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Orthotics question - need your collective wisdom

gdionelli

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Formalities first: Hi, my name is geedee, and I...

So I haven't been around this joint in a while - kinda hard when you're perpetually injured. But now I'm running (figuratively speaking) back to you for insights about custom orthotics. I've never had them before, so I don't quite know what to expect, or if what I'm experiencing is normal, or...?

I just got my second pair for sesamoiditis. The first pair made the pain worse. The jury is still out on this one, but...I'm using them in my customary 4mm heel drop shoes, and I feel like the heels are sliding around on me. Probably because the orthotics are much higher in the heel and the shoes were not made for an elevated heel insert. Does this mean I need to buy new, higher drop, shoes just to accommodate the stupid inserts?  I don't want to make the investment till I know the orthotics are going to work, but I may not know if the orthotics are going to work until I have shoes that will work with them. 

I'm getting the impression that foot doctors all think that foot problems can be solved with a high rigid arch support. And I'm finding that to be almost as painful as the sesamoid problem. I told the doc after the first pair how uncomfortable the arch was, and he promised this pair would be less rigid. Well, it is, but only marginally. It still feels like I have a large boulder in my shoes, in not quite the right place for my arches. Is this common, or should I be raising a ruckus? I've already raised several ruckuses  with this doc - mostly when it took seven weeks to get the first pair and then many more weeks to get a follow-up appointment.  

I also fail to understand why elevating my heel and arch would help offload stress off the sesamoid area (just behind the big toe on the underside of the foot.) I don't have an engineer's mind, but it seems to me that I would be putting MORE stress on that area by angling the foot downward?  There's more to the insert that than - there's sort of "cut-out" that's supposed to help with the offloading - and I think it does work - so why the heck do I need the unpleasant arch supports?

Your experiences and insights would be much appreciated!



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The only thing that I was told when I started using them was to switch to a neutral shoe. The orthos are making all the needed adjustments.  I'm not sure if you should change the drop.  Did your doc see you in those specific shoes?

Give the arches sometime to get used to.  I had inserts with metatarsal pads that drove me batty for weeks until I stopped feeling them.  The type of arch support I have now for my type of tendon problem was described by one doctor as "almost obnoxious" but I don't notice them anymore.  

How often are you going to see him for adjustments?  

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Thank you, KRG! He saw me in those shoes and I mentioned the sliding around - he just indicated I would probably get used to them.  I don't see that the sliding would stop given the "shortness" of these shoes. 

I'm seeing him again in about 3 weeks. Still working up to wearing these things all day. Yes, "almost obnoxious" is a good description.

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I don't wear inserts but my heels do often slide around in shoes. Heel lock lacing makes a huge difference.

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Thank you both. I will try heel lock lacing for the sliding problem. 

I'm still not convinced, however, that I can tolerate the high arches - I wore them about five hours today, and finally had to ditch them for a while - it just hurt!  I'll keep plugging away at it.

 

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Just like chiropractors think everyone needs a weekly adjustment, podiatrists think every foot problem needs an orthotic. (apologies to chiro fans - but it's true)  Did he talk about break-in time? Increasing the time you wear them over a period of a couple of weeks? Especially with a radical change, your feet need to get used to them.

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I've worn custom orthotics off and on over the years - two different pairs - had no real problems with them, but eventually went to a neutral shoe and stopped wearing them. I never had pain or discomfort with mine (maybe a little bit of muscle soreness on lower legs) - so if yours are painful, it sounds like they're not right for you. No advice - except I think your instincts are right (keep complaining). 

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I have no idea about any of this, except hopefully the new lacing strategy helps. 

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11 hours ago, Dave said:

Just like chiropractors think everyone needs a weekly adjustment, podiatrists think every foot problem needs an orthotic. (apologies to chiro fans - but it's true)  Did he talk about break-in time? Increasing the time you wear them over a period of a couple of weeks? Especially with a radical change, your feet need to get used to them.

Thanks, Dave. Yes, he talked about break-in time, and I'm working up gradually. 

From what I read orthotics are the only real treatment for (relatively) mild sesamoiditis. I've already spent a month in a walking boot for it, plus used a lot of anti-inflammatories. There is a surgery, reserved for tougher cases, and trust me - I don't want surgery again!

