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Orthotics

Posted by christines on 9/13/03 at 20:58 (129926)

Can anyone reccomend a good doctor in central NJ (union or middlesex county) that makes good orthotics for pf, bunion, and neuroma?

Re: Orthotics

Nan D on 9/14/03 at 21:11 (130028)

Christine,
I have the neuroma problem and after trying zillions of orthotics and wasting valuable time w/ Podiatrists, I finally found something that worked great. Check these websites & see what you
think:www.footpainfree.com,www.drkiper.com. Both have a 2 part orthotic & the design makes the most logical sense of any made since it's a soft custom made gel. You can take the gel part out and wear w/ regular shoes or sandals. Honestly, after about two weeks of wearing these, my neuroma pain was cut dramitcally. SAS sandals and shoes have been the very most comfortable after researching these horrible foot/shoe problems for almost a year. SAS does not have a website, but you can call this #-210-921-7415 for a location near you.
Nan

Re: Orthotics

PhysicsRon on 9/15/03 at 13:32 (130079)

Post bunion surgery is a tough condition for orthotics. It would be a good test to see if the silicone fluid could cushion your bumps & valleys. Dr Kiper would answer questions as to your condition. We would all be interested in your outcome. Good luck

Re: Orthotics

Ed Davis, DPM on 9/15/03 at 14:32 (130085)

christines:
Dr.Z practices in NJ -- I am not sure how close to you. There are zillions of devices being hocked on the web. Some may actually be helpful but considering what you have gone through already, I would recommend sticking with a professional in your area. One source of referrals is http://www.acfas.org
Ed

Re: Orthotics

Nan D on 9/15/03 at 16:31 (130100)

Ed, You might be right, but it's my opinion that one of those too numerous, 'surgery happy professionals', has caused that poor person's problems! At least the Orthotics I mentioned have a money back guarantee!

Re: Orthotics

Ed Davis, DPM on 9/15/03 at 16:36 (130101)

Nan:
It was not clear from the poster that the surgery was unsuccessful, just that biomechanical control was needed. Most individuals with forefoot problems such as bunions need good midtarsal joint controland none of the sellers of web devices explained how that could be accomplished.
Ed

Re: Orthotics

christines on 9/15/03 at 16:41 (130103)

Thank you to everyone who has responded to this post so far. To clarify, I had the surgery for plantar facsiitis in July of this year. All of my symptoms have returned with worse pain. The bunion surgery is fine (whish was done in Dec of this year.) My main concern is that since I have healed from the surgery for PF, my entire feet, legs and lower back ache incredibly. Also, the arch and heel pain has returned to a greater degree. Does this mean the surgery was done badly? I certainly didn't go through surgery to be wrose off--but it looks like this is the case. I am a teacher and spend all day on my feet, so I am worried about this condition a great deal. I wear conservative cushiony footwear, but still even after 10 minutes on my feet Im in serve pain. I also ahve trouble once I get up int he morning--like everything is stiff and i cant stretch back into walking postion. Any input into this is greatly apprecaited. Again thank you to those who replied so far.

Re: Orthotics

Ed Davis, DPM on 9/15/03 at 18:02 (130112)

christines:

Not having actually seen the surgery done, it is hard to say how well or not the surgery was done. The important thing to understand is that the plantar fascia is a supporting structure so releasing it actually weakens the foot. The need for support is increased because of that and thus the need for a very good set of orthotics.
Ed

Re: Orthotics

PhysicsRon on 9/18/03 at 12:54 (130444)

Ed, ...you recommended to this lady that she should go to someone local, well that's what she has done without success. There have been mostly good reports from those patients who have used the silicone dynamic orthotic by Dr Kiper. Regardless of your understanding how it works, maybe Christine should try it and find out for herself, she has nothing to lose and everything to gain. After all, she can't do any worse and at least she can get her money back.

Re: Orthotics

Ed Davis, DPM on 9/22/03 at 15:08 (130704)

PhysicsRon:
The element of time is a factor so experimenting with relatively untested and unproven devices is fine if there is no financial risk but I have to question if that should take the place of time tested, proven treatment.
It is easy to flood a website with scores of testimonials -- I can show you that with the Alznner devices / Goodfeet Stores and numerous online products. When you say mostly 'good reports' I realize that Nan regularly promotes the SDOs on this site. Yes, she may be a very satisfied and happy customer but considering the frequency of her posts, I have to question if she is more than an end user of the product. Otherwise, we don't have a that many reports. Again, I realize that any one can get on a computer and send in testimonials under numerous names.

