressed in the same way that it was before.

My take on this has always been that if there is a weakness that has caused or contributed to PF (e.g. excessive pronation, flat feet or whatever) there is always going to be a weakness. Therefore I've drawn the conclusion that I will be keeping company with my orthotics for good.

Fortunately, I love them, and the sturdy shoes they live in, and don't hanker after any others (except for Arizonas, which are my constant indoor companions). I know you do hanker after prettier shoes, though, and I hope you'll be able to wear them before too long - perhaps with a daintier orthotic.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Carole C in NOLA on 4/04/02 at 11:51 (078483)

Julie, I've been wearing the women's SAS shoes that are what I want to wear, without orthotics, from 10-14 hours/day every day for nearly a month now (since March 9th). I wear them to work every day. That is, every day except for three days on the ship last month, and a couple of other days when I felt a little 'iffy'.

I'm not saying you or anyone should do this or even try it, because I am not a person that knows much about feet; I'm just trying to hear what my feet are telling me and to act on that. They are telling me that these women's SAS shoes without orthotics are letting my feet move around enough to strengthen the muscles, without causing pain. My feet are not like anyone else's feet, though.

I'm perfectly happy wearing the women's SAS shoes, which are what I was wearing when I originally got PF (except a new pair now). My pain level has been less than 1 and I am leading a normal life at last. Well, normal except that I am very cautious and I pay close attention and take action to protect my feet if there are unusual stresses, and I stretch and occasionally ice, still. I don't have to rest all the time any more, and at last my apartment is beginning to look like someone civilized lives here (and keeps it clean!). For those that are reading, yes! there is light at the end of the tunnel and Julie and I are two of those that are seeing it.

While I'm on the ship, I'll play it safe and wear my custom orthotics and the big ugly men's SAS shoes they are in. I don't want to mess up my women's SAS shoes anyway! and this will give my feet extra protection and also will give me time to think about the issues we are discussing on this thread.

Whether or not I decide that my lack of orthotics might result in PF (frankly in my case I doubt it would, without the repetitive motion that caused it the first time) I still might go to a DPM and get smaller 'ice scraper' type orthotics for the purpose of straightening out my gait and perhaps causing less strain on my knee and hip joints and less pain in those joints. Even though the prices I've heard here ($450) makes me gasp as if I'd just taken a sucker punch, still, I am worth it.

Carole C

Re: Custom Orthodics vs over the counter

Mahatmelissama on 4/05/02 at 17:01 (078604)

I asked my pod this very question today during my feet casting for custom orthodics. She said 'Yes and no...some find they always have to wear the orthodics or the pain comes back ... some of her patients don't have to continue wearing them after the orthodics take the stress off the feet..'

Well, she might have put it differently but that is what I understood.

I do hope my custom orthodics from her work better than the ones I got from Walkrite shoes (a foot store that did a foot scan and then made some semi-rigid orthodics). The ones I have now are very comfortable however they don't do ENOUGH supporting and I find I still can not stand in line long at the grocery store. :(

I will let you all know what happens.

My pod's last day was today...she is going to go have a baby. I get a new Pod for an indefinite time. Darn it, I was starting to really like her and develop a good patient doctor relationship...and then she has to go away to give birth. How dare she! ;)

TGIF everybody.

:)
Melissa

Re: Custom Orthotics and over-pronation - another question for Dr Z

Ed Davis, DPM on 4/05/02 at 22:41 (078633)

Julie:

Need to interject a bit here....

The plantar fascia originates on the heel bone and inserts into the ball of the foot, much about the big toe joint base area. Overpronation is only half of the equation----overpronation at the subtalar joint pulls on the proximal end of the fascia but oversupination of the midtarsal joint pulls on the distal end. The interplay between subtalar joint overpronation and midtarsal joint oversupination is what often leads to excess plantar fascial tension and strain.
Ed

Re: Custom Orthotics and over-pronation - another question for Dr Z

Julie on 4/07/02 at 16:25 (078756)

Thank you Ed. I've been away - hence no response till two days later. I appreciate your concern. I think I understood this (I know it's not that simple!) That being the case, what is your feeling about the need for orthotics after the acute stage of PF has passed - i.e. once a pain-free state has been reached, as is the case with me?

