[pt4u67]

In your arrogance you assume I am a layman. But let's not worry about me. You are using your status as a medical professional to slam a particular company.

You use words like "consistently" and based your rationale on testimony from your patients. That seems hardly valid in that it is a small slice of the population. Have you personally inspected the sales practices of this company? Have they ever been investigated for practicing medicine without a license?

When people offer opinions as layman, those opinions are taken with a grain of salt because they are the opinions of people with little evidence beyond their own experiences. When medical professionals give opinions, they carry some weight within society because of the authority that comes with our position in society. Do select your language carefully. The company you speak of may be all of the things you say they are, however you have no proof. You are, in fact, nothing more than a layman yourself in that your evidence is restricted to your experience only.

It is night and a light pole sheds light on the ground. There is change on the ground and someone asks you to point out where the change is. You naturally point to the illuminated area where you see the change, not realizing that there may be more change where the light doesn't shine. But of course, with 23 years experience, you already knew that.

 

[cdavant]

Not a lot of evidence out there but I find a quick search on medline finds data for plantar fasciitis. It is only one cause of foot pain, so I won't generalize:

"However, custom-made orthotics have been shown to reduce the tension in the plantar aponeurosis, whereas standard orthotics did not produce the same effect.[17] As stated earlier, because tension at the origin of the plantar aponeurosis is the likely etiology of plantar fasciitis, reducing the tension in the plantar aponeurosis would likely reduce pain and aid healing.

Recommendation. Heel pads are not recommended for the treatment of plantar fasciitis but may provide relief for patients with pain due to a heel contusion. Orthotics are recommended in the initial treatment of plantar fasciitis. Custom molded orthotics are more effective than preformed orthotics. The cost of custom-molded orthotics, however, may limit the utility of this treatment option.

Level of Evidence. Small RCTs showed a trend toward benefit."

 

[pt4u67]

Not a lot of evidence out there but I find a quick search on medline finds data for plantar fasciitis. It is only one cause of foot pain, so I won't generalize:

"However, custom-made orthotics have been shown to reduce the tension in the plantar aponeurosis, whereas standard orthotics did not produce the same effect.[17] As stated earlier, because tension at the origin of the plantar aponeurosis is the likely etiology of plantar fasciitis, reducing the tension in the plantar aponeurosis would likely reduce pain and aid healing.

Recommendation. Heel pads are not recommended for the treatment of plantar fasciitis but may provide relief for patients with pain due to a heel contusion. Orthotics are recommended in the initial treatment of plantar fasciitis. Custom molded orthotics are more effective than preformed orthotics. The cost of custom-molded orthotics, however, may limit the utility of this treatment option.

Level of Evidence. Small RCTs showed a trend toward benefit."

I'm not arguing the virtue of custom FO's vs. OTC FO's. My argument is summarized above.

Please understand, I'm not anti orthotic. By the way, although orthotics are AN answer, they are not THE answer as the causes of plantar fascitis are multi-factorial. That is beyond the scope of this post however and I'll just leave it at that.

 

[DocD]

pt4u67,

Please Doctor,

Let's be honest and let's be realistic. Tell me that in your years of practice, you've never formed an "opinion" based on your years of experience, which in reality is anecdotal and not really evidence based. There's not a practicing physician that doesn't dictate what he/she does on a daily basis, based on his/her experiences in practice. This isn't always what is written in the book or what is in the literature, but what works for you and your patients.

And yes, I have had the opportunity to venture into a "Foot Solutions" store. And although there isn't a store near my office, there is one near my home. And I was literally attacked when I entered and then the salesman proceeded to "evaluate" my gait and foot structure and attempted to "diagnose" my ailment (though I was basically asymptomatic). Naturally, I did not clue him on how I put food on my table. He then wanted and almost insisted that I "needed" a product that I absolutely did not need, and for my particular foot type would have actually been contra-indicated.

So, my opinion was based on a real experience in addition to the experiences of my patients.

I'm a very strong advocate of patient rights and I'm not a big fan of any patient being taken advantage of by any type of practitioner, store, online offer, mail offer, etc.

I do understand your point, but do believe that I can voice my opinion responsibly when indicated. I understand the meaning of peer reviewed literature/evidence based medicine. I have had several articles published in well respected journals in conjunction with some very well known and respected docs from some very prestigious teaching hospitals/universities in Philadelphia. And ironically, one of the papers we published involved plantar fasciitis.

