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A hymn to orthotics

Posted by Julie on 11/18/04 at 06:47 (164232)

I posted a post the other day about my foot-misery: I've been without my orthotics for several weeks while new ones were being made to replace the clapped-out four-year-old ones, and my feet were not happy. Well, the new orthotics arrived today, and I could hear the sighs of relief my feet were breathing as they were fitted. What a difference!

Now I am going to do what I said the other day I wouldn't do, and sing the praises of orthotics as a treatment for plantar fasciitis. Orthotics have had a mixed press here. There are several reasons why they may not work:

Inexpert casting
Faulty prescribing
Bad manufacturing

Not breaking them in gradually
Not wearing them inside good shoes
Not wearing them all or most of the time

are just a few.

But orthotics that have been properly casted and prescribed by a skilled podiatrist or pedorthist, and made by a reputable lab, may be THE most important ongoing treatment for cases of plantar fasciitis whose cause is biomechanical. Well, in my opinion, it is the most important. A biomechanical imbalance/flaw - i.e. a consistent, permanent fault in the way one walks - such as excessive pronation, needs to be permanently corrected. If not corrected, the problem will persist.

An orthotic is only as good as the shoe it is worn in, a factor often overlooked. This is a huge topic in itself. When I look around at the kinds of shoes most people wear, I am amazed that there is as little PF as there is.

Everyone's experience is different. I have always been careful not to set forth my own experience as general advice for everyone else. But in the case of orthotics, and in the euphoria of my relief at having my new ones, I'm making an exception. I am NOT saying orthotics are the solution for every case of PF. It depends on the cause of the PF, and that cause needs to be investigated and determined through examination by a foot specialist, not hit-or-miss on an internet forum. But if there is a biomechanical cause (and in a very large proportion of cases there is) orthotics are, certainly, a very important part of the solution.

There: I've said it. I know that many people here have had orthotics and have not found them helpful. But see again my small selection of reasons why that may have been, and - if the cause of your PF is biomechanical - perhaps try again. There has been plenty of advice here, notably from Richard, on what to look for and questions to ask. It is really worth looking into.
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Re: A hymn to orthotics

john h on 11/18/04 at 10:52 (164255)

Julie: I run hot and cold on orthotics. Some have definitely made my feet worse. Without question the Airizona Birk is the most comfortable footwear for me. I even mow the lawn in them (dangerous). I have had about 4 sets of custom orthotics. I cannot really say they helped or did not help. For the past 2 weeks I have not been wearing orthotics when not wearing Birks. I have just been wearing a good shoe (SAS Shoes) with the standard insert that comes with it. My feet seem no worse or better than with the orthotics. If you think they will help chances are better that they will help. Some people clearly have a mechanical problem which can be seen and identified and probably corrected with an orthotic. I guess most of us do not have a clear indication for orthotics but go to them anyway in an effort to eliminate pain. There are always an army of Doctors ready to prescribe them. Today I am without orthotics. Next week I may be back into them. If I am going climbing or some activity that will bend my foot in many ways I will wear them for what I perceive as a preventative measure.

Re: A hymn to orthotics

Julie on 11/18/04 at 16:09 (164270)

As far as I know, John, orthotics are a corrective device, and there is little point in having them if there is no biomechanical problem for them to correct. The doctors or Richard will correct me if that is not correct.

Lots of 'corrects' and 'corrections' there. :)

Why were you prescribed orthotics? and why four pairs? Do you have a biomechanical issue? (I must look at that photo of you at Dr Z's again!)

