Run Run Away

Question:

I have a heel injury and/or arch injury that occurred recently. A sports podiatrist has recommended orthotics used with heavy motion control shoes from now on. Before I follow his recommendation  would like to hear from others who have had a similar problem or are knowledgeable about this type of problem. Here is more detailed info for those who can maybe offer some advice. About 3 1/2 weeks ago I developed a heel pain at the inside front part of the heel which I gather is also called plantar fascitus.  I didn’t do much running, did some toe stretches I read about in a book, and I thought it was getting better.  So I did a few runs (one long run, one short) last week.   It swelled a little bit after the long run (2 hours) but I put some ice on it and it calmed down.  About four days after this and two days after my short (1/2 hr) run my heel felt much worse and I now have been unable to walk normally for the last four days.  Also the pain has transferred to my arch on the inner side.   I went to a sports podiatrist and he said "orthotics!" in use with a heavy motion control shoe from now on.  Although I want to correct this problem, from reading I had done I was a bit worried about immediately embracing this extreme measure without at least seeking some more advice. I also did not completely understand his reasoning of how this problem developed and how orthotics would cure it, in fact he stated it wasn’t clear that it would cure it and that he gave "no guarantees".  Since it seemed he had a definite 3 week timetable for fitting and adjusting orthotics it wasn’t clear at all to me given my current state whether I would be able to run at all before this time period was up and I became worried about being left cold with a pair of orthotics that I would later find out didn’t help my running  in addition to being out the time and expense (about $400.).  I’m of course going to get (at least) a second opinion from another podiatrist.  But I was also curious to hear from others that may have some helpful info and/or similar experiences.  I.e. 1) Should I first try some other less drastic measures such as different shoes, over the counter inserts, exercises? Or is this just an inferior alternative and delaying the inevitable. The cost is not an issue, but finding something that works is. 2) If a second podiatrist recommends orthotics, what questions should I be asking about the orthotics and the fitting process itself?  Should I shop around and/or wait longer to have a well-recommended podiatist fit the orthotics or is this a common enough problem that I should just go with the earliest appointment I can get to have them made rather than delay.  3)Meanwhile,   even if I go with orthotics it seems it will be at least several weeks and maybe as long as several months to get an appointment with a podiatrist I feel I can trust and/or orthotics with the above podiatrist so I’m wondering about doing something to try to run before then (assuming my heel begins to feel a bit better).  Of course I’m not sure I should be doing that but the thought of giving up running for a long time is not pleasant.  So any advice on this would be welcome also. 4) If I do pronate I realize now that I have not been wearing the best shoes recently. My shoes are due for replacement anyway soon. Should I buy new running shoes before getting orthotics? In case you want to know: BRIEF RUNNING/INJURY HISTORY:         I am 42 years old and have been running regularly for the last 12 years with mileages of 50-60 per week and 1-2 marathons per year. During the past year I did increase my training by doing 60-65 miles per week and entering some shorter races as well as racing competitively in marathons (finishing first or second in most local races) until this past   February when I had an injury to my left rear-end muscles.  I didn’t run for about two months after that and was gradually recovering from this and working my mileage back up.  I was only back up to 45 miles per week when this recent heel injury occurred.  Prior to these two injuries I never had a serious running injury. This recent podiatrist seems to be saying that he thinks I pronate, although didn’t seem sure, particularly since my running shoes show no unusual signs of wear as he noted.  He also said the leg with the foot injury was longer than the other, although I had not been previously aware of this and thought it strange that my physical therapist never mentioned this in connection with my rear-end injury. THANKS tons for any feedback you can give!

Response:

I have had four pairs of orthotics.  The first was provided by a podiatrist that was the president of the organization for such doctors at the time. They caused me great pain (This was in 1972, I should add.)  I think the guy’s name was Barnes, in Burbank, California.  I went back twice to get them adjusted.  They cost a great deal of money for me at the time. They never did anything for me. They made the sole of my foot burn. After a while it was either give them up or not run at all.  In the first race of my life, in 1975, I hurt so bad that I stopped during the race, sat on the ground, took the orthotics out and threw them into the bushes.  Luckily, there were only 17 people in that 20K race so no one saw me.  I got up and finished 7th. Many other orthotics tried to help my biomechanically-challenged foot complex.  I spend a lot of money but got nothing in return but promise — followed by depression. Ask the foot doctor to help you *without* orthotics.  That is were the inept of their ilk make their money.  Ban orthotics and most foot doctors would be out of business. Sure, there are some good ones: e.g., John Pagliano. —–Al Hromjak

