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orthotics

Posted by Sandy W on 12/22/02 at 21:02 (103805)

why when companies make orthotics do they flatten the latteral side
yet mold the medial side to the foot? I have shorten fourth and fifth
metatarsal heads that do not stop the latteral roll enough when placed
in an orthotic. and I can't seem to get anyone to mold the latteral side
of the orthotic to my foot and it's also flat in between the medial and
lateral arch and i know from experience and casting myself that my foot
is not flat. I have severe PF going on three years that seems to get
worse with every new orthotic that I try.
Anyone?

Re: orthotics

Carole C in NOLA on 12/23/02 at 07:02 (103826)

The lateral side of my custom soft orthotics is not flattened. It curls upwards but just isn't built up like the medial side. The orthotic holds my foot in place from every angle and straightens out my gait.

I've forgotten; were your orthotics made by a C.Ped.? If not, you might want to go to the best C.Ped you can find. They may be able to straighten out that lateral roll through some type of C.Ped 'magic'.

Carole C

Re: orthotics

Richard, C.Ped on 12/23/02 at 08:06 (103828)

There is really no magic in making an orthosis the correct way. The tricky thing is, no two feet are the same, so the orthosis can not be made the exact same way for everyone. Ours is made with a lateral wall that tapers down as it reaches the fifth met head.

I would love to see a picture of your orthosis if you are able to post one.
Richard

Re: orthotics

Mar on 12/23/02 at 11:36 (103846)

Sandy -

I notice that when I wear my birks the ball of foot pain and metatarsal head pain is much less. My pod is currently trying to have another pair of orthotics made with the front like a birk front -- like a little shelf for the toes. I've been waiting 7 weeks so far, but we'll see. I too have severe bilateral PF. Good luck -- Mar

Re: orthotics

Sandy W on 12/23/02 at 22:06 (103876)

all orthosis are made tapering the lateral arch down to the fifth metataral and that's where the problem lies. when the medial arch is
applied, it causes my foot to roll to the lateral side where there is no
arch support causing a great deal of pain under my fifth metatarsal head.
and also causes burning under the fourth metatarsal head therefore creating
a posible neuroma.

Re: orthotics

Sandy W on 12/23/02 at 22:13 (103877)

I went to a podiatrist, & a orthopedic surgeon who was more interested in
prescribing the newest shock treatment and didn't beleive me when I told
him my foot rolled out to far with the standard orthotic. and wrote the
priscription simply for 'Orthotics in neutral position. so I had them
made twice because the orthotist didn't know what to do with me either.
what is a c.ped? The first time I had orthotics they were perfect
but when they wore out i threw them out, thinking they could be duplicated.
and have been in hell ever since.

Re: orthotics

Sandy W on 12/23/02 at 22:16 (103878)

I don't have ball of foot pain except when I wear an orthotic. then i have
all sorts of ball of foot problems. I wear birkenstocks too.

Re: orthotics

Mar on 12/24/02 at 08:24 (103895)

This ball of foot pain is very intersting. My right foot ball pain started after wearing a surgical shoe for 2 weeks in Nov 2000. After I stopped the shoe, it took about a month for the pain to go away (I'm talking debilitating pain.) I wore a surgical shoe again in May 2001 for 2 weeks after a minor surgery to remove undissolved stitches from bunion surgery. The ball of foot pain started again (couldn;t put full weight on it) after removing the surgical shoe and it is now chronic, always there and the more i walk the more debilitating it gets. The left foot: In August 2001 I started wearing orthotics and the 4th metatarsal started to hurt a little. Stopped the orthotics and kept having them adjusted, got new ones, etc. that pain was always there, minor though. Just wore a surgical shoe for 5 days and then a cam walker for 5 days -- the left ball of foot pain and 4th metatarsal is horrible! Hope it is not chronic now too. Birks are the only thing that help a little. the orthotics seem to place more pressure on the ball of foot. Hope those birklike orthotics come in soon. Mar

Re: orthotics

Mar on 12/24/02 at 08:25 (103896)

Yes, what exactly is a pedorthist? Makes orthotics?? Mar

Re: orthotics

Richard, C.Ped on 12/24/02 at 09:05 (103905)

I don't think that is necessarily the problem. I am wondering if the heel cup is very low causing no cradle for the heel.

