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Orthotics caused knee pain and other foot pain?

Posted by DavidLou on 3/30/05 at 22:52 (172238)

I suffered mild PF for several years before it became painful enough to seek treatment about a year ago. I have very high arches and supination with bowleggedness (there's a proper term for this somewhere). I have excellent flexion too, though I tried stretching as part of my initial self-treatment. My podiatrist prescribed custom orthotics, which I began wearing last summer. On my 'normal' foot, I could feel slight arch support/pressure, but on my PF foot, I felt no support so I asked Dr to raise the arch on the orthotic. After doing so, PF was somewhat improved but I found myself walking on the outside of my foot even when barefoot - extreme supination. Knee pain began also. He brought the orthotic back to same level as 'good' foot, but after another month I began having pain on the outside edge of foot in metatarsal area. Knee pain persists on the inside edge. PF is about 30% better than initially. I stopped the orthotics completely 6 weeks ago and am now wearing Eccos and NBs, both with good support. PF is mild but not worsening, but outside edge of foot still painful under the 5th phalange/metatarsal joint - and knee pain is worsening on the inside of joint (not interior of joint, but on the same side of joint as arch). I'm assuming extreme supination was placing too much weight on outside edge of foot, but did that cause knee pain too? I'm male, slight build, 150 lbs, active hiker, no running. Will knee pain subside? PF actually feels better without orthotic, but what to do now? Knee pain didn't begin when I stopped orthotics - it was progressing before that time. I should have gone straight to ESWT at the outset! Help! And thanks for reading such a lengthy post.

Re: Orthotics caused knee pain and other foot pain?

Julie on 3/31/05 at 01:30 (172244)

I'm not a doctor. Walking abnormally can certainly cause problems higher up (knee, hip, lower back - in your case, knee). The excessive supination combined with your bowleggedness could well have strained your medial ligament. You need to find a way of normalising your gait so that your knee and hip joints aren't being stressed.

I wonder if you find taping helpful. It would give your feet at least some of the support they need without the problems you say were caused by the orthotics. Have a look at the section on taping in the heel pain book, and give it a try. If the problem is simply that you're walking on the outside edge of the foot to avoid pain, taping might relieve the pain sufficiently to get you walking normally again. It's worth a try.

It should be possible for orthotics to made that would help you, even though the ones you have haven't. You might like to do another post on the Inserts, Orthotics, Shoes board and get Richard's opinion. He has talked about the problems of high-arched feet in the past and might have some ideas for you.

Re: Orthotics caused knee pain and other foot pain?

Julie on 3/31/05 at 01:31 (172245)

Correction: that should have read 'I wonder if you would find taping helpful'.

Re: Orthotics caused knee pain and other foot pain?

Richard, C.Ped on 3/31/05 at 08:33 (172255)

Adding more to the arch of a supinated foot was the wrong move in my opinion. It did exactly what you said, push your foot out even more. Also in my opinion, the pes cavus foot is one of the more difficult to treat. It is usually rigid. You have to be careful not to push in excess supination. When I make an orthosis for high arch, it is usually soft material, and just enought to cushion the foot as well as good support.

Re: Orthotics caused knee pain and other foot pain?

DavidLou on 3/31/05 at 10:38 (172272)

Thanks both of you for the useful input. It seems a high-arched foot with PF would be difficult to treat by raising the arch even higher, due to the collateral damage caused. I'm hoping that with time, my knee pain and metatarsal issues will resolve on their own since I'm out of the orthotics. But I suppose there's the possibility that other methods may accelerate the return to normalcy (or may actually be necessary as resolution won't be automatic). I'll look into taping, too. I've used a compro brace too, but it's rather uncomfortable despite its helpfulness in supporting the arch. Wouldn't a Pod see a high arch and realize more arch support will cause other problems?

Re: Orthotics caused knee pain and other foot pain?

Shouldknow on 3/31/05 at 16:12 (172312)

As far as your question about the knee. By doing what they did you increased the compressive loads on your medial knee compartment. If you have reduced joint space available you could or can damage the cartilage in your knee. The problem is too many orthotics providers dont know how to treat that and they dont pay attention to the knee.

Re: Orthotics caused knee pain and other foot pain?

A Manoli II MD on 3/31/05 at 20:11 (172334)

this is, unfortunately, an old subject here. high arches do not usually need an arch support, and may make a varus knees worse. see this article. we just published another one in foot & ankle international. dr. richard is absolutely correct.


Manoli A 2nd, Graham B.
The subtle cavus foot, 'the underpronator'. Foot Ankle Int. 2005 Mar;26(3):256-63.


Re: Orthotics caused knee pain and other foot pain?

Julie on 3/31/05 at 20:35 (172335)

It seems you've got your answer, David. As a brief addendum to what I said earlier, I had precisely the opposite problem. I have a low arch, and have always over-pronated. About 25 years ago I developed pain on the medial side of my right knee,the aftermath of a skiing injury ten years earlier, and a podiatrist suggested orthotics (my first pair). I got them, they sorted the over-pronation out, and the knee pain resolved within a couple of months.

Whatever the feet are doing will affect whatever goes on above them. I hope your knee issues resolve soon.

Re: Orthotics caused knee pain and other foot pain?

ray on 3/31/05 at 21:43 (172341)

orthotics are made to make your feet better and align your gait no way will they cause you hip pain please do your research and be careful who you lision to on this site they are not doctors and can easyly cause you more pain and long term harm

Re: Orthotics caused knee pain and other foot pain?

Julie on 3/31/05 at 22:07 (172343)

Ray, what an extraordinary thing to say. Three professional people: one doctor, one pedorthist, and one teacher of yoga with some knowledge of anatomy have given their opinions in order to help David, and all agree.

Orthotics should indeed be 'made to make your feet better', and at their best, they do. But unfortunately they are not always properly prescribed, casted, or constructed, so unfortunately they do not always do good, as many people here have testified.

Please inform yourself(you could start with the recent discussion of orthotics on the relevant board) and do not make ignorant statements of this nature.

Re: Orthotics caused knee pain and other foot pain?

Shouldknow on 4/01/05 at 08:23 (172354)

RAY, Thanks for your contribution. With all due respect, and I am not sure how much is due, I could make an orthotic and give you a shoe that would make your back, hip, knee AND feet kill you. Just like putting nearsighted glasses on a far sighted person will give them a migraine

Re: Re julie

ray on 4/01/05 at 21:13 (172396)

that was not an igorant statement im sure people like you who are'nt a doctor could not give medical advive and are hurting people i always see your name with very stupit advice please get a life and get off this site your not a doctor just a homely womon with no life your going to hurt somebody you fat hole

Re: shouldnot know

ray on 4/01/05 at 21:31 (172398)

your mama stupit ass

Re: Orthotics caused knee pain and other foot pain?

Ed Davis, DPM on 4/01/05 at 21:50 (172402)

Dr. Manoli;
Here may be an example where it is important to ditinguish between arch supports and orhtotics. Many high arched individuals tend to have forefoot valgus requiring an orthotic with a forefoot valgus post. Often a well cushoined rearfoot coupled with a forefoot valgus post so that shock absorbtion is enhanced while oversupination in propulsion in minimized.
Ed Davis, DPM

Re: Re julie

april l on 4/01/05 at 22:43 (172409)


Re: shouldnot know

april l on 4/01/05 at 22:44 (172410)