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Frustrated with Orthotics

Posted by A Golden on 8/21/02 at 14:02 (093103)

I have been trying with great deal of frustration with my Podiatrist to get a pair of custom orthotics to fit and be comfortable. They are rigid orthotics and he seems to think those are the best for my feet which pronate but not horribly so. However, the orthotics definitely make things worse and I just cannot ever imagine them being comfortable. I have had heel pain for about 5 to 7 years - who wants to keep count- and am at the end of my rope. I don't know what to do.

Re: Frustrated with Orthotics

Carole C in NOLA on 8/21/02 at 16:29 (093124)

There are lots of foot professionals that will make you soft custom orthotics for people with feet that pronate but not horribly so.

My suggestion is that you find someone who is more responsive to your needs in an orthotic.

I pronate, but not horribly so, and my doctor referred me to a C.Ped. The C.Ped made me soft custom orthotics, which worked quite well for me and were pivotal in my recovery from PF, in my opinion. I realize that there is no one treatment that works for everyone, but I really feel like you haven't had a chance to find out whether or not soft orthotics would work for you. All you've had is hard ones!

Carole C

Re: Frustrated with Orthotics

Ed Davis, DPM on 8/21/02 at 16:59 (093130)

Your podiatrist needs to work closely with you. The more control placed in an orthotic, the more precise the molding needs to be. There are many factors to consider such as your ankle range of motion....

It is not always possible to provide 100% of the support a patient needs right away, sometimes it must be done incrementally via gradual adjustments.

The key factor is that you and your doc are actively working to make the devices work for you.
Ed

Re: Frustrated with Orthotics

Kim R. on 8/22/02 at 08:10 (093188)

Try a soft-flexible orthotic. Mine are called Amfit. Also, my physical therapist recommended to start wearing them gradually - 2 hours the first day - 4 the second and so on, because there is an adaptation phase. Good luck.

Re: Frustrated with Orthotics

bob h on 8/23/02 at 21:32 (093375)

Hey there,
I know what you're going thru and feel I can speak with authority on the subject of orthotics. There are many different variables concerning foot problems and having orthotics made to alleviate the problem. Following are some of the things that may be causing youer problems:
1. you have to remember that doctors are ONLY middlemen peddling orthotics. They have NO CLUE as to how orthotics relate to shoes. It may be that your feet do not fit into normal shoes and you need to have shoes made for you. THAT will end all your problems.
2. Did your dr. make full length orthotics? They must be full length. Also you must take out the insert that comes with the shoes so your orthotic can fit properly. If you have two different size feet make sure your orthotics are also different sizes. Can't tell you how many times drs. made mine the same length but i have different sized feet.
3. If you have high arches you do need firm support. Only normal or flat footed feet can tolerate soft support. The firmness holds the feet and keeps them bio mechanically inefficient.
4. If your feet are real unbalanced there is no way you wiil ever find comfort in orthotics only.
5. YOU also have to remember that it will take at least a week for your body to adjst tot orthotics or anything else so give it time and wear your orthotics gradually until you can wear them all day. THEN NEVER go without them or you will have to start over as your body readjusts.
Those are tips from someone who has been there. I know what you're going thru. Trust me.

Re: Frustrated with Orthotics

Carole C in NOLA on 8/24/02 at 03:30 (093391)

Bob, it sounds like you had a TERRIBLE doctor and your orthotics don't even sound like they were custom made, if they weren't different for your two different feet. I'm sorry you had such an awful experience.

I am perplexed that you say that doctors have no clue as to how orthotics relate to shoes and 'are only middlemen peddling orthotics'. SOME doctors might be like that, and I'm sorry that your doctor was so awful. The C.Ped that my doctor sent me to see, custom made my orthotic to fit my feet in a particular shoe that she specified and I had to buy that shoe as well as the orthotic from her. I was firmly directed to wear that custom orthotic in that shoe all day at work, and to wear my Birkenstocks in the evenings for a rest.

Taking out the insert in the shoes was not relevant in my case because she custom fit the orthotic to my feet IN THE SHOES, and had already taken it out and inserted the custom molded orthotic in the shoes to do that before she did the final adjustments to it. Didn't your doctor finish the custom fitting process?