Mine began to help me from the beginning, and have helped for four years. i was lost without them for the few weeks it took to get the new ones made. Now I'm having the old ones recovered/restored, so I shall have a spare pair and that will never happen again. The experience proved to me beyond doubt that, as I've always believed, I shall have to be careful for the rest of my life to avoid a recurrence of PF. If that means always wearing my orthotics (or my Arizonas, of which I am as big a fan as you - indoors and NOT for mowing the lawn) I am happy with that.
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Re: A hymn to orthotics

john h on 11/18/04 at 17:43 (164282)

Why do I have orthotics? Well, the various Doctors prescribed them. Back when I did not know much about PF I did not ask them what they were correcting. One pair were soft, one pair were hard, one pair were semi-rigid and one pair is sort of hard to describe. If you look at my shoe wear pattern you can see I over pronate somewhat but probably have been doing that all my life. I think two pair of orthotics were sold to me to more or less make money. I think the other two pair the prescribing Doctor's thought they 'might' help. The most medically qualifed of them all never mentioned orthotics. Clearly I do not have flat feet or high arches. I was an active runner and participant in all sorts of high impact sports all my life so most probably I am now paying the price. Aside from all that I did not recognize my problem when it first occured and continued with my running,etc until it became chronic before I looked for treatment. I think if I had just gone into the rest mode when the problem first occured I would be alright today. I can live with what I have and still will continue to search for the magic bullet.

Re: A hymn to orthotics

Suzanne D. on 11/18/04 at 19:50 (164304)

Oh, good, Julie; I'm so glad you have your new orthotics!

What you have written should benefit many readers here. Thank you.

Suzanne :)

Re: A hymn to orthotics

Julie on 11/19/04 at 02:55 (164322)

John, are you saying that the doctors prescribed orthotics without a biomechanical evaluation to assess whether over-pronation, or any other biomechnical abnormality, actually required them? Did they watch you walking? Didn't they share their observations with you?

I'd really be interested to know. If there wasn't an abnormality to correct, I can't see why they prescribed orthotics, and if you didn't need orthotics I'm not surprised they haven't helped. Orthotics certainly aren't a cure-all for all pf, but if they are needed they should help, and there is no question in my mind that they are a necessary corrective for biomechanical abnormalities.

As far as your case goes, your self-diagnosis is probably correct: you ran through the pain and aggravated the injury. It's good that you have come as far as you have and are able to be -active, if not as active as you'd like, and I hope your particular magic bullet will strike one of these days.
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Re: A hymn to orthotics

Julie on 11/19/04 at 02:59 (164323)

Thank you, Suzanne. I wore them yesterday evening on my way to and from teaching, which involves two 15-minute walks and my feet felt good! The difference is enormous: my feet feel they have the support they need. All my joints - ankles, knees, hips - felt misaligned while I was without them and walking actually felt dangerous. I am so glad to have them back - and the new ones are fine. I am also having the old ones restored so I shall have a spare pair now: I thought they were beyond redemption, but it was only the covering that was badly broken up; the structural part is ok and the lab says they are worth re-doing.

The bunion-joint is still painful, but that doesn't surprise me after almost a month of bad walking, and it should clear up in a few days.

Thanks again for your concern!
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Re: A hymn to orthotics

Elyse B on 11/19/04 at 08:04 (164333)

Julie I have been to 4-5 podiatrists (in NYC no less and ALL of them were so called 'running podiatrists) and NOT ONE SINGLE one of them did a gait analysis or watched me walk before prescribing orthotics. I would say out of the 4-5 visits, maybe one of them lasted more than 10 minutes. That is why educating yourself is so important and you know about PF before you go see a podiatrist.

That is why this Board is heaven sent for those with PF. Not everyone needs orthotics.

Re: A hymn to orthotics

Julie on 11/19/04 at 09:16 (164337)

Elyse, I know that not everyone needs orthotics, and I said so. I said that people with biomechanical faults/abnormalities need those faults corrected, and orthotics are what provide the correction. Therefore they are necessary for those with biomechanical abnormalities

Of course educating ourselves is important. But equally important, and going hand in hand with self-education, is getting professional help from doctors who have been trained to evaluate and diagnose the cause of a condition. I'm surprised that at least one of the four (or five) podiatrists you've seen has not done a gait analysis or watched you walk. On that evidence, I would conclude that the standard of podiatry in the US is low - but in fact I don't believe that.