Re: need for long term orthotic use

Ed Davis, DPM on 4/10/02 at 20:35 (079151)

The need for orthotic use past the acute stage is related to the degree to which biomechanical problems exist including vocational and avocational factors.
Ed

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/01/02 at 20:06 (078220)

This is going to depend the function of your foot. How long have you had the pf . If there is excessive pronation in your gait custom orthosis may be helpful. IF you have had the problem for a real long time go for the ESWT it is a curative approach where as orthosis don't cure but relieve pain

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/01/02 at 22:43 (078222)

Mike, my custom orthotics have helped a lot in healing me. I don't know all there is to know about what's available out there, but nothing else that I tried (not even Birkenstocks) were anywhere near as helpful in healing my feet as my custom orthotics. I've never used the blue insert, but when my PF was bad I bought 5 pairs of Birkenstock sandals and clogs, both classic and Tatami high arch footbed. I can wear them, but they don't heal me like my custom orthotics do.

Some other people here have not had as good results as I have had with custom orthotics. But why not try them? You might find them to be very helpful.

Carole C

Re: Custom Orthodics vs over the counter

Julie on 4/02/02 at 00:28 (078225)

I have found custom orthotics very helpful: I think they were a major, possibly the major, contribution to my recovery from PF. The point is that they are made for YOUR feet, to correct any biomechanical faults in your gait. Once the fault - such as over-pronation - is addressed, the fascia has a better chance of healing. They are not simply 'arch supports', although they do also give support to the arch.

Of course, if you recover and then return to not wearing orthotics, the fault is still there and the problem may recur. I have assumed, perhaps incorrectly, that having had PF due at least partly to over-pronation, that I will need to use custom orthotics forever.

Re: Custom Orthodics vs over the counter

Richard, C.Ped on 4/02/02 at 09:38 (078248)

Hey Mike..
A custom orthosis is not really a 'cure' for PF. What it does is support the fascia in a proper way, thus relieving stress in the affected area. A custom orthosis is usually prescribed where there is a biomechanical abnormality, such as pes planus or pes cavus, as well as short heel cord and forefoot varus. An off the shelf insert cannot 'correct' (for lack of a better word) these conditions.

There are some pretty good off the shelf inserts out there, but if there are underlying conditions that are causing the pain, a custom orthosis would be the way to go...in my opinion. You have to get to the root of the problem. What is causing the pain? That takes a thorough examination. Make sure you find someone willing to take time with you. Always...of course...the device has to be made correctly in order to work.

Richard, C.Ped

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 16:36 (078271)

Hi

It is great that you are feeling good. Custom orthosis are made for feet that have abnormal function. Do you know if you had servere abnormal foot function such as pronation. Do you have any pain now. Do you have pain without the orthosis.

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 17:40 (078282)

Dr. Z, thank you for your interest!

In answer to your first question, I don't know if I have any abnormal foot function. I don't think that I do, or at least nothing too severe. I'm pretty sure I don't pronate severely. BG CPed who posts here wondered if maybe I had a subtle cavus foot after looking at photos of my feet, which I posted at

http://www.geocities.com/CLCinNOLA/pronate-supinate.html

but beyond that I don't really know. My Achilles tendon and other tendons and muscles have been very tight when I was in more pain but I am much better now.

Now I am mostly recovered and I am not normally wearing my orthotics any more. I have a little pain now but it is very minor, less than 1 one a scale of 1 to 10. If I begin to hurt more, stretching helps to lessen the pain. This is in regular shoes; I am not wearing my custom orthotics most of the time any more, because I'm so much better. However, if I'm doing something that I feel might strain my PF, such as standing on concrete lifting heavy boxes for a whole day, I wear my custom orthotics because I feel safer. I am still a little scared of tearing something in that sort of situation.

When my PF was bad I wore my custom orthotics about 12 hours a day because they were really all I could wear except Birkenstocks. But the Birkenstocks did not seem to heal my PF like my custom orthotics. My custom orthotics seemed to cradle my feet in a position where the PF were not strained so much and provided considerable cushioning and protection for them. I feel like they held my foot in a position so that they could heal without the PF being accidently strained.

