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Re: Plantar Fasciitis
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Re: Plantar Fasciitis - September 9, 2005 9:43:00 AM
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JLS_PT_OCS
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From: USA
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I was actually thinking of the custom ones, John.
I was thinking of the comparison between prefab vs custom orthotics, and the issue of no convincing evidence for customs (almost always more expensive) versus prefabs (usually pretty cheap). Unless I'm behind the evidence curve on this one.
I'm not saying it's crazy to make custom orthotics, don't get me wrong, but it seems to me they may be generally overused.
I have had several patients who improved immediately with custom orthotics but for whom the prefabs weren't helpful. But I just didn't send them for the customs right out of the gate...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Plantar Fasciitis - September 10, 2005 5:07:00 PM
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PTupdate.com
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From: Pittsburgh, PA USA
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Quite correct Jason...prefabs are an easy and cheap method and word the majority of the time. In fact, I have found that even correcting mechanical issues by <50% can still result in full resolution. The more one tries to get at 100% the more he/she risks tipping the scale the other way, and opening up a Pandora's box of other problems. This is something more commonly seen with custom orthotics that were just not done right.
I now issue 50x more pre-fabs than make customs. Plus, the pre-fabs give the patient more confidence in the out of pocket expense of customs....if they try pre-fabs and get 50-75% improvement, they are more confident that customs will be even better, and worth the cost
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
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www.PTupdate.com
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Re: Plantar Fasciitis - September 10, 2005 5:09:00 PM
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jma
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From: NY
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I agree. Custom orthotics did not work for me but good shoes with proper support did and is still helping me.
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Re: Plantar Fasciitis - September 14, 2005 9:13:00 PM
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goodlooks58
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From: CA
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Anyone heard of the Strassburg sock? From the description it looks like a Dynamic splint to give a prolonged stretch in dorsiflexion of the ankle. Any comments?
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Re: Plantar Fasciitis - September 15, 2005 3:19:00 AM
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Shill
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From: Madison WI USA
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Has anyone tried to put a medial post on some of the over the counter orthoses? It seems to me that this might be a really easy way to customize a cheap orthotic and get some greater benefit. I havent tried it, just looking for suggestions on what to use.
Thanks,
Steve
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Steve Hill PT
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Re: Plantar Fasciitis - September 15, 2005 6:55:00 AM
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coloradojulie
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From: colorado usa
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One of our PTs uses it...to me is looks like a less cumbersome version of a dorsiflexion splint. A sock with two straps that hold the foot into DF.
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Re: Plantar Fasciitis - September 15, 2005 2:40:00 PM
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jma
Posts: 2409
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From: NY
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I agree. Here a lot of good things about the "sock".
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Re: Plantar Fasciitis - September 16, 2005 7:08:00 AM
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truthseeker
Posts: 148
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I think that often the orthotics that are of the shelf or even the custom ones bother plantarfasciitis more because they are "arch supports" in the literal sense. The arch is not built to hit the ground. It is built to absorb load like a spring, allow the subtalar joint to evert which mechanically and plyometrically loads nearly all of the muscles in your LE. If the rearfoot and/or forefoot is in varus, then orthotics that post are indicated for a host of diagnoses. if the foot structure is neutral or near neutral and the foot looks flat, then they have a failed ligament or horrible proprioception or something else unusual.
If the orthotic has a big medial arch hump, then you are not correcting the problem, just preventing the arch from going down. ITs supposed to go down, then come back up.
Here is a story I tell my patients when I explain foot function:
Mr. McGregor is the farmer that Peter Rabbit steals lettuce from. Mr McGregor has a stone wall around his garden and a stone archway so that he can get his tiller in. There is a gate so that he can close it and keep the critters out.
If the keystone of the archway begins to fall how should he fix it??
If he asks the people that believe in "arch supports" he would put a post underneath the keystone so that it couldn't fall. That would solve the problem but destroy the function of the arch.
If he asks a stone mason (someone who understands how to build an arch and how they work{the PT in the analogy}) they would say to shore up the sides of the archway and if they don't move apart, the keystone can't fall and viola, you have fixed the arch and maintained its function.
I like that one.
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Re: Plantar Fasciitis - September 27, 2005 10:39:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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Any info on ESWT? I am just learning about my options to treat my Plantar Fasciitis. How effective is ESWT compared to surgery?
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Re: Plantar Fasciitis - September 28, 2005 5:39:00 AM
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Yogi
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From: San Antonio, Tx., USA
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Duff, I found the same thing, alot of money wasted sometimes, and I like to try the more accomodative Ali-Med othoses first. I once saw a 15 y.o. male whose navicular was banging the pavement, and he refused to even use a gel insole. He was mildly retarded. I often used just a heel lift for LLD, also, in fact I've seen a quarter inch heel lift equalize step length and normalize gait. But sometimes we had to go so far as a BFO, and a single bar upright with a medial t-strap, to somewhat align the calcaneus and unload the ligaments.
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Re: Plantar Fasciitis - September 28, 2005 8:10:00 AM
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jma
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From: NY
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From what I have heard, ESWT by itself did not have any favorable outcomes. Can't remember the study that did this. Don't know if they compared it to surgery. They must have by now. Just haven't read it yet.
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Re: Plantar Fasciitis - September 28, 2005 11:18:00 AM
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srcase
Posts: 551
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From: Michigan
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What is ESWT?
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Re: Plantar Fasciitis - September 28, 2005 11:27:00 AM
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Sean Weatherston
Posts: 102
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From: Idaho
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Extracorporeal Shock Wave Therapy---last study I heard about using ESWT for plantar fasciitis showed something like a 40% favorable response? That was 2 or 3 years ago I think and I can't remember which journal....Has anything else been published?
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Sean Weatherston, PT, OCS, CSCS
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Re: Plantar Fasciitis - September 28, 2005 11:54:00 PM
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Randy Dixon
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This has come up before if you search the archives. I think I read a Cochrane report on it. The early studies looked promising but that seemed to fizzle if I recall correctly.
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Re: Plantar Fasciitis - September 28, 2005 11:58:00 PM
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Randy Dixon
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Goodlooks, What is the longest you have been non-weight bearing with PF? There is a good chance you have just never given it a good chance to heal.
If you have it bilaterally and equal you can do a study, NWB on one side, with equal treatment with everything else. Do it for science.
What about those everted feet? Do you have them?
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Re: Plantar Fasciitis - September 29, 2005 5:35:00 AM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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Randy: I have been weight bearing as I am working. I only have the problem on the right side. I do have everted feet and I have been wearing orthotics since last 15 years. I even went to an Orthotist and he made me another kind of orthotics which gave a computer/force generated impression, however, they were a disaster. So went back to my old, hard orthotics.
I will try to give it a rest.
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