You have said that you are not even certain that you have/had PF. After seeing so many podiatrists, you should know. It is not that difficult to diagnose.
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Re: A hymn to orthotics

Elyse B on 11/19/04 at 10:09 (164341)

sorry Julie but I have agree to disagree. You are right though that not everyone needs orthotics and I agree they are great for correcting biomechanical abnormalities. I do not think PF is that easy to diagnose especially if you are atypical. I think it is much easier to say one has PF than not to render a diagnosis. Unfortunately, the medical care in the US has led me to be negative.

How do you think I felt when I went to see the podiatrists and none of them watched me walk and I had to ask them to do it? That is what I learned from reading this site. I again disagree that the standard of podiatry is low in the US. The best help I had was from pedorthists who sat with me and discussed mechanics and watched me walk.

Of the 5 podiatrists I went to 4 said I had PF after 5 minutes of a visit, one said he ws not sure because MRI was negative and ultrasound was negative. Remember I have had atypical PF, no morning pain and only arch pain.

In the meantime from the education and stuff I learned on this site, I feel 98% better.

Re: A hymn to orthotics

john h on 11/19/04 at 10:42 (164345)

Your post goes along with my thinking that what we call PF can be pain caused by a multitude of things. Out of the many Doctors I have seen only one watched me walk. Then again, I often wonder just how much they can learn by watching you walk. Over the years I have paid close attention to how people walk particularly when I am at the health club walking behind them and can closely observe. Some people have such strange ways of walking you wonder how they avoid having serious foot problems. Fact is many people have all sorts of what we would call mechanical foot problems and yet have no foot problems. They have walked their strange way all their lives. Let us say one who has been a severe over pronator all his life of 55 years and then develops PF which very well may be from something other than over pronation. The Doctor looks at him and say ah! you are overpornating and orders up some custom orthotics.It very well may be that this could make him worse. Changing the way he has walked his life may not be the thing to do. One would almost need a baseline to work from to conclude that your stride or mechanical way you walk is the problem causing your PF. If your way of walking has been changed by some traumatic event then perhaps the orthotic is the way to go. Changing the way your feet have been striking the ground for a lifetime is no small event as you pound the pavement with all your weight many hours a day. You change the muscle and tendon use with every step. It would not take much of an error to cause problems you never had to start with or make the ones you had worse.When a Doctor prescribes orthotics for you ask a lot of questions as to why, what are they supposed to correct,.how did he/she arrive at the conclusion you need orthotics, whe is he/she prescibing rigid, semi rigid, or soft orthotics, why want an off the shelf orthotic work,etc, etc.

Re: A hymn to orthotics

HilaryG on 11/19/04 at 10:44 (164346)

I have to chime in here-- I have paid a lot of money for lousy orthotics from podiatrists who HAVE watched me walk and supposedly analyzed my gait. Finding the right orthotics has been torture and extremely expensive. And I am still happiest in my Birks.

Re: A hymn to orthotics

HilaryG on 11/19/04 at 10:46 (164347)

I forgot to add that I definitely need orthotics because I have extremely flat feet. Sometimes I use Birkenstock inserts instead of my prescription orthotics just to change off.

Re: A hymn to orthotics

Elyse B on 11/19/04 at 10:47 (164348)

one more thing I mean no disrespect to Dr. Ed and Dr. Z, their help on these Boards are invaluable. I just believe that it is not easy to find a caring and compassionate physician. That being said, it does not mean they are not out there.

Re: A hymn to orthotics

Elyse B on 11/19/04 at 10:49 (164350)

Excellent post John.

Re: Elyse

Julie on 11/19/04 at 11:24 (164354)

Elyse, I didn't make my post in order to start an argument, only to give encouragement to people about orthotics, which have not always had a good press here. I believe they are an important treatment protocol in cases of PF whose cause is biomechanical. I wanted to restore the balance, as so many people have had bad luck with orthotics, either because they have been badly casted or made, or unnecessarily/wrongly prescribed in the first place.

