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RSD/CRPS and rigid orthotics

Posted by Connie A. on 7/14/04 at 23:24 (155478)

I'd like to know if other people out there have developed RSD/CRPS (Reflexive sympathetic distrophy/ complex regional pain syndrome), from wearing rigid orthotics. My pedorthist informed me that a few unlucky souls like myself can't tolerate rigid customized orthotics (to treat overpronation, posterior tibial tendon weakness and some kind of TTS) and develop this pain syndrome. What are alternatives? I would of course, ask the person who made my rigid orthotics, if that were possible.. Unfortunately, I now live on the other coast, and have to get advice from other sources. I've tried more cushiony customized orthotics and they were just as bad for different reasons (my arches in both feet, including my good one got so irritated from them that I had to be in a wheelchair for several weeks),

BTW, I've done lots of physical therapy (which has helped some of the RSD symptoms a little), and I am also familiar with drugs recommended to treat RSD. I'm mainly interested in other orthotic options and in hearing from others who've had the same experience (or a similar experience).

Just out of curiosity, why is it that this excellent web site does not have a message board for another very common and challenging foot condition: posterior tibial tendon dysfunction (PTTD)? It often goes hand in hand with PF and TTS. . . .

Re: RSD/CRPS and rigid orthotics

Richard, C.Ped on 7/15/04 at 09:33 (155502)

Hi Connie,
I have spoken with many people that have had problems come about by using very ridgid orthotics. I personally do not recommend ridgid for someone with flat feet, very sore feet, or someone who has never worn orthotics before.

I wear the hard plastic type (I know it's good because I made it...haha), but I like that. My wife has worn orthotics for years, but can not tolerate the ridgid material. I also see quite often that the orthosis is not posted correctly for certain conditions. That will play a huge factor in being able to tolerate an orthosis.

I see quite a bit of post tib problems. At least five or so per week. I hardly see any TTS problems. That leads me to believe that there could be a possible mis-diagnosis with post tib -vs- TTS sometimes.

Re: RSD/CRPS and rigid orthotics

Connie A. on 7/15/04 at 14:06 (155542)

Thanks for your quick and helpful reply! Is it possible to make an orthotic that is rigid enough to provide the support that the posterior tibial tendon needs, but not too rigid, for those who can't tolerate very rigid orthotics? I just recently called up the 1-800 number given elsewhere on this site (by Ed Davis) for the Northwest Podiatric Laboratory and found a very interesting page showing recommended materials for different foot conditions that they make. 'Superglass' was the highest recommended material for PTT. I don't know if 'superglass' is their name for a material called something else by other companies. But if that means anything to you, I'd be interested in your take on that recommendation.

If post-tib problems are so common, do you have any idea why that condition is not addressed in a message board of its own on this web site devoted to such a wide variety of foot problems?

Re: RSD/CRPS and rigid orthotics

Richard, C.Ped on 7/16/04 at 13:14 (155612)

Post tib problems are mentioned quite often, or atleast they were. As for materials, I have tried many and my personal favorite is EVA. Excellent support, cushion and easily to grind. I only use two other types of material, but those are for turf toe or UCBL type orthotics.

Some may think that EVA does not provide for a good orthosis, but some told Columbus that the world was flat too...haha.

Re: RSD/CRPS and rigid orthotics

Ed Davis, DPM on 7/16/04 at 15:12 (155623)

I have not heard of anyone actually developing RSD/CRPS from the wrong orthotic. If you have RSD/CRPS make sure it is treated as quickly and completely as possible. It is the shape of the orthotic that is more important than the materials -- one can gain a desired effect by many different combinations of materials.

Re: RSD/CRPS and rigid orthotics

Dr. W on 1/03/07 at 00:26 (218763)

RSD (CRPS) is often the result of frank trauma and to my knowledge never is the etiology mechanical overuse or irritation. What you are describing sounds like several different possible diagnoses, all of which should be evaluated by a physician. Whenever I see a patient with symptoms on both sides of the body I start thinking metabolic or systemic (diabetic vs. B-12) vs. structural (spinal stenosis, degenerative arthitis etc.) Bottom line is you should seek an orthopedic spinal specialist and start there, lab tests would be diagnostic and prudent at this point.

In the event that these are ruled out get a referral to a doctor who specializes in disorders of the foot and ankle. If your problem is related to foot mechanics a PROPERLY designed orthotic can be a Godsend.
I personally only cast functional orthotics non-weight bearing and avoid rigid orthotics, I find patients just cannot typically tolerate them. you may need to wear an accomdative orthotic with good STJ control until the problem subsides and then move into a semi-rigid device.

Keep us posted and I wish you well.