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Returned Orthotics/Gave up on Podiatrist/What next?

Posted by Elyse B on 5/14/04 at 07:51 (150563)

story in brief, diagnosed with PF at end of March. Was casted for orthotics by podiatrist, made 3/4 ones which I did not ask for, told him they killed my arches, tried to break them in, returned them for full length ones, tried to wear them, still killing my arches. The orthotics he made full length from 3/4 length were shoddy. I wrote to him and he returned them and he stated 'Orthotics should not hurt. Orthotics, as a stand alone treatment are 87% successful in treating PF and is the only treatment modality that deals with the underlying cause of PF.'

I have been running/walking throughout this. I am also having active release technique done 2 times a week. Last night I ran/walk and did it with nothing but the inner soles in my sneakers. My feet definitely hurt afterwards. I am awaiting delivery of the SOF inner soles and I ordered Dr. Kiper's SDO's. I am just confused, do I see another podiatrist who is going to prescribe another pair of orthotics? I don't want to do that, I was actually thinking of going to a pedorthist in NYC and have a consultation with him. I am assuming that this is biomechanical as I have really high arches and both the Active Release guy and the sneaker guy said I need support. As you can see, I am all over the place here and was wondering what you guys thought.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Kathy G on 5/14/04 at 08:36 (150565)

Elyse,

At first, I was surprised that your Podiatrist didn't grind down the arches of your orthotics to see if he could make them more comfortable. Both the 3/4 orthotics I wore when I started foot problems with a neuroma and later on, my custom orthotics, had to have the arch adjusted because they hurt so much. Then I read what you doctor had written to you and I wasn't surprised at all. First of all, what about the other thirteen per cent who don't respond to the orthotics? And secondly, as you have read here, orthotics are certainly not the only treatment option that works for PF. You are wise to stop going to him.

You are wise to try to see a Pedorthist. In my case, I saw one to get a second opinion on my orthotics and she fortunately agreed with the route my Pod was advising. A second or third opinion can't hurt. Ultimately, it will take trial and error on your part, armed with the education you get from reading the Heel Pain Book, to find the proper combination of treatments that work for you.

I hope you find some relief soon.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/14/04 at 08:42 (150567)

Thanks Kathy, I am awaiting the SDO's, I figure why not give those a try. I was so annoyed with the podiatrist because I know there are other ways to treat PF. I have read the heelspur book countless times for info. I know trial and error will help. I am going to the pedorthist to see what he has to say about orthotics and the different types he has. You know I just did not want to deal with the podiatrist any longer which is why I did not bring the orthotics back to him to adjust. At least with a pedorthist they can do the adjustments on site and I don't have to wait weeks and weeks. Can you believe I got my money back?

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Kathy G on 5/14/04 at 08:53 (150570)

We must be on the Boards at the same time. No, and I should have said, in that doctor's defense, at least he was nice enough to send you your money back. That shows that he has some scruples.

Read on about the success Rachael has had with her SDOs. Maybe they'll work as well for you!

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/14/04 at 10:15 (150579)

I have read about Rachael's success and am e-mailing with her. Just came back from Active Release Therapy and he thinks I am getting better. Boy do they dig deep into my arches and calf muscles. Yes in his defense he was nice enough to send me my money back, but he knows my running team so he kind of had to.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Ed Davis, DPM on 5/14/04 at 11:19 (150581)

Kathy:
Your suggestion of the podiatrist grinding down the arches is completley reasonable. The problem can be in the prescription or in the way the foot is held during casting. So many of us, in the podiatry professsion, are frustrated that a segment of our profession, the profession most highly trained in the biomechanics of the foot has so many members that place so little emphasis in this area and use so little of their training to do things 'right.'
Ed

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/14/04 at 11:21 (150582)

Dr. Ed, I could not agree more, that is why I returned the orthotics and am going to see a pedorthist because I feel I will get 'better' service from them where they do the casting, adjustments and the actual making of the orthotic in one place.

