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Orthotic survey

Posted by Pauline on 8/25/02 at 20:34 (093515)

Please post your opinion on what type of feet you think are the hardest to fit and adjust to orthotics.

I personally think a person with a high arch has a better chance of adjusting to an orthotic than a person with low or flat arches. In addition if that person has a straight healthy knee alignment that is even better.

We exercise most every muscle in our body, but very little attention is paid to the feet. Hardly any attempt is made to stretch and tone those muscles except after P.F. Wearing orthotics doesn't do this either. Instead they inhibit most of the natural arch movement of the foot. We're told they are providing support and that they do, but providing support while sacrificing flexibility and natural movement of the arch I don't think is a good trade off.

Some people love them others would love their money back. My personal opinion is that our feet are much better off without becoming dependent on orthotics. We were never meant to wear ice scrapers in any shape or size.

Re: Orthotic survey

Dr. Zuckerman on 8/25/02 at 20:44 (093517)

I have found that a high arch foot is the toughest foot to get an orthosis to both fit and work. Most of the time a high arch foot lacks pronation and then when an orthosis is used especially a hard type the foot motion is reduced even more and the pateint is usually in more pain and sometimes develops referred pain. I will usually use an orthosis with alot of padding for the high arch foot and never try to control motion.

Very interesting comment about how feet my be better off without orthosis I could introduce you to podiatrists, etc who feel that even feet that feel great need orthosis.

My problem with orthosis is that in theory the are great but people have to walk with all kinds of different shoes and that is a very tough task to control the shoe gear that people wear. I myself could never remember to place my orthosis in the three pairs of shoes that I wear. Eventually you stop wearing the shoe or at least reduce your wearing time.

Re: Orthotic survey

Pauline on 8/25/02 at 20:50 (093519)

That would be no different than an Ears, Noses & Throat doctor thinking every person must have a straight septum. Both type of doctors are wrong.

Re: Orthotic survey

Dr. Zuckerman on 8/25/02 at 21:00 (093523)

True. My personal opinion is that orthosis are very useful and effective in very selective cases. In order to understand orthosis you have to review the history of how they become popular. It was in the 1970's and the running craze. Yes orthosis were very effective and helful in the runner and then it was extended to all types of patients. I feel orthosis and running are the perfect fit until running too much ruins your feet.
I always say running is great for the heart , lungs but ruins the feet,knees and hips and maybe the lower back

Re: Orthotic survey

Pauline on 8/25/02 at 21:00 (093524)

Your post says compliance is more of a determining factor than actual need.

Like alcohol or drugs people become dependent on orthotics if they become wearers. When they do their foot muscles and flexibility grows weaker not stronger.

Re: Orthotic survey

Dr. Zuckerman on 8/26/02 at 16:33 (093594)

The need is determined by the treating doctor . This would include his past experience with the orthosis and his effectiveness.

Re: Orthotic survey

Carole C in NOLA on 9/02/02 at 08:27 (094198)

Sorry to not answer sooner! I have been moving to a new house and I missed this thread somehow. It's very interesting, though. I'm especially interested in your comments about orthotics working better if you have straight and healthy knee alignment. I've found that orthotics can help the knee alignment, in my case.

If I had not had PF, I might never have discovered that a great deal of my knee pain (diagnosed as severe osteoarthritis) can be reduced depending on the orthoses/shoes/whatever that I'm wearing.

I think this is because my knees are not aligned in a completely straight and healthy way, and I am a heavy person so this results in pain. Custom orthotics can't correct my overweight but they can correct my knee alignment a little bit by their effect on my gait and the tilt of my foot. This reduces the pain in my knees (though not completely).

I haven't worn my orthotics for about six months, despite the fact that they were a very important treatment for PF for me when my PF was very painful. I don't feel that I need them now. I feel that my feet need to be able to move more in order to strengthen the muscles, now that my pain is nearly gone, and maybe my orthotics restrict my foot movement too much. I seem to be doing pretty well without orthotics and just wearing New Balance running shoes.