Response:

| Ask the foot doctor to help you *without* orthotics.  That is were the | inept of their ilk make their money.  Ban orthotics and most foot | doctors would be out of business. As much as I hate to agree there is too much over-prescription of orthodics. Where I live there are about 10 Podiatrists. Of the 10, 7 will have a nurse mixing the plaster for the mold as you sign in at the frontdesk with any problem using running in the description of the problem.   As Al suggests be an informed consummer and seek a non-orthodic solution. As Dennis, our resident foot Dr. suggests, try a commercial off the shelf lift first combined with strength/stretching  exercises. If that fails they maybe a real custom made orthodic is what you need. The same advice works when the first suggestion to solve a problem is to grab for the knife and take a few tucks. — Doug Freese  All opinions are mine. IBM Tele: 8-293-8098

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– Hide quoted text — Show quoted text -(Doug Freese) writes: | Ask the foot doctor to help you *without* orthotics.  That is were the | inept of their ilk make their money.  Ban orthotics and most foot | doctors would be out of business. As much as I hate to agree there is too much over-prescription of orthodics. Where I live there are about 10 Podiatrists. Of the 10, 7 will have a nurse mixing the plaster for the mold as you sign in at the frontdesk with any problem using running in the description of the problem.   As Al suggests be an informed consummer and seek a non-orthodic solution. As Dennis, our resident foot Dr. suggests, try a commercial off the shelf lift first combined with strength/stretching  exercises. If that fails they maybe a real custom made orthodic is what you need. The same advice works when the first suggestion to solve a problem is to grab for the knife and take a few tucks. — Doug Freese  All opinions are mine. IBM Tele: 8-293-8098

I have had many pairs of orthotics, all costing well over $100.00. Yet, I have found that Dr. Scholl’s Flexos work as good as anything. With plantar fasciitis, I found that wearing them all the time in running shoes helps the most.  Now if your boss complains, I guess the boss is not a runner.  Tell the boss the shoes are not part of your job description — unless, of course, you are "a person of the night." ——-Al Hromjak

Response:

Hromjak) writes: I have had many pairs of orthotics, all costing well over $100.00. Yet, I have found that Dr. Scholl’s Flexos work as good as anything. With plantar fasciitis, I found that wearing them all the time in running shoes helps the most.  Now if your boss complains, I guess the boss is not a runner.  Tell the boss the shoes are not part of your job description — unless, of course, you are "a person of the night." ——-Al Hromjak

Orthotics might be overprescribed, but for some people (like me) they can make a huge difference.  I have flat feet which make my knees fall inward, resulting in knee pain.  I tried Dr. Scholl’s and they helped a bit.  Then I tried Spenco’s and they helped more.  And then I got custom orthotics and they helped _a lot_.   Interestingly, the guy who did my orthotics did not push them hard on me.  He (a chiropractor) had me stretch and do some leg strengthening excercises first, and adjusted my back — over several weeks.  Then, once he had the rest of my screwed up body in order, he took a mold and made the orthotics. John Tomlinson

Response:

– Hide quoted text — Show quoted text – l Hromjak) writes: | Ask the foot doctor to help you *without* orthotics.  That is were the | inept of their ilk make their money.  Ban orthotics and most foot | doctors would be out of business. As much as I hate to agree there is too much over-prescription of orthodics . Where I live there are about 10 Podiatrists. Of the 10, 7 will have a nurse mixing the plaster for the mold as you sign in at the frontdesk with any problem using running in the description of the problem.   As Al suggests be an informed consummer and seek a non-orthodic solution. As Dennis, our resident foot Dr. suggests, try a commercial off the shelf lift first combined with strength/stretching  exercises. If that fails they maybe a real custom made orthodic is what you need.

I agree with views expressed here, ie that orthotics should be regarded at least somewhat skeptically when prescribed by a podiatrist who is going to profit from making them. My experience is this: when I developed plantar fasciitis from excessive speedwork, I first saw the only podiatrist in my small city. After a cursory 5-minute examination (which consisted of him lookimg at me stand bare-footed) he pronounced the solution was custom-made orthotics. He did not examine my running gait and was uninterested in examining my running shoes. Therefore I was very skeptical of his solution -a pair of $400 orthotics that his staff would make. I subsequently travelled to big cities to see 3 sportsmedicine physicians who all said the same thing: that I was a moderate over-pronator and that orthotics would be a last measure if icing,stretching,strengthening,firmer shoes etc… didn’t solve the problem. Now maybe that podiatrist was right and I do need orthotics. However, if I ever do consider orthotics again I will do it this way: I will see at least two podiatrists that runners recommend. I will solicit their opinion only and make it clear that I would not be buying the orthotics from them. Peter James Belleville, Ont, Can

Response:

In rec.running you write: As Dennis, our resident foot Dr. suggests, ….