What is your foot type? Pes planus? Pes cavus? Does the fifth met head have a callous? What type of orthosis do you have now? Hard plastic that stops at the met heads?
Richard,C.Ped

Re: orthotics

Carole C in NOLA on 12/24/02 at 09:22 (103906)

A C.Ped is a Certified Pedorthist, and a good C.Ped is an expert at making custom orthotics. It might be worth getting another such prescription and then seeking out the best C.Ped you can find, unless that is what you already did.

Carole C

Re: orthotics

Carole C in NOLA on 12/24/02 at 09:26 (103912)

A pedorthist is someone who makes orthotics according to a prescription from a foot doctor. A C.Ped is a certified pedorthist, which means he has to have had training to get certified. My C.Ped did a wonderful job with my orthotics.

Carole C

Re: orthotics

Dr. Z on 12/24/02 at 13:18 (103920)

Richard's comment about not a proper heel cup portion of the orthosis is one of the first things to take a look at. They have to take a look at your present shoes. This could be as simple as adjusting the orthosis to fit the shoe may be too much over correction past neutral. The orthosis could be too long too short. Need Richard to take a look. Why were the orthosis make in the first place.? plantar fasciitis? . Is there pain at the insertion of the heel. Why did the doctor want to go to ESWT without trying other types of treatments first. I do love ESWT but only for chronic INSERTIONAL plantar fasciitis. Give us additinal history etc of your foot pain

Re: orthotics

Sandy W on 12/24/02 at 22:24 (103952)

I have a pes cavus foot and no my fifth metatarsal does not have a callus
I've never beared weight on my fourth or fifth metatarsal in my life.
my weight bearing has always been on my first three metatarsal heads
I have one pair of hard plastic and one pair of EVA and yes they stop at the met heads the EVA orthotic is molded better under the fifth
metatarsal head and the arch seems good but it still causes me a great deal of heal pain and i can't wear them with any biomechanically correct
shoe (ie new balance) because the lateral pull is too much and causes a
great deal of heal pain and metatarsal pain. I've been to the orthotist
many times in the last 6 month's for this and finally they just told me
to go away. I can't seem to convey this to anyone I see. I've had 10
custom orthotics made over the last 3 years and they all do this. I'm
fed up!

Re: orthotics

Sandy W on 12/24/02 at 22:26 (103953)

I can't find a c-ped in this county. I tried finding one after reading
several messages on this board about how good they are, but unfortunately
we are bombarded by podiatrists and orthotists who don't know what they
are doing.

Re: orthotics

Sandy W on 12/24/02 at 22:40 (103954)

yes I have bilateral plantar fasciitis. Pain at the insersion of the heel?
I've had PF for five years, three years without successful treatment. first
the doctor recommeded heel cups and other over the counter crap when I told
him that I had tried all of that , and would like custom orthotics , he
recommeded the ESWT claiming that it would help heel the area. If I cant't correct my gait then the ESWT won't do me much good because I will
definately tear the fascial again because my metatarsal heads do not function well in controling pronation or supination. I have allways pronated but have never needed orthotics until 5 years ago , when I bought
the wrong shoe and wore it too long and gained alot of weight. My first
pear of orthotics worked really well and the lab molded them to the exact
shape of my foot with no tapering or altering and they were EVA material.
they took the stress off of my heels and metatarsal heads and put more
stress under the arch area of my foot.

Re: orthotics

Julie on 12/25/02 at 01:21 (103957)

Sandy, which county/country? You know there are good C.Peds around, and in your shoes, with your desperate need, I would be making a journey to see one. Why don't you get on a plane to North Carolina and see Richard?

