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who is best trained to make inserts/orthotics

Posted by Angela S on 2/25/03 at 16:45 (110736)

I'm not sure who I should go to for some kind of insert that will help Tarsel Tunnel Syndrome.
In NC it seems a Podiatrist must write a perscription for orthotics, and I've learned they don't always know what's best.
The only others I know that make othotics are Chiropractors and mine doesn't know what would work.
Is there a difference between an insert and an orthotic?
Thanks for the education,

Re: who is best trained to make inserts/orthotics

BGCPed on 2/25/03 at 20:16 (110767)

Generally I would not use a Chiro for orthotics unless they are very skilled at them. Many Chiros use a brand called Foot Levelers and I am not too impressed with them. They lack much control and have little heel cup.

I would seek out a podiatrist that knows his stuff or a C.Ped. Peds make them all day long usually in their own lab. They also will be versed in proper footwear. Check around with a few sports teams and Dr to see if you get a common name that pops up

Re: who is best trained to make inserts/orthotics

Richard, C.Ped on 2/26/03 at 13:36 (110867)

Hi Angela,
I am in Columbia, South Carolina...howdy neighbor. I prefer to work by prescripton. This first keeps from seeming like I am diagnosing a problem and also allows me to run the orthtoics through insurance to see if they will pay.

A good DPM or sports medicine doc is a good start. Or, if you are close, I would be glad to take a look at you and point you in the right direction.

Richard, C.Ped

Re: who is best trained to make inserts/orthotics

Concerned Practitioner on 2/26/03 at 22:20 (110939)

As a CPed., your education is very simple and short, you are not allowed to diagnose and must confirm all work or Rx orders with the doctor. I do not think that your opinions of a profession, such as chiropractic is a fair assessment. Chiropractors are medically trained and not in 3 weeks. Also to imply that you are paralled with a Podiatrist or in the same scope is absurd, people write mail to obtain correct information, which this site offers in many areas except in your petty comments section,

Re: who is best trained to make inserts/orthotics

BGCPed on 2/27/03 at 06:27 (110952)

Well concerned, I felt that was an honest and fair assesment on my part. I do appreciate your input but I stand by my statement. I assume you have a Chiro background? I was not slamming them or any other but I didn state fact. Chiros use, often times footlevelers, that are a sandwich construction meaning a bottom layer has pieces placed on it then a layer to cover it. Think of a sandwich with lettuce and a piece of meet. Should you care to debate the funtion or lack thereof I would be glad to.

You are correct I dont make a DX but what I do is make over 110 orthotics per month, myself from start to finish. I work with one of the best and most respected Chiropractors in my area. We have a great dialog and guess what? He just sent his daughter to me for fo and he wanted to talk about some foot issues and ways of correcting them.

I did not try to compare CPed to Pods, how you came to the one I am mystified. I will say that there are CPeds that must have slept through most of the day and make junk. I will also say that I have seen things from Pods that are also junk. Meaning that there are good and bad in all. Hence the reason I told this person to ask around and gave other sound advice.

I dont adverticse. I have a referral source that is vast. One Orthopod sends about 3 patients a week from a 3 hour drive away. My 2 main sources are the two busiest fellowship trained foot and ankle guys in the area. I do work for 2 major college athletic departments. Several pro sports teams. A team Doc for the us gymnastic team. I have a patent pending on a foot orthotic. Co-wrote a paper published in BioMechanics Magazine,was one of the greatest number of pages ever.

I get about 4 to 7 pt a week that have a bag full of shoes and a bag full of orthotics, there is a reason for that. If I didnt know what I was doing I wouldnt be so busy that on most days I dont get more than 10 minute break to eat lunch. I have been making orthotics since 1984. I took the board exam in 1994. I got, I think,6 questions wrong and finished it an hour early. I would submit to you I have casted, made, fit and fabricated many more devices than any person you know, yourself included ( it is hard to say for sure when you hide behind a new handle)

As I said I would be happy to debate you on any aspect of lower extremity biomechanics/foot orthotics. I was not slamming or comparing myself to anyone. I was just answering an honest question with an honest answer. If you would like to read other gems from me that may make you get even more tourqed at me, go to the social board (I bet thats where you came from, but we wont tell anyone)
p.s. That was a nice touch not introducing yourself with the old 'I AM NEW HERE, NORMALLY I LURK. I JUST HAD TO RESPOND TO THIS'

p.p.s. Since I only have 3 weeks of training how, long do you think it would take for you to teach me how to do the Alzner test from the infomercials?p.p.p.s. naner-naner-naner

Re: who is best trained to make inserts/orthotics

Richard, C.Ped on 2/27/03 at 09:57 (110976)

I have to agree with you Brian. Granted, our training is only three weeks...most of which could be so much more informative. I have also learned the vast majority of what I know due to experience. I have not been practicing as long as Brian, due to the fact he is sooooooooo much older than me...haha, but I think I am pretty damn good at what I do.

With any profession, you have good people who do good honest work. You also have idiots who do crappy dishonest work. I have seen it. Brian has seen it. I am pretty darn sure you have seen it.