It took me about ten minutes to get used to my soft custom orthotics once my C.Ped was done, despite the agony that had me in tears as I waited for hours in her waiting room for her to show up for my appointment. She had me walk around in my orthotics for a half hour or so before I went home. I was able to say right there during the fitting process that my custom orthotics felt really good and to provide my input while she finished the adjustments. Following her directions I wore them at least ten hours a day starting on day one. You are correct that it's usually a good thing to break in new orthotics, but it's not invariably necessary and one's foot professional will probably know when it is and when it isn't.

I think the problem that a lot of people have may be that they get rigid orthotics right off the bat when they need a soft orthotic to begin with, that they can get into right away and that can start helping their PF to heal. My soft custom orthotics, along with considerable rest, were the main factors in healing my PF. My C.Ped said that BECAUSE of my high arches, I need a lot of cushioning, and the combination of shoes and soft custom orthotics she made for me provide that to me.

Carole C

Re: Frustrated with Orthotics

A Golden on 8/25/02 at 12:37 (093485)

How do I go about finding a good practitioner to fit the orthotics/shoes?

Re: Frustrated with Orthotics

Peggy on 8/26/02 at 15:17 (093581)

All of this talk about orthotics makes me curious. My pod who is treating my neuroma indicates that he would suggest the rigid orthotics -- without even taking anything else into consideration. Pronation, high/low arches, etc. I have neuroma and metatarsalgia on one foot. I am so skeptical about getting these made because I am not sure this is way to go; and being that they are so rigid, I'm not sure if I will wear them. Right now I'm wearing the metatarsal orthotics from the good feet store because they seem to help and are more flexible then the ones that he would recommend. But I've now noticed that since I moved my ankle wrong getting out of my chair the other day; my ankle got swolen and appears to hurt a bit. Maybe this isn't the way to go either but how many of these things will I -- or anyone have to go through before a doc. actually knows what is best for such problems?

And because of my ankle problem, I have made an appointment to see an Orthapedic Surgeon. When I called my Pod and told him of the swelling he thinks it's because I've compensated so long on one injured foot. Not even wanting to xray thinking it could be strain, sprain, hairline fracture(?)perhaps I should find another Pod that isn't so passive.

Anyone else have suggestions.

Re: Frustrated with Orthotics

Pauline on 8/26/02 at 16:50 (093596)

Peggy,
The discussions on orthotics continues to go round and round. Many of us have spent hundreds of dollars on what we now call ice scrapers only to find they cause us more pain with them than without.

Some people will post that they love their ice scrapers and still others have opted for what they describe as a 'soft' orthotic one made of materials other than plastic or fiber glass etc.

In your case the use of the orthotic is probably being used to try to distribute your weight off the area where your neuroma is located.
If you push up against your metatarsal joints they will spread and the doctor is hoping this will provide some extra space and releave some of the pain from your neruoma.

Remember once it develops it will always be there unless its physically
cut out. How you treat and deal with the pain is where you have options.

Question is do you need a $300 dollar pair of orthotics to try and provide the comfort or will padding the neruoma with Dr. Scholl's corn cushions and using wider shoes with low heels help the problem. Certainly this is the cheaper of the two so you might want to try this first. Remember no pumps.

The way I look at it is if you don't have additional foot problems why begin a life of dependency on orthotics if they are not necessary.

Often a steroid injection at the neruoma site will help the swelling and help the problem. In simple terms what you have is something tooo large for the space it's occuping. Many Pods use alcohol injections to kill the nerve. Dead nerve, no pain. Others like to suggest and use surgery to cut out the neruoma. Most of them always suggest Orthotics. I've come to believe Pods think orthotics are the universal treatment for any and all foot problems.

The decision of purchasing orthotics and the course of treatment is really up to you. I was very successful treating my neruoma using the corn cushions and wider shoes. This was the conservative advice of my Orthopedic Surgeon. I have never returned to wearing high heeled shoes which would put direct pressure on the area where my neuroma is located.

We live together, sort of a compromise. I don't put pressure on it by wearing the wrong shoes and it doesn't hurt me. This was my solution.