Re: orthotics

Dr. Z on 12/25/02 at 11:01 (103974)

What I meant was does the pain in your plantar fascia only hurt where the plantar fascia attaches into the bottom of your heel. If is very important as Richard has pointed out to make sure the calcaneus is in proper alignment and or deep enought to holdl the calcanues. In a high arhc foot. you could have a tight achilles tendon which has to be address with a heel lift and or stretching. The metatarsal bones don't control pronation in the gait control. Why you only are placing weight on the middle three metatarsal bones and not all five needs to be addressed also. The range of motion of your foot joints is very important.

You need someone with experence . Where do you live?

Re: orthotics

Sandy W on 12/26/02 at 15:19 (104042)

I'm in Melbourne, Florida. My mistake, I thought metatarsal heads had something to do with controling pronation. When I wear metatarsal pad I
don't seem to pronate as much. I have noticed when I stretch
that my calves are very tight. My fourth toe sits on top of my foot on
my right foot it does not touch the ground. If you were to look at the
bottom of my foot it would look like I have four toes instead of five.
My fifth metatarsal just doesn't work. I have tried wearing New Balance
and tore my lateral arch.

Re: orthotics

Sandy W on 12/26/02 at 15:21 (104043)

I live in florida, brevard county. and in my local phone book there are no c-peds.

Re: orthotics

Julie on 12/26/02 at 17:06 (104053)

See my earlier post. I suggest you consider travelling to see a reputable C.Ped. If your first orthotics worked for you, there is an orthotic out there that will work for you again. You need to find someone who can assess you properly, and make it properly. I would consider it worth a journey.

Re: orthotics

Richard, C.Ped on 12/27/02 at 08:01 (104088)

Sorry for my late response...I am an idiot because I did not notice the response..haha.

I can really feel your frustration. This is what I have done in the past with someone with pes cavus feet that felt like the arch support was causing them to roll even more into supination. I noticed that with the plain straight forward orthosis, they were not in a neutral position. It was obvious that they were having excessive supination. I simply added a lateral wedge to both orthotics which helped position their feet in a more sub talor neutral position. I honestly do not think I have ever had a problem with that modification. The people that I did this for all said it solved their problem.

Just a thought.
Richard

Re: orthotics

Richard, C.Ped on 12/27/02 at 08:03 (104089)

Sandy...go here: http://www.pedorthics.org/framed11.html

You can type in your zip code and it will locate a C.Ped near you.

If not...well come on up to beautiful South Carolina and I will be glad to help you out. ;-)

Richard

Re: orthotics

Sandy W on 12/27/02 at 15:19 (104116)

yeah, I saw earlier posts where your web site was on it and found one.
I must say that was brilliant! I've been looking for one for quite some
time and could never find one until I reached your website. Thank you
for that tool.

Re: orthotics

Sandy W on 12/27/02 at 15:22 (104117)

did you add the lateral wedge at the heel? I may try that. It certainly
can't hurt.

Re: orthotics

Richard, C.Ped on 12/28/02 at 09:05 (104160)

I started the wedge at the heel and extended it to the fifth met head.
Richard

Re: orthotics

Richard, C.Ped on 12/28/02 at 09:06 (104161)

You are very welcome!!! Good luck!
Richard

Re: orthotics

TC on 1/01/03 at 23:03 (104522)

My prescription orthodic was made with layers of specialized foam which were heated in a microwave, then allowed to cool with my ankle held straight and my weieght on that foot. There's a photo at:
http://home.attbi.com/~tim47/orthodic.jpg
I don't know if this type is appropriate for anyone else's problems or not, but it holds my heel up the few degrees I need since breaking my heel. I was told that for any more 'tilt' a 'hard' orthodic would be required.

Re: orthotics

nancy s. on 1/01/03 at 23:21 (104523)

tc's orthotic looks kind of interesting to me. richard and/or bg, do you have any thoughts?

nancy
.

Re: orthotics

Richard, C.Ped on 1/06/03 at 09:33 (104950)

What is that...the bottom of the orthotic??? My computer screen is not the best, so I can't really tell what that is. It almost looks like a UCBL type orthosis. Does it come up or over your ankle?
Richard

Re: orthotics

TC on 1/08/03 at 23:54 (105141)

The orthodic I mentioned in the post above is an insert that goes into the bottom of the shoe only. I have another picture at http://home.attbi.com/~tim47/orthodic2.jpg (They are the same size, the one in back is simply further away in the picture.)

