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? for those with high arches

Posted by Morgan W on 10/25/03 at 15:18 (135506)

Hi everyone,

Thanks for taking the time to read my post. I am a 22 year old with high arches and tibial varum. My heels are naturally in an inverted position. I have had problems with bilateral insertional achilles tendinitis/haglund's deformity for 8 months. I was a long-distance runner (ultra-marathoner)before i got hurt. I have not run in 7 months. I haven't really been doing much in terms of physicaly stressful activity.

I have seen several orthopedic surgeons and been through the run of the mill physical therapy. No help at all, honestly. I visited a podiatrist and was fitted for orthotics in a non-weight bearing position with plaster casts. He gave me semi-rigid orthotics that follow the contour of my high arched feet. The orthotics are 3/4 length with heel lifts/posts that are inverted 4 degrees. I wore the orthotics religiously for 5 months with minimal success - in fact, now the bottom of my feet hurt just as much, if not more, than my posterior heels. He advised me to wear motion-control shoes to give the orthotics a firm base. I followed the advice.

After reading the article in biomechanics that was posted a few weeks ago i am quite confused as to how these problems should be treated. I am very tight throughout the lower body, especially in the peroneal muscles on the lateral side of my calves. I do yoga daily, self-massage with tennis balls daily, and am now in the beginning stages of a series of 10 rolfing sessions. It makes sense to me that if i stand in a supinated position (i.e. on the lateral sides of my feet with my calcaneous' in an inverted position) i will put more stress on my already stressed lower legs. The orthotics i have seem to put me in an even more supinated position.

I am now wearing new shoes that are cushioned (i.e. designed for people with high arches). Some days i wear the orthotics and some days i don't. Doesn't seem to make to much of a difference. My feet hurt all the time, even at rest. Does anyone have any advice as to what advice i should follow now? Has anyone with high arches been treated similarly to me with minimal results? Has anyone tried lateral wedging to bring the foot into a more neutral postion (i.e heel cord vertical to the ground rather than inverted?) Any advice would be greatly appreciated. Thanks ahead of time.

Morgan

Re: ? for those with high arches

Dr. Z on 10/25/03 at 16:32 (135520)

Hi

The goal is to place the foot into a neutral position or bring the floor up to the heel so that the heel is perpendicular to the floor.
Deep heel heel cups with a good shock absorbing material such as poron, plastizole are very heelful.
You may need to have the orthosis wedge into a more everted position to as you say get the weight off of the laterel aspect of the foot.
Stretching is very important. Addressing the equinus ( tight heel cord) is a must.
Alot of people just can't tolerate the hard semi-rigid material that your orthosis were made from. EVA is an excellent material to use for your type of foot stucture

Re: ? for those with high arches

Morgan W on 10/25/03 at 18:45 (135547)

Thanks for your response Dr. Z.

I have so many more questions for you....but i'll only ask a few now. :-)

So the goal of an orthotic is to bring the heel (and the entire foot) perpendicular with the floor. So considering my heels naturally contact the floor in a supinated position while standing still, the orthotics should have eversion posting to bring me to perpendicular. Since the orthotics that i have been wearing are inverted 4 degrees, is it presumable to say they put me in more of a supinated position while standing and actually make the problem worse?

Experimenting with insoles that have been cut down the middle and placing only the lateral side of the isole under my normal insole (not orthotic) places my foot in a more everted position (probably close to perpendicular with the floor) and rotates my knees and entire legs to the inside. This seems like it would actually help my legs track better while i am walking, rather than having a bunch of compensatory movements to go forward while having external rotation of the knees and internal rotation of the feet.

I know i am not a podiatrist, but does what i am saying have credibility? It makes sense intuitively. Why then, would the podiatrist who made my first orthotics have inverted my feet more?

Morgan

Re: ? for those with high arches

Dr. Z on 10/25/03 at 22:03 (135574)

You are on the correct thinking track. You should be more everted and less inverted. I am really not sure why they would invert a foot that is supinating to start with.