I don't feel I need my custom orthotics now that I am mostly healed. They do help to straighten out my gait, which is nice because I have a little residual clumsiness in my left leg due to minor effects of an old neurological problem. I've noticed that my knee pain that was supposed to be osteoarthritis, was less when I had PF(either due to the orthotics, or to the resting, I think). However, I am very overweight so that contributes and my plan is to lose weight. I've never had foot problems before this PF, which I believe was caused by repetitive injury in a poorly thought out new exercise regimen.

My custom orthotics were soft ones made of very thick foam on a layer of eva, and the C.Ped used a foam tray to make them right there, rather than sending them off to somewhere.

Hope this answers your questions.

Carole C

Re: PS - comments are welcome, Dr. Z and others! (nm)

Carole C in NOLA on 4/02/02 at 17:43 (078283)

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Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 17:53 (078285)

Hi

The reason that I asked you this was for the following reasons. How do we know if the orthosis healed your foot or was it time.

Just by looking at your feet and tying to picture your walking I am going to guess that you do how at least a moderate case of pronatin. Why do I say this . It appears that in the stance position your heels are everted so if I try to magnify this with you walking then there is excessive pronation. Then again I may be just looking at feet too much. My opinion is too wear your orthosis as much as possible.

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 18:06 (078288)

Dr. Z, thank you for your post! I appreciate and value your opinion.

Friday I am going to sea for a week (I'm an oceanographer) and I will wear my orthotics there because of the heavy work. When I return, I'll try to see a DPM for the first time and get a gait analysis so he can find out if I have overpronation or not. If I need to continue wearing orthotics, I will need smaller ones because I simply hate wearing huge orthotics in huge shoes like I have.

I hope I can find a DPM as good as the foot professionals on this board.

Carole C

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 18:14 (078290)

That's exciting . So where are you going

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 18:16 (078291)

I'll fly to Galveston Friday morning to get on the ship, and then the ship will take us across some of the deepest areas of the Gulf of Mexico. We'll be collecting measurements in deep water directly south of New Orleans, for the most part. Then the ship will take us back to Galveston (its home port) and I'll fly back to New Orleans.

Yes, I'm very excited about it! This is my idea of fun. :)

Carole C

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 18:19 (078293)

P.S., do you happen to know any good DPM's in the New Orleans area? I live in the New Orleans suburb of Metairie. Any tips on how to select one?

Carole C

Re: Custom Orthodics vs over the counter

Mike J on 4/02/02 at 19:01 (078295)

Thanks everyone for your comments on my post. I just talked to Dr Z over the phone today and got a different perspective on my pf. (funny how if you talk to three doctors you get three different opinions) My dilemma now is should I fork out the big bucks, see dr z and get the ESWT done or pay $400 and try the custom orthodics and wait to see if that helps.

Some people are saying they think the custom orthodics has cured them however may of the Doctors are saying it just helps the pain but the pf is still there. If I understand what I am being told the ESWT will actually cure the pf so I can use regular shoes and wont have to have orthodics. However, even if the custom orthodics helps I will still always have fp and always need to use the orthodics.

Does this sound right? If so any suggestions... I am going to give myself a day or two but want to make a decision very soon since I am desperate to get better, especially since spring is around the corner and I am a very avid golfer that loves to walk. (I've been using golf carts and am getting tired of it but I physically cannot walk 18 holes because of the pain)

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 19:44 (078296)

Mike, from what I've read here, sometimes it takes several ESWT treatments. It might be important to see if your insurance covers it since in the past that has been a problem for many. This is a much more expensive treatment than orthotics (which are not cheap either).

If it was me, I'd see a DPM and get a gait analysis and a thorough examination of my feet. I'd talk to him about the cause of my PF, and the alternatives for treatment, and I'd either follow his suggestions in the order suggested or else I'd start over with another DPM, another gait analysis, more talk, and so on. Find one that is both highly qualified and that you trust. There's a lot of money (maybe yours) that could be well spent or poorly spent depending on your decision.

Carole C

Re: Custom Orthodics vs over the counter

Carole C in NOLA on 4/02/02 at 20:21 (078297)

Dr. Z,

You say that orthoses don't cure but relieve pain, but that ESWT cures.

Would you then recommend ESWT for someone who had PF but who no longer feels any pain, due to the diligent use of orthotics, stretching, icing, rest, and so on in previous months while they were experiencing pain?