Re: orthotics

Carole C in NOLA on 12/23/02 at 07:02 (103826)

The lateral side of my custom soft orthotics is not flattened. It curls upwards but just isn't built up like the medial side. The orthotic holds my foot in place from every angle and straightens out my gait.

I've forgotten; were your orthotics made by a C.Ped.? If not, you might want to go to the best C.Ped you can find. They may be able to straighten out that lateral roll through some type of C.Ped 'magic'.

Carole C

Re: orthotics

Richard, C.Ped on 12/23/02 at 08:06 (103828)

There is really no magic in making an orthosis the correct way. The tricky thing is, no two feet are the same, so the orthosis can not be made the exact same way for everyone. Ours is made with a lateral wall that tapers down as it reaches the fifth met head.

I would love to see a picture of your orthosis if you are able to post one.
Richard

Re: orthotics

Mar on 12/23/02 at 11:36 (103846)

Sandy -

I notice that when I wear my birks the ball of foot pain and metatarsal head pain is much less. My pod is currently trying to have another pair of orthotics made with the front like a birk front -- like a little shelf for the toes. I've been waiting 7 weeks so far, but we'll see. I too have severe bilateral PF. Good luck -- Mar

Re: orthotics

Sandy W on 12/23/02 at 22:06 (103876)

all orthosis are made tapering the lateral arch down to the fifth metataral and that's where the problem lies. when the medial arch is
applied, it causes my foot to roll to the lateral side where there is no
arch support causing a great deal of pain under my fifth metatarsal head.
and also causes burning under the fourth metatarsal head therefore creating
a posible neuroma.

Re: orthotics

Sandy W on 12/23/02 at 22:13 (103877)

I went to a podiatrist, & a orthopedic surgeon who was more interested in
prescribing the newest shock treatment and didn't beleive me when I told
him my foot rolled out to far with the standard orthotic. and wrote the
priscription simply for 'Orthotics in neutral position. so I had them
made twice because the orthotist didn't know what to do with me either.
what is a c.ped? The first time I had orthotics they were perfect
but when they wore out i threw them out, thinking they could be duplicated.
and have been in hell ever since.

Re: orthotics

Sandy W on 12/23/02 at 22:16 (103878)

I don't have ball of foot pain except when I wear an orthotic. then i have
all sorts of ball of foot problems. I wear birkenstocks too.

Re: orthotics

Mar on 12/24/02 at 08:24 (103895)

This ball of foot pain is very intersting. My right foot ball pain started after wearing a surgical shoe for 2 weeks in Nov 2000. After I stopped the shoe, it took about a month for the pain to go away (I'm talking debilitating pain.) I wore a surgical shoe again in May 2001 for 2 weeks after a minor surgery to remove undissolved stitches from bunion surgery. The ball of foot pain started again (couldn;t put full weight on it) after removing the surgical shoe and it is now chronic, always there and the more i walk the more debilitating it gets. The left foot: In August 2001 I started wearing orthotics and the 4th metatarsal started to hurt a little. Stopped the orthotics and kept having them adjusted, got new ones, etc. that pain was always there, minor though. Just wore a surgical shoe for 5 days and then a cam walker for 5 days -- the left ball of foot pain and 4th metatarsal is horrible! Hope it is not chronic now too. Birks are the only thing that help a little. the orthotics seem to place more pressure on the ball of foot. Hope those birklike orthotics come in soon. Mar

Re: orthotics

Mar on 12/24/02 at 08:25 (103896)

Yes, what exactly is a pedorthist? Makes orthotics?? Mar

Re: orthotics

Richard, C.Ped on 12/24/02 at 09:05 (103905)

I don't think that is necessarily the problem. I am wondering if the heel cup is very low causing no cradle for the heel.