 

[mipcar]

As a doctor who mostly treats above the feet and a runner for 50+ years (27 marathons, 4 Bostons) I've used orthotics for as long as I can remember. If you really need an orthotic you should invest in a couple of pairs of professionally fitted custom inserts. You won't do lasting damage to your eyes by using glasses fitted to someone else. The same isn't true of your feet.
You ought to save a bit by getting two pairs at once, they will last twice as long and switching one pair from running to tennis to dress shoes all the time is a pain.

I totally support that statement. I was suffering terrible foot cramps, more and more of my shoes I could not wear, saw many "specialists" before finally finding the right one. Had custom orthotics made, they fit in all my shoes and my problem is 90% resolved. It will never become 100% cured due to the lesions/hardening I have acquired on some of the nerves in my foot. As a side benifit my posture has also improved.

Mychael

 

[pt4u67]

pt4u67,

Please Doctor,

Let's be honest and let's be realistic. Tell me that in your years of practice, you've never formed an "opinion" based on your years of experience, which in reality is anecdotal and not really evidence based. There's not a practicing physician that doesn't dictate what he/she does on a daily basis, based on his/her experiences in practice. This isn't always what is written in the book or what is in the literature, but what works for you and your patients.

And yes, I have had the opportunity to venture into a "Foot Solutions" store. And although there isn't a store near my office, there is one near my home. And I was literally attacked when I entered and then the salesman proceeded to "evaluate" my gait and foot structure and attempted to "diagnose" my ailment (though I was basically asymptomatic). Naturally, I did not clue him on how I put food on my table. He then wanted and almost insisted that I "needed" a product that I absolutely did not need, and for my particular foot type would have actually been contra-indicated.

So, my opinion was based on a real experience in addition to the experiences of my patients.

I'm a very strong advocate of patient rights and I'm not a big fan of any patient being taken advantage of by any type of practitioner, store, online offer, mail offer, etc.

I do understand your point, but do believe that I can voice my opinion responsibly when indicated. I understand the meaning of peer reviewed literature/evidence based medicine. I have had several articles published in well respected journals in conjunction with some very well known and respected docs from some very prestigious teaching hospitals/universities in Philadelphia. And ironically, one of the papers we published involved plantar fasciitis.

I do form opinions, however I don't go around flaming legitimate businesses in public online forums. You're certainly free to conduct yourself in anyway you see fit when in a room alone with your patient, however you are literally blowing apart a company based on second hand information. I believe in law this is called hearsay evidence.

And while I can appreciate that you personally went into A foot solutions store and felt accosted, I would remind you that it was A store and not ALL stores. Furthermore, you are asking the readers here to take you at face value that you were "attacked" when you went into this store, when you have already prefaced your revelation with an expressed contempt for the company. I'll end this now and stick to matters of clothing. Thanks.

 

[DocD]

Doctor,

Just as I formed my opinion on the combined information of my patients and my single experience in the store I visited, I believe you're being just slightly critical and using my medical degree as an excuse as irresponsible degrading of one company.

However, I do believe that the members of this site are certainly intelligent enough to make their own decisions, and do realize that they are reading the opinion of one specialist, based on my own single set of observations.

Additionally, I read members on this forum stating very strong opinions on a daily basis regarding manufacturers/companies that are disliked, "trashed", etc., (certain suit manufacturers, retailers, shoes companies, etc.) due to a poor experience, poor customer service, poor quality or a plethora of reasons. And for some reason you didn't seem to have a significant problem with the "flaming" of those companies. I don't see where there's a difference, just because my "opinion" was formed as a professional. As a matter of fact, I do believe some of the opinions regarding "flaming" of companies WERE formed by those that can be considered professionals in their respective fields, such as tailors, etc.

Your points are well taken, and I understand that as a professional I have a responsibility. And I sincerely believe that I maintained that responsibility by letting those on this forum know my feelings about the particular company in question. Obviously our thoughts differ on this matter, so apparently we will have to agree to disagree and simply move on.....respectfully.

 

[guitone]

I have never had a great experience with either OTC orthotics or custom made ones. Unless you have a shoe that already has an insert in it, or unless the shoe is too big these will simply not fit a shoe that is a good fit for you now. In have had better luck with finding a shoe with a last that works for me and it a good fit. I do wear some OTC orthotics in my RM Williams boots and they work fine because they were a bit wide and have plenty of toe room, and a high enough toe box.

 

[Mike Petrik]

As a medical professional I think you should preclude yourself from giving such strong opinions unless you are prepared to back it up with empirical evidence. You're using your professional standing as a launching pad for calling a OTC foot orthotic a "snake oil salesman".