From what you are saying, it is not clear to me if you are recommending use of ESWT on someone with no pain or complaint at all.

Carole C

Re: How do we know if it was the orthosis that healed my foot or was it time.....

Carole C in NOLA on 4/02/02 at 20:25 (078298)

I don't think we KNOW anything for any given individual. However, consider this:

Each time I didn't wear my custom orthotics, and wore normal shoes without orthotics or went barefoot, I felt a tearing feeling in my plantar fascia and that resulted in more pain for days. This happened a number of times, until I 'got the hang of it'. For me, recovering from PF meant not re-injuring my plantar fascia in this way for about two months so that they could heal.

Carole C

Re: Custom Orthodics vs over the counter

Dr. Zuckerman on 4/02/02 at 20:29 (078299)

ESWT is for PAINFUL chronic proximal insertional plantar fasciitis with or
without a heel spur. The person has tried other conservative treatments such as stretching, physical therapy , heel pads, orthosis, casting, nsaid
The pain has been present for a period of at least six months and last by not least they can afford the cost of ESWT

Re: Custom Orthotics and ESWT - question for Dr Z

Julie on 4/03/02 at 02:36 (078312)

I'd like to set out my understanding of orthotics and ESWT so that you can put me right if I have misunderstood anything.

This is my understanding of custom orthotics. They correct abnormal foot function, such as over-pronation, normalizing one's gait and taking the strain off the plantar fascia, thus allowing it to heal. The inflammation goes, and so the associated pain goes. (I would say that this constitutes healing, not simply 'pain relief', as we get from, say, pain medication.)

However, I would assume that if we stop wearing orthotics once the fascia has healed we are painfree, the functional abnormality will return, and we risk a recurrence of plantar fasciitis.

My understanding of ESWT (learned from you - thank you!) is that it initiates the healing process by stimulating blood flow to the area, so that in the many successful cases, the PF goes.

However, if the root cause of the PF was abnormal foot function, and if this has not been addressed with custom orthotics, isn't there the same risk of PF returning, even after successful ESWT treatment?

Or are you saying, when you say that ESWT cures PF, that it can correct abnormal foot function (or deal with any of the other root causes of PF)?

I am not asking these questions to challenge you - I hope you realize that. But I have found this thread somewhat confusing. Mike believes he needs to make an either/or decision between custom orthotics and ESWT, but I can't see that the two are mutually exclusive. Surely if he needs custom orthotics, as recommended by his doctor, he needs them whether or not he decides for ESWT?

Re: Custom Orthotics and ESWT - question for Dr Z

Dr. Zuckerman on 4/03/02 at 07:11 (078318)

Hi

You never challenge me in anyway. Ok ESWT micro- injures the plantar that is damaged. at the heel insertin. If it damaged to the point of no healing which means there is no micro circulation to the fibers of the plantar fascia at the insertion then it is never going to heal without either surgery or ESWT. It is very subjective when the doctor determines that it won't heal

This is why the doctor will exhaust all treatment before surgery because of has complications. With ESWT you can go ahead before all treatments are exhausted due to the lack of complications. but conservative treatment should be attempted at this time

So how do orthosis heal the problem. If the damage is not beyond the body's ability to repair then they can heal or reduce the pain if there is a biomechanical problem

The main bimechanical function that you are addrsssing is abnormal excessive pronation that is caused from a compensation from the body's movement during the gait cycle. For example tight achilles, short leg.
midtarsal abnormal function.

It in my opinion that excessive pronation contribute to the pf if prsent but doesn't cause the problem. I have seen many many patients with abormal excessive pronation and after an x-ray is taken have heel spurs and no pain at all.

Plantar fasciitis is a repetitive motion-traction injury that may or may not heal and can or can't be helped with orthosis even if there is a biomechanical functional problems. The podiatrist can help to determine if the patient does have excessive pronation but the sucess will depend on just how bad the micotrauma is to the plantar fascia and how long it is has been there.

I hope that I haven't confused this anymore is so I will try again

So in summary

1. orthosis can heal the pf depending on the biomechanical examine and the degree of damage to the pf
2. Many people have abnormal foot function and heel spurs and no pain
4. Orthosis can prevent pf with people with biomechinical faults.
5. Orthosis hecome very popular with runner's in the 1970's
6 If there is no circulation to the fibers of the pf much like a mal or non union in bone then the only treatment that will cure the problem is either ESWT or surgery.