The pedorthists and docs posting here want to be open minded to all suggestions but we must state what the 'standard of care' for treatment is and ask for some reasonable substantiation of 'new' ideas. If we don't, we are not practicing a science (I realize that medicine is a science and an art).
Ed

Re: Orthotics

christines on 9/22/03 at 18:18 (130714)

Dr. Davis- I have often had podiatrists make me a 'hard' orthotic..though never had one made that is comfortable. Is this more a matter of just correctly casting the foot and making the correct indentations or are those orthotics not always considered a good method? They seem to not work for me because they make my feet sore since they are like walking on a hard surface with no cushioning. I relaize I need a good custom orthotic, but wonder if she a thing exists that is cushiony and has shock absorption. Several ppl ahve reccomeneded the SDo's, but I would like to have a doctor to actually 'see'.

Re: Orthotics

Ed Davis, DPM on 9/22/03 at 18:57 (130720)

christines:
The more rigid the orthotic, the more precise the biomechanical exam and molding/casting must be. There is a range of rigidity from very soft to rigid and everything in between so it is not just a matter of hard vs. soft.

Unfortunately there are practitioners who tend to place every patient in the same type of device and they really are not doing their job. I may not know a specific practitioner in your area but tend to feel that the more careful practitioners use the better orthotic labs. One trick may be to work backward by calling the lab and asking them who in your area uses their services. Northwest Orthotic Lab is a lab that is used by practitioners who take their orthotics very seriously --- their number is 800-443-7260.

Also, you may find that pedorthists tend to use devices of more intermediate flexibility. Again, the trick may be to find the right one so BCG or Richard may know someone in your area.
Ed

Re: Orthotics

christines on 9/22/03 at 19:11 (130724)

Thank you for the quick reply. Since I'm on the east caost, is there a similar place to Northwest Labs that you could poin me towards? What is a pedorthist? You had mentioned before that a good pair of orthotics is crucial after PF surgery. Is it possible that a lot of my pain might be resulting from not having that support I need now? This is my estimate.

Re: Orthotics

Nan D on 9/22/03 at 19:51 (130730)

Dr Davis,

The only reason I frequently post responses here is to try & help other people so they DO NOT have to go through all the pain & suffering I did, due to incompetent Podiatrists.(3 of them) People like YOU who are so closed minded and want to practice the way you have for years, use the same old techniques & same old products etc, need to retire. You said 'experimenting with untested devices'....I'd say that SDO's are NOT UNTESTED at all!I spoke to Melissa in person, who posted here for a couple of years, about her positive experience with SDOs. Then there has been Carmen, Elliott, Harry, Barbara and just the other day Andrue to mention a few. Now if you were really a progressive Doctor & really 'looking for new ideas', you would TRY the SDO's on several patients and test them for yourself. I can only account for my experience which was DRAMATIC pain reduction after wearing the SDO's for ONLY 2 weeks.

There aren't zillions of posts about the product here, because for some unknown reason, most of these people seem to prefer to endure their pain, instead of trying this product that actually works, and a product that they can't lose any money on, if it DOESN'T work! DO YOU GUARANTEE your orthotics? And if so, HOW many times do you have to send them off for correction while people wait in excruciating pain & agony to get them right? Again, I can only account for my experience of having them resent multiple times for weeks and they were never right. I'm sure more damage was done to my foot during this frustrating waste of time while they still never fit properly. It also cost me thousands of dollars in lost income because I could barely work.

A person from this forum emailed me about the SDO's, who lives in my city and I offered to meet her to show her the 2 part SDO's. She ordered them immediately and she thought they felt better than her semi rigid orthotics from her Pod. Plus, they are so versatile that you can wear the gel section with nice shoes or sandals or the full SDO w/ closed shoes or sneakers. This is absolutely the best invention for foot pain & are designed to fit in real shoes.

I personally have NO interest in Dr Kiper or the SDO product in any way. When I found them on the internet, it made total logical sense to me that this is the easiest, best way to help foot pain. It makes NO SENSE to put any hard surface that doesn't 'give' against a bruised sore tender foot. I just read archived messages from Dr Kiper to the Doctors explaining medically all the benefits of the SDO's. It is TOTALLY UNFAIR for the doctors on this forum to BASH this product without even trying it for the good of your patients !!! I am a self employed professional businessperson and frankly I think it all boils down to GROSS PROFIT. Pods can't make as much money on SDO's, since they are more expensive than the ice scraper orthotics, so they bash them. Plus, you make lots more money on surgery & other related expensive procedures. I am sure there are plenty of Pods in the upper 10-20% of the profession that are very good as in any profession, but it appears from all the devastating posts here, many Pods are very bad. All anyone has to do is read Christine's recent account of what that Pod. did to her. Her feet may be ruined for the rest of her life and she is only 22. This is an absolute crime & that Pod should have his licensed revoked! BUT, he certainly charged her insurance company a nice fat surgical fee. I know many of the Docs here are good & giving their time for free to help people, but you just set me off. I do not appreciate your comments about me having any alterior motive and I will be happy to discuss this in person with you at any time.
Nan

Re: Orthotics

Ed Davis, DPM on 9/22/03 at 19:59 (130731)

christines:
Northwest lab has plenty of doctors on the east coast who utilize them.

