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Happier without orthotics

Posted by peter f on 3/07/03 at 03:13 (112089)

after 2.5 yrs of pf (high arch) and countless orthotics custom and off shelf I have finally accepted the fact that my feet are more comfortable in normal shoes with flat but firm soft inserts with no arch (arch ALWAYSaggravates my medial calcaneus)-the shoes have a slight inbuilt arch like most shoes

DOES IT REALLY MATTER ? DOES EVERYBODY NEED ARCH SUPORTS ?-my pf was caused by sudden overuse in squash for a year after 34 yrs of no problems

Re: Happier without orthotics

BGCPed on 3/07/03 at 07:04 (112091)

Yurs is a common problem with orthotics/high arch. I would say if you are symptom free and it doesnt come back then you are ok without them

Re: Happier without orthotics

eileenc on 3/07/03 at 08:35 (112100)

What flat firm inserts do you use?

Re: Happier without orthotics

peter f on 3/07/03 at 08:53 (112102)


Re: Happier without orthotics

peter f on 3/07/03 at 08:54 (112103)

I have sponge insoles with leather tops which are part of the shoe and put flat 2mm thich green spencos on top of those for comfort

Re: Happier without orthotics

Richard, C.Ped on 3/07/03 at 09:35 (112109)

If you seem better without them...thats wonderful. Orthotics are not for everyone.

We see alot of sports teams that wear orthothics..not to heal foot pain, but to give them a better purchase to the ground. It helps with their stability.

Re: arch supports vs. orthotics

Ed Davis, DPM on 3/07/03 at 18:13 (112181)


I don't know if you have a need for biomechanical control or not. Arch supports are not exactly the same as orthotics. An orthotic can place very little pressure in the arch yet still have a lot of control. Arch support can be a component of an orthotic..

Re: arch supports vs. orthotics

Pauline on 3/09/03 at 10:52 (112333)

Dr. Ed,
Would you explain how an orthotic would be designed so it doesn't place pressure on the arch?

Re: arch supports vs. orthotics

Carole C in NOLA on 3/09/03 at 12:05 (112336)

Pauline, I am not Dr. Ed... but I know that one of the main benefits from my custom orthotics is that they very firmly cradled my foot in the position that it needed to be in to heal. Even if they had not had any arch support, they would have helped a lot.

They also straightened out the way that I walk which is probably the biomechanical aspect of it. To me that seemed nice but less important than the way that they firmly cradled my foot in a way so that my plantar fascia weren't easily over-strained again, so they could heal.

Well anyway, that is my subjective, non-expert opinion.

Carole C

Re: arch supports vs. orthotics

Ed Davis, DPM on 3/10/03 at 15:13 (112454)


If we desire an orthotic to place minimal pressure in the arch we would ask the lab to add extra plaster fill to the arch area of the positive cast. That creates a gap between the arch and the orthotic. Another means would involve casting the patient in a more pronated position which may have the effect of lowering the arch.

Much of the subtalar joint control comes from the heel cup. The heel cup is posted (canted or wedged). A Kirby skive can be added to the heel cup which is made by shaving a small amount of plaster off the medial aspect of the heel on the positive cast. That makes the heel cup asymmetrical such that it is thicker on the medial side.

Much of the midtarsal joint control comes from the forefoot post and possibly a dpression for the first metatarsal head to gain better first ray function.

The arch height itself is secondary to the above, although it is helpful in adding additional control when needed.

Re: arch supports vs. orthotics

Pauline on 3/24/03 at 12:38 (114231)

Dr. Ed,
Would the foot then be supported only in the heel and ball of the foot allowing the arch not to touch the orthotic? I guess I don't get a picture of what is really happening when extra plaster is added to the positive cast.

This is when a drawing would be more understandable I think. In any case, it sounds like this could be helpful for posters who have all their pain located in the arch area and anything that touches it sends them through the roof.

Your post might be something they should print and take to their doctors if orthotics are next on their agenda.

Re: arch supports vs. orthotics

PatsyC on 3/29/03 at 16:15 (114903)

Dr. Ed, I too am very anxious to understand and pursue an answer to this dilemma. While recovering from unrelated surgery 7 years ago, I developed metatarsal pain, like walking on hot rocks. My dr. sent me to a neurologist who diagnosed idiopathic neuropathy and prescribed meds. Having done a little research of my own, I went to a podiatrist who agreed that there might be a structural problem. He prepared custom orthotics, and good girl that I am, I wore them as directed though the pain in my metatarsal area was not helped and I developed pain in my arch and across the whole sole. I was sent to an orthopedic surgeon, who ordered new orthotics--Footmaxx--which I also used as directed for eight months with what seemed to me even more intense pain. (After a certain level it's hard to describe, but I was incapacitated.) He sent me for physical therapy, and the PT convinced me my orthotics were wrong and fit me with a THIRD pair. I got stronger overall from the PT, but my feet were still a mess. My own doctor then sent me back to a neurologist who sent me to a pain clinic. Now I take ultram for the pain, which of course relieves the symptoms, but I, too, have reverted to soft shoes with little or no arch and additional flat Spencos, which is why this post sounded so familiar. I am very concerned that the acceleration of the problem was due to the orthotics irritating the nerve. Your description gives me hope that I am not doomed to be medicated for life. More specific advice?