You may not like this type of arrangement so one of the injection methods might solve your problem. I'd advise that you avoid any foot surgery if at all possible. Many times what is suppose to be a simple operation turns out to provide empty promises and a round robbin of additional pain and surgeries. Read the surgery board on this site for a few months before you choose this option.

My opinion is if you purchase the expensive hard orthotics without an additional foot problems they may turn out to be an expensive pair of ice scrapers you store in your closet.

Good luck

Re: Frustrated with Orthotics

Peggy on 8/26/02 at 18:24 (093611)

Hi Pauline,

Thanks for all your info. At the moment, I'm receiving the sclerosing injections that seem to help. I'm not sure this has happened to you with your neuroma but sometimes if I put total weight on my foot, my toes get that 'muscle spasm' neuroma pain so I'm hoping the slcerosing injections will help over time. I've only got three so far. But my major problem is the ball of foot pain. That is how my problem began in April; it was like walking on a marble or something. I'm really not sure what orthotic is best for this but wearing metartarsal pad helps; that is why I got the metatarsal orthotics from the good feet store. It takes the weight off the ball of the foot. I may just exchange the size for one that doesn't lift my foot so much -- which makes my foot go too much forward; it leads to my toes being cramped in my sketchers. And I never wear pumps. I am hoping to wear flat boots this fall though. I am definitely avoiding foot surgery. My Pod did mention that if my ball of foot pain continued they could do surgery to lift the bone; I guess it's dropped and that's the problem(?) I don't think I would consider that. I'd be concerned with scar tissue and not being able to walk at all; besides I've never heard surgery for that. I'm wondering if you have any knowledge about this metatarsalgia problem -- at least I think that's what's it's called.

Thanks again.

Peggy

Re: Frustrated with Orthotics

Pauline on 8/26/02 at 19:37 (093613)

Peggy,
Before I'd have anyone perform surgery to start 'lifting' my bones I'd get a second opinion from an Orthopedic Surgeon to find out what's happening.

Maybe your neuroma isn't really a neuroma afterall. You could have something else going on.

First and foremost remember all part of the foot are interconnected. They all work together. Their not like the mattresses that allow one partner to sleep in comfort on one side, while the other partner jumps up and down on the other. When this happens in your foot the result is pain.

It takes time and money for second and even third opinions, but if it saves you from a needless surgery it will be well worth it.

Your heading in that direction anyway, just throw this problem in with the rest. I think you'd have a pretty difficult time finding an Orthopedic Surgeon that would provide you with the slcerosing treatment your currently receiving.

Re: Frustrated with Orthotics

Peggy on 8/26/02 at 22:34 (093625)

Thanks again Pauline. I do look forward to seeing the Orthopedic Surgeon soon. But I'm sure I had a neuroma. And from my research, Neuromas can develop as a swolen nerve in the ball of the foot -- between the base of the third and fourth toes. And sometimes at night, I do get neuroma pain between the third and fourth toe. It all began with a walking injury and my toes got numb; I only wished I knew to take care of it months before that happened. But I kept wearing high heeled boots. And my pod did the test for the audible click they call it. I definitely have that - and now in the right foot as well. But I was lucky that I don't have the ball of foot pain to the extreme as the right foot; that was caught in time.

Anyhow, I'll let you know what the outcome is after I see the surgeon September 5th. I'm also having the ankle pain and knee pain; it is all related.

Peggy

Re: Frustrated with Orthotics

Mark J. on 9/05/02 at 03:26 (094507)