There do indeed seem to be plenty of cases of PF that are 'atypical', but the majority are probably 'typical'. Many if not most of these have a biomechanical cause for which orthotics may prove to be part of the solution.

My own case of PF was typical and straightforward, caused mainly by excessive pronation, aggravated by a minor lower back injury, and exhibiting all the classic symptoms. Getting good orthotics two months after onset was the start of my recovery; with them and other conservative treatments I was fine within another three months, and have been ever since. I was lucky with my podiatrist, who clearly knew what he was doing, and with my orthotics, which were right for me from the start and have been my trusty companions for four years. Being without them for a month until yesterday was awful, a real eye-opener, and getting them back was such a relief, and so good an experience, that I was moved to encourage others who could be helped by orthotics to persevere in getting good ones.

Finally, I said that I do NOT believe the standard of podiatry is low in the US - please don't misquote me. It was you who were complaining about the many podiatrists you saw.

I'm glad you're feeling better.
.

Re: Elyse

Elyse B on 11/19/04 at 11:39 (164355)

thanks, no arguments from me. The only point I make is to be educated and come armed with information to ask the correct questions to any physician that you see. I also believe orthotics can help although it is interesting that on my running team, I would say that out of 35 women, only about 4 wear them. Not sure why though.

Julie if you believe that the standard of podiatry is so high in the US then how come 'so many people have had bad luck with orthotics, either because they have been badly casted or made, or unnecessarily/wrongly prescribed in the first place' when podiatrists seem to be physicians that prescribe most of the orthotics?

I am confused.

Re: John

Julie on 11/19/04 at 11:45 (164356)

John, you make some good points here, but you're not being entirely logical (very rare for you :) ).

If someone has over-pronated all his life and develops PF, the over-pronation has - probably - been the chief cause of it (barring injury or other trauma). Why would it not be? Over-pronation puts a strain on the plantar fascia at its insertion point at every step. 55 years and millions of steps, and bingo: PF. Sure, something else may have happened that turns out to be the straw that broke the camel's back (as in the case of 'slipped disc' which feels like a sudden trauma but is the result of a lifetime of overuse) but the over-pronation was - probably - the cause.

Our feet are our base, our ground. Good standing, good walking, begin with the feet. It's impossible to over-emphasise the importance of good alignment from the feet up. Over-pronation causes misalignment of the entire lower limb. A flat or flattening arch (the case with most over-pronators), causes the ankle to collapse inward, which strains the knee joint. Ultimately the hip joint and the lower back may suffer also.

Changing this is crucial to solving the foot problem and to avoiding problems higher up the leg. Orthotics can - if properly prescribed and well made - correct the alignment and thereby solve the problems. (So, of course, can exercise, to strengthen weak muscles and lengthen tight ones, but that is a long job and most people wouldn't have the patience for it.) The way the person walks DOES need to be changed. It's illogical to say that if someone walks badly it's all right because he's walked that way all his life. Can't you see that?

(Christ, I wish Richard would come in on this, I had no intention of being a one-woman fan band for orthotics or explainer of body mechanics, about which I know much less than he or the doctors.)

OK. To continue. What on earth makes you think that all those funny-walking people (yes, I see them too - flat feet, collapsed ankles, bad shoes, wornout shoes) DON'T have foot problems? Or that they aren't going to have foot problems once they're out of your vision, or a year or ten years down the line.

