foot orthotics survey

[layton]

you can tape your toe in the meanwhile...google turf toe and taping.

 

 

As for hard vs. soft in arch height. Here's the logic. Over-pronators tend to roll their foot in too much, causing a decrease in arch height. Pronation is a loose packed position in the foot, creating shock absorption. Supination is the closed packed position, creating a rigid lever for stability and propulsion. Under-pronators=Too rigid=soft curved slip lasted shoe. Over-pronators=too floppy=board lasted stiffer shoe. The arch is meant to act as a support for your body to use, much like cars on a bridge. There are plenty of normal and abnormal variations in arch height that have nothing to do with how much you do or do not pronate.

[brukb]

Some additional things to consider:

The firmness of an orthotic device is most appropriately determined by the mobility of the joints within the foot. A very mobile foot typically does well with a harder device, while a less mobile foot does better with a softer device. It is true that in most cases a high arch relates to lack of mobility and a low arch relates to too much mobility, however the patients that I meet who have been unsuccesful with orthoses in the past have had devices made according to their arch height without regard to how much the joints within the foot move. It is also worth noting that the joints may move differently depending on the task imposed on them (nonweightbearing vs. standing vs. walking vs. running/hiking). A person with a floppy, low-arched, overpronating (most common biomechanical abnormality of the foot in our society)foot can learn to overcome their issues with a progression of foot "posture" or stabilization drills, progressing through a series of static, then dynamic weightbearing exercises. An orthotic is often a quick and easy fix, however I have had patients that either did not want an orthosis in their shoe, or could not put one in their shoes (dancers, gymnasts, etc.) that, with the proper training, developed excellent control of their feet and eventually eliminated the need for orthoses completely.

[sampdx]

Sherri - I'm interested in the name and location/contact info of the person who made the custom orthotics for you. Can you pm them to me as well?

[catbirdseat]

I saw the doc again yesterday. He tells me he looked at the x-ray again and decided that the little toe had been dislocated. Neither he nor the doctor in California had noticed this before. So I asked him what could be done, and he said it was too late to manipulate the joint. He just taped the toe to its neighbor. Now that joint is going to be prone to arthritis.

 

I told him the left heel started hurting after going on a run three days ago. It was my first run in a month and was only two miles. He said it was a recurrence of plantar faciitis. I asked him if it might have been brought on because of artificially pronating the foot to avoid putting pressure on the little toe. He said definitely, but he still wanted to modify my orthotic device to raise the arch, so I surrendered it to him and was sent home with instructions to keep the foot taped using the Low Dye technique. I get the orthotic back on Monday.

 

http://www.cise.ufl.edu/~jnw/PlantarFasciitis/low-dye.pdf

Edited February 2, 2007 by catbirdseat

[Sherri]

PM'd you.

[layton]

catbird...

 

Sorry to hear about all the foot trouble!

 

I've got some thoughts and ideas you may want to investigate and ask your doctor about. Just ideas, not recommendations.

 

That's a great taping technique for plantar fascitis. In fact, there are probably hundreds of different combinations of different tapes, and patterns that may help if that one doesn't. Worth some investigation. You should have someone evaluate that shoes you are using too, maybe they aren't the right pair for you? Believe it or not, Cold Laser is emerging as a useful tool in treatment. You have to keep an open mind since you can't really feel anything, but chronic suffers of this problem usually are willing to try anything. Extracorporal-shockwave-lithotripsy (yikes!) is being researched too, and shows promise. It sounds fancy, but is basically the ultrasound used on things like kidney stones. Of course stretching and intrinsic foot exercises can help, especially stretching your gastrosoleus (calf muscles). In fact, in extreme cases, some people find vast relief by using a posterior night splint to apply a prolonged static stretch to their calf. For you, maybe it's a really good pair of orthotics.

If there are muscle or tendon adhesions adding to your issue, stripping out the fascia with a technique similar to Graston Technique(or the actual named technique). Also working out the trigger points in your foot and calf muscle may help.

Finally, have someone watch how you run or walk. Maybe you are running incorrectly-not just because of a structural foot problem, but maybe you aren't firing your muscles in a correct pattern, or have habitually trained yourself in a mal-adaptive gait pattern like being a forefoot striker or early toe-off (which could explain the turf toe).

 

Whatever the problem or treatment, it's important to look at the big picture.

 

And as for the turf toe-same goes for the taping or splinting. But if your are concerned about long term effects (the big toe is hugely important in correct gait) I'd have someone work on that toe after it's stable and healed. Having it manipulated should decrease your chances of degenerative joint disease.

[catbirdseat]

Strictly-speaking, "turf-toe" is an injury of the big toe is it not? I found a source for taping the big toe, but am not sure whether it can be applied to the small toe.

 

There is no question that my gait was messed up. I expect that it will improve as the small toe injury heals.

 

I asked Newell about the extracorporeal-shockwave therapy and he said that he has used it, and it works, but he puts it in the category of method of last resort, along with traditional surgery. These devices are so expensive that they don't actually own them, but arrange for them to be brought in. It requires local anaesthesia, etc.

