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For Dr. Z

Posted by elyse b on 7/01/04 at 05:32 (154311)

Dr. Z I would like your opinion in light of the posting and treatments by Dr. Sandell. It has been my experience and again I am only speaking about my experience, that podiatrists believe that the first and at least 'best' way to treat PF is with orthotics? I have seen 3 podiatrists and have spoken to at least 2 more who believe that the root cause of PF is biomechanical and the most efficient way to treat it is to treat the underlying biomechanical flaws with orthotics. If you don't treat the biomechanics with orthotics than PF will not go away. Your thoughts will be appreciated as always. I ask because I am sitting here with 3 pairs of uncomfortable orthotics which do not seem to be making much difference in my treatment.

Re: For Dr. Z

john h on 7/01/04 at 10:19 (154316)

elyse just stick with it and you will have 10 or more pair like me. at some point we as patients must accept responsibility for our care. I did not have to buy those 10 plus pair of orthotics. With the most recent pair of orthotics I purchased you can be assured they will be the last pair. They were casted and feel ok after wearing them a few days. I am now savy enough to be able to easily see i overpronate and these address that problem. Of course, I may have over pronated all my life.as I have no idea and the over pronation may have nothing to do with my foot pain. Ortotics could easily make your feet worse as you are asking your feet to strike the ground and roll differently than they have since you started walking. After many years of this I am very skeptical of anyone who promises a cure or worse a quick cure. We regularly see post on the board from people who seem to have been cured and are convinced that what ever they did for a cure would work for us all. This is never the case. We go in cycles on the board on what is new and hot in foot care for PF. ESWT was the rage for several years and we had 6 board members (the Ossatron 6) travel to Canada for treatment. ScottR our Lord of The Rings Webmaster even went on this trip. Currently we are strongly into various methods of massage as a cure. This to shall pass and hopefully a few will be helped or perhaps even be cured but the vast majority of us will continue on looking for the elusive solution. We are fortunate to have some Doctors like Dr.Ed and Z and now Dr.Sandell to provide some insight into this disease. Dr Ed and Z have been seeing PF patients for many many years so I tend to pay attention when they speak. Dr. Sandell presented an informative post recently and although he may be a young Doctor he appears to have a keen interest in the treatment of PF and the intellect and vigor that comes with youth to search where others may not have searched. I have not had the patience to try Yoga as Julie our resident expert uses but I suspect there is real help here if one can really stick with it as a lifestyle. If you have had this disease for more than a year you are probably chronic and a cure is going to come slowly so do not look for a magic quick fix or you will be in for a big letdown. Do not panic and be prepared to try various things and be in this for the long haul. When I think things really suck for me because of PF I take a look at Christopher Reeves and wonder where does he get his strength to go on. He would love to feel pain in his feet.

Re: For Dr. Z

Chris T on 7/01/04 at 10:42 (154318)

I think you are absolutely correct John. What is working for me is custom orthotics - which I have had adjusted twice with heel lifts, a night splint which I wear every night all night and never, ever walking barefoot. I am at about 95% right now. I do not have the grinding daily pain but I do get the odd pain in my heel now. My arch is much better. I am able to walk but if I overdo it I know it and my foot will be sore for the rest of the day. I think the orthotics prevent me from re-injuring my foot and the night splint keeps the fascia and calf stretched at night.

Re: For Dr. Z

Robert J on 7/01/04 at 12:31 (154327)


Just to show how complicated this business can get, my own case of 2.5+ years of PF has finally begun to improve but only after I threw out 3 pairs of custom orthotics (actually, I just stuffed them in the back of my closet. It's hard to throw away something that cost $400/each)and began doing vigorous strengthening exercises of the intrinsic muscles of my feet and calves. I even stopped taping my feet on the theory that the taping was acting like a back brace and actually weakening the muscles. I'm now breaking virtually every rule in the PF orthodoxy, even walking around bare-footed and going for substantial recreational walks, and I'm doing far better.

I'm not saying that this plan would work for most people, and maybe it wouldn't work for anyone else. But, so far, it's working for me, and that's why I agree with John H that the path to recovery almost always involves much trial and error and everyone must set out on this path on their own. The truth is, there is no assured route to recovery, just a bunch of ideas about what might help. In your case, I would stick with your massage therapist for a while and see if it helps. I don't think there's any other way to get the answer about the benefits of massage therapy for you.

Re: For Dr. Z

Pauline on 7/01/04 at 13:37 (154334)

Think about all the people who have P.F.? The numbers are staggering. Do you really think that each and everyone needs orthotics? Personally I don't. I think they are over RX'ed and a very good income product. One with usually no return policy. I'll be shot down for my thinking but there have been many of us who purchased several pairs of orthotics and cannot and do not wear them, but everyone has the right to choose and try the path of treatment they think will help them.

Re: For Dr. Z

lauriel on 7/01/04 at 15:17 (154343)

Well, I am an overpronator with a flexible flat foot. Everyones says because i Have this I need orthocis, the first pair I lost which were made for my TTS. They were hard, and were very differenthan the ones I have now. now If I could only get a new semi-rigid pair like these, NOOO, they have to make these clunky things that only fit in tennis shoes, second pair, couldnt even stand up without excrutiating pain, and they barely fit in my tennyes. third pair are collecting dust until I can get them adjusted. the perthoditits says I need to work thru the pain WRONG! made him take some of it down since the arch is too high, he did. I have been trying to wear them for short of amount of time, but they are making my PF worse by tightening up my calf muscles like crazy, so I need to go back and get them reaadjusted. I did find a pair of orthotics from footsmart for PF sufferes, I like them because they are not bulky and give me just the amount of support without my feet hurting.


Re: For Dr. Z

Dr. Z on 7/01/04 at 15:41 (154346)

Elyse B

Orthosis do have a place in the treatment of plantar fasciitis. Not all patients need custom ( casted) types. It is my opinion that the entire lower extremity can play a part with what is causing plantar fasciitis. It is also my opinion that hard surfaces such as cement are also a factor.
Is there a root cause?. No there are many causes one of which is the biomechanics of the human body. It is the physician that evaluates and dispenses a specifice treatment protocol depending on the patient's condition and the degree of pf that is important. I really like the power step orthosis and would try this device first so long as I didn't have a severe biomechanical foot problem. I hope this answers you questions. I will continue with this subject if more information is needed

Re: For Dr. Z

Dr. Z on 7/02/04 at 00:46 (154369)

I though I answered this Elsye. Custom orthosis do work but must be for specific patients, specific stages of plantar fasciitis. The correct diagnosis must be made also. The type of orthosis is important. So in summary orthosis aren't for everyone but can help a great deal for alot of patients at the correct stage and in conjunction with other treatment. IF there is more you would like to know please ask.

Re: For Dr. Z

lauriel on 7/02/04 at 11:04 (154390)

My question is, What are your thoughts on my orthodics tightening my calf muscles making my PF worse, it seems to me they dont have them adjusted right.

Or is this as the perthodtists says I need to get worse before I get better


Re: For Dr. Z

Rose on 7/06/04 at 10:47 (154603)

Could you please elaborate on the strenghtening exercises you do? Thank so much.