They will. Betcha.
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Re: A hymn to orthotics

Julie on 11/19/04 at 11:50 (164357)

Hilary, I'm sorry you've had so much trouble. It has been clear for years from my reading here that many people have had similar experiences: I'm not ignoring or denying that, simply trying to balance that out with my good experience, and my albeit limited understanding of body mechanics. I'd say, though, that if you are happy in your Birks, which have an orthotic foot bed that is obviously right for your feet, that you were unlucky with the orthotics, which should really have been as helpful as the Birks and would have allowed you a wider choice of footgear.
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Re: Elyse

Julie on 11/19/04 at 11:58 (164360)

I can't answer the question. I have no views on the standard of podiatry in the US. I did not say 'the standard of podiatry is so high' - again you're putting words in my mouth. I said I did not believe it was as bad as you seemed to be saying it was. I do not live in the US and can make no informed judgements. It is possible that some of the people who come to this message board have had less than satisfactory experiences with podiatrists and that is why they are here - a skewed sample.
.
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Re: Elyse

Elyse B on 11/19/04 at 12:35 (164361)

I am not against orthotics. I just think they are overprescribed and unfairly prescribed as a money-making venture. There are many, many people who have been helped by orthotics.

But again if you say 'I wanted to restore the balance, as so many people have had bad luck with orthotics, either because they have been badly casted or made, or unnecessarily/wrongly prescribed in the first place.'

Julie not to beat a dead horse but why do you think people have been so badly casted etc. if not for the physcian prescribing them.

As for Richard, I would see a pedorthist in a NY Minute rather than a pedorthist and I did.

Re: Julie's wisdom

Ed Davis, DPM on 11/19/04 at 14:25 (164371)

Julie:
See my response on the shoe/orthotic board. You have said it so very well once again! Orthotics have reached a level of public awareness that the dilemna of when I started practice in 1982 are different from today. In 1982, I had to spend much time making patients aware of what orthotics do. In 2004, I have to spend an almost equal amount of time doing so but explaining to too many a patient why their prescription is wrong and why a 'proper' prescription will make a difference. That is hard to do when a patient walks in the door with a shopping bag full of dysfunctional devices. There needs to be more standardization of the process, but, I have been asking for that to occur for 20 years now. My solace is my wife who is an audiologist who has to explain to patients why their hearing aids don't work and that a 'correct' prescription is attainable -- so podiatry is far from being in a unique dilemna.
Ed

Re: Julie's wisdom

Elyse B on 11/19/04 at 14:53 (164372)

Dr. Ed well said. As you can see I think you and Dr. Davis do a wonderful service by offering your knowledge on this site. I have no doubt that it has benefitted many people. More power to you if you spend the time with a patient and explain orthotics to them. I wish that would have happened to me when this first happened. I was a 'dumb' patient and 'bought in' to what the doctor was saying. It did not take me long to get the info I needed to be a better patient.

Re: John

john h on 11/19/04 at 16:06 (164374)

Julie just from personal observation it appears few people walk alike. People clearly foot strike on their feet in various places. Some even appear to land on the balls of their feet If there is any such this a 'perfect' foot strike or gait what would it be and who defines it. Many people have adjusted to obvious deformed feet or other injuries that have changed how they walk and how their foot stikes the ground and never develop foot pain. A person may be 25 years old, over pronate, and develop PF. A person may be 55 years old and have always overpornated and not have PF. I do not think Dr Ed or any Doctor can tell if you have PF or pain just by determing if you over pronate, have flat feet, high arches, or most any other condition. Clearly things other than the way we walk can cause PF. 'I think' that if you have PF and over pronate or have some other such mechanical condition that you are not necessarily one in need of orthotics. Just from reading post on this board I have seen few to any that have said orthotics cured them no matter what their problem was. I have been through the orthotics to the tune of 4 pairs of custom made and untold over the counter models and I cannot say with any certainity that any helped but that some certainly did hurt. I have read a number of articles indicating that orthotics are much over prescribed and that some studies have indicated that over the counter to be as effective as custom. Currently for the past two weeks I have not been wearing orthotics to see what effect it has on my pain level. So far no more or less pain with or without orthotics. Dr. Ed statistically do you have a feel for what percentage of people you see with PF that you prescribe orthotics. I have worn orthotics off and on for 9 years. One of my Orthopedic Foot and Ankle Surgeons will only prescribe them for some sort of severe foot problem and indicated for the most part many people are harmed by using them because they do not need them in the first place or are improperly fitted if they do need them.

