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Orthotics or no orthotics?

Posted by Steve R on 4/26/04 at 06:12 (149543)

After 30 years of virtually injury free running I picked up PF in my left foot.
It took a while to go away so I had a cortisone injection. This definitely helped and I was back running again after a short time.
Unfortunately it returned with a vengence and I was laid up again.
More injections,othotics, rest etc etc but no improvement.
Four sessions of ESWT seemed to make an improvement but the sheer length of time my being laid up(12 months) may have contributed to natural healing so I cannot be sure of its benefit.
If I cycled or if I had driven to work made no difference, so I cycled to try to keep fit, then a remarkable thig happened.
I was knocked off my bicycle and suffered ligament damage to my right groin.
Not being able to move around very freely for a couple of days at home without my orthotic appeared to improve the situation, so when I was ready to return to work I left out the orthotic and just wore good support town shoes.
The results were amazing.Within two weeks the pain had virtually gone and one month later I am back running - albeit over the park every evening for just a few miles - but NO PAIN.
So In my case the orthotic actually hampered my healing.I wish I would have realised that months ago.
I am not saying this would be correct in evey case but for me it worked.
Best wishes to all suferers.

Re: Orthotics or no orthotics?

Robert J on 4/27/04 at 00:16 (149616)

Steve --

I'm glad you brought up this subject, because I had a similar experience last year. After 1.5+ years of PF, pursuing all the classic conservative treatments, I had made virtually no progress. My case was atypical, and I suspect this is important. I'm curious to know if yours also was atypical.

In any case, I grew weary of the custom orthotics that produced no recovery, and I also grew weary of avoiding every footstep and sitting on my butt. I had followed this régime for many months and it wasn't working. So I tossed out the orthotics and began, very slowly, to pursue strengthening exercises for the foot and calf.

Within days, I was better. I continued to tape my feet -- my problem was bilateral -- for several weeks and then dropped even that. I started walking around in my bare feet. This was heresy, of course, but I'll be damned if I didn't get better yet.

My progress continued for weeks and then plateaued. I did not go on long hikes, or run, or anything extreme. I rode my bike and walked around the house but my feet told me that I could not tolerate much more, so I didn't try it.

The good times -- or sort of good times -- lasted for more than six months. Then I did something crazy, overdid it, and I suffered a major setback.

No big deal, I thought. I gave it a couple days rest and went back to the proven régime. But the recovery did not repeat itself. Since the setback, last December, I have been trying to duplicate the conditions that led to my initial recovery. It hasn't been easy, and it has left me mystified.

In the last month or so I have begun to improve again but, in truth, I am not sure why. I still don't use the orthotics and I still sense that lots of rest, for me, is counterproductive. This is a confounding injury and, I am convinced, it is especially confounding for those with the atypical version. We are in a minority and it is possible that we have injury that is fundamentally different from the 'typical' variety. The doctors say that ESWT doesn't work for us, nor does EPF, and, quite honestly, no one knows why.

On the other hand, strategies that might be harmful to typical PF may be beneficial to the atypical variety. Pardon if I have digressed into a atypical rant -- most likely your case is perfectly typical -- but I suggest we start to consider on this message board that we are dealing with two possible injuries here -- the typical and the atypical -- which are different in their origins in their solutions.

I'd like to know what others think about this.

Re: Orthotics or no orthotics?

john h on 4/27/04 at 10:50 (149630)

I would think an orthotic that does no fit properly is worse than no orthotic at all. I have seen many post from people who feel orthotics made them worse. My first ever pair were of the icescraper variety and the Doctor sold them to me within 10 minutes after walking into his office. I personally think they made my PF worse. that was over 8 years ago.

Re: Orthotics or no orthotics?

Steve R on 4/27/04 at 11:12 (149635)

Thanks for your mail.
Mine were actually crafted by a Podiatrist from a mould of my foot.
I was somewhat sceptical of him however when he said 'PF is easy to get but easier to get rid of with these super duper orthotics!'
He had lots of letters behind his name and I am sure he was a professional because he charged me a wedge for his services!
Time was to tell for me his product was a hinderance to my rehabilitation.

Re: Orthotics or no orthotics?

CarlW on 4/27/04 at 13:28 (149639)

Robert & Steve,

Thanks for your comments. As a 5 year severe 'atypical' case I wonder about the exact same things. I have had all the treatments including ESWT and surgery in Nov 03. My feet 'appear normal'. I have often thought about the orthotic issue too. My current physio therapist is incouraging me to try to walk around without them to build up stregth. I am somewhat reluctant because of all the standard consensus on constant support but will give it serious consideration in approx 4 months after I have given my surgery reasonable time to heal. At this point I can say that my surgery was not a negative outcome and maybe slightly positive(but difficult to tell) but I will give it more time to heal.

With most other injuries the typical treatments are stretching & strenghting with initial bracing and then removal of the brace. Why are orthotics something that must be worn forever. I could appreciate if you have obvious structural problems but if your general biomechanics are reasonable, why are they necessary long term?


Re: Orthotics or no orthotics?

Pauline on 4/27/04 at 14:51 (149641)

It's my opinion that while there may be some patients who need orthotics it's all to often become the universal 'food' for anyone with foot problems.

I personally think it's an easy product to sell to someone who is in P.F.
pain and want's a fast cure. They will usually try anything even if it means shelling out about $300 or more for something that comes with no guarantee or return policy. Additionally many insurance companies will pay for one pair of orthotics so WHY NOT when a patient has the coverage.
If they don't have to pay for it, it must be good and besides it's free.