Re: ? for those with high arches

Dr Kiper on 10/31/03 at 10:30 (136061)

Doing yoga daily is one of the healthiest things you can do regardless if you're a 'tight' person or not. But stretching does not increase the length of a muscle fiber, it simply makes it more pliable/flexible and this is very important to the tissue health.
Being a severe supinator, means that you have a very limited range of pronation motion. However, you need to understand that even with that limitation, your arch is spreading as far as it can and or needs to, to absorb incoming shock. When your arch spreads beyond the 'neutral' (I prefer to call this 'optimal') position, you are OVER pronating. Hence a lifetime of each step has accumulated to a point of injury.
A foot such as yours is harder to fit for an orthotic (and since I'm sure you have two feet, this makes it twice as hard to get each foot fit correctly). Any orthotic must first meet four criteria in order to fit and work precisely:
1-It 'must' fill the arch so that you feel the support, it should feel full or snug.
2-It 'must' be comfortable (not in the sense of relieving your symptoms) or if the neuro-muscular senses are too damaged from years of injury, at least feel that it is 'tolerable' so that it doesn't create new problems.
3-You 'must' feel stable on your feet when you are on the ground so that you DO NOT FEEL tipped over on the outside edge of your foot or wobbly (side to side) on your footstep.
4-It 'must' fit the way your muscles and feet are working and not necessarily the shape of just the foot.

If these criteria are met, then it matches the way you walk, and it is working.
The problem with what you have is that you are overcorrected and that has shifted the way your foot(s)--(intended) is used to. That's why you have increased pain now. If you remove the orthotics, everything will go back to the way it was. If that's better, do so, if not continue as is. Best thing is get something that fits better.

Re: ? for those with high arches

sue p on 11/01/03 at 22:38 (136176)

Morgan,

I have suffered from planter's fasciitis since May. I, too, have high arches. I have found that wearing Mephisto shoes with their high arch support, soft leather insole, cork and thick rubber sole have really made a difference. I am now able to walk normally with little or no pain. I am even running/jogging again for short periods of time (in tennis shoes)
I wish you well.

Sue

Re: ? for Dr. Kiper

Morgan W on 11/03/03 at 21:59 (136305)

Thanks for responding to my questions to everyone,

Dr Kiper (or other foot professionals) - How do you deal with posting a person whose feet are tipped in a cavovarus position? I have read so many different approaches. When you are making an orthotic for this type of foot, do you try to support the lateral side of the foot so the heel cord ends up being 'perfectly' perpendicular with the floor (eg. as it is in a person with a normal foot). If this is the goal, does that take the ST joint out of its neutral position?

Also, how do deal with the orthotic/shoe combination. My orthotics now are semi-rigid polypropyline, and the podiatrist who casted me for them advised i wear i stiff motion-control shoe. I visited a pedorthist last week and he said that with an orthotic like mine, i should be in a cushioned shoe. He felt that a harder orthotic goes with a softer shoe, and a softer orthotic should generally go with more of a motion-control shoe. It makes sense. I was fit for a new pair of orthotics using the amfit machine in a semi-weight bearing position. With the computer program he added lateral posts and met. posts, something that is completely lacking in my current orthotics (in fact, its just the opposite, which makes me feel good). These new orthotics will be EVA, i'm not sure what durometer, probably middle range or maybe a combination of the three.

The pedorthist suggested i wear a stiff motion control shoe with these orthotics since they will be relatively soft. What are your thoughts on this topic? I'm trying to learn as much as i can. Do you ever post your silicone dynamic orthotics.

Thanks ahead of time.

Morgan

Re: ? for Dr. Kiper

Dr Kiper on 11/06/03 at 13:48 (136558)

Hi Morgan,
A cavo-varus foot is the hardest to fit, because there is very little range of pronation motion available. This means that you go from the maximum supinated position through the 'neutral' position in a very short time. Kind of like a car that bottoms out and hits the frame when you go over a bump. The key in balancing your foot is to support the overpronated position in an 'optimal' position so that you get shock absorbancy. This will be most efficient for your mechanics. Also by doing this the frame of your arch is resting on some support, this will take some of the load off of your lateral (outside) side of the foot.
As for the Silicone Dynamic Orthotics you asked about, they can be seen on Scott's Products page which links to my site http://www.drkiper.com
If you have any further questions you can contact me directly at (email removed). If you wish to speak with me, leave a message on my voice mail 800-DR KIPER

Re: ? for Dr. Kiper

Larry.N on 11/08/03 at 01:17 (136779)

Dr Kiper can you explain how your device does that?