Re: Custom Orthotics and ESWT - question for Dr Z

Mike J on 4/03/02 at 08:28 (078332)

Thank you everyone for adding to this thread with your questions and thank you Dr Z for answering the questions. This has been extremely eductional and helpful for me. It now sounds like the million dollar question is... 'Is my foot damaged enough where there is no circulation to the micro fibers?' If so then i will need ESWT, if not then custom orthodics should do the trick.

I guess the even bigger question is how do you tell if there is curculation to the fibers or not? Can you tell by the pain level or how you have progressed (or in my case declined) over the months? When I talked to you Dr Z you said you thought I had a tair in my PF since on a few occasions it hurt so bad it took me almost an hour of stretching in the morning before I could even tollerate the pain of my first step. Does a tear mean you have no circulation to the fibers?

Thanks again for your help.

Re: There is a continuation of this thread by Dr. Z on the ESWT board entitled "ORTHOSIS". (eom)

Suzanne D on 4/03/02 at 12:17 (078359)

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Re: Custom Orthotics and ESWT - question for Dr Z

Dr. Zuckerman on 4/03/02 at 18:49 (078389)

Either you have no micro-circulation or very little . The fact that you have pain on palpation and it hurts pretty bad is a very good indicator that there is a tear. If the x-ray shows calificaton and there is pain that is another indicator. It really is a diagnosis that a doctor can make with a good physical palpation of the area.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Julie on 4/04/02 at 00:38 (078454)

Thank you very much for your detailed reply. This is the first time it has been explained (or at least the first time I've seen it explained) that there is a stage at which PF cannot be resolved with conservative treatment (i.e. when there is no blood circulation to the fibers) and will not heal without surgery or ESWT. That is extremely interesting (even allowing for other variables, such as the fact that so many PF sufferers cannot easily change their work or their life style).

Could you now elaborate a little more on abnormal pronation and orthotics, please?

You said that you don't consider abnormal pronation a cause of PF, but simply a contribution to it. I don't really see the difference: if over-pronation puts a strain on the fascia, doesn't that constitute a 'cause'? You said that you've examined many over-pronators who don't display symptoms of PF or spurs, but you also say that PF is a repetitive motion injury. Doesn't this mean that after a certain unspecified number of repetitions (however many millions over 30, 40, 50 or 60 years) over-pronation is likely to 'cause' PF? Perhaps the asymptomatic folks just haven't got a PF problem YET?

I've been a (moderately) abnormal pronator all my life, but didn't develop PF until I was 65. I have custom orthotics and I am quite sure they have helped me: my PF began to improve markedly as soon as I got them, though of course time and other conservative measures must also have helped. I've been pain free, except for the odd twinge, for over a year. I continue to wear the orthotics, or Birkenstocks, because I assume that the predisposing factors that gave me PF in the first place have not gone away, that once an over-pronator always an over-pronator, and that therefore if I stop wearing the orthotics I risk a recurrence of PF.

Am I right or wrong? Am I being sensible or over-cautious?

(I should say that I'm happy and totally comfortable with my orthotics and the shoes I wear them in, and with Birkenstocks, and, having finally got my footgear sorted out I have no intention or desire to change. In other words, I'm just asking for your view on the question, not for your approval to switch to stilettos and winkle-pickers.)

Thanks for your time. I'm very sorry to hear (on another thread) that your feet hurt! PF must be a podiatrist's occupational disease - my pod gets it too.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Dr. Zuckerman on 4/04/02 at 01:11 (078458)

Lets see. Your life style is very important . If you are an over pronator and really don't stand alot or stand on hard cement or if you are a runner or plays tennis then generally speaking the over pronation isn't going to be a major factor.

I really don't think that there have been any controlled studies showing that you are more prone to pf if you are an over pronator but I would have to agree that over pronation could make you more prone to pf.

So what I am saying is that without repetitive motion you won't have pf
you can have pf with over pronation but without repetiive motion you won't have pf

Now to complicate this even more. An orthosis won't function or control over pronation unless it is in a proper shoe and worn everyday.