That's the part that really angers me. It's a very expensive 'trial and error' product whether the patient or their insurance pays the price.

Re: Orthotics or no orthotics?

francesc on 4/27/04 at 15:35 (149643)

hi steve,

i'm glad you posted this as well because i feel the same way.

last july, my PF got bad (my fault) and i finally went to a podiatrist who gave me a cortisone injection and fitted me with those hard, rigid orthotics. while the foot which had the injection seemed great, the other foot just couldn't seem to feel comfortable with the rigid orthotic. i kept wearing them because the Dr. swore this worked for most of his patients. we had been adjusting them and adjusting them and they just never seemed quite right.

finally, in December, i went christmas shopping for 3 days in a row walking for several hrs per day. my PF came back with a vengeance and i was wearing the orthotics the whole time. it came back worse than before because now it was bad in BOTH feet. before it was only bad in one foot and the other was compensatory PF.

since then, i have quit the rigid orthotic, quit seeing that podiatrist, and gone back to physical therapy but with some non-traditional therapy. my therapist has tried light therapy and trigger point therapy. the latter seems to have worked very well with my compensatory PF which was all along my arch area rather than just at the heel.

i am now also trying the SDO's provided by Dr. Kiper. the other podiatrist i went to see recommended i try the Amfit orthotics. they were more tolerable but, i still felt like they weren't quite right. could be that i need to go back and get them adjusted for my new pair of running shoes. but, now i have the SDO's and i'm trying that now.

this is a long post but i also wanted to put a plug in for the Trigger Point Therapy Workbook. my therapist read about the Morton's Foot in that book and tried me with some pads just past the 1st metatarsal. and guess what? it seems to help me a lot.

good luck to you and may you continue to be recovered.

Re: Orthotics or no orthotics?

Dr. Z on 4/27/04 at 19:04 (149653)

I understand where you are coming from . I personally will guarantee any product and or orthosis in my practice. All medicine is a trial and error product if you are going to view medical care as a product service. There is no way you can promise and or gurantee any medical product and or treatment.
My personally opinion is that all doctor should guarantee foot orthosis. They would have more happy patients. It is also just good business sense period

Re: Orthotics or no orthotics?

Pauline on 4/27/04 at 20:26 (149657)

So are you saying if I purchase a pair of custom orthotics from you and cannot wear them for any reason I get all my money back?

What about if my insurance company paid for them? Do you reimburse the insurance company as well?

What period of time must pass before I can ask for my refund either to me or my insurance company?

(Just using myself as an example here)

Re: Orthotics or no orthotics?

Dr. Z on 4/27/04 at 21:11 (149662)

Yes that is correct. I do want to add you must be a candidate for orthosis. All patients pay our office for orthosis. There is no time period but usually a patient will return an orthosis within 90 days,if they are not happy. Here is an interesting question that just came into my mind . A patient purchases an orthosis, returns the device, their insurance company refunds them, we refund them . Pauline here is a new line of work for someone.
I think the real problem with orthosis is that there limitations and not everyone should be prescribed biomechanical orthosis. In many cases the patient were prescribed the wrong type of device. In the right hands, the right device there can be alot of happy patients.

Re: Orthotics or no orthotics?

Pauline on 4/27/04 at 21:19 (149665)

Why would you allow them to be refunded double if they are getting a refund from both their insurance co. and you? Seems like some type of paper work is missing to double dip in refunds.

Re: Orthotics or no orthotics?

john h on 4/29/04 at 11:36 (149769)

The problem with orthotics as I see it Pauline they are oversold and in some cases make people worse. If you have foot pain but have perfectly good foot mechanics and then are sold a pair of orthotics that do not fit right you can very easily just make your problem worse. As I have wrote many times the first Doctor I ever saw had me casted for orthotics within 10 minutes after I walked into his office. Hed did not ask me to walk and observe my gait. He just took the usual x-ray and wanted to immediately give me a shot (I refused) and I was shelling out over $300 for orthotics not covered by insurance. I knew nothing about PF in those days. I remember the Doctor had the old PF needle in his shirt pocket and was reaching for it when I said no thanks.

Re: Orthotics or no orthotics?

BudP on 5/01/04 at 02:14 (149869)

Dr. Z,
That's a great idea. I wore my orthotics for 3 months with no positive outcome. It would have made very happy to get that money back. Then I could have started to put it towards ESWT or surgery. I do think that whomever paid for them should be reimbursed,no double dipping. That's one of the reasons the insurance companies are so screwed up. The first thought from an adjuster or insurance rep is,this person is faking or somehow screwing us.Especially in the work comp. arena. Everyone is faking thier injuries. He lost that arm on purpose or that knee works it just bends all the way back.


Re: Orthotics or no orthotics?

Monte on 5/03/04 at 10:35 (149941)

I am in my 4th pair of orthotics. But I have been able to finally tolerate the arch support that orthotics provide. I have been wearing these for over 6 months.

I am a moderate pronnator.

My problem and question is this....I get alot of lateral column pain ... especially in my left foot. I also have pains on the top side of both feet. The bones are sore when I press on the tops of my feet toward the lateral side.

I am not sure if orthotics are causing me compensatory pains by making me walk/stand differently.

My othotics have a 'Toilet seat' heel which doe not allow the center of the heel to press too hard into the orthotic.

Any ideas?