A pedorthist is a professional trained in the fitting of shoes including custom and molded shoes for people with foot problems as well as shoe inserts such as orthotics. Our two resident posters Richard and BGC can probably give you the 'official' definition and a lot more info.

It is possible that your pain is caused by what you mention and that is why you should see a professional to have that pain evaluated before going forward with obtaining orthotics.
Ed

Re: Orthotics

Ed Davis, DPM on 9/22/03 at 20:31 (130732)

Nan:
I have always let you have your say but since you have taken the opportunity to attack me personally as 'closed minded' I need to respond.

The first question I will aks you is why you are not recommending ART (Active Release Therapy) and Jade 168 cream to posters when there have been those posters testifying to the successes they have had with those modalities. Are you closed minded to those treatments or are you here to push one product? The real answer is that you simply don't have enough information to evaluate such products or treatments and neither do I.
Now, how would you respond if a poster stated, 'forget about the SDO, go for the ART instead?' How would you respond to a poster who stated 'don't waste your money on SDO's, they are just out to make a quick buck, they don't fix the problem, get the ART instead?'

Pods can make a lot more money on SDO's than conventional custom orthotics because insurance companies fix the reimbursement for the custom orthotics. Sometimes the profit margin on custom orthotics is so narrow that practitioners use inferior labs, rush the process, or delegate the process to poorly trained personnel. That is a big problem and it is wrong. It does not mean that properly made prescription orthotics are somehow not effective. If SDO's are not covered by insurance, podiatrists could charge a higher fee and make more money on them. So I think your interpretation of the profit motive has little validity.

I don't have all the details on christines' case so there is no way I can render judgement on what occurred from a surgical point of view. I will and have repeatedly stated that surgical treatment for PF is a last resort.

If I and others, posted as non-doctors, our perspective and to a large extent, our obligation to the manner we evaluate information would be different. Our obligation is to utilize our expertise and professional judgement to formulate opinions based on the body of accepted scientific knowledge. I simply do not have enough information to make an educated judgement on the efficacy of ART. So if a poster who has had a good experience lists that and recommends that others try it, I cannot comment one way or the other. On the other hand, if that same poster states...'forget about ESWT or orthotics ... do the ART instead,' I would have to take issue with that individual because they would essentially be telling readers to move away from accepted, conventional treatments and do the 'unconventional' instead.

There are numerous professional journals, schools, meetings and the like where new treatments can be introduced. Every practitioner I know is anxious to see new and effective treatments. It is our obligation to examine and critically review those proposed treatments. I am not sure exactly why Dr. Kiper is not utilizing those channels, channels which are open to every practitioner.
Ed

Re: Orthotics

BGCPed on 9/22/03 at 21:26 (130748)

Northwest is good. I use them when I need a graphite device. I do most of mine on an amfit machine but ad extrinsic posting as an adjunct on all of them.I am sorry if I missed your location Cristines, can you post it again?

Re: Orthotics

BGCPed on 9/22/03 at 21:28 (130750)

What area of the east are you located in?

Re: Orthotics

christines on 9/22/03 at 21:34 (130752)

Im located in NJ.

Re: Orthotics

BGCPed on 9/22/03 at 21:41 (130754)

A very well reasoned post Dr Ed. I had a few qustions regarding the SDO and I didnt get a solid answer, then was told that basically I dont get it and its too long to explain. I have always maintained there are too many yahoos making orhtotics, I see a few pt per day with a bag full.

I would also maintain that some pt wont respond well to more funtional control. I dont get the claim that 'ice scrapers' are bad just because they are rigid. I dont use a great deal of rigid hard devices but I have very good luck with them...why? Because I use a great lab. I also take great care when evaluating, casting AND fitting them.

The reasons you cited are also valid as to why some devices fail. There are some patients that call for you to toss the rule book out and provide more cushion and less functional control. I have one pt tht refuses to wear shoes with any support. She has a shoe that is trashed but she wont try anything new for more than 10 minutes and clims excruciating pain.

Ones like that you just put a bag of whipping cream in the shoe if thats what works

Re: Orthotics

BGCPed on 9/22/03 at 21:45 (130758)

Jeff Rich at US Orthotics in Manhattan is good. He does work with Dr A Sands who is a fellowship trained foot/ankle surgeon. He makes his own devices using different degree of firmness eva. Might make it a one day trip and get a 2nd opinion and possibly get casted for the orthotics. You can go to http://www.bootfitters.com and search in NY area. That should have his number and contact info

Re: Orthotics

BGCPed on 9/22/03 at 21:48 (130759)

http://usorthoticcenter.com/

Re: Orthotics

christines on 9/22/03 at 22:10 (130762)

I had made an appt with the Podiatry Associates of Beleville...have you heard of them? How would I be able to figure out what kind of orthotics they use before commiting to have them made by them? It seems I go through the whole process only to find out that the doc doesn't use a system that works well with me. Thanks for the links.