What is your foot type? Pes planus? Pes cavus? Does the fifth met head have a callous? What type of orthosis do you have now? Hard plastic that stops at the met heads?
Richard,C.Ped

Re: orthotics

Carole C in NOLA on 12/24/02 at 09:22 (103906)

A C.Ped is a Certified Pedorthist, and a good C.Ped is an expert at making custom orthotics. It might be worth getting another such prescription and then seeking out the best C.Ped you can find, unless that is what you already did.

Carole C

Re: orthotics

Carole C in NOLA on 12/24/02 at 09:26 (103912)

A pedorthist is someone who makes orthotics according to a prescription from a foot doctor. A C.Ped is a certified pedorthist, which means he has to have had training to get certified. My C.Ped did a wonderful job with my orthotics.

Carole C

Re: orthotics

Dr. Z on 12/24/02 at 13:18 (103920)

Richard's comment about not a proper heel cup portion of the orthosis is one of the first things to take a look at. They have to take a look at your present shoes. This could be as simple as adjusting the orthosis to fit the shoe may be too much over correction past neutral. The orthosis could be too long too short. Need Richard to take a look. Why were the orthosis make in the first place.? plantar fasciitis? . Is there pain at the insertion of the heel. Why did the doctor want to go to ESWT without trying other types of treatments first. I do love ESWT but only for chronic INSERTIONAL plantar fasciitis. Give us additinal history etc of your foot pain

Re: orthotics

Sandy W on 12/24/02 at 22:24 (103952)

I have a pes cavus foot and no my fifth metatarsal does not have a callus
I've never beared weight on my fourth or fifth metatarsal in my life.
my weight bearing has always been on my first three metatarsal heads
I have one pair of hard plastic and one pair of EVA and yes they stop at the met heads the EVA orthotic is molded better under the fifth
metatarsal head and the arch seems good but it still causes me a great deal of heal pain and i can't wear them with any biomechanically correct
shoe (ie new balance) because the lateral pull is too much and causes a
great deal of heal pain and metatarsal pain. I've been to the orthotist
many times in the last 6 month's for this and finally they just told me
to go away. I can't seem to convey this to anyone I see. I've had 10
custom orthotics made over the last 3 years and they all do this. I'm
fed up!

Re: orthotics

Sandy W on 12/24/02 at 22:26 (103953)

I can't find a c-ped in this county. I tried finding one after reading
several messages on this board about how good they are, but unfortunately
we are bombarded by podiatrists and orthotists who don't know what they
are doing.

Re: orthotics

Sandy W on 12/24/02 at 22:40 (103954)

yes I have bilateral plantar fasciitis. Pain at the insersion of the heel?
I've had PF for five years, three years without successful treatment. first
the doctor recommeded heel cups and other over the counter crap when I told
him that I had tried all of that , and would like custom orthotics , he
recommeded the ESWT claiming that it would help heel the area. If I cant't correct my gait then the ESWT won't do me much good because I will
definately tear the fascial again because my metatarsal heads do not function well in controling pronation or supination. I have allways pronated but have never needed orthotics until 5 years ago , when I bought
the wrong shoe and wore it too long and gained alot of weight. My first
pear of orthotics worked really well and the lab molded them to the exact
shape of my foot with no tapering or altering and they were EVA material.
they took the stress off of my heels and metatarsal heads and put more
stress under the arch area of my foot.

Re: orthotics

Julie on 12/25/02 at 01:21 (103957)

Sandy, which county/country? You know there are good C.Peds around, and in your shoes, with your desperate need, I would be making a journey to see one. Why don't you get on a plane to North Carolina and see Richard?

Re: orthotics

Dr. Z on 12/25/02 at 11:01 (103974)

What I meant was does the pain in your plantar fascia only hurt where the plantar fascia attaches into the bottom of your heel. If is very important as Richard has pointed out to make sure the calcaneus is in proper alignment and or deep enought to holdl the calcanues. In a high arhc foot. you could have a tight achilles tendon which has to be address with a heel lift and or stretching. The metatarsal bones don't control pronation in the gait control. Why you only are placing weight on the middle three metatarsal bones and not all five needs to be addressed also. The range of motion of your foot joints is very important.