Re: Adjustments

sandy h. on 5/15/04 at 04:43 (150620)

It took my latest pod three adjustments to get it right by lowering the arch (and a previous pod took three adjustments to make the orthotics progressively worse by raising them). I think less aggressive is best if you feel it is digging in to the arch.

Re: Adjustments

Elyse B on 5/17/04 at 08:04 (150691)

thanks Sandy. Right now I am at a standstill no orthotics. I am seeing a pedorthist tomorrow to have a consultations. I am using an over-the-counter orthotics as I await my trial paid of Dr. Kiper's SDO's. I ran twice this weekend on the over the counter inner soles and my feet were not too terrible.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Ed Davis, DPM on 5/17/04 at 10:56 (150696)

Elyse:
One does not get a better prescription from an optometrist who diagnosis and prescribes vs. one who dispenses eyeglasses. Same with a dentist -- most don't make their own dentures. The source of production is not an issue; it is the accuracy of the prescription and the ability to follow through on the prescription that matters.
Ed

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/17/04 at 11:01 (150698)

With all due respect, I beg to differ. I think many things come into play regarding orthotics. I think it is the skill of the podiatrist while casting, the ability of the podiatrist to decide what kind of orthotics to prescribe etc. Why would I see another podiatrist now when I already know I have PF? Is a new podiatrist going to tell me something I don't already know? I know I need orthotics so why go back to a podiatrist, I would rather go to a pedorthist or orthotist whose only business is to make orthotics and does adjustments on site rather than a podiatrist where one has to wait weeks for any adjustment.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

HilaryG on 5/17/04 at 12:22 (150711)

Elyse- I'm with you- I have a closet full of orthotics I cannot wear- all from podiatrists. The only pair I CAN wear is from a pedorthist who worked with me until they were perfect (and I didn't have to wait weeks for each adjustment and then send them back when the adjustment was incorrect or insufficient). Just had to add my two cents. Hilary

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/17/04 at 14:04 (150713)

Thanks for agreeing with me Hilary.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Richard, C.Ped on 5/19/04 at 13:56 (150851)

Hi Elyse,
Sorry you are having all the problems with the orthosis. What foot type do you have? Flat? High arch?

Also, were you tested for a short heel cord?
Were you tested for fore foot varus?

We see many cases where the patient has flat feet but also has something called fore foot varus. Many times, with the FFV, if not posted correctly, the arch will seem to high.

Short heel cords will cause the calcaneous to lift sooner than normal, thus causing excess pulling on the fascia.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/19/04 at 14:01 (150852)

Hi Richard, thanks for answering. I think actually I have medium arches. I was never tested for short heel cord nor fore foot varus. The podiatrist only gave me x-rays for heel spurs and then immediately fitted me for orthotics. Right now I am going 'naked' with no orthotics as I have returned them to the podiatrist but using the SOF sole arch plus inner sole. I am running 4 times a week mostly on soft surfaces. The pain is not excruciating so I think I have a mild case. I am also doing Active RElease therapy.

I am doing something 'controversial' on these boards and going to try the SDO's. I had an appointment with Dr. Jeffrey Rich at U.S. Orthotics but cancelled it because I cannot handle too many things at once and will give the SDO's a try first and then go to the pedorthist. Where are you located by the way?

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Ed Davis, DPM on 5/19/04 at 15:13 (150865)

Elyse:
You are making assumptions that just are not correct like 'having to wait weeks' for an adjustment. The accuracy of the prescription means a lot. Beyond that, there is both a science and an art to making an orhtotic device. We often know what we need to accomplish from a biomechanical point of view but cannot completely pre-determine how a patient will respond. Once we have the orthotics, adjustments are made in the office in a matter of minutes, not weeks.
Ed

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Ed Davis, DPM on 5/19/04 at 15:16 (150866)

Elyse:
You are not even taking your own advice that you seemed so certain about a couple of posts back.
Ed

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Richard, C.Ped on 5/19/04 at 15:20 (150867)