Carole C

Re: Orthotic survey

Mark on 9/05/02 at 02:16 (094503)

In my professional opinion, rigid feet are the hardest to fit with orthoses. I am an orthotist and have made and delivered thousands of them. I would say that I get flat rigid feet significantly more than high rigid feet, but I agree with Dr. Zuckerman regarding his/her comments about high arches. I also agree that insoles can be beneficial to healthy feet. The orthosis is not intended to make a foot healthy, it is to help treat an acute condition, support a deformity, or prolong the health of a normal foot. If a person wearing a custom insole becomes weaker and more involved, it is because it is destined to happen. Muscle weakness and malalignment go hand in hand and are usually secondary to a problem with the line of progression through the joints, or improper gait. The best course of treatment for anything other than a fixed, rigid deformity is stretching, strengthening and retraining the neuromusculature system of the lower extremity by changing the weight-bearing stimulation patterns through gait training. An insole is just a shock absorber and pressure redistributor. I have worn custom supports for almost 30 years and my feet are in much better shape than when I started...not because of the orthoses, but because of the stretching and gait therapy. Although I don't wear them in all my shoes, they do give me extra comfort when I have to be on my feet alot. After all they are made from molds of my feet. And by the way, mine do not look anything like ice scrapers. :)

Mark M. Joyce, CO
Certified Orthotist

Re: Orthotic survey

Julie on 9/05/02 at 02:43 (094506)

Hello Mark

And welcome. (I don't believe you've posted here before.) I hope you will come more often and give us the benefit of your experience and knowledge of orthoses (and feet).

Where are you? As we're both posting in the wee small US hours, I guess that you may, like me, be in England. Right?

Re: Orthotic survey

Mark J. on 9/05/02 at 11:20 (094523)

Julie,

I have saved this page to my favorites; and plan on returning on a regular basis. I am in West Michigan, but since I work in orthotics during the day, I often find myself spending half the night working on web pages and communicating online. I found my way here via a post from Dr. Davis on the Good Feet discussion board. Wow. Doctor, my hat is definitely off to you. By now you have surely bitten completely through your tongue many times over. I admire your ability to maintain your professionalism. I am off for lunch now and must return to my duties, but will keep popping in to say hi if it is alright with everyone.

Mark

Re: Orthotic survey

Julie on 9/05/02 at 15:58 (094535)

Mark

Ah. That explains it. A midnight owl. I'm glad you've found your way here thanks to the good Dr Ed, and am glad you will be looking in. Your expertise is needed.

Re: Orthotic survey

Dr. Zuckerman on 8/25/02 at 20:44 (093517)

I have found that a high arch foot is the toughest foot to get an orthosis to both fit and work. Most of the time a high arch foot lacks pronation and then when an orthosis is used especially a hard type the foot motion is reduced even more and the pateint is usually in more pain and sometimes develops referred pain. I will usually use an orthosis with alot of padding for the high arch foot and never try to control motion.

Very interesting comment about how feet my be better off without orthosis I could introduce you to podiatrists, etc who feel that even feet that feel great need orthosis.

My problem with orthosis is that in theory the are great but people have to walk with all kinds of different shoes and that is a very tough task to control the shoe gear that people wear. I myself could never remember to place my orthosis in the three pairs of shoes that I wear. Eventually you stop wearing the shoe or at least reduce your wearing time.

Re: Orthotic survey

Pauline on 8/25/02 at 20:50 (093519)

That would be no different than an Ears, Noses & Throat doctor thinking every person must have a straight septum. Both type of doctors are wrong.

Re: Orthotic survey

Dr. Zuckerman on 8/25/02 at 21:00 (093523)

True. My personal opinion is that orthosis are very useful and effective in very selective cases. In order to understand orthosis you have to review the history of how they become popular. It was in the 1970's and the running craze. Yes orthosis were very effective and helful in the runner and then it was extended to all types of patients. I feel orthosis and running are the perfect fit until running too much ruins your feet.
I always say running is great for the heart , lungs but ruins the feet,knees and hips and maybe the lower back

Re: Orthotic survey

Pauline on 8/25/02 at 21:00 (093524)

Your post says compliance is more of a determining factor than actual need.