Peggy,

I'm sorry to hear you are having so much trouble. I am an orthotist and have made many inserts to treat your type of problem. You are right about the neuroma; you wouldn't have gotten as far as you have with the shots if it hadn't been confirmed by your physician. Metatarsalgia is inflammation and swelling around the metatrsal joints, or the ball of the foot. It can become worse when a bone has dropped lower than the rest and quite often a surgical procedure can be very successful at correcting it. The first thing to consider is that you should never follow the advice of someone who has been there just because what they did worked for them. People draw strange conclusions sometimes, but more importantly, what works for one will not always work for the other. Start from the ground and work your way up. Look at the shoes you are wearing. Are they soft, squishy, stretchy and bendy? Or are they hard, stiff and tight? They should be light weight, firm, yet flexible enough to allow your foot to function properly and above all they should provide ample room for your foot. Cross trainers(look at the stability walkers at http://www.propetusa.com) are generally the best in my experience, but I cannot say for sure in your case without seeing your feet and watching you walk. Once you have the proper shoe, it is important to fill the gaps between the inside surface of the shoe and the bottom surface of your foot. Suppose you poured some liquid jello into your shoe and then put your foot in and waited for it to set up. Once the jello has set, if you could remove it, you would find that the top of the jello is identical to the bottom of your foot. Equally important, the bottom of the jello is identical to the inner surface of the shoe. This is the basic shape your insole should consist of. Note that it looks nothing like an ice scraper. Now...feel the bottom of your foot by squeezing it from top to bottom, using your thumb on the bottom surface. Notice how the skin stretches and pushes up into cavities of the foot, mostly behind the ball of the foot. This is where you want to have a metatarsal pad added to your insole, but it must be exactly the right height. The shafts of the bones in this part of your foot are a certain distance from the surface of the shoe and that distance should not be compromised. You should only have enough lift on these bones to adequately unweigh the ends of the bones without jacking them a half inch off the bottom of the shoe. Also notice the shape of the cavity. It is a tear-drop shape. If you lift your toes as high as you can you will feel a tendon that runs along your arch to your big toe. The tear-drop shape runs right along side this tendon. On the other side of the tear drop, on the outside of your foot, you will feel a lump of bone -- between the heel and the ball of the foot. The tear drop shape should be to the inside of this bone. You may also notice that because of this bone, your foot is not a smooth flat surface, but is very contoured and has soft pockets which can be compressed. These soft pockets are good places to redistribute pressure, so on your jello mold, imagine small raises where the soft pockets are and where the tear-drop shape is. Now you can picture what a properly made insole should look like. In your case you will probably have a few dimples where the metatarsal heads are prominent; speaking of which, before having the bone raised to fit the shoe, it is sometimes worth trying to lower the shoe to fit the bone. Many times I have used a dremel type tool and ground out a recess in the inside of the shoe to allow the insole and all to drop into a pocket as a relief for the prominent bone. I hope this helps answer some of the questions you have. I'm sure if you keep checking out all your options you will eventually find some reliable sources you feel comfortable working with. If you have any more questions, post back, or feel free to email me at (email removed). Best of luck to you.

Mark M. Joyce, CO
certified orthotist

Re: Frustrated with Orthotics

Carole C in NOLA on 8/21/02 at 16:29 (093124)

There are lots of foot professionals that will make you soft custom orthotics for people with feet that pronate but not horribly so.

My suggestion is that you find someone who is more responsive to your needs in an orthotic.

I pronate, but not horribly so, and my doctor referred me to a C.Ped. The C.Ped made me soft custom orthotics, which worked quite well for me and were pivotal in my recovery from PF, in my opinion. I realize that there is no one treatment that works for everyone, but I really feel like you haven't had a chance to find out whether or not soft orthotics would work for you. All you've had is hard ones!

Carole C

Re: Frustrated with Orthotics

Ed Davis, DPM on 8/21/02 at 16:59 (093130)

Your podiatrist needs to work closely with you. The more control placed in an orthotic, the more precise the molding needs to be. There are many factors to consider such as your ankle range of motion....

It is not always possible to provide 100% of the support a patient needs right away, sometimes it must be done incrementally via gradual adjustments.

The key factor is that you and your doc are actively working to make the devices work for you.
Ed

Re: Frustrated with Orthotics

Kim R. on 8/22/02 at 08:10 (093188)

Try a soft-flexible orthotic. Mine are called Amfit. Also, my physical therapist recommended to start wearing them gradually - 2 hours the first day - 4 the second and so on, because there is an adaptation phase. Good luck.