No, we are not able to diagnose conditions, but that does not mean we are stupid idiots that do not know what the hell we are doing (well...again, some are). You would not believe how many physicians do not know what to do with an orthosis. That, in my opinion, is where the C.Ped comes into play. We know what to do. If you know what to do too...great..I am very happy for you. The many, many, many (did I mention many??) physicians and sports teams I work with, trust me to provide the proper device for that specific person. That is what I do. That is what I love and enjoy doing.

I am not a fan of foot levelers either. I am not just jumping on these guys...anyone who has read my stuff here knows how I feel about other stuff too. Why they do what they do is beyond me. My pet peeve the most in this business is that a proper functional orthosis is not hard to make. It really isn't. I hate that people are 'trying to make a better mousetrap' with what they provide.

Do not think that Brian was getting on your case specifically. Again, there are good chiros, dpms, sports docs, cpeds, and so on all over. With that, you also have quack chiros, dpms, sports docs, cpeds and so on.

Brian...I need to meet you one day. With all that business...you can buy lunch..haha
Richard, C.Ped and proud of it

I have never met Brian, but he sounds like he works the same as me. We do honest work. We do not try to push a POS product on someone if they do not need it.

Re: who is best trained to make inserts/orthotics

BGCPed on 2/27/03 at 11:04 (110983)

No prob Richard. Ill buy lunch and you can cover the travel expense down there. Dont let this concerned person get to you. In retrospect I highly doubt this poster is even a 'paractitioner' in the biomech field. I think it was just a person that has an axe to grind. That is also ok by me. Sometimes it is better to let some people run their mouth rather than silence them. I do wish concerned would give us an update on their background

Re: who is best trained to make inserts/orthotics

Ed Davis, DPM on 2/27/03 at 14:41 (111017)


Tarsal tunnel syndrome is often not improved by orthotics so the first question you may consider is the reason you are seeking that modality.
If there is significant overpronation (foot rolling in), that can lead to stretch or tesnion on the laciniate ligament, the ligament which forms the roof of the tarsal tunnel, then orthotics can help. Has it been established that that is your situation?


BGCPed on 2/28/03 at 14:52 (111187)

Concerned, where are you? I thought you would at least post a follow up of some sort. Maybe you are busy preparing your CV for posting

Re: who is best trained to make inserts/orthotics

Ed Davis, DPM on 3/01/03 at 12:32 (111283)

Don't you love these anonymous posters. They can say just about anything if they don't reveal who they are. Occasionally we get an 'insider' like Bill on the ESWT board. See my recent discussion with Pauline on Bill. Readers need to question the credibility of any anaonymous poster who attempts to sound authoritative. As professionals we feel an obligation to set innaccuracies straight: protectors of information integrity (not necessarily critiques of opinion) has become a volunteer job for us here.

Re: who is best trained to make inserts/orthotics

BGCPed on 3/01/03 at 13:36 (111298)

I hear you. I bet 'concerned' is not even a practitioner but most probable a person with an axe to grind. I could be wrong, perhaps they are preparing their line of questioning to prove how correct they were. Usually when people fake a name to do hit and run posting it only proves how silly they are. If they were confident in the assesment they would be proud to use their regular name.

concerned post x silence = stupidity

Re: who is best trained to make inserts/orthotics

Angela S on 3/01/03 at 19:13 (111328)

Okay, I am showing my ignorance now. What does C. Ped stand for and also DPM?
Columbia is a couple hours from me but I would love to talk to someone who knows something.
My podiastrist only likes rigid orthodics. I can't wear those.
My physician is also a Sports med. Doc and he just said, sometimes they work sometimes they don't.
I talked to one place that makes orthotics. He said he hasn't heard to Tarsal Tunnel in 22 years of working. Seems with Tarsal Tunnel one would want something different than what is needed for P.F.
Anyway thanks for the offer. Perhaps I could call you to ask more questions?

Re: who is best trained to make inserts/orthotics

Angela S on 3/01/03 at 19:36 (111336)

Hi Ed,
I am told there is some overpronation. But the Podiatrist didn't say (or know?) what he thought was causing it. He felt that since 2 sets of shots, rigid generic orthodics, and anti-inflammitories for 2 months did not work that surgery was the only option.
I am searching for other options.
I spent a lot of time on ladders this last year. Perhaps that aggravated it. I have had mild pain for some years now. Though before it was usually just on the inside of the ankle and the back of the heel. Now it is also the bottom of both feet.
A NVC test did not show any problem with the nerves.
Thank you for your thoughts, and question. I can use the help!

Re: who is best trained to make inserts/orthotics

BGCPed on 3/01/03 at 20:25 (111339)

May I ask what type of footwaer you have been in most of this time? brand, type etc. I am not trying to make a dx here but that wide range of syptoms and pain zones seems a bit vast to be just tts. A ladder can irritate the pf and foot in general especially if you wear softer flexible shoes. What type of footwear lecture did you get when your Pod gave you the orthotics?

