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Custom orthoses?
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 2015-09-22 11:16 AM |
 26 |  Subject: Custom orthoses?I started running in VFF (Vibram Five Fingers) in early 2012 and built up to ~14 miles on a long run, only to come down with what I thought was a severe case of ITBS. Lateral pain right above the knee joint, tightness when driving, sitting for long periods, etc. I swam for 6 months, no running, recovered and then built back up again to ~9 miles...only to come back down with ITBS. Since then I've had two bouts with Achilles tendinitis and today can't even run a mile without my knee buckling and tightening up. I get what I presume is ?sciatic pain in my leg/feet. I've switched away from the minimalist shoes to traditional shoes (which I really hate) and was fitted by a local guy who designs shoes for a living and has multiple patents to his name. I've consulted two orthos, a sports medicine doc, chiropractor (ART was completely worthless and a waste of time/money), two physical therapists, had an MRI of the knee (nothing there) and still no resolution to my issues except that I was told I had flat feet. I've had shoes suggested to me and tried OTC orthotics and was able to get up to ~3 miles earlier this summer, but am back to zero (I lasted 3 minutes on my latest attempt). None of these "experts" can explain why I was able to run 14 miles at one point pain-free and now can't even manage a quarter-mile. My PT who is working on my neck/shoulder for a trapped nerve suggested custom orthotics, but the guy she's recommending wants $350 for the casting and gait analysis. Given my experience with the OTC stuff I am skeptical to say the least. I am tired of throwing money at this problem for the last three years to make no headway at all. The only thing I can say is that I stopped lifting weights once I started tri training and that may have been a BIG mistake, since I lost ~20 lbs of muscle in the process. I've noticed all sorts of muscle imbalances (glute muscle tone, trapezius size) pop up over the past 3-4 years and my orthopedic issues cropped up around the same time. Once my cervical nerve heals (if it ever does) I will be getting back into the gym to remedy these imbalances. Does anybody have any suggestions as it relates to ITBS/flat feet and custom orthotics? |
| 2015-09-22 12:03 PM in reply to: sentient.couch |
Member 1748    Exton, PA | Subject: RE: Custom orthoses? I have flat feet too, I guess the first time I noticed they were flat was when I was a teenager; over 30 years ago. Dr.'s always said to use orthodics in my shoes, I never did the custom insets just off the shelf stuff. When I started running 9 years ago the running store put me into shoes with lots of structure, I was ok with them and experimented on my own with different shoes over the years. The last 4 to 5 years I have found myself in minimalist shoe(not 5 fingers). These are the best thing I have ever found(for me), very comfortable and never have any issues. I think I spent about 4 or 5 months(over the winter) doing mostly slower maintenance runs getting used to them. I did have some major back issues in 2009, my best resource turned out to be a Physical therapist, who was able to tell me what was wrong how we were going to correct it, and what caused it. Weight training to strengthen supportive muscle can help, as well as stretching(tight muscles can cause imbalances). Good luck |
| 2015-09-22 12:10 PM in reply to: sentient.couch |
Expert 623 Issaquah, WA, | Subject: RE: Custom orthoses? A few questions. Has anyone looked at your running gait? Did they do a video analysis? Did you actually do PT for this problem or was it just a consult? |
| 2015-09-22 12:28 PM in reply to: harmony |
| 319 Sarasota, Florida | Subject: RE: Custom orthoses? Possibly off topic, but I would also consider external causes and medications. I believe there is exaggerated propaganda around some meds, but a friend of mine was taking ciprofloxacin which caused symptoms you describe and it took her months to recover. I have seen PTs for back pain and sciatica in the past and their exercises helped, but ultimately what helped the most believe it or not was swimming. I wish the PTs would have prescribed that a long time ago. I personally do not know of anyone with custom orthoses, or anyone with flat feet but that sounds like a likely factor. Good luck, I know these things can be frustrating. |
| 2015-09-22 1:11 PM in reply to: harmony |
| 26 | Subject: RE: Custom orthoses? I did have a gait analysis done by both PTs. One was done in the VFFs, the other in the more cushioned traditional shoes (PIs) + orthotics. PT#1 gave me stretches and some strengthening exercises, the other one said flexibility wasn't the issue (I am somewhat hyperflexible) and that I was overpronating...and so the custom orthotics suggestion. The orthotist is a PT by training and a gait specialist, so maybe it is worthwhile just to go for that. |
| 2015-09-22 1:13 PM in reply to: 0 |