You need someone with experence . Where do you live?

Re: orthotics

Sandy W on 12/26/02 at 15:19 (104042)

I'm in Melbourne, Florida. My mistake, I thought metatarsal heads had something to do with controling pronation. When I wear metatarsal pad I
don't seem to pronate as much. I have noticed when I stretch
that my calves are very tight. My fourth toe sits on top of my foot on
my right foot it does not touch the ground. If you were to look at the
bottom of my foot it would look like I have four toes instead of five.
My fifth metatarsal just doesn't work. I have tried wearing New Balance
and tore my lateral arch.

Re: orthotics

Sandy W on 12/26/02 at 15:21 (104043)

I live in florida, brevard county. and in my local phone book there are no c-peds.

Re: orthotics

Julie on 12/26/02 at 17:06 (104053)

See my earlier post. I suggest you consider travelling to see a reputable C.Ped. If your first orthotics worked for you, there is an orthotic out there that will work for you again. You need to find someone who can assess you properly, and make it properly. I would consider it worth a journey.

Re: orthotics

Richard, C.Ped on 12/27/02 at 08:01 (104088)

Sorry for my late response...I am an idiot because I did not notice the response..haha.

I can really feel your frustration. This is what I have done in the past with someone with pes cavus feet that felt like the arch support was causing them to roll even more into supination. I noticed that with the plain straight forward orthosis, they were not in a neutral position. It was obvious that they were having excessive supination. I simply added a lateral wedge to both orthotics which helped position their feet in a more sub talor neutral position. I honestly do not think I have ever had a problem with that modification. The people that I did this for all said it solved their problem.

Just a thought.
Richard

Re: orthotics

Richard, C.Ped on 12/27/02 at 08:03 (104089)

Sandy...go here: http://www.pedorthics.org/framed11.html

You can type in your zip code and it will locate a C.Ped near you.

If not...well come on up to beautiful South Carolina and I will be glad to help you out. ;-)

Richard

Re: orthotics

Sandy W on 12/27/02 at 15:19 (104116)

yeah, I saw earlier posts where your web site was on it and found one.
I must say that was brilliant! I've been looking for one for quite some
time and could never find one until I reached your website. Thank you
for that tool.

Re: orthotics

Sandy W on 12/27/02 at 15:22 (104117)

did you add the lateral wedge at the heel? I may try that. It certainly
can't hurt.

Re: orthotics

Richard, C.Ped on 12/28/02 at 09:05 (104160)

I started the wedge at the heel and extended it to the fifth met head.
Richard

Re: orthotics

Richard, C.Ped on 12/28/02 at 09:06 (104161)

You are very welcome!!! Good luck!
Richard

Re: orthotics

TC on 1/01/03 at 23:03 (104522)

My prescription orthodic was made with layers of specialized foam which were heated in a microwave, then allowed to cool with my ankle held straight and my weieght on that foot. There's a photo at:
http://home.attbi.com/~tim47/orthodic.jpg
I don't know if this type is appropriate for anyone else's problems or not, but it holds my heel up the few degrees I need since breaking my heel. I was told that for any more 'tilt' a 'hard' orthodic would be required.

Re: orthotics

nancy s. on 1/01/03 at 23:21 (104523)

tc's orthotic looks kind of interesting to me. richard and/or bg, do you have any thoughts?

nancy
.

Re: orthotics

Richard, C.Ped on 1/06/03 at 09:33 (104950)

What is that...the bottom of the orthotic??? My computer screen is not the best, so I can't really tell what that is. It almost looks like a UCBL type orthosis. Does it come up or over your ankle?
Richard

Re: orthotics

TC on 1/08/03 at 23:54 (105141)

The orthodic I mentioned in the post above is an insert that goes into the bottom of the shoe only. I have another picture at http://home.attbi.com/~tim47/orthodic2.jpg (They are the same size, the one in back is simply further away in the picture.)