Re: Frustrated with Orthotics

bob h on 8/23/02 at 21:32 (093375)

Hey there,
I know what you're going thru and feel I can speak with authority on the subject of orthotics. There are many different variables concerning foot problems and having orthotics made to alleviate the problem. Following are some of the things that may be causing youer problems:
1. you have to remember that doctors are ONLY middlemen peddling orthotics. They have NO CLUE as to how orthotics relate to shoes. It may be that your feet do not fit into normal shoes and you need to have shoes made for you. THAT will end all your problems.
2. Did your dr. make full length orthotics? They must be full length. Also you must take out the insert that comes with the shoes so your orthotic can fit properly. If you have two different size feet make sure your orthotics are also different sizes. Can't tell you how many times drs. made mine the same length but i have different sized feet.
3. If you have high arches you do need firm support. Only normal or flat footed feet can tolerate soft support. The firmness holds the feet and keeps them bio mechanically inefficient.
4. If your feet are real unbalanced there is no way you wiil ever find comfort in orthotics only.
5. YOU also have to remember that it will take at least a week for your body to adjst tot orthotics or anything else so give it time and wear your orthotics gradually until you can wear them all day. THEN NEVER go without them or you will have to start over as your body readjusts.
Those are tips from someone who has been there. I know what you're going thru. Trust me.

Re: Frustrated with Orthotics

Carole C in NOLA on 8/24/02 at 03:30 (093391)

Bob, it sounds like you had a TERRIBLE doctor and your orthotics don't even sound like they were custom made, if they weren't different for your two different feet. I'm sorry you had such an awful experience.

I am perplexed that you say that doctors have no clue as to how orthotics relate to shoes and 'are only middlemen peddling orthotics'. SOME doctors might be like that, and I'm sorry that your doctor was so awful. The C.Ped that my doctor sent me to see, custom made my orthotic to fit my feet in a particular shoe that she specified and I had to buy that shoe as well as the orthotic from her. I was firmly directed to wear that custom orthotic in that shoe all day at work, and to wear my Birkenstocks in the evenings for a rest.

Taking out the insert in the shoes was not relevant in my case because she custom fit the orthotic to my feet IN THE SHOES, and had already taken it out and inserted the custom molded orthotic in the shoes to do that before she did the final adjustments to it. Didn't your doctor finish the custom fitting process?

It took me about ten minutes to get used to my soft custom orthotics once my C.Ped was done, despite the agony that had me in tears as I waited for hours in her waiting room for her to show up for my appointment. She had me walk around in my orthotics for a half hour or so before I went home. I was able to say right there during the fitting process that my custom orthotics felt really good and to provide my input while she finished the adjustments. Following her directions I wore them at least ten hours a day starting on day one. You are correct that it's usually a good thing to break in new orthotics, but it's not invariably necessary and one's foot professional will probably know when it is and when it isn't.

I think the problem that a lot of people have may be that they get rigid orthotics right off the bat when they need a soft orthotic to begin with, that they can get into right away and that can start helping their PF to heal. My soft custom orthotics, along with considerable rest, were the main factors in healing my PF. My C.Ped said that BECAUSE of my high arches, I need a lot of cushioning, and the combination of shoes and soft custom orthotics she made for me provide that to me.

Carole C

Re: Frustrated with Orthotics

A Golden on 8/25/02 at 12:37 (093485)

How do I go about finding a good practitioner to fit the orthotics/shoes?

Re: Frustrated with Orthotics

Peggy on 8/26/02 at 15:17 (093581)

All of this talk about orthotics makes me curious. My pod who is treating my neuroma indicates that he would suggest the rigid orthotics -- without even taking anything else into consideration. Pronation, high/low arches, etc. I have neuroma and metatarsalgia on one foot. I am so skeptical about getting these made because I am not sure this is way to go; and being that they are so rigid, I'm not sure if I will wear them. Right now I'm wearing the metatarsal orthotics from the good feet store because they seem to help and are more flexible then the ones that he would recommend. But I've now noticed that since I moved my ankle wrong getting out of my chair the other day; my ankle got swolen and appears to hurt a bit. Maybe this isn't the way to go either but how many of these things will I -- or anyone have to go through before a doc. actually knows what is best for such problems?

And because of my ankle problem, I have made an appointment to see an Orthapedic Surgeon. When I called my Pod and told him of the swelling he thinks it's because I've compensated so long on one injured foot. Not even wanting to xray thinking it could be strain, sprain, hairline fracture(?)perhaps I should find another Pod that isn't so passive.

Anyone else have suggestions.