Are your opinions based on research that has been published in a peer reviewed journal or are they your own opinions? Please refer us to the appropriate studies that can back up your claims. Otherwise, I'm afraid your 23 years of experience means little.

Comment deleted by poster for prudential reasons.

 

[gng8]

Genuine question

I use both custom and OTC orthodics and won't enter the discussion of which is best.

My question is what shoes are stylish and still do well with orthodics. If I go to a shoe store and tell the sales person I wear orthodics, I get shown what can best be described as "clodhoppers." If I buy shoes that look good, I can't walk for long distances without feeling like I am, and sometimes actually, walking out of my shoes.

Suggestions for dress shoes please.

 

[DocD]

I have never had a great experience with either OTC orthotics or custom made ones. Unless you have a shoe that already has an insert in it, or unless the shoe is too big these will simply not fit a shoe that is a good fit for you now. In have had better luck with finding a shoe with a last that works for me and it a good fit. I do wear some OTC orthotics in my RM Williams boots and they work fine because they were a bit wide and have plenty of toe room, and a high enough toe box.

Naturally, if you have a shoe that was an excellent fit prior to the need for an orthoses, adding an orthoses certainly has the potential to significantly alter the fit of the shoe. Sometimes if the shoe has an existing removable insole, this can be less of a problem, but if it doesn't, the added bulk of an orthoses (custom or OTC) may require a new shoe.

Therefore, it's always recommended that a patient bring his/her orthoses with him/her when trying on and purchasing new foot wear. Unfortunately, the orthoses may not fit in any current foot wear that the patient already owns.

 

[DocD]

I use both custom and OTC orthodics and won't enter the discussion of which is best.

My question is what shoes are stylish and still do well with orthodics. If I go to a shoe store and tell the sales person I wear orthodics, I get shown what can best be described as "clodhoppers." If I buy shoes that look good, I can't walk for long distances without feeling like I am, and sometimes actually, walking out of my shoes.

Suggestions for dress shoes please.

You bring up an excellent question. Once again, many "dress" shoes simply are not made to accommodate the bulk of most orthoses, custom or OTC. Additionally, some high quality shoes such as Alden have a steel shank in the shoe (Allen Edmonds do NOT have a steel shank), and this steel shank can actually "compete" with an orthoses due to the rigidity.

Many shoes that can accommodate an orthoses are "extra-depth" and have a high toe box but are rather unappealing aesthetically and are considered "clodhoppers".

However, there can be a solution. Most custom orthoses labs have a "dress" type of orthoses that are considerably less bulky and are made to fit a dressier type of shoe. There is some level of compromise regarding the biomechanical control that these types of orthoses offer, but they are an excellent alternative for those that need some level of support and control. You can speak with your doctor about these types of orthoses.

Additionally, the OTC company that I personally prefer (PowerSteps) actually makes a product exactly for this application. It is less bulky and made for dress shoes. The product is called the PowerStep "slim-tech". I actually wear these in my soccer shoes due to the low profile of the soccer shoe and low bulk of the insert.

If you are looking for a custom orthoses for your dress shoe, speak with your doctor about a "dress" orthoses and I'm sure he/she can accommodate your needs. If you're looking for an OTC product for a similar application, I would recommend the PowerSteps "slim-tech".

Please note that I have absolutely NO financial intersest in the PowerStep company (though I wish I did!!).

 

[budrichard]

As a former USCF bicycle racer, XC Racer and jogger, I have had to go through a number of foot problems. Early on I found that professional treatment was the only option and a good Podiatrist an assest. I firmly believe that obtaining advice and orthotics from a running store or any such establishment, 'bricks and morter' or eStore is folly.
Find a good Podiatrist and if from a Sports related problem preferably one connected with a Sports Medicine Clinic.
BTW, I have no problems with a qualified Podiatrist expressing his/her opinion.-Dick

 

[mipcar]

I have never had a great experience with either OTC orthotics or custom made ones. Unless you have a shoe that already has an insert in it, or unless the shoe is too big these will simply not fit a shoe that is a good fit for you now. In have had better luck with finding a shoe with a last that works for me and it a good fit. I do wear some OTC orthotics in my RM Williams boots and they work fine because they were a bit wide and have plenty of toe room, and a high enough toe box.

Sorry, must disagree, whilst none of my shoes are custom made I can still comfortably wear each and every pair I own with my custom made orthotics in them.

Mychael