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looking for large inserts

Posted by Michie on 9/28/04 at 00:47 (160622)

My husband has heel spurs. I'd like to order him some inserts, but his shoe size is 14 wide, and the largest inserts I've seen is 13 1/2. DO you think those will work, or do you know of any larger products? Thank you.

Re: looking for large inserts

John H on 9/28/04 at 09:55 (160630)

You definitely do not want the wrong size for an orthotic. You may be forced into a custom orthotic. There are some that can be had for around $100. I think an improper fitting orthotic is really a bad idea. Even an orthotic that fits if you do not need one is a bad idea. Make sure he needs an orthotic. I think you can find some orthotics on http://www.footsmart.com that are made from an impression. This is probably not as good as ones your Podiatrist might cast for you but if money is a concern you do what you got to do. Some of us think ill fitting orthotics early in our disease was partly responsible for our disease becoming chronic. Has your husband tried Birkenstocks? They have an orthotic footbed built in.

Re: looking for large inserts

John H on 9/28/04 at 09:58 (160631)

I saw men's spenco orthotics up to size 15 on the http://www.footsmart.com site.

Re: looking for large inserts

Suzanne D. on 9/28/04 at 17:53 (160656)

I checked out http://www.superfeet.com and found 6 different styles of inserts for men which all are available through size 14.

Good luck!
Suzanne :)

Re: looking for large inserts

Wally on 9/29/04 at 12:29 (160689)

I bought some orthotic inserts from http://www.yoursole.com and i have a strong belief in them that they are the best inserts i have ever worn including 2 pairs made by 2 different specialists. They are not all that bad priced. They have provided me with good arch support as well as alot of cushioning. I bought these on a suggestion of my chiropractor and have really been happy with them ever since. I suggest the ultra padding ones. I have both types and like the ultra padding better. I just looked at their website and their sizes go up to 17 so i know those could help his PF. They have helped mine along with proper stretching and and rehab exercises.

Re: looking for large inserts

Pauline on 9/29/04 at 14:39 (160690)

Wally,
I think you bring up an interesting topic. I wish we could pin point what makes an orthotic work and be comfortable for those purchasing them. I doubt that this can ever be done.

Some people have success with custom made orthotics and others don't. The same is true for OTC ones I think. Then there are soooo many brands, but I've not found a doctor holding any up and saying this one has this feature, but I like this one better because of this. They cast and the next thing you know bingo you got what ever they ordered for you.

How much should we know about orthotics? What choices do we really have when purchasing them and what makes the difference in one person having great success and another not.

Do people with higher arches fair better than those with low to moderate arches in finding comfort? What about those that have flat feet?

This summer I can't begin to tell you how many people I've seen wearing nothing but a pair of flip flops. Not a support around accept for the natural one in their foot. They don't appear to have any arch pain and they spend their entire day wearing little to nothing on their feet.

What is the mystery hidden inside the making of orthotics and exactly how does one get that perfect fit between foot and support all the time instead of hit and miss? Maybe this will remain a secret forever.

Re: looking for large inserts

Ed Davis, DPM on 9/29/04 at 21:48 (160712)

Pauline:

There is a science to making orthotics, understanding their function.
Measuring their function objectively is a bit tricky as there is a paucity of measuring devices that really give us the parameters we need.
The F-Scan is one way of performing both in and out of shoe force analyses and seeing how certain parameters change with and without orthotics. It is not complete in its analysis but one of the better measuring 'sticks' we have when interpreted with skill.

Certainly, the science involved is far beyond hit and miss.

The response of patients to orthotics includes a degree of unpredictability as patients subjectively have a wide range of responses. It is often the case that one orthotic is not adequate and some have suggested that optimal results occur if a progression of devices could be made. Economically, that does not work so most devices made represent a compromise between therapeutic value and an estimate of patient tolerability. One way around this is to have adequate skills to modify devices so that we use one device but progessively fine tune the therapeutic effect.

The one thing that is needed, very much so, is a set of internationally accepted standards in orthotic design, not to mention standardization of definitions. A number of othotic labs have gotten together to form sort of an accrediting body, still a bit small and loosley knit but a step in the right direction.

A large percentage of the biomechanics of the foot studied in school that should be applied when ordering/fabricating orhtotics is sometimes laid by the wayside due to attempts to speed things up, economy and the failure to recognize the biomechanical exam that really should take place before one proceeds with the orthotic order. Too much emphasis is placed on the device and not the process.