Re: Orthotics

Dr. Z on 9/22/03 at 23:16 (130769)

I know this group very well. Dr. Cozz is an excellent physician. Good luck

Re: Orthotics

Aly on 9/23/03 at 08:13 (130786)

Ha! A bag of whipping cream in my shoes sounds like a wonderful idea! I'll try that ;)

Re: Orthotics

Richard, C.Ped on 9/23/03 at 08:39 (130787)

Jeff Rich is a total nut...but knows his stuff. My father-in-law is teaching at the Master Bootfitting course next week. I am sure Jeff will be there too.

And Brian...I told you to stop calling me a yahoo!!! ha ha
Richard

Re: Orthotics

Nan D on 9/23/03 at 08:42 (130788)

Christine,

It will be VERY EASY to determine if the Podiatrist group you are seeing will fit you properly for orthotics.

ASK THEM FOR A MONEY BACK GUARANTEE !!!!!

IF they refuse to give it or ask you to sign a release that they are not responsible if they do not fit.....forget it!
(See the post under 'ask the doctors', a person wrote where her Pod had her sign a release not only from improper fitting Orthotics, but they were not responsible if further harm was done to her feet due to their lousy product..........AND the worst part is..... she signed it!!!!(AND OF COURSE THE ORTHOTICS DID NOT FIT!!!!)

Re: Orthotics

BGCPed on 9/23/03 at 11:14 (130800)

I also teach them. I will be doing the Toronto and Michigan courses. Your Father-in-law must be Mr Tambling correct? Jeff has mellowed alot since he had his kid.

Re: Orthotics

BGCPed on 9/23/03 at 14:33 (130809)

I dont offer a money back guarantee, does that mean my orhtotics are poor and inferior to the SDO? Based on that argument, I guess your Attorney and Accountant give you refunds if you dont win the case or pay too much in taxes?

I charge a fair fee and it is well under the standard amount. I evaluate their footwear as well. Sending things via mail and getting non hands on eval may be ok. The fact that a person doesnt give refunds on what they do is not indicitive of a bad business practice or incompetance.

We are not talking about happy meals here

Re: Orthotics

christines on 9/23/03 at 14:46 (130811)

BGCPed- I have a question about footwear you might be able to answer...am I correct in thinking that cushiony,supportive sneakers (usually I wear New balance..and replace them often) are the best for feet. I mean , instead of hard soled dress shoes,etc. I am standing on hard floors all day on my feet. Just curious of your opinion. Thanks!

Re: Orthotics

Ed Davis, DPM on 9/23/03 at 15:00 (130812)

BG:
There are also legal restrictions involved with offering guarantees in medical care.

I don't know what it costs to make an SDO but based on descriptions they are fairly simple, inexpensive devices sold at a high markup. Now, if they work, that markup may be totally justified but little is lost in terms of expenses when some are returned. The price of any product can be adjusted to factor in a percentage of returns and refunds. Most healthcare professionals do not have that latitude since the cost of medical devices is often determined by third parties.
Ed

Re: Orthotics

BGCPed on 9/23/03 at 15:18 (130813)

A running shoe would be much better than a leather dress shoe. There is much more room, better fit and the support-cushion is much greater

Re: Orthotics

BGCPed on 9/23/03 at 15:20 (130815)

Good points Sir

Re: Orthotics

Richard, C.Ped on 9/23/03 at 16:14 (130826)

Yes...he is Mike Tambling. Wow...a mellow Jeff. Im gonna have to tell Mike about that. haha
Richard

Re: Orthotics

BGCPed on 9/23/03 at 21:08 (130846)

When he was in town last year I took him to my Chiro to get his neck adjusted. A few weeks before he was riding his mountain bike and went over the bars. Jeff being accident prone that was not enough. When he landed he hit his head and shoulder on a big log. That was still not enough, the log a hornets nest in it and he got nailed by them also.

Re: Orthotics

BGCPed on 9/23/03 at 21:12 (130847)

You are correct about the markup. When you dont have to do a face to face eval, casting or follow up you cut down on time, which is very valuble. You could do them out of a warehouse which is much lower than medical office space.

There are a few other considerations as well

Re: Orthotics

Richard, C.Ped on 9/24/03 at 14:01 (130896)

lol
Richard

Re: Plantar Fasciatis

Joye C on 10/01/03 at 09:49 (131827)

You mentioned the stiffness when you get out of bed in the morning. I have found that a night split has been like a miracle cure for that condition. It keeps your tendon from tightening up as you sleep so when you get out of bed, walking is no longer a limping-event. Hope this helps.