I am down south in South Carolina. I have never met Jeff Rich, but my business partner/father-in-law knows him well. He is a good guy.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/19/04 at 15:22 (150869)

Again, with all due respect, maybe in your office adjustments are made in minutes but my podiatrist had to send the orthotics out to make an adjustment. I can say that of my friends on my running team, only one of the podiatrists has a 'lab' in their office, ALL of them have to send the orthotics out to be adjusted so I am not sure how much of an assumption that is.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/19/04 at 15:26 (150870)

thanks for the input on Jeff Rich.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Ed Davis, DPM on 5/19/04 at 15:28 (150871)

Elyse:
It is always possible to find some practitioners practicing below the standard of care. There are some major adjustments that require orthotics be sent out but not any of the examples cited here so far. Most practitioners make their own orthotic adjustments. I cannot accept an example of a 'poor' practitioner being used to represent how things are done in my profession.
Ed

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/19/04 at 15:33 (150875)

Dr. Ed, I will not debate you, I can only go by my experience with the podiatrist that I saw who fyi was supposedly the 'guru' of podiatrists who deal with runners in NYC. To make my adjustment I had to wait 2 weeks. There is no doubt in my mind that there are good podiatrists and 'bad' podiatrists just like in life. But again, I can only tell you how they do it in NYC, they send the orthotics out to a lab, they do not make them in their offices. That is something I am not fabricating, it just the way it is.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Pauline on 5/20/04 at 19:54 (150931)

Elyse,
To put your mind at ease all the custom orthotics I had made were not fabricated in the doctors office. They were put together in a lab.

All adjustments which consisted of grinding down the arch areas were done by a tech in the Pods office. I would show the doctor where they hurt, he would draw two lines with a pencil and a tech would grind down the area between the two lines. The machine used was similar to the grinder in a shoemakers shop, the same type they use to grind new heels to size after putting them on shoes.

There were no magic adjustments, just grinding or the glueing of a small piece of leather under the heel, then the words 'here try this'. I walked up and down hallways and even outside on each return visit staying there almost an hr. each time because I was looking for pain free orthotics.

Bottom line I never have been able to wear any of the custom orthotics that I had made. They now 'sleep with the fishes'.

Your story is very familiar to me.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/21/04 at 07:27 (150942)

Pauline well it seems that I am getting 'yelled' at by certain doctors on this board who 'insist' that work is done in doctors' offices. I know for a fact that my podiatrist did not have a tech and I had to wait for every adjustment. Very funny about your orthotics 'sleeping with the fishes.' That is where mine are now as well. The only positive thing is that I got my money back for the custom orthotics which was a very pleasant surprise. If you have read my posts, I am awaiting the SDO's and am going to see how they work, nothing to lose and everything to gain by trying them as at least Dr. Kiper has a money back guaranty. It is interesting how Dr. Kiper 'thinks outside of the box' and gets rammed for it on these Boards. Anything is worth a try with this insidious thing. And as I also said, if necessary I will see a pedorthist or orthitist NEVER a podiatrist again for this. I wish more people had access to pedorthists as I know they are far and few between.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Pauline on 5/21/04 at 15:40 (150979)

Elyse,
One good tip to remember is that people's passions run high on this sight so don't take anything personal. I'm the renegade that has heard it all. Heck I've been called names, threatened, and even 'cyberstoned' on this site. Just as night turns into day the print eventually runs off the page.

I think your idea to try Dr. Kiper's orthotics is a good move. As you say you really have nothing to lose. Unfortunately I never got one dime back from any Pod that made custom orthotics for me.

I have to agree with you that Dr. Kiper has taken some 'ramming' as you say. Discussions and questioning that in my opinion that could have been handled privately simply by emailing him directly.

Some people have been helped by his product, others not, but this seems to be the norm for P.F. sufferers. P.F. is a strange condition that has similarities, yet people still tend to differ in how they respond to various treatments.

Please let us know your experience with his orthotics.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Elyse B on 5/21/04 at 16:02 (150981)

Pauline, I certainly don't take things personally especially on the internet. Good analogy, the 'print runs off the page.'