It is more important to look at the process than the end product as it is that process that defines the therapeutic goal of the device to be dispensed. Failure to understand the process makes it difficult to understand the differences between devices. I try to explain to my patients the therapeutic or functional goal we are working toward with an orthotic. I demonstrate on the patients' foot what positioning or repositioning we are trying to achieve.
Ed

Re: looking for large inserts

Pauline on 9/30/04 at 08:23 (160738)

Dr. Ed,
You mention the use of F Scan but not everyone doctor making orthotics uses this. It's difficult for a patient to judge whether the doctor they are seeing really knows anything about making orthotics.

Sometimes the only thing a patient receives after seeing the doctor is an assistant telling them to lay on their stomach and as they put wet plaster rags over their feet and call them casts for your orthotics.

Sometimes its the assistant telling them to step into a foam box and somethimes it the doctor merely holding their heel in what feels like an unfamilar stance on a measuring platform that sends peg like things under their foot that will translate later into an orthotic design.

I've personally never had any doctors shown me a variety of orthotics
prior to him/she telling the assistant to drape my feet in plaster rags or even show me what choice I might have in orthotics. In fact I've never seen the orthtoic that I needed and purchase until it was made.

It would certainly be nice to have ' a list of things to watch for and some questions to get answered ' when a patient is told they are about to be fitted for orthotics.

Simply forcing one's heel into an a different position never seemed to work for me whether using wet plaster rags, foam box or little pegs.

What does a patient really check for to insure a good finished product?

Re: looking for large inserts

Ed Davis. DPM on 9/30/04 at 09:54 (160752)

Pauline:
Every podiatric physician is trained in the science behind making the devices. How he or she choses to apply that is not enforced.

There is a very specific position that the foot is to be held, different for every patient to be determined by the biomechanical exam. I try to explain the reasoning behind the positioning to my patients.

I can only suggest that a patient ask how and why their foot is being held in a particular position. A checklist is a bit challenging to make as there are reasons behind every positional change in the casting process and then in the prescription process. A curious patient can ask the rationale behind each step of the way and ask to see their finished casts and prescription. Only a small percentage of patients ask this amount of information.

Chances are, if you are being asked to walk over a mat or stepping in foam, the 'capture' of the 3 dimensional image, positioning may be in question by current standards.
Ed
Ed

Re: looking for large inserts

Ed Davis. DPM on 9/30/04 at 09:59 (160755)

As far as actually 'seeing' the orthotic before it is made, that is not possible becasue a true custom orthotic is unique for each person. we can show a similar orhtotic althoug that may be as meaningless as asking an optometrist to let you look at someone elses eyeglasses; other than observing the frame, the functional portion will yield little information to the observor-- it all looks like a piece of glass. Same with orthotics-- they will look like a plate made of a plastic, graphite or layered materials the shape of which will have nothing to do with one's own needs.
Ed

Re: looking for large inserts

john h on 9/30/04 at 10:57 (160762)

Ed: I think more important than how the orthotic is made or made of is the science of determining if the person really can be helped by an orthotic.My experience was that my very first Doctor had me in orthotics within 10 minutes of being in his office. My foot pain had just began and I continued to run in those hard orthotics until I could run no more. I do not think the Doctor had a clue as to whether I needed orthotics or not or whether they could help me, In the end I think they contributed to making me worse. I surmise that there are to many orthotics being sold to make money rather than help the patient. I wonder what percentage of patients with PF enter a Doctors office for the first time and end up with orthotics? We as patients are looking for anything to reduce pain so we are a very easy sell. We are also inundated with information about orthotics and after a while you began to think that they are an immediate cure. I have been to perhaps 8-10 Doctors over the past 9 years about my feet. I do not remember one ever asking me to walk so he could observe my gait or foot strike. Some have looked at my foot wear pattern. My local runing shoe provider not only had me run several times while filming and looking at my feet and shoes he asked me if my feet hurt anywhere and wanted to know all the details. He would then recommend shoes he thought were appropriate for me. Being a big time runner himself he really took an interest in trying to put his customers in the correct shoes. Maybe this was all just good salesmanship but I left thinking this guy was really trying.

Re: looking for large inserts

john h on 9/30/04 at 11:00 (160763)

Along this line I would like to know why do so many people find relief with Birkenstocks? They have an orthotic footbed that is not custom fitted but from my personal experience and reading post this shoe/sandal has done more to relieve foot pain than most any product I have seen. Why?