Re: Frustrated with Orthotics

Pauline on 8/26/02 at 16:50 (093596)

Peggy,
The discussions on orthotics continues to go round and round. Many of us have spent hundreds of dollars on what we now call ice scrapers only to find they cause us more pain with them than without.

Some people will post that they love their ice scrapers and still others have opted for what they describe as a 'soft' orthotic one made of materials other than plastic or fiber glass etc.

In your case the use of the orthotic is probably being used to try to distribute your weight off the area where your neuroma is located.
If you push up against your metatarsal joints they will spread and the doctor is hoping this will provide some extra space and releave some of the pain from your neruoma.

Remember once it develops it will always be there unless its physically
cut out. How you treat and deal with the pain is where you have options.

Question is do you need a $300 dollar pair of orthotics to try and provide the comfort or will padding the neruoma with Dr. Scholl's corn cushions and using wider shoes with low heels help the problem. Certainly this is the cheaper of the two so you might want to try this first. Remember no pumps.

The way I look at it is if you don't have additional foot problems why begin a life of dependency on orthotics if they are not necessary.

Often a steroid injection at the neruoma site will help the swelling and help the problem. In simple terms what you have is something tooo large for the space it's occuping. Many Pods use alcohol injections to kill the nerve. Dead nerve, no pain. Others like to suggest and use surgery to cut out the neruoma. Most of them always suggest Orthotics. I've come to believe Pods think orthotics are the universal treatment for any and all foot problems.

The decision of purchasing orthotics and the course of treatment is really up to you. I was very successful treating my neruoma using the corn cushions and wider shoes. This was the conservative advice of my Orthopedic Surgeon. I have never returned to wearing high heeled shoes which would put direct pressure on the area where my neuroma is located.

We live together, sort of a compromise. I don't put pressure on it by wearing the wrong shoes and it doesn't hurt me. This was my solution.

You may not like this type of arrangement so one of the injection methods might solve your problem. I'd advise that you avoid any foot surgery if at all possible. Many times what is suppose to be a simple operation turns out to provide empty promises and a round robbin of additional pain and surgeries. Read the surgery board on this site for a few months before you choose this option.

My opinion is if you purchase the expensive hard orthotics without an additional foot problems they may turn out to be an expensive pair of ice scrapers you store in your closet.

Good luck

Re: Frustrated with Orthotics

Peggy on 8/26/02 at 18:24 (093611)

Hi Pauline,

Thanks for all your info. At the moment, I'm receiving the sclerosing injections that seem to help. I'm not sure this has happened to you with your neuroma but sometimes if I put total weight on my foot, my toes get that 'muscle spasm' neuroma pain so I'm hoping the slcerosing injections will help over time. I've only got three so far. But my major problem is the ball of foot pain. That is how my problem began in April; it was like walking on a marble or something. I'm really not sure what orthotic is best for this but wearing metartarsal pad helps; that is why I got the metatarsal orthotics from the good feet store. It takes the weight off the ball of the foot. I may just exchange the size for one that doesn't lift my foot so much -- which makes my foot go too much forward; it leads to my toes being cramped in my sketchers. And I never wear pumps. I am hoping to wear flat boots this fall though. I am definitely avoiding foot surgery. My Pod did mention that if my ball of foot pain continued they could do surgery to lift the bone; I guess it's dropped and that's the problem(?) I don't think I would consider that. I'd be concerned with scar tissue and not being able to walk at all; besides I've never heard surgery for that. I'm wondering if you have any knowledge about this metatarsalgia problem -- at least I think that's what's it's called.

Thanks again.

Peggy

Re: Frustrated with Orthotics

Pauline on 8/26/02 at 19:37 (093613)

Peggy,
Before I'd have anyone perform surgery to start 'lifting' my bones I'd get a second opinion from an Orthopedic Surgeon to find out what's happening.

Maybe your neuroma isn't really a neuroma afterall. You could have something else going on.

First and foremost remember all part of the foot are interconnected. They all work together. Their not like the mattresses that allow one partner to sleep in comfort on one side, while the other partner jumps up and down on the other. When this happens in your foot the result is pain.

It takes time and money for second and even third opinions, but if it saves you from a needless surgery it will be well worth it.

Your heading in that direction anyway, just throw this problem in with the rest. I think you'd have a pretty difficult time finding an Orthopedic Surgeon that would provide you with the slcerosing treatment your currently receiving.