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9 hours ago, CompulsiveRunner said:

I've worn custom orthotics off and on over the years - two different pairs - had no real problems with them, but eventually went to a neutral shoe and stopped wearing them. I never had pain or discomfort with mine (maybe a little bit of muscle soreness on lower legs) - so if yours are painful, it sounds like they're not right for you. No advice - except I think your instincts are right (keep complaining). 

Thanks, Carol. I probably will! 

According to the doc, if the orthotics do what they're supposed to I should eventually be able to get back to going without them.

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11 hours ago, Dave said:

Just like chiropractors think everyone needs a weekly adjustment, podiatrists think every foot problem needs an orthotic. 

🙄 I'm pretty sure that first she tried PT, then surgery, then a boot, then PT, then running, then another boot, then PT, then an orthotic.  

Reed, I hope these put you back on the road to recovery.  It took me over a year of tweaking them before they were perfect.  Don't get discouraged if they aren't perfect yet.

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Just now, Keep Running Girl said:

🙄 I'm pretty sure that first she tried PT, then surgery, then a boot, then PT, then running, then another boot, then PT, then an orthotic.  

Reed, I hope these put you back on the road to recovery.  It took me over a year of tweaking them before they were perfect.  Don't get discouraged if they aren't perfect yet.

Haha! You got that about right! Yes, the podiatrist talks about tweaking them - it's just such a time-consuming process, and after all this  I'm sick of waiting weeks for a new set, then weeks for my next appointment.  It's pretty hard now not to get discouraged!

Thanks for the support, KRG!

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My only experience with orthotics was...ahem...a few years back when I was a teen. I found they worked well as long as I took out the innersole from the shoe (and made sure any new shoes coped/fitted snug with the orthotic). Something with a low drop I'm guessing would be ideal if the orthotic is adding height.

Keep asking questions. It's frustrating because often these specialists are working from general experience, not necessarily from running, and as we all know running research continues to change rapidly . It was only a few years ago everyone was meant to be going barefoot to strengthen their feet.

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36 minutes ago, ChocTop said:

My only experience with orthotics was...ahem...a few years back when I was a teen. I found they worked well as long as I took out the innersole from the shoe (and made sure any new shoes coped/fitted snug with the orthotic). Something with a low drop I'm guessing would be ideal if the orthotic is adding height.

Keep asking questions. It's frustrating because often these specialists are working from general experience, not necessarily from running, and as we all know running research continues to change rapidly . It was only a few years ago everyone was meant to be going barefoot to strengthen their feet.

Thanks. Yes, I've removed the original innersole. The thing about the low drop shoe is that it's designed for a low drop innersole - that's why I'm wondering if I'd be better off with a higher drop shoe. 

You are absolutely right about the specialists not understanding. And it doesn't help that my two and a half year foot saga has culminated in me not looking like a runner!

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Haha I'm not sure I've ever "looked" like a runner!

I've found that podiatrists love nothing more than to give you something to add drop to your shoes. Whether that's helpful or not I really don't know. I do agree with your logic about your foot being pushed towards your stress area. Maybe a bit of arch support might help but I'd be reluctant to raise the heel. It sounds like you've had a long complex process so just keep asking the questions & good luck.

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"Orthotics for Sesamoiditis are prescribed specifically to help take weight off of the painful Sesamoid and to distribute the force onto the arch or onto the non-painful metatarsal heads. This requires an orthotic that conforms extremely close to the arch of your foot."

https://www.footankle.com/pain-balls-feet/sesamoiditis/

I'm so sorry I've been so commenty on this post. Feet are kinda my thing.  (Yes, I am aware how weird that is)

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I’ve never worn orthotics so my only frame of reference is from my son. He had seisimoiditis also. Sorry you are dealing with this after all of your other issues.

He was in a boot and then had a super rigid orthotic. He hated it, but the idea was to not letvthe foot bend too much so the very low blood supplied seisimoid could heal.

The orthotic makers expect to make adjustments. If it feels that wrong definitely go back and tell him/her what issues you are having.