| 26 | Subject: RE: Custom orthoses? Originally posted by runtim23 Possibly off topic, but I would also consider external causes and medications. I believe there is exaggerated propaganda around some meds, but a friend of mine was taking ciprofloxacin which caused symptoms you describe and it took her months to recover. I have seen PTs for back pain and sciatica in the past and their exercises helped, but ultimately what helped the most believe it or not was swimming. I wish the PTs would have prescribed that a long time ago. I personally do not know of anyone with custom orthoses, or anyone with flat feet but that sounds like a likely factor. Good luck, I know these things can be frustrating. I don't take any meds except for the occasional 200-400 mg of ibuprofen so I don't know of any other causes. Swimming is unfortunately out because of the pinched nerve in my neck...and the "walking" suggested by my PCP was just...insulting. Edited by sentient.couch 2015-09-22 1:16 PM |
| 2015-09-22 5:06 PM in reply to: sentient.couch |
Expert 623 Issaquah, WA, | Subject: RE: Custom orthoses? Originally posted by sentient.couch I did have a gait analysis done by both PTs. One was done in the VFFs, the other in the more cushioned traditional shoes (PIs) + orthotics. PT#1 gave me stretches and some strengthening exercises, the other one said flexibility wasn't the issue (I am somewhat hyperflexible) and that I was overpronating...and so the custom orthotics suggestion. The orthotist is a PT by training and a gait specialist, so maybe it is worthwhile just to go for that. Was it running gait or walking gait? I am assuming running but want to make sure because it makes a big difference. Has anyone tried taping your foot to correct the overpronation? Sometimes that can give you an idea if custom orthotics will work. Transitioning from a traditional shoe to a barefoot shoe can be quite a process since the foot has somewhat adapted to being in a more supportive shoe. It is possible that you could strengthen your foot/arches so that you do not overpronate when you walk/run. It is also possible that you have problems farther up the chain (hip, core) that need to be addressed. Seeing a good PT that does a full running assessment and looks at the hip, knee, and ankle is important. He/she should do a video analysis so that it can be slowed down to really identify what is going on with your running gait. Since you don't mention that you have pain with everyday walking I assume that the overpronation is not an issue with lower impact through the leg. Your running form may need to be tweaked so that you are not putting so much stress through that leg. |
| 2015-09-22 5:25 PM in reply to: harmony |
| 26 | Subject: RE: Custom orthoses? Originally posted by harmony Was it running gait or walking gait? I am assuming running but want to make sure because it makes a big difference. Has anyone tried taping your foot to correct the overpronation? Sometimes that can give you an idea if custom orthotics will work. Transitioning from a traditional shoe to a barefoot shoe can be quite a process since the foot has somewhat adapted to being in a more supportive shoe. It is possible that you could strengthen your foot/arches so that you do not overpronate when you walk/run. It is also possible that you have problems farther up the chain (hip, core) that need to be addressed. Seeing a good PT that does a full running assessment and looks at the hip, knee, and ankle is important. He/she should do a video analysis so that it can be slowed down to really identify what is going on with your running gait. Since you don't mention that you have pain with everyday walking I assume that the overpronation is not an issue with lower impact through the leg. Your running form may need to be tweaked so that you are not putting so much stress through that leg. Running gait, actually. It's entirely possible I did the transition too quickly, although I spent about 3-4 months building up distance. I definitely took it too fast to start with, but the second time through I took my time. Then there is the issue of the nerve-like/sciatic pain (?) in my leg over the past 4-6 months...I assume maybe I may have caused permanent damage. I have an old back injury besides. Thanks for the input, I will probably just go through with the orthoses/gait eval since it sounds like the PT evals I have done in the past were woefully inadequate...I don't know that they looked at all parts of the chain from back downward. This PT was recommended by more than one person, so it may be worth the $$$. I appreciate the direction that the responders in this thread have given me. |
| 2015-09-23 1:45 PM in reply to: sentient.couch |
Veteran 495 Calgary | Subject: RE: Custom orthoses? Here's a link to a painscience.com article on orthotics... If you're familiar with the painscience web site you won't be surprised to find that the article includes some skepticism and warnings about the way orthotics are often prescribed and manufactured. https://www.painscience.com/articles/orthotics.php |
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