Like alcohol or drugs people become dependent on orthotics if they become wearers. When they do their foot muscles and flexibility grows weaker not stronger.

Re: Orthotic survey

Dr. Zuckerman on 8/26/02 at 16:33 (093594)

The need is determined by the treating doctor . This would include his past experience with the orthosis and his effectiveness.

Re: Orthotic survey

Carole C in NOLA on 9/02/02 at 08:27 (094198)

Sorry to not answer sooner! I have been moving to a new house and I missed this thread somehow. It's very interesting, though. I'm especially interested in your comments about orthotics working better if you have straight and healthy knee alignment. I've found that orthotics can help the knee alignment, in my case.

If I had not had PF, I might never have discovered that a great deal of my knee pain (diagnosed as severe osteoarthritis) can be reduced depending on the orthoses/shoes/whatever that I'm wearing.

I think this is because my knees are not aligned in a completely straight and healthy way, and I am a heavy person so this results in pain. Custom orthotics can't correct my overweight but they can correct my knee alignment a little bit by their effect on my gait and the tilt of my foot. This reduces the pain in my knees (though not completely).

I haven't worn my orthotics for about six months, despite the fact that they were a very important treatment for PF for me when my PF was very painful. I don't feel that I need them now. I feel that my feet need to be able to move more in order to strengthen the muscles, now that my pain is nearly gone, and maybe my orthotics restrict my foot movement too much. I seem to be doing pretty well without orthotics and just wearing New Balance running shoes.

Carole C

Re: Orthotic survey

Mark on 9/05/02 at 02:16 (094503)

In my professional opinion, rigid feet are the hardest to fit with orthoses. I am an orthotist and have made and delivered thousands of them. I would say that I get flat rigid feet significantly more than high rigid feet, but I agree with Dr. Zuckerman regarding his/her comments about high arches. I also agree that insoles can be beneficial to healthy feet. The orthosis is not intended to make a foot healthy, it is to help treat an acute condition, support a deformity, or prolong the health of a normal foot. If a person wearing a custom insole becomes weaker and more involved, it is because it is destined to happen. Muscle weakness and malalignment go hand in hand and are usually secondary to a problem with the line of progression through the joints, or improper gait. The best course of treatment for anything other than a fixed, rigid deformity is stretching, strengthening and retraining the neuromusculature system of the lower extremity by changing the weight-bearing stimulation patterns through gait training. An insole is just a shock absorber and pressure redistributor. I have worn custom supports for almost 30 years and my feet are in much better shape than when I started...not because of the orthoses, but because of the stretching and gait therapy. Although I don't wear them in all my shoes, they do give me extra comfort when I have to be on my feet alot. After all they are made from molds of my feet. And by the way, mine do not look anything like ice scrapers. :)

Mark M. Joyce, CO
Certified Orthotist

Re: Orthotic survey

Julie on 9/05/02 at 02:43 (094506)

Hello Mark

And welcome. (I don't believe you've posted here before.) I hope you will come more often and give us the benefit of your experience and knowledge of orthoses (and feet).

Where are you? As we're both posting in the wee small US hours, I guess that you may, like me, be in England. Right?

Re: Orthotic survey

Mark J. on 9/05/02 at 11:20 (094523)

Julie,

I have saved this page to my favorites; and plan on returning on a regular basis. I am in West Michigan, but since I work in orthotics during the day, I often find myself spending half the night working on web pages and communicating online. I found my way here via a post from Dr. Davis on the Good Feet discussion board. Wow. Doctor, my hat is definitely off to you. By now you have surely bitten completely through your tongue many times over. I admire your ability to maintain your professionalism. I am off for lunch now and must return to my duties, but will keep popping in to say hi if it is alright with everyone.

Mark

Re: Orthotic survey

Julie on 9/05/02 at 15:58 (094535)

Mark

Ah. That explains it. A midnight owl. I'm glad you've found your way here thanks to the good Dr Ed, and am glad you will be looking in. Your expertise is needed.