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2 hours ago, Keep Running Girl said:

"Orthotics for Sesamoiditis are prescribed specifically to help take weight off of the painful Sesamoid and to distribute the force onto the arch or onto the non-painful metatarsal heads. This requires an orthotic that conforms extremely close to the arch of your foot."

https://www.footankle.com/pain-balls-feet/sesamoiditis/

I'm so sorry I've been so commenty on this post. Feet are kinda my thing.  (Yes, I am aware how weird that is)

Don't apologize - I asked for comments. 

My orthotics, the ones that put me in MORE pain, were designed to distribute the force to the arch. When that didn't work he went the other direction - transferring the force to the non-affected metatarsals. That DID work, when he accomplished it by sticking pads that he'd cut with scissors onto the bottom of the shoe insert. So then he ordered the second pair of orthotics - but they seem to combine the two approaches.

I also think that they don't "closely conform" to my arch - the arch of the insert seems to me to be too far back, with a lump under the beginning of my heel pad. 

 

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2 hours ago, ocrunnergirl said:

I’ve never worn orthotics so my only frame of reference is from my son. He had seisimoiditis also. Sorry you are dealing with this after all of your other issues.

He was in a boot and then had a super rigid orthotic. He hated it, but the idea was to not letvthe foot bend too much so the very low blood supplied seisimoid could heal.

The orthotic makers expect to make adjustments. If it feels that wrong definitely go back and tell him/her what issues you are having.

So the strategy worked for him? 

I feel like my month in the boot was wasted because I should have gone straight from it to the orthotics. But after I got out it was almost 3 months before I received the first pair.

I can put up with these orthotics if there's a good hope they will fix the problem.

Thanks, OC!

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3 hours ago, gdionelli said:

So the strategy worked for him? 

I feel like my month in the boot was wasted because I should have gone straight from it to the orthotics. But after I got out it was almost 3 months before I received the first pair.

I can put up with these orthotics if there's a good hope they will fix the problem.

Thanks, OC!

It finally worked but took probably over a year. his was exceptionally bad. They weren't sure if he had fractured the seisimoid or if they were just inflamed. His progression was boot, to non flexible, rigid orthotic, to regular orthotic. It took him a couple of years to finally get over.

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10 hours ago, ocrunnergirl said:

It finally worked but took probably over a year. his was exceptionally bad. They weren't sure if he had fractured the seisimoid or if they were just inflamed. His progression was boot, to non flexible, rigid orthotic, to regular orthotic. It took him a couple of years to finally get over.

I'm glad it finally worked! Mine is actually a relatively mild case - at this point. I don't want it getting any worse!

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On 5/15/2018 at 6:51 AM, gdionelli said:

That DID work, when he accomplished it by sticking pads that he'd cut with scissors onto the bottom of the shoe insert.

I had custom orthotics for neuromas (tumor of the nerves in the metatarsals) and had just that experience - orthotics were so painful I couldn't run in them, big lump in the arch.. 

and the solution was the same, cut some pads out of orthopedic felt and glued them to the existing insoles, to take the load off the neuromas. Since that worked I didn't go back to get the orthotics tweaked. I have a roll of the felt so every new pair of shoes gets a custom set of pads.. 

my trick to get the custom orthotics wearable, was to buy a new pair of oversized walking shoes, and put the orthotic under the existing insole. The existing insole cushioned the lump and those boots were my primary shoes for some time, seemed to work. 
 

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2 hours ago, doug in co said:

I had custom orthotics for neuromas (tumor of the nerves in the metatarsals) and had just that experience - orthotics were so painful I couldn't run in them, big lump in the arch.. 

and the solution was the same, cut some pads out of orthopedic felt and glued them to the existing insoles, to take the load off the neuromas. Since that worked I didn't go back to get the orthotics tweaked. I have a roll of the felt so every new pair of shoes gets a custom set of pads.. 

my trick to get the custom orthotics wearable, was to buy a new pair of oversized walking shoes, and put the orthotic under the existing insole. The existing insole cushioned the lump and those boots were my primary shoes for some time, seemed to work. 
 

I have had a mild neuroma. Didn't have custom orthotics, but did put a neuroma pad under the insole - and it DID help. 

I'm on the verge of ditching the orthotics altogether. I did think about getting a bigger pair of shoes to accommodate the orthotics under the insoles, but dang it -  who's to know if that will work? And I'm getting tired of spending money on stuff that doesn't work!

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