Help me help my feet!
January 31, 2012 11:01 AM   Subscribe

Do I need these custom orthotics, store-bought ones, or a new podiatrist?

Warning: long-ish; skip to TL;DR for summary.

For the past several years, I have had intermittent but severe calf pain when walking. Finally, my GP sent me to a neurologist and a vascular expert to rule out nerve or circulation issues and found no problems. I gave up at that point and just took frequent breaks when walking.

Fast forward about a year. My calf symptoms had improved quite a bit and I spent a weekend walking around the city with friends, wearing flats (not ideal, obviously). My left ankle started hurting after that weekend, on the outside of the ankle under the ankle bone to about mid-foot on the side of my foot. I assumed it was sore from all the walking and did RICE for a few days. Several weeks passed and it still hurt, so I went to a podiatrist, who diagnosed tendinitis in the ligament that is attached to the outer foot bone that goes under the ankle bone (he did not mention the name of the tendon). He gave me some topical anti-inflammatory gel, taped my foot with athletic tape into a position that would take pressure off the injury, and examined my walk. He told me I might need orthotics.

A few weeks later my ankle felt better and he made up some faux-orthotics for me by modifying some of my existing shoes' insoles with felt. I tried them out, but they made my arches hurt; these shoes had never caused foot pain before. He told me that they would feel better in time, and that real orthotics would not hurt because they are molded from your actual foot, so I ordered the orthotics. When they arrived, I tried them in the same shoes with the same result (immediate pain in my arches), but he said I should try them for a week and in different shoes to make sure, and that the padding on top of the graphite base of the orthotics would soften a bit and would stop hurting. Unfortunately, I have tried wearing them for the prescribed amount of time for the past two weeks, since per the manufacturer's instructions I am supposed to break them in gradually, and they still make my arches hurt almost immediately after putting them on. The podiatrist insists they will feel better once they are "broken in", but I can't see how I can be expected to continue breaking them in when my arches are screaming at me to take them off after a few minutes. When I sit down after walking or standing with them for 10-20 minutes, my arches actually throb. My podiatrist insists this will improve, but it hasn't, and he has been dismissive and reluctant to adjust the arch height.

As I see it, my options are: get these orthotics adjusted again by the podiatrist (he adjusted them once already) and hope for the best; ditch them and try a different style (the manufacturer page is here; I have the Graph-Rite, but the Women's Dress line appears more in line with the types of shoes I wear most often); get a second opinion; buy some stability insoles off the shelf like these; or some combination of these options.

If you have experience with wearing custom orthotics, did they hurt when you first got them? What is your experience with adjusting them? Do you prefer them, or did you find that off-the-shelf inserts got the job done just as well? Any other suggestions?

TL;DR: My podiatrist prescribed custom orthotics and they hurt and aren't getting better. He is indifferent to my complaints. Should I a) keep adjusting the expensive inserts, b) get a second opinion, c) try another orthotic or insole, or d) other?

I know YANAD, YANMD, etc.; I am looking more for personal experience with custom orthotics vs. store-bought, but people with podiatry/physical therapy/anatomy expertise are welcome.
posted by bedhead to Health & Fitness (13 answers total)
I've been wearing custom orthotics for about 15 years now and when I first started wearing them, there was some mild discomfort but the relief from all my other related issues was a fucking revelation that this was how I could've been feeling for so long, oh the humanity, &c.

I've had better results from the ones that entirely replace the insole of your shoes than with the ones that are just half-foot inserts sitting on top of the shoe's regular insole. The brand name is a bit worn away but it looks like "RunFlex" - they have a hard layered/stacked heel that looks like the heel of a men's dress shoe, with a hard curved plastic half-foot arch support attached, and the entire thing is fit to a durable foam inner sole the size and shape of a regular sneaker insole.

(note: I got these kind specifically because I'm a runner - idk what they'd look like for non-sneakery shoes)
posted by elizardbits at 11:09 AM on January 31, 2012

I have never found any other viable answer to "(medical specialist) is indifferent to my complaints" that consists of anything other than "find another doctor".

Pain tends to mean there's something wrong. No doctor should be ignoring this without a better explanation and reasoning than "it'll improve with time", and when the pain comes as a result of treatment that doctor's ordered in the first place, it is DEFINITELY time to make sure that the first guy hasn't completely screwed things up somehow.

Or, to phrase it differently: after the time the doctor told me "just keep taking the pills, the side effects will improve with time" when I was BLATANTLY SUICIDAL as a result of an anti-depressant - and on my own a thousand miles from home at the time - I just flatly stopped paying attention to that particular advice, when given, and sought alternate doctors accordingly.

Foot pain is not analogous to depression, your situation is not mine, and I am most emphatically not a medical professional of any kind - but that is the best advice I can think of to give.
posted by mie at 11:13 AM on January 31, 2012

I've had good and bad orthotics. The good ones feel lovely and took almost no time at all to break in. The bad ones -- rather more expensive, made via computer scanning rather than plaster cast, and with a metatarsal pad that my good ones didn't have -- always felt wrong immediately and started hurting after an hour or so.