Re: looking for large inserts

Pauline on 9/30/04 at 13:24 (160770)

John,
I think they work well for people that have higher, but not extremely high arches. Middle of the road sort. I've tried them and the arch was too high and hurt my feet. Although not flat footed, I have a very low arch even roll bars in shoes bother me because I feel them like a rod across the area where my heel and arch meet.

I wonder how Birks feel to others who have my type of arch, low to flat or to those with a really high arch.

The heel cup on them felt nice and comfortable, but the arch too hard and high. They really hurt. Even today without any pain, I'm afraid to try to wear them for fear of them causing arch pain in a heeled foot because of their firmness. Maybe having thinner fat pads plays a roll in this too.

Re: looking for large inserts

Ed Davis, DPM on 9/30/04 at 15:33 (160783)

John:

Not having gait analysis (analyzing the way you walk) is an example of someone not doing their job, pure and simple. What else can I say.

The freuency of orthotic use is because orhtotic is the closest thing to a 'magic bullet' to alter a patient's biomechanics. Remember the treatment triad -- inflammation, biomechanics and tissue quality. They exist in different percentages with different patients but we, as practitioners, are still going to go after the factors that we have the most control over and that is the biomechanics. In the majority of PF sufferers, if one focuses on the biomechanics, then the body has a chance to heal itself BUT it has to be done right. I had emphasized in a recent post that patients not become too obsessed with the orthotic itself but the PROCESS involved. I don't view orthotics as an product but as an end result of a therapeutic process. I modify my own orhtotics anywhere from one to 5 times in a number of patients continually fine tuning the biomechanical end effect. There is a specific therapeutic effect, primarily leading to a significant reduction in plantar fascial tension that must be achieved and the orthotics are a means to that goal. We are measuring and testing to look for our result. Often the doc is at fault for dispensing and forgetting but sometimes the patient wants the orthotic to be that immediate magic bullet and that will happen only sometimes.
Ed
Ed

Re: looking for large inserts

Ed Davis, DPM on 9/30/04 at 15:36 (160784)

Birks are basically a high quality prefab orthotic so they will work well if their therapeutic effect achieves a significant reduction in plantar fascial tension.
Ed

Re: Birkenstock Orthotics

Darlene on 9/30/04 at 16:13 (160785)

John - that's an interesting point you make about the Birkenstock sandels.

I have had many custom orthotics made over the years, but the best ones are still the non-custom blue Birkenstock inserts. They have a great arch support and a pretty good met pad. My pedorthist added some material to the met head and some fill under the arch. Then she glue a new cover on to make it easier to slip in and out of.

I'm surprised that many non custom orthotics are mentioned here, but not the Birkenstocks.

Darlene

Re: Birkenstock Orthotics

Ed Davis, DPM on 10/01/04 at 14:40 (160839)

I just mentioned them in the prior post.
Ed

Re: Birkenstock Orthotics

Joiner on 10/15/04 at 17:05 (161603)

Ed:

Your positive comments about Birkenstocks caught my eye. I have plantar fasciitis and had seen a good bit of improvement with use of the Powersteps, reaching a point where I had only mild heel discomfort in the mornings. Hoping to get even more relief, I began looking for a more aggressive over the counter arch support as sort of an appropriate 'next step'. Like you, it appeared to me that the Birkenstocks were a really quality product at a reasonable price.

Therefore, I purchased a pair of BirkoBalance arch supports and am in the initial few days of breaking them in. They felt wonderful when I tried them on and provided a welcome bit of extra 'push' or 'pressure' under my arch; substantially more than I feel with my Powersteps.

After 3 or 4 days of wearing them about 2 hours per day they still feel good while wearing them with just a bit of soreness as my foot adjusts to the various 'bumps and shapes' characteristic of Birkenstocks. Having been warned that they require a bit of breaking in, this hasn't really bothered me. However, the one thing that concerns me is that after removing them from my shoes and putting back in my Powersteps, my heels and arches begin to hurt a bit and seem a bit sore in places that had not been sore before. In addition, the initial heel pain in the morning seems to have become a bit worse than when I wore just the Powersteps.

I'm willing to endure a little short term set back in return for long term gain but I could use a bit of reassurance at this point. Do you have any thoughts or insights including:

1. What is the normal break in time for these deep arch supports?
2. Is indeed soreness and some modest pain an acceptable part of the process?

In short, I need a little help in discerning what is just normal discomfort and what might indicate that these particular inserts just might not be for me.

Thanks,
Joiner