Re: who is best trained to make inserts/orthotics

Angela S on 3/01/03 at 21:39 (111345)

Hi Brain, Please ask away! I am at a loss as to waht to do next.
I spent most of my leisure time in summer wearing Clark sandles, except when I took walks (a lot) or worked on the ladder. Then I wore Easy Spirit Walking or perhaps they were running shoes. For awhile I wore Carolina brand work boots and Ecco hiking boots but only for a couple days a week.
For about a year I used a generic orthotic by Birkinstock in my gym shoes.
A C.Ped, (I'm learning ;-) added 'height' on the outside heel part of the orthotics. That seemed to work for a year but then started hurting.
My shoes show wear on the outer side of the heels.
In the winter I wear Uggs sheepskin boots which have no arch. I mostly like flat shoes :-P
My podiatrist did not have any recommendations when I asked about shoes. I said that I couldn't find any that didn't hurt, (I must of tried about 100 pairs.) He said to wear what ever hurt the least.
Well now that I have written a book about it, I'll stop!
Thank you, Angela

Re: who is best trained to make inserts/orthotics

BGCPed on 3/01/03 at 23:18 (111347)

All of your shoe choices are of the soft type. Ecco are ok for some feet but many people think since they cost so much they are the best. They have a durable latex sole but it is also too flexible for many foot conditions.

I also dont care for any easy spirit shoe. They are marketed for how light and soft they are, as such they offer lame support.

Your Pod just said wear what feels best is a bad response. It may seem obvious but it is their job to tell you what footwear is best suited to your foot type

The added lift on the outside heel puzzles me. If that is where it was located that is a very odd place to put posting (lift) for several reasons. The outside border of shoe is normal for wear. If you look at the heel from behind about 60 % of the mass of the heel is located outside of centerline, meaning the outside hits first and bears more wt (in normal to average foot)

Unless you have a rather unique foot it is rare to put lateral post undr heel. I would try to buy a good solid running shoe or a decent pair of merril or similar hiking shoes. They have a firm midsole or shank that limits foot motion and the soft tissue pulling that can make feet hurt

Re: who is best trained to make inserts/orthotics, Z-coil shoes

Ed Davis, DPM on 3/02/03 at 11:20 (111384)

Good line of questions. Many orthotics can be so poorly suited to deal with forces coming from bottom to top.

By the way, talking of ladders, I need to issue a warning. I bought a pair of the Z-coil shoes out of curiosity and wear them from time to time.
I was on a ladder with them yesterday and WATCH OUT! The spring mechanism gets caught on the ladder rungs and can be hard to extricate when caught. Could be very dangerous on ladders.

Re: who is best trained to make inserts/orthotics, Z-coil shoes

BGCPed on 3/02/03 at 11:50 (111400)

z-coil and ladder, sounds like a 2 for 1 for the ambbulance chasers. Did the shoe come with a warning sticker? sure you didnt fall? sure you arent scared of ladders now? sure you dont need some counseling?

Re: orthotics/good shoes

Angela S on 3/02/03 at 15:35 (111454)

Hi Brain,
After you wrote about the heel lift I had to check mine. The lift is on the inside, not the outside of the heel, woops. But are you saying it's strange to put a lift on the heel at all?
About the pod. saying wear whatever, I agree that that was a poor answer. Especially realized it after I wrote it. I need another Podiatrist's opinion. More $$$$ oh well!
Thanks for the shoe info. It's just that anything harder then jello rubbing on my feet hurts!
Also doesn't the tibial nerve run down the back of the leg to the inside of the ankle and under the foot? Guess that is why I thought my pain symptoms 'fit' the diagnosis of T.T.

Re: orthotics/good shoes

Angela S on 3/02/03 at 15:37 (111456)

B-R-I-A-N-there! I am determined to type Brain. Well maybe you are one :-)

Re: orthotics/good shoes

BGCPed on 3/02/03 at 16:19 (111463)

Thanks for the compliment. It is not strange to have correction or post under heel. It is strange to have it on the outside of heel since that is not very common. Look for a specialty running shoe or pedorthic clinic in your area to evaluate and provide proper shoes

Re: who is best trained to make inserts/orthotics

Richard, C.Ped on 3/03/03 at 08:37 (111556)

Hi Angela. Please feel free to call me..or to save a little money, I will be happy to call you. My number here is 803-407-9195. If you want me to contact you, feel free to email your number to (email removed). I have been known to travel to NC, GA and Florida to see new patients.

PS...Thanx a heck of alot for giving the Brian a bigger head with the 'brain' comment. Geeze...just what we needed. LOL!!!! JK Brian!!!!


Richard, C.Ped on 3/03/03 at 08:51 (111558)

Concerned...please help me with something. I would like to know the pharmacokinetics of Cefamandole Nafate -vs- Ceftriaxone.

Re: who is best trained to make inserts/orthotics

Angela S on 3/04/03 at 20:30 (111819)

Hi Richard, Okay got the number. I'll call you as I have unlimited calling.
It may be a few days. Thanks! Angela

Re: who is best trained to make inserts/orthotics

Richard, C.Ped on 3/05/03 at 11:57 (111866)

You are very welcome ;-)