 

A question for you Michael, is that when I get the modified orthotic back, is there anything to be gained from continuing to tape for a while? Or does the orthotic completely fill the same role as the tape?

[layton]

That's a question the person who prescribed your orthotic will have to answer.

[griz]

For what it's worth, my brother has had ITBS for years now and tried the custom made inserts with no favorable results. Just last year though, he used something similar but just a $20 Dr.Sholls heel insert and helped allot. Between that and his first try with a chiro in Seattle he did a 3 week backpacking trip w/o pain. Something he has not been able to do for nearly a decade.

 

About two months ago, I started to get ITBS too. Been looking into inserts myself. Will let you know how they work out.

 

Also, any advice on how to shop around for a good chiro,layton? Questions to ask,things to look for,ect? Thanks.

[layton]

Wait 6 months and see me?

 

No really, I'd see someone who attacks problems from a biomechanical standpoint, rather than a rack-em-and-crack-em subluxation based doc. Stay away from the ones with flashy ads, ask how long regular appointments are (no less than 15 min!), ask if everyone gets x-rayed (don't do it), ask if they are going to "scan your spine" with fancy equipment (scam or patient retention tool), see someone who does more than just "adjust". Sometimes good docs offer free 1st exam/tx to get patients...but more bad ones do that. Ask if the doc treats sports injuries specifically, not in a roundabout way by adjusting your neck to free the nerves or whatever. They should take a thorough history, perform a relevant physical including orthopedic tests, and give you a good reason for their treatment. Be aware of the package deals, although it is a good idea and a way to save money, a lot of scumbags use this. Not everyone needs to be treated 12 times.

 

I wish that the folks in my profession giving us a bad name would

be forced to change their titles to technician, not doctor. It's not solely their fault, I think if insurance companies would shape up, the crappy docs would do.

[moira armen]

In college I was on the cross country team and my coach sent me to a podiatrist who had me get some orthotics for overpronation, because I was running 50 miles a week and my arches and ankles were hurting. My feet were cast and the casts sent away to Seattle and they made me some graphite orthodics (sp?). I have been using them ever since for running, working (all my jobs have always required me to be on my feet all day), hiking, and cross-country skiing. They help a ton, if I don't use them my arches hurt. I have high arches. That was 12 years ago. I got them for free because my college paid for them out of their sports budget! I have no idea how much they would have cost.

[i_like_sun]

Orthotics have helped me out tons! I have essentially no arch, so they just compensate for that. If anything, its [my] opinion that by simply having your feet and ankles work within proper movement patterns, your muscle-activation patterns get re-wired! I find that I can now take my orthotics out of my shoes for a day or two, and my gate and muscles stay good. I then cyle back onto the orthotics.

 

Its actually very interesting to me (I'm an exercise science major); by "cycling" like this, I find that my feet and ankles remain stronger than if I always relied on the orthotics. There are actually studies that show that people who run and exercise barefoot, have the lowest insident of injury! Barefoot running is also super fun.

 

I think that orthotics make a real difference if you have a good therapist and orthotic maker; but also strengthening the right muscles has made even more difference for me.

Edited February 17, 2007 by i_like_sun

[Akim]

You might want to try the posture control insoles for flat feet (either pronation or supination). I found a cool blog about them. Apparently there is a small wedge under the big toe and the rest of the insole is slim. You can cut them to various shoe sizes to fit your gear. There is a cool blog about them: http://myflatfeet.blogspot.com/

Check it out.

 

[layton]

A medial forefoot wedge is nothing new! But they work.

Still, the fundamental issue is the shoes. A flexible shoe with a toebox being the widespart of the shoe (hard to find), no heel elevation (even harder to find), and toes that don't point upwards will do much more than any orthotic. Then you can add a medial forefoot wedge, metatarsal pad, hindfoot wedge, and a heel lift(if there is a leg length discrepancy).

 

If anyone knows of a super low-profile orthotic that can be customized with these features and doesn't require plaster casting....let me know.

[mythosgrl]

I am in love with my orthodics! They are the best and have never hurt me. I was having a lot of shinsplint pain while running cross country in high school so i got them. I had a my left leg was shorther than my right so my pT also put a lift in that shoe. I pronated a lot more on my right foot, so that was also corrected. I can't remember how much i paid for them cuz my parents paid for them, but i think insurance covered a bit. The only problem i have had from them is that the padding got rubbed down on my right arch so the plastic started cutting my foot. I just got it resoled and it is as good as new!

[RichardKorry]

I've had periodic lower back pain for over 35 years (I'm 52). I also got periodic knee pains whenever I began to train for a longer run (e.g. marathon) and never was able to run one. I did lots of hiking and cycling without too many problems.

 

I've had orthodics for ~20 years. The first set were done by a podiatrist on Roosevelt and 90th and were hard plastic from the heel to the ball of the foot. I wore a flat spenco pad over it for padding. That helped my lower back and knees. Those died when I stepped on a nail on the trail heading up to the Grand Teton. The nail went up through my boot and cracked the hard plastic. Saved my foot though!

I then went to BioSports NW which is not Prorobics on Eastlake. I had a cast orthotic that was full length. I am very bowlegged and need the anterior posted 5 degrees to get my leg into a neutral position. This really helped my skiing by allowing me to get onto my inside edge more than I have be able to before. It also helped running and lower back problems.