Re: A hymn to orthotics

Dr. Z on 11/19/04 at 16:41 (164376)

Elyse,

I took no disrepect. I understood exactly where you were coming from

Re: Ed

Julie on 11/20/04 at 03:01 (164394)

Thanks, Ed. Glad you agree. I was hoping my post would make people look at orthotics with a less jaundiced eye, but it seems only to have drawn out people's ingrained attitudes. Perhaps I have just been the lucky exception to the rule: a good podiatrist, and a good pair of orthotics that worked from day one. I find that hard to believe, but I'm not going to go on about it: the discussion has become repetitious.

But I did want to thank you for your comments here and on the orthotics board. I don't think I've ever had a post framed - what an honour!
.

Re: Ed

Ed Davis, DPM on 11/20/04 at 12:56 (164430)

Julie:
Eventually, the public will reach a level of awareness that a demand if not a request will go out for some reasonable level of standardization in the measurement and production process of orthotics. Patients must know what exactly they are getting and that will happen. When?-- I have no idea.
Ed

Re: Elyse

Helene R on 11/21/04 at 10:21 (164480)

Just to add my two cents, I have to vouch for what Elyse B said. I've also seen many podiatrists in NYC who did not watch me walk yet were quick to cast me for orthotics which ended up not working. I recently brought a bag of 4 pairs of orthotics that don't work to a new podiatrist, and he said well, if you have so many pairs and they don't work, then you just can't wear orthotics! Yes, it is important that the patient be educated in PF before seeing a dr. The problem is that some drs. don't take well to an educated patient. They seem to find it intimidating so sometimes I don't let on to the dr that I know as much as I do. I also have the feeling that some drs just don't want to bother with the more difficult PF cases, of which mine is one.

Re: Elyse

elyse1 on 11/21/04 at 14:56 (164493)

welcome to my world Helene!!! Who have you seen in NYC? We have probably seen the same ones!!! You are so right about an educated patient, doctors don't like them.

Re: Elyse

Helene R on 11/21/04 at 16:31 (164499)

We've educated ourselves so that we can partner with our drs and make informed decisions. Ironically, it's self-defeating when we end up feeling the need to pretend we don't know much. I don't want to list names of whom I've seen here but I'd be happy to let you know by e-mail. You're probably right, they could be the same!

Re: Elyse

Dr. Z on 11/21/04 at 16:49 (164502)

Hi

Do any of the podiatrist taping you ? I have to agree that after four pair
of orthosis that maybe you can wear them. Maybe you need additional care and not just orthosis. Maybe you can't control your foot.
Orthotic control in some cases is worse for your foot and there is a judgement as to whether to control or add shock to your feet. What was the chief complaint that you had orthosis made ?

Re: Orthotics with a "channel"?

Helene R on 11/21/04 at 18:10 (164504)

Hi Dr. Z. Yes they did tape me and it seems to help somewhat. I have high arches and my complaint is not the classic 'first step' PF pain, it is arch pain which increases the more I walk. Sometimes it's a burning pain in the arch, as if the nerve's been stretched. Orthotics worked well for me for a couple of years - no more PF problems at that time- but then things changed (I don't know why) and the orthotics started to feel too high in the arch, like I was stepping on a golf ball. They inflamed the arch and caused the same PF pain I used to get before I wore orthotics. Kind of a catch-22? I had the arches on my last orthotics lowered to accomodate the fascia but then I got PF when I walked in them so I stopped wearing them.
Only one pod suggested making an orthotic with a 'channel' in the portion that hurts my arch. I didn't proceed with that but may in the future. Dr Z, have you or anyone else heard of an orthotic with a 'channel' and can it work?

Re: Elyse

elyse1 on 11/22/04 at 05:31 (164529)

helene e-mail me at (email removed). I have seen 4 that were recommended by the New York Road Runners organization.