I will definitely keep you all posted on the SDO's. I know I was lucky that I got my money back from the podiatrist. I personally think he knew he made a 'mistake' because I asked for full length ones and he ignored me and he did not listen when I told him that they were painful and I kept questioning him about it so he really had no standing, and again I am an attorney so.....

Yes I see that Dr. Kiper has taken some 'ramming' which I don't quite understand. I think people should be open to everything, ART, acupuncture etc. As you said different things work for different people.

I also know that I am pretty lucky because I am still able to run and be active. I am a proactive person and I am trying to learn as much as I can about PF and treatments that is why I came onto the board in the first place and I will be happy to share my experiences with everyone.

Re: Returned Orthotics/Gave up on Podiatrist/What next?

Ed Davis, DPM on 5/22/04 at 00:57 (151010)

Elyse:

Getting money back for a precscription device is a good thing. Most would not give a full refund. So I guess you had some good and bad in your experience.

Podiatric physicians take more courses on the pathology and pathomechanics of the foot than any profession I know of. Most schools include courses on the fabrication of orthotics. Most pods do not make their own as it is not cost effective and their are excellent labs out there that own technologies unavailable to the average practitioner. There are also mediocre labs out there. Better labs charge the doctor more so I am impressed when docs are willing to set aside the profit motive and use the better labs. One effective tactic is to 'work backwards.' That is, get a hold of the top lab and see who uses them in your area. One of the best labs in the country is Northwest Podiatric Lab, Inc. of Blaine, WA. There number is 1-800-443-7260. I often have patients call them to find out who is using their services in a particular geographic area. You may have already made a decision but I am posting this for the benefit of all readers. There is no way that I can make or anyone for that matter can, in their offices fabricate an orthotic as good as theirs. Nevertheless, we often perform modification to the orthotic after recieving it in order to maximize its effects. All it takes is a heat gun allowing one to soften the graphite the orthotic and 'bend' it to a better shape -- it does not require a comprehensive lab or a lot of equipment.

Some docs underemphasize conservative care as they view it as a stepping stone to surgery, ie, try conservative care first and if it does not work, go on to surgery. We can ALWAYS make an orthotic that is comfortable and wearable for a patient. As such I have no patients with 'unwearable' orhtotics that I know of from my practice. The more challenging thing is to make an orthotic that is comfortable but has sufficient therapeutic value.

Releif of strain on the plantar fascia is necessary to effect a cure so the orthotics must do that. Some have proposed starting with a soft, comfortable orthotic and gradually increase the support but that would be very pricey -- occasionally that does need to be done. The efficacy of the orthotic is related to the quality of the biomechanical exam which provided the doctor with the figures (numbers) for the corrections and the manner in which the foot is held (manipulated) during the casting or molding process. Even a good lab requires a 'good' cast and an accurate set of instructions.

Trying various things like ART, accupuncture, etc. is fine if one has the money. The way I see it, I will treat patients with the 'core' modalities, that is, effective orthotics plus physical therapy because that is what gets reults most of the time. If one has some extra cash, adding on things like ART is fine but such modalities have an unproven, limited track record and we are determined to go with what we know works in the vast majority of cases. I often see patients who start with the 'peripheral' modalities, have marginal releif and then are moving toward the 'core' treatments. The one problem with doing so can be that PF (especially if you spend time perusing this site) has a tendency toward chronicity so my goal is to get rid of it ASAP by aggressive, effective conservative treatments with a long, proven track record.
Ed

Re: Being "yelled at"..... ps

Ed Davis, DPM on 5/22/04 at 01:27 (151011)

Elyse:

I am sorry that you feel that you are being 'yelled at' here. You have my sympathies for encountering a practitioner that provided you with what sounds like poor care. We are answering you here but also educating all the other readers of the site so we must point out what constitutes good and bad care. I feel yelled at by you when you make statements like 'I will never see a podiatrist again...' as that implies that there is something wrong with all practitioners based on the bad experience you encountered so I don't consider that to be a fair statement. All professions have individuals with varying abilities and techniques and I would never state that I would 'never' see an attorney again based on running into one that did a poor job. As a professional you must realize that such generalizations just make little sense.