Very difficult to wear the proper shoes and your orthosis every day.
Can be done but difficult. I have patients every day that stop and start their orthois wearing. Once the pf is gone they stop the orthosis. Some will go for years without the orthosis before the pf return. Is this proof that the pf came back due to not wearing the orthosis . I believe no because they stopped for years but then they either started a new type of job whick required standing or started a new excercise program.

So for you keep wearing the orthosis.. And yes once an over pronator always To be continued tommorrow.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Carole C in NOLA on 4/04/02 at 05:27 (078459)

Whatever abnormal or normal gait I have, I did not have the slightest foot problem either until I reached 53, Julie.

From what Dr. Z has already said in this thread, my views on this are not correct and the views he has already expressed are identical those you express; that in other words people like you and I that were helped by orthotics during PF should wear orthotics for life.

My take on the situation (with which Dr. Z has already expressed disagreement, I believe, and which disagreement has caused me to question my thoughts on this) is that the orthotic helped more in functioning almost as a splint or cast does for a broken arm; it kept my foot in a position where the plantar fascia and various tendons were not overly stretched or strained during walking, so they could heal. My orthotics also corrected my gait, which I feel was not much of a correction and not nearly as important in my recovery as the way they cradled my foot firmly, giving it just the right support and limiting the range of motion inside the shoe during healing.

While healing, going without my orthotics for a day set me back days or weeks in my recovery (such as on January 8th when I took a chance and went without them for most of a day, and had a major setback). They played a big role in my recovery which I do not feel was solely due to rest. Now that I am just about entirely healed, I'm quite comfortable without orthotics as long as I'm not expecting any major strain of my PF. I go about my daily life and work on building up my strength and walking more without my orthotics and with as little pain as when I wear my orthotics. Once I'm completely healed and have been so for some time, I would expect to be able to deal with more strain on my PF than I can now. Just like with a broken arm or other healing tissue.

Previously injured tissues may be more likely to fail under stress. However, if they recover sufficiently that they do not, one would not require further treatment and the podiatrist would not know about it, it seems to me. All the preceding verbiage in the past few paragraphs is what I had been thinking, derived from my own experiences with orthotics, and what I am now questioning because of Dr. Z's post.

Carole C

Re: Custom Orthotics and over-pronation - another question for Dr Z

Carole C in NOLA on 4/04/02 at 05:32 (078460)

Oh! OK! That explains it... the missing factor for the first half century of my life was the type of repetitive motion that strained my feet and achilles tendon so much.

Right before I got PF I did some really dumb things on my recumbent bike, involving repetitive straining of these tissues, that I will not be doing again for the next fifty years at least.

I didn't see this post yet when I posted my other post just below. Sorry!

Carole C

Re: Custom Orthotics and over-pronation - another question for Dr Z

Dr. Zuckerman on 4/04/02 at 07:21 (078462)

Pronation is a three plane motion. The limiting of motion in your shoe and preventing overstretching of the muscles in your foot is part of excessive pronation. Excessive pronation isn't a simple type of motion.

I know what you are saying about the crading and splinting. that too can happen with orthosis, but is it the control of abnormal motion which then allows the foot muscles to function at the right time during the gait cycle.

Yes it still could of been the splinting, so over the counter semi- custom, semi rigid orthosis can provide splinging .

So long as your othosis are comfortable wear them. They should be checked once per year to make sure the posts are not worn down

Bimoechanicl analysis and manufactoring of orthosis is very complex and is both an art and a science. There ar so many motions in the human foot that are altered with different type of orthosis.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Julie on 4/04/02 at 10:33 (078479)

Hi Carole

This has been a useful discussion, hasn't it?

To ruminate on one of your points: I don't think the broken arm analogy was useful. Once a broken bone has healed it is forever healed, unless you keep repeatedly doing the same thing to it that broke it in the first place: that's unlikely, but if you do, it will probably break again. With a plantar fascia that is no longer supported by orthosis, we're talking about an injured tissue that healed, but that is now being repeatedly stressed in the same way that it was before.

My take on this has always been that if there is a weakness that has caused or contributed to PF (e.g. excessive pronation, flat feet or whatever) there is always going to be a weakness. Therefore I've drawn the conclusion that I will be keeping company with my orthotics for good.