As a former long-distance runner sidelined with a lifetime overuse injury, I’ve just today begun to look at rec.running.  Could you share with me the identity of this "Dennis" and his e-mail address? In what state is he located? Having seen numerous orthopedists and other physicians, none of whom share my passion for running, I’d like to seek his advice on my condition.  Thanks. —

Response:

As much as I hate to agree there is too much over-prescription of orthodics. Where I live there are about 10 Podiatrists. Of the 10, 7 will have a nurse mixing the plaster for the mold as you sign in at the frontdesk with any problem using running in the description of the problem.  

Try an orthopedist, who may also prescribe an orthotic but who has no financial incentive to do so. —

Response:

Richard Estock spake thus… (Doug Freese) writes: As much as I hate to agree there is too much over-prescription of orthodics. Where I live there are about 10 Podiatrists. Of the 10, 7 will have a nurse mixing the plaster for the mold as you sign in at the frontdesk with any problem using running in the description of the problem.  

I went to a sports medicine orthopedist who does not cast for orthotics.  He referred me to a good sports medicine PT who treated with orthotics and other means (night splint).   — Scott D. Benton Optimism indicates that the situation has not been clearly understood.

Response:

Richard Estock spake thus… (Doug Freese) writes: As much as I hate to agree there is too much over-prescription of orthodics.  Where I live there are about 10 Podiatrists. Of the 10, 7 will have a nurse mixing the plaster for the mold as you sign in at the frontdesk with any problem using running in the description of the problem.

I ‘m struggling with Plantar Fasciitus (sp?). I thought I had it under control then I bruised it during a hike. Geez! I haven’t run for 2 going on three weeks. My Doc ( a Navy Sick Call type), What’s to take the conservative approach. I went in suggesting an orthodics and a night cast. He gave me 500mg of Naproxen (Aleve). So far this works 100 times better than Motrin (for me anyway). The conservative Doc told me, if there is still pain (after two weeks there is) when I return from vacation he’ll shoot me with cortisone. This doesn’t strike me as conservative. Conservative to me is stretching, icing, arch supports, possibly orthodics, night cast. A needle! Maybe I’m just a big wimp and cortisone is what is needed.

Response:

This doesn’t strike me as conservative. Conservative to me is

stretching, icing, arch supports, possibly orthodics, night cast. A needle! Maybe I’m just a big wimp and

cortisone is what is needed. To some doctors "conservative" means doing what they’ve been doing for years regardless of new approaches to treatment that have come along. I would find a different doctor. — University of Wisconsin Anesthesiology Dept.

Response:

Scott, I’ve been dealing with PF since early April.  Through taping, icing and over-the-counter anti-inflammatories I’d been able to keep it in check but was never able to overcome the problem.  Finally, I decided to see a podiatrist.  My insurance (HMO) requires that I see my family doctor first and obtain a referral for the podiatrist and of course the family doctor explained that all I needed was to stop running.  As he put it; "Running isn’t good for you!"  I explained that neither was sitting in his waiting room for an extra hour with deathbed flu sufferers, but we each need to do what we need to do.   Anyhow, I finally saw the podiatrist (32, brunet, very attractive) who explained that the goal was more than to reduce the pain.  The goal was to enable me to continue my lifestyle (to include running) but without the pain.  In her words "If your butt’s on the couch, how would we determine if her therapy was working?"  She also stated that in many cases good over-the-counter insoles were as effective (and much more cost effective) than custom orthotics.  I’m now using Spenco Heel Supports (not the heel cushions, arch supports, or heel cups) and so far so good.  They support a weakness in my arch and protect the area where the PF attaches to the heel.   I’m not suggesting that my fix will help you.  What I’m suggesting is that you might want to get a second opinion from a podiatrist with a sports medicine background.  I’ve had the cortisone shot before and swear that I’ll exhaust all else first next time. As a side note:  I noticed your web service is located in the Tidewater area of VA.  I ran for ODU in the ’80s and they had a fantastic sports medicine program there at the time and used to offer help to local runners as well as the university athletes.  It might be worth a try ! Good Luck, – Mike —    __/__,      Newington, VA. USA  (703) 550-5510             O/

Response:

I had plantar fasciitis last year — total agony.  I went to an orthopedic surgeon who works extensively with professional athletes – i.e., people who are not going to stop.  He gave me a program of cold massages and stretching that I could do easily at home along with some very thin unobtrusive heel cups for my shoes.  After 6 months the pain is gone and is staying gone.  I agree with one of the other respondents — get a second opinion — you don’t have to stop or shoot yourself up with steroids. Good luck Roberta

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