Re: ? for Dr. Kiper

Dr Kiper on 11/08/03 at 13:10 (136829)

A picture is worth a 1000 words. If you go to my web site, see the index on the left,then link to 'computer foot scans'. There scroll down to the two supinator examples. It's called 'fluid mechanics'.

Re: ? for Dr. Kiper

Larry.N on 11/08/03 at 17:17 (136843)

I understand how gel and fluid squishes around and moves. I wanted to know how the foot is changed as in what bones get supported or move when the gel squishes away. The other thing is that my arch is high and I walk on the outside of my feet. I have incoles custom that were hiarche. It said yours support the arch but doesnt that make my foot roll out still?
thansk

Re: ? for Dr. Kiper

Dr Kiper on 11/09/03 at 17:59 (136887)

You need to review my responses of 10/31 and 11/6. Your question deserves the same answer. To support your foot and take pressure off the outside margins, we place a support under the arch so that it can 'lean' on it, thus distributing the pressure, away primarily from the lateral margin. This may be difficult to understand, I find my coLleagues have trouble with it as well, so you certainly deserve too also.
Suggestion: give me a chance to help you and learn it first hand, 'YOU HAVE NOTHING TO LOSE, EXCEPT YOUR PAIN'.

Re: ? for Dr. Kiper

Larry.N on 11/09/03 at 21:41 (136907)

I still dont get it. I walk on the outside of my foot and roll my ankles all the time. I have had a few insoles done that are high up in the arch and they dont work. I dont understand how putting support under my arch on the inside will make me take pressure off the outside. If i use support under the arch it rolls my foot outside were it shoulodnt be.

Re: ? for Dr. Kiper

Dr Kiper on 11/10/03 at 12:05 (136954)

It is a hard concept to grasp, particularly if you are reading traditional and or current concepts in biomechanics.
There is no literature on the SDO except for my web site.

If you review the earlier posts, Dr Z to ld you that the idea is to bring the fllor up to the arch. This is exactly correct. The difference is that by adjusting the fluid volume until that is accomplished is done so because unlike a traditional support which is in a 'fixed' position. Even adjusting it (if possible) does not shift the architecture of the shape of the foot in it's best position on the floor. The SDO because of it's scientific principles of fluid mechanics, does exactly that. A change in the volume of fluid automatically shifts under the high and low pressures of the foot and moves exactly into that architectural position. Thus supporting enough of the midtarsal joint (and the bones involved) to an 'optimal' position on the floor.

I don't think I can explain it any better. Maybe you should try it for yourself and see.

Re: ? for Dr. Kiper

AndrueC on 11/10/03 at 16:19 (136980)

I'm one of Dr. K's patients and after using the SDOs for 8 or so months I can see how they have helped me and I'd like to encourage others to try them. I have no link with Dr K. other than being a very pleased patient.

One aspect of the SDO that isn't clear until you've used them is that they aren't just a balloon filled with water. The 'skin' of the SDO is quite rigid. It's more like that of an air bed or rubber dinghy. It'll deform a bit but only so far - I doubt whether many people could stretch them out of shape by hand for instance. The fluid is not like water either. it's more viscous - like engine oil perhaps.

You have to carry your body wheight somewhere and at present you are carrying it on the outside of your foot. The fluid in the SDOs will move away from this area into your arch. Speaking from experience I can tell you that the fluid doesn't actually 'run away' - it fights the movement quite considerably. Think of a partially deflated air bed. You can move the air around a bit but eventually it begins to push back.

It's this pushing back that takes the force away from the outside of your foot. The fluid doesn't run away and sit quietly under your arch minding its own business. It won't fit under your arch and it will push back against it. This means that your arches start to carry some of your body wheight where before they did not. Since the body wheight hasn't changed this means that the outside of your feet /must/ be carrying less wheight.

Conventional orthotics seem to work in a similar way but a big difference is that the SDO is continually adjusting to the shape of your foot and the loads you put onto it. I can feel the SDO as I walk. A wave of pressure passes along the soul of my feet from just in front of the heel to just behind my big toe.

At first this did aggravate some sensitive areas but within a week they had stopped being a problem. I now like the feel of resistance along the bottoms of my feet. It's a bit like walking in wet sand but with a bit more resistance.