 

I used these for ~ten years and had lots of success (i.e. no pain) running ultra-marathons, alpine climbing, backcounry skiing, etc.

 

However I still had a tendency to get tendinitis in my knees and I would run with neoprene sleeves over them to keep them warm. Three years ago I got a really bad back spasms while heaving some heavy suitcases and not paying attention to body mechanics.

That was a wake-up call that more needed to be done sooner rather than later.

 

I then went to see Donna Bajelis who does a combination of Rolfing/Hellerwork and her own ideas that she calls "Structural Medicine". I'm a total info-mmercial for her as she's reworked my body. I no longer have a "sway back", back pain, tendinitis in my knees, or lots of other problems we tend to get as we age. She's hard to get an appt with and is really pretty expensive. But her type of therapy has really helped me.

 

I still use orthotics for most everyday activies.

 

 

[marylou]

I've been getting customs made by the UW orthotics school students for years. Some good, some bad, some great. Comfortwise the cork ones have always been my faves, but they "pack out" after a while. Last year, both sets the kids made me hurt my feet in odd ways and so the instructor whipped out a pair for me. They are pretty rockin' as long as I wear them almost every day. These ones are semi-hard ones and there's nothing really to pack out on them.

 

My biggest foot problem is arthritis in the subtalar joint, and the footbeds hold the bone in a neutral position where it doesn't hurt too much. I'm thinkin' after I get some bone spurs removed I might be able to run again.

 

I totally swear by orthotics.

[sk]

how do i find someone who will fit me in a pair of shoes properly???

[billcoe]

how do i find someone who will fit me in a pair of shoes properly???

 

Muffy, I thought you live in the best town in the world for that kind of thing. Runningville, Oregon USA.

 

Probably have quality running shoe stores on every other street corner who should do this quite capably. You might do some surfing on running sites to see what or who the bloggers and posters like in your town.

 

My wife did the Portland Fit series to work up to do the marathon (walking it) last year. It caused some big time lingering pain in her hip (which she only just told me about last month). So I offered to buy her 2 pairs of the orthodics, which she picked up from a recommended shoe store: so that she would not be uncomfortable and reluctant doing it.

 

I was shocked to learn how much these puppies go for...but if it works....it's a hell of a lot better than crippling yourself. Course, she could have just gone and seen Layton for a hell of a lot less than that too and probably gotten the benefit as well.....

 

She did not breath a word of it to me at the time....just suffered in silence......and kept on soldiering on....

 

kind of dumb

_______________________________________________________

 

Like I posted on the other site, I got plantars from soloing up Beacon Rock SE Corner and running the trail down. 2nd lap down I felt the pain starting. Gent (who workd at a hospital excercise/rehab thing for a living) recommended 3 things:

 

1) When you wake up in the AM, before you get out of bed. do stretches of your feet. I would start by just rolling them around and letting them stretch , then later would pull on them some with my hands.

 

2) When you are watching TV, sitting in a chair - take a rolled towel and by rolling it under your feet, lightly work it and your muscles.

 

3) Buy insoles for your shoes. EVERY pair you are wearing. Do'n't pad out of bed without a pair of supportive footwear either. I bought the green superfeet from REI. They are damned expensive, but better than the alternative.

 

 

BTW, Layton had a better, more descriptive version of the excercises somewhere on the site you should look for. Mine was just to paraphrase, cause obviously, they worked and fixed my problem so I forgot at least half of what Gent told me:-)

[sk]

Thanks Bill. I will go check out one of the running shops. I know there is a place in town that puts you on a tred mill and finds the right shoe for you gate and step etc... but i have always baught shoes at payless or k-mart, the mall or in more recent years REI. But i have never been fitted for shoes at the REI here. we are lucky if we can get someone to go in back and bring out the box with the shoes i want to get in about the right size. i honestly can't remember the last times someone measured my foot and helped me find the right size of shoe.

[i_like_sun]

I freaking love my orthotics! Actually, its time for some new ones. Perhaps Layton will be able to hook it up some day!

[Mark O'Neal]

When I first started heavily hiking and backpacking I developed acute pain in my achilles that switched back and forth between the two feet. The podiatrist fitted me with a custom orthodic and the pain promptly went away at the same level of activity. Problem was that it took some time to get it fitted correctly and also over time it weakened my ankles and I think caused knee pain. My achilles pain was gone but it was replaced with other pain. In the last year I have ditched the orthodics and have been wearing Sole inserts in my hiking boots and in my sneakers at the gym. The achilles pain has not returned and the knee/ankle pain is much better. The theory goes that the orthodic was preventing my knee from pronating properly thus causing that pain. I suspect that I could have gotten rid of the orthodics a long time ago once my achilles adjusted to the new level of abuse.

 

I over-pronate and do not have great flexibility in my achilles (i.e. I can't push my heels to the ground when doing Down Dog). I had Sport orthodics that were rigid at the arch but had a softer heel. They were full length but past the arch was essentially just padding. I think they were about $250 but my insurance covered them so I only paid $10!