Re: Elyse

john h on 11/22/04 at 09:56 (164537)

A couple of years ago I visited a MD Foot and Ankle Surgeon. His group had just recently received the Ossatron and I was interested to find out what their charges would be. I advided him I had 4 treatments of ESWT and he questioned me for 25 minutes and readily admitted I was much more informed on the procedured and equiment than he was. I would guess he had a one or two day insturction from a factory rep at his offices. Like with most things he would learn with experience.

This past week the first artifical disc was implanted in Little Rock and it was of course the first procedure this Doctor had done. I happen to know him and know that he and two of his partners had gone to Canada for a one week course on how to perform this procedure. I know that someone always has to be first when a Doctor is learning a new procedure but I am not so sure I would want to be the first when it comes to an invasive procedure.. My Doctor in Dallas has performed over 300. procedures.

Re: Ed

john h on 11/22/04 at 10:17 (164538)

Ed: since there are an infinite number of ways to manufacture or even measure for orthotics I think any standardization will be slow in comming. I was measured by computer by walking across a pad with sensors, measured by standing in foam, measured by laying on my stomach and being casted (twice). These three methods are bound to produce three different results and who is to say what is right or wrong. Each method has its detractors and supporters. Then we have the various types of ortotics such as rigid,semi-rigid,soft and many in between. Add to all this the results can be further altered by the shoe you place them in and the possibility the person may or may not benefit from even the correct orthotic if the Doctor was able to properly diagnose the problem. This seems very much a murky area that surely is an 'art'. Results from orthotics are across the board from great to made me worse. How long should one wear an orthotic before you decide you should no longer wear it? Most orthotics come with the instructions to start out wearing a couple of hours a day and work up to full time but if your feet are no better in a week,month,2 months,etc when should you discontinue use because I think a bad orthotic is worse than no orthotic (opinion). Some people are helped by orthotics so there is a place for them but it is the process of finding out who they are and what orthotic helps them that is my question. My personal experience has not been good in that about 7 out of 9 Doctors I have seen wanted to sell me orthotics. I think one watched me walk. Then again, I am not even sure you can determine if a person needs orthotics by watching them walk or not. Perhaps they are best prescribed by what the patient tells you, looking at shoe wear, and observing their feet. Perhaps we are making to much about watching someone walk as I have posted before from walking behind people it looks to me like half the world would need orthotics by observation.of walking.

Re: Elyse

Elyse B on 11/22/04 at 10:19 (164539)

Yup someone has to be first but it will hopefully never be me.

Re: Ed

Elyse B on 11/22/04 at 10:58 (164543)

wow great post John.I too have been measured in foam while sitting and measured with plaster while lying down and have walked across sensors as well. I agree about the watching you walk thing. I have always brought my sneakers into the doctor to show them the wear and tear but the doctors were not interesed in that at all.

Re: Ed

Ed Davis, DPM on 11/22/04 at 13:52 (164548)

John:

You are correct in that much is an art in this area. But, there also is a lot of science. Unfortunately, doing the orthotic process 'right' is time consuming and expensive. There must be a way for doctors who do the process in full to be able to differentiate what they are doing from the mass produced products.

Here is one of the limitations of verbal desciptions but I can demonstrate, on your foot, or any person's foot how one achieves a level of minimum plantar fascial strain and how it it the goal of orthotics to try to hold the foot in that position.
Ed

Re: Orthotics with a "channel"?

Ed Davis, DPM on 11/24/04 at 13:43 (164670)

Helene: It is possible to place a groove in the orthotic to remove direct pressure from the plantar fascia. One must be very careful about the groove placement as a misplaced groove can be a source of irritation unto itself.
Ed

Re: A hymn to orthotics

annie on 11/24/04 at 22:08 (164693)

I feel sorry for anyone who feels they were treating unfairly. I think an informed patient would be a god's send to a physcian. My DPM is absolutely great. I have spent much time with her discussing treatments and other alternatives. I feel we as a, so to say, consumer have to inform ourselves. Good luck to you. There seem to be many unethical companies and physcians out there. We need to protect ourselves.