Hopefully, the SDO's will do the job for you. They are an interesting concept but one that is not generally accepted by my profession at large. I have chatted with Dr. Kiper by phone and found him to be knowledgeable and a pleasant individual. We discussed the possibility of trying them myself but lost touch with him. I need to order a pair and be my own guinea pig to see how they 'feel' and try to assess how they work.
I am still a bit unsure why he has not introduced the concept directly to to podiatric, orthopedic nor pedorthic professions but from what I can determine, he had made some early efforts, encountered resistance and pulled back. There are researchers willing to 'test' the concept if he is interested in further studies on the SDO's.
Ed

Re: Returned Orthotics/Gave up on Podiatrist/What next?

elyse on 5/22/04 at 14:53 (151038)

thanks Dr. Ed for your valuable advice, I really appreciate it. Yes I had a bad experience but I learn so much from you and the Boards. Thanks again. I know I need orthotics and hopefully will find something that works.

Re: Being "yelled at"..... ps

elyse on 5/22/04 at 14:55 (151039)

thanks Dr. Ed. I am new to the Boards and do not know that much about Dr. Kiper except what I have read. Not sure why his orthotics are not accepted by the podiatrity profession but wouldn't you think that they are worth a try especially since he offers a full refund? It seems that trial and error is the way to go for PF and what works for one may not work for another and vice versa.

Re: Ya'll be careful

scott r on 5/22/04 at 16:27 (151045)

Elyse's new here and she's being nice and politically correct. I can read minds and I can foresee someone thinking about brewing trouble. Don't harm the recent peace.

-- Scott R
The Moderator

Re: Being "yelled at"..... ps

Ed Davis. DPM on 5/23/04 at 00:33 (151057)

Elyse;

You may have noticed that I have been a major recommender of ScottR's Heel Pain Book on this site. My one criticism of the book and with certain aspects of the site is that one may get the impression that the treatment process is more random than it really is; almost like one can throw a whole bunch of stuff at the problem with the hope that certain things will 'stick.' I think that ScottR would agree with me that, even looking backwards at his own history, an organized plan is feasible. In fact, my very first set of post on this site, several years ago, I suggested the possibility of a flow sheet.

Some difficlties arise when discussing certain modalities becasue assumpitons need be made that the modalities in question are applied properly. For example, an indiviudal with a tight heel cord will see significantly more benefit from a night splint than a person who does not have one. Another assumption that gets even trickier involves orthotics. Orthotic dipsensation should not be very different from eyeglass prescribing and dispensation wiht a reasonable set of standards. We have seen here that fairly drastic variability exists in those standards. I, for one, prefer to see much of that variability eliminated. Unfortunately, the trend has actually been in the opposite direction.
Ed

Re: Ya'll be careful, ScottR

Ed Davis. DPM on 5/23/04 at 00:45 (151058)

ScottR:
I think that we have a meeting of the minds on this one. Although, with my very first post here a number of years ago I voiced a concern that still stands. That is, there is an enormous amount to be learned from this site as Elyse confirms BUT the information may come across, even to a professional such as Elyse, that the process involved is more random or has more variability than it perhaps should. Some of that variability is generated at the provider level where areas in need of greater standardization, ie. the orthotic prescription itself. The variability encountered in the community does not necessarily reflect what is being taught in the schools or even the action of the better labs but more often by a 'dumbing down' in the measurement and production process. Here is where perhaps incorporating a piece from one of the 'experts' would be of value. Beyond that, a flow chart may still be an option to 'bring togtether' the Heel Pain Book and much of the site information.
Ed

Re: Ya'll be careful, ScottR, la link to look at

Ed Davis. DPM on 5/23/04 at 00:48 (151059)

Look at:
http://www.pfola.org/
This organization may be a good contact point to look for standardization in the area of orthotics.
Ed