If they can't be broken in, they're broken. I doubt you'll get a refund from the specialist (mine did dick-all). Try finding a well-recommended podiatrist in your city for your next pair. (Really, I have a huge bias for plaster casting over scanning, just from this experience.)
posted by maudlin at 11:18 AM on January 31, 2012

You should get a second opinion. I don't know if there's any way to prevent the feeling of throwing good money after bad, or any recourse to help you get money back that you spent on the useless orthotics. It would be tempting to try to convince the first doctor to "fix it" on the assumption that the total bill would be less but I'm not at all sure that the orthotic industry works that way. Ask the person at the front desk (who does the billing) if there's any special money deal for the replacement orthotics when the first ones don't work (yes, that's currently hypothetical but you can get info anyway), and unless they see this as a normal situation that they know how to help you with, there's absolutely no reason to waste time trying to convince the first doctor, you may as well start over.
posted by aimedwander at 11:19 AM on January 31, 2012

Just to double check - was this person a DPM (i.e. qualified Doctor of Podiatric Medicine)? If so, then just treat them like any other doctor and trust their treatment until you reach a threshold of wanting a second opinion (see elizardbits, above).

But - and this is quite a big but - be very careful since the custom orthotic industry is not well-regulated and in my experience infested with charlatans. There's a guy who runs a performance footwear shop near me (hiking boots and running shoes mainly) who has a string of TLAs after his name and a special scanning and reconstruction machine that diagnoses everyone I've ever seen go in with a terrible progressive gait problem that will lead to "crystal deposits like knives in your feet" unless you buy his £350+ custom orthotics.
posted by cromagnon at 11:23 AM on January 31, 2012

To clarify, yes, he is a DPM and he ordered the orthotics through a reputable custom orthotics manufacturer. He did plaster casts, not scans. We had a lengthy discussion about the types of shoes I wear and I wanted dress orthotics; it appears that the type I got were for "he active patient or athlete who needs control or accommodation in tighter fitting foot gear", which sounds like they may be for running or other active shoes rather than dress shoes. I have been testing them in sneakers and winter boots.

Fortunately, I have only paid about half of the fee for the orthotics - he took a deposit but told me not to pay the rest until I am satisfied with them, so I will attempt to get these ones fixed or re-made if possible, but I'm not out the full $$$ fee yet.
posted by bedhead at 11:32 AM on January 31, 2012

Can you get a referral for physical therapy and/or massage? One of my co-workers had tremendous pain in her feet when walking, and went through all kinds of specialists (including neurologists, podiatrists, etc), but what worked for her was physical therapy and myofascial massage. Good luck.
posted by mogget at 11:44 AM on January 31, 2012

I agree that you need a second opinion. In the meantime, I would also experiment with stretching your calves, achilles tendons and -- as much is possible -- your arches. If my feet/legs are too tight, I find my orthotics to be more uncomfortable than usual (however, I still think there's something wrong with the ones you've got).

Also seconding mogget's recommendation for massage/physical therapy -- also the only thing that really worked for me.
posted by Mrs. Rattery at 12:02 PM on January 31, 2012

One relatively low-cost option: Sole insoles. For $40-$50, you can basically make your own custom insoles. (You heat them in the oven, put them in your shoes, stand in them for a few minutes, step out, and let them harden.) I have no idea how likely they are to work for you, but the cost for a possible permanent solution is less than a single massage/doctor visit, so it might be worth a shot.
posted by Mr.Know-it-some at 12:59 PM on January 31, 2012

As another point of anecdata: I have worn both cast and computer scan custom orthotics for running. I loved the computer scan orthotics--ran marathons in them with no problem (but the place that made them went out of business before I could get another set), and have been struggling with the cast orthotics. YMMV.

I concur that you should get a second opinion from another reputable doctor. If you can find someone who will recommend shoes that work well with the orthotics, that would be even better, since both the shoe and the orthotic affect your gait, but I don't know if that's possible with dress shoes.
posted by beryllium at 2:15 PM on January 31, 2012

orthotics dramatically changed my life for the better several years ago. they are absolutely worth the money.

yes, they hurt for the first month or so of wearing them. that is expected as your feet, legs, body readjust to this new positioning of everything.

you should be wearing them with sneakers or wide toebox type shoes. not high heels or whatever. i got exceptions to the dresscode at all my jobs to wear sneakers because of my foot issues.

my issue was tendonitis and plantar fasciatis. the pf was terrible, but the tendonitis made me feel like my ankles were going to shatter with every step. we tried foam inserts first, but then i ponied up for the $400 orthotics. i was dubious, but within a few weeks of wearing them, i was 95% pain free. i wore them for twoish years, then felt so good that i started wearing flip flops again. all the time. bad idea, don't do this. now my feetsies are getting hurty again, but my feet have changed shape so my old orthotics don't fit right. dumb dumb dumb.

i also got some pt for a couple of weeks, but felt it was wasteful to pay for an appointment for someone to tell me to do shit i could do at home for free. (of course i didn't. you should also not do that. you should maybe go to a couple of sessions to find out what would help you specifically, then actually do it at home for free.)
posted by misanthropicsarah at 2:50 PM on January 31, 2012

I have been using custom plastic-molded orthotics for more than fifteen years, and while they don't remove all of the pain from walking, they're incredible. Mine have never caused me pain like yours apparently do.
posted by willbaude at 2:58 PM on January 31, 2012

it was ten years ago that I was fitted for custom orthotics and they were uncomfortable and possibly even painful for a couple of weeks to a month and then I got used to them. because it was ten years ago and I don't wear them anymore (long-ish and possibly not relevant story) I do not remember these things exactly. I had tried other sorts of inserts and orthotics before getting the custom ones and nothing worked as well as the custom ones. I would say it is likely worth the difficulty getting them fitted properly.
posted by spindle at 7:17 PM on January 31, 2012

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