Re: Frustrated with Orthotics

Peggy on 8/26/02 at 22:34 (093625)

Thanks again Pauline. I do look forward to seeing the Orthopedic Surgeon soon. But I'm sure I had a neuroma. And from my research, Neuromas can develop as a swolen nerve in the ball of the foot -- between the base of the third and fourth toes. And sometimes at night, I do get neuroma pain between the third and fourth toe. It all began with a walking injury and my toes got numb; I only wished I knew to take care of it months before that happened. But I kept wearing high heeled boots. And my pod did the test for the audible click they call it. I definitely have that - and now in the right foot as well. But I was lucky that I don't have the ball of foot pain to the extreme as the right foot; that was caught in time.

Anyhow, I'll let you know what the outcome is after I see the surgeon September 5th. I'm also having the ankle pain and knee pain; it is all related.

Peggy

Re: Frustrated with Orthotics

Mark J. on 9/05/02 at 03:26 (094507)

Peggy,

I'm sorry to hear you are having so much trouble. I am an orthotist and have made many inserts to treat your type of problem. You are right about the neuroma; you wouldn't have gotten as far as you have with the shots if it hadn't been confirmed by your physician. Metatarsalgia is inflammation and swelling around the metatrsal joints, or the ball of the foot. It can become worse when a bone has dropped lower than the rest and quite often a surgical procedure can be very successful at correcting it. The first thing to consider is that you should never follow the advice of someone who has been there just because what they did worked for them. People draw strange conclusions sometimes, but more importantly, what works for one will not always work for the other. Start from the ground and work your way up. Look at the shoes you are wearing. Are they soft, squishy, stretchy and bendy? Or are they hard, stiff and tight? They should be light weight, firm, yet flexible enough to allow your foot to function properly and above all they should provide ample room for your foot. Cross trainers(look at the stability walkers at http://www.propetusa.com) are generally the best in my experience, but I cannot say for sure in your case without seeing your feet and watching you walk. Once you have the proper shoe, it is important to fill the gaps between the inside surface of the shoe and the bottom surface of your foot. Suppose you poured some liquid jello into your shoe and then put your foot in and waited for it to set up. Once the jello has set, if you could remove it, you would find that the top of the jello is identical to the bottom of your foot. Equally important, the bottom of the jello is identical to the inner surface of the shoe. This is the basic shape your insole should consist of. Note that it looks nothing like an ice scraper. Now...feel the bottom of your foot by squeezing it from top to bottom, using your thumb on the bottom surface. Notice how the skin stretches and pushes up into cavities of the foot, mostly behind the ball of the foot. This is where you want to have a metatarsal pad added to your insole, but it must be exactly the right height. The shafts of the bones in this part of your foot are a certain distance from the surface of the shoe and that distance should not be compromised. You should only have enough lift on these bones to adequately unweigh the ends of the bones without jacking them a half inch off the bottom of the shoe. Also notice the shape of the cavity. It is a tear-drop shape. If you lift your toes as high as you can you will feel a tendon that runs along your arch to your big toe. The tear-drop shape runs right along side this tendon. On the other side of the tear drop, on the outside of your foot, you will feel a lump of bone -- between the heel and the ball of the foot. The tear drop shape should be to the inside of this bone. You may also notice that because of this bone, your foot is not a smooth flat surface, but is very contoured and has soft pockets which can be compressed. These soft pockets are good places to redistribute pressure, so on your jello mold, imagine small raises where the soft pockets are and where the tear-drop shape is. Now you can picture what a properly made insole should look like. In your case you will probably have a few dimples where the metatarsal heads are prominent; speaking of which, before having the bone raised to fit the shoe, it is sometimes worth trying to lower the shoe to fit the bone. Many times I have used a dremel type tool and ground out a recess in the inside of the shoe to allow the insole and all to drop into a pocket as a relief for the prominent bone. I hope this helps answer some of the questions you have. I'm sure if you keep checking out all your options you will eventually find some reliable sources you feel comfortable working with. If you have any more questions, post back, or feel free to email me at (email removed). Best of luck to you.

Mark M. Joyce, CO
certified orthotist