Fortunately, I love them, and the sturdy shoes they live in, and don't hanker after any others (except for Arizonas, which are my constant indoor companions). I know you do hanker after prettier shoes, though, and I hope you'll be able to wear them before too long - perhaps with a daintier orthotic.

Re: Custom Orthotics and over-pronation - another question for Dr Z

Carole C in NOLA on 4/04/02 at 11:51 (078483)

Julie, I've been wearing the women's SAS shoes that are what I want to wear, without orthotics, from 10-14 hours/day every day for nearly a month now (since March 9th). I wear them to work every day. That is, every day except for three days on the ship last month, and a couple of other days when I felt a little 'iffy'.

I'm not saying you or anyone should do this or even try it, because I am not a person that knows much about feet; I'm just trying to hear what my feet are telling me and to act on that. They are telling me that these women's SAS shoes without orthotics are letting my feet move around enough to strengthen the muscles, without causing pain. My feet are not like anyone else's feet, though.

I'm perfectly happy wearing the women's SAS shoes, which are what I was wearing when I originally got PF (except a new pair now). My pain level has been less than 1 and I am leading a normal life at last. Well, normal except that I am very cautious and I pay close attention and take action to protect my feet if there are unusual stresses, and I stretch and occasionally ice, still. I don't have to rest all the time any more, and at last my apartment is beginning to look like someone civilized lives here (and keeps it clean!). For those that are reading, yes! there is light at the end of the tunnel and Julie and I are two of those that are seeing it.

While I'm on the ship, I'll play it safe and wear my custom orthotics and the big ugly men's SAS shoes they are in. I don't want to mess up my women's SAS shoes anyway! and this will give my feet extra protection and also will give me time to think about the issues we are discussing on this thread.

Whether or not I decide that my lack of orthotics might result in PF (frankly in my case I doubt it would, without the repetitive motion that caused it the first time) I still might go to a DPM and get smaller 'ice scraper' type orthotics for the purpose of straightening out my gait and perhaps causing less strain on my knee and hip joints and less pain in those joints. Even though the prices I've heard here ($450) makes me gasp as if I'd just taken a sucker punch, still, I am worth it.

Carole C

Re: Custom Orthodics vs over the counter

Mahatmelissama on 4/05/02 at 17:01 (078604)

I asked my pod this very question today during my feet casting for custom orthodics. She said 'Yes and no...some find they always have to wear the orthodics or the pain comes back ... some of her patients don't have to continue wearing them after the orthodics take the stress off the feet..'

Well, she might have put it differently but that is what I understood.

I do hope my custom orthodics from her work better than the ones I got from Walkrite shoes (a foot store that did a foot scan and then made some semi-rigid orthodics). The ones I have now are very comfortable however they don't do ENOUGH supporting and I find I still can not stand in line long at the grocery store. :(

I will let you all know what happens.

My pod's last day was today...she is going to go have a baby. I get a new Pod for an indefinite time. Darn it, I was starting to really like her and develop a good patient doctor relationship...and then she has to go away to give birth. How dare she! ;)

TGIF everybody.

:)
Melissa

Re: Custom Orthotics and over-pronation - another question for Dr Z

Ed Davis, DPM on 4/05/02 at 22:41 (078633)

Julie:

Need to interject a bit here....

The plantar fascia originates on the heel bone and inserts into the ball of the foot, much about the big toe joint base area. Overpronation is only half of the equation----overpronation at the subtalar joint pulls on the proximal end of the fascia but oversupination of the midtarsal joint pulls on the distal end. The interplay between subtalar joint overpronation and midtarsal joint oversupination is what often leads to excess plantar fascial tension and strain.
Ed

Re: Custom Orthotics and over-pronation - another question for Dr Z

Julie on 4/07/02 at 16:25 (078756)

Thank you Ed. I've been away - hence no response till two days later. I appreciate your concern. I think I understood this (I know it's not that simple!) That being the case, what is your feeling about the need for orthotics after the acute stage of PF has passed - i.e. once a pain-free state has been reached, as is the case with me?

Re: need for long term orthotic use

Ed Davis, DPM on 4/10/02 at 20:35 (079151)

The need for orthotic use past the acute stage is related to the degree to which biomechanical problems exist including vocational and avocational factors.
Ed

Re: calcification

emelda brignac on 8/08/07 at 19:20 (234102)

can you suggest what mineral to take or any other suggestion