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Richard, CPed and others

Posted by R C on 11/12/03 at 14:42 (137256)

I have a technical question about supporting the foot.

I have extremely flat feet, and have never had any success with orthotics. It seems that any upward pressure against the bottom of my feet (even the healthy one) results in pain that equals the PF injury.

I have an idea that may be an alternative to orthotics.

I notice that the inside (medial) egdes of my feet 'collapse' completely when I put weight on my feet. The ankles roll inward during this collapse. As a result, most of my weight is carried on the aspect of the fascia that connect the big toe to the heel (rather than being evenly dispersed throughout the foot). I think that is why I am susceptible to the injury.

If we can compensate for this collapse, then some of the strain can be taken off the injury site. I tried to do this by putting a slice of foam rubber against the inside edge of my foot, as opposed to an orthotic that presses up against the sole. This seemed to help a little. Before I pursue this further, I was wondering -- is this an accepted clinically established therapy? Are there any commercially available products that would serve this purpose?


Re: Richard, CPed and others and Dr. Z

john h on 11/12/03 at 15:36 (137262)

R.C. I have seen and actually used some half sole type arch supports made of a softer material. They do offer support to the inside of the foot arch area but give enough not to cause any damage if this is not what you need. The Doctors can address flat feet as I have read many and various ways to deal with this. Clearly with that band of fascia from the great toe to the heel and your foot flat there must be some strong tugging on your heel. Do you have heel spurs? Sounds like you should. I would 'guess' that orthotics would be the order of the day for a person with flat feet. I have often wondered why a surgeon could not lengthen the fascia tendon? We do the Tommy John elbow surgery where a tendo is transplanted. One of you smartie Doctors tell me why this is not possibe with the fascia?.

Re: Richard, CPed and others

Dorothy on 11/12/03 at 22:26 (137323)

What I have been thinking about after reading your post has to do with exercise theory and practice - you know, that if you exercise one set of muscles, you must also exercise the opposing set and so on. Well, doesn't it seem logical that if the foot is 'collapsing' on one side and the ankles then roll inward as a result, that implies that the muscles and supporting structures on that collapsing side are weaker than the opposite side? And if so, doesn't it seem that if somehow you could find exercises that would strengthen the weaker muscles, they could buttress themselves against the collapse and join with the opposite side to support the ankle and the foot? Actually, probably it would mean strengthening the calf muscles on the collapsing side as well as the ankle and foot muscles. Just thinkin' aloud....

Re: Richard, CPed and others

R C on 11/12/03 at 23:27 (137328)

Thanks for your thoughts.

John h, what I had in mind was an insert that does not touch the bottom of the foot at all, but rather sits between the side of the shoe and the inside edge of the foot. The insert would thus push horisontally against the first metatarsal, and keep the weight from pushing it inward. Consequently, the fascia wouls then be spared that last bit of strain. I could explain this immediately by showing you my feet. If you have 'normal' feet, however, the insert I am considering would not do anything constructive.

Dorothy, I think that the collapse I am observing goes beyond muscle tone, and cannot be significantly corrected by exercise. Rather, it appears to be an overall flaw in the architecture of my foot (i.e., how the bones come together). [Is the condition called 'forefoot varus?' I don't remember.] There was probably a brief window of time when it could have been corrected when I was a toddler, but that was ancient history. Think of it as being similar to someone's (spinal) posture, which is pretty well fixed beyond youth.

Now that I think of it, the first podiatrist that I went to (and subsequently fired) once mentioned a surgical solution to the collapse. The idea is to imbed two smooth round headed screws into two bones on the outside of my ankle. The two screwheads would push against each other, forcing the two bones apart, and by a lever action raise the collpsed inside edge of my foot. (Again, this is easier explained using a visual. Maybe I ought to set up a webcam. ) But I would not contemplate surgery if there's a non-invasive approach that works.

Re: Richard, CPed and others

Dorothy on 11/13/03 at 01:13 (137334)

If this sounds simplistic, well, just ignore - BUT - have you tried to construct the kind of insert you are thinking of? You can buy lambswool (dancers supply stores carry it, for one resource) or you can buy foam - maybe there are other materials you could try? Just a thought. It might be interesting - and wouldn't it be wonderful if it even made a big, good difference!

Re: Richard, CPed and others

Julie on 11/13/03 at 02:15 (137342)

This is definitely one for the experts, and I hope Richard returns soon and applies his awesome expertise to it. He must have encountered the problem before, and I'll bet he can think of something.

I think I recall his saying in the past that orthotics don't always suit flat feet (something about having to avoid painful pressure in the arch area) but I could be wrong.

As you probably know, Richard is busy having a baby right now. It might be a good idea to post your question again when he comes back. You could also post it on the Inserts, Orthotics, Shoes board (if you haven't already done that).


Re: Richard, CPed and others

Richard, C.Ped on 11/13/03 at 13:02 (137399)

Hey RC,
I am sure we have chatted before regarding fore foot varus. That should be taken in consideration and posted for. It also sounds as though you need a post to accomodate valgus heel. A little wedge under the medial side of the heel sounds like it might work.

Re: Richard, CPed and others

R C on 11/13/03 at 13:53 (137403)

Thanks. And congratulations!

Re: Richard, CPed and others

Richard, C.Ped on 11/13/03 at 14:28 (137406)

your welcome......and thank you!!