A person with chronic foot pain wrote to me recently asking if custom orthotics would help her chronic foot pain.  Please see my responses in italics

I am currently 52 years old and have suffered with foot pain for 20 years. I used to do quite a bit of running in my 20’s and 30’s. After pain developed in the ball of both feet and in my heels, I gave up the running and walked for exercise. At the age of 37, even the walking brought on pain (as did standing for long periods of time). I have been to numerous doctors and podiatrists over the years (Scripps, UCSD, various podiatrists) and have had several different custom orthotics made. Most of these were of the very rigid plastic variety, and all but one caused me so much discomfort that I finally quit using all of them after many months of use for each orthotic. The only exception to this pattern was a custom orthotic made by Scope (recommended by a UCSD doctor) back in 2001. This particular orthotic was made of a very dense and firm foam-like material which was flexible if bent. While it didn’t get rid of all my pain, it did help me get by for several years until they wore out. However, they were very expensive and were not 100% effective – so I haven’t tried to get another pair from them since.

Do you have any other conditions that might be responsible for your foot pain, for example, Rheumatoid Arthritis, Gout or any other chronic inflammatory conditions?  Do you still have the pair of orthotics even if they are deteriorated?  I can make soft, foamy orthotics which work well for people with chronic foot pain or neuropathy.  I can also make flexible, semi-flexible or hard custom orthotics.  I choose the firmness and density of the material based on the persons condition(s) and orthotic history.  In your case your have already tried many hard plastic orthotics that did not work and experienced the best relief with the foam orthotics so that is exactly what we would make for you.

I found your website a while back and read about your use of flexible and semi-flexible orthotic materials. The last time I had a custom orthotic made was in 2013 by a local podiatrist. The resulting product was another rigid hard plastic orthotic with a full-length pad on top which caused even more foot pain right from the start. The doctor tried to modify it several times, but finally gave up. Since then, I have rotated between older pairs of orthotics that I have on hand to alleviate my pain. The pain is no longer confined to just my feet. In fact, I actually get more pain in my knees and hips now than I do in my feet. When the pain gets bad enough, I switch to another orthotic in my collection and it usually (temporarily) relieves my pain condition for a few days. However, at that point the pain starts up all over again and grows worse until I switch again to a different pair of orthotics. And the constant switching between orthotics is not working as effective as it used to.

I have seen this exact type of situation a few times over the years.  For some reason CHANGE is a positive for you and then after a little bit of time it does not work anymore.  I believe this happens because change is a good thing.  For example, if you are sitting at a computer in one position for too long it becomes uncomfortable.  Maybe your back or your butt begins to hurt so you shift and change positions.   It appears your orthotics will shift pressure from one area to another helping a little…….but then you have to shift again.

Based on what I have told you, do you believe that I am a good candidate for your type of foot orthotics? If you don’t think so, then I would like to know that too. I have postponed seeking treatment again for some time due to the cost of custom orthotics. (I am self-employed and draw custom house plans for a living, but the custom home market is not what it used to be). In addition, my wife suffered some very serious medical issues a while back so there was no way I could afford to pursue further treatment. Your site states that you charge $367 for one pair of orthotics. Is that the total cost, or is there also an office visit charge too? Do I need to have a prescription from a doctor? I grew up in Escondido but have lived in San Jacinto near Hemet (in Riverside County) since 2002. I am more than happy to make the trip down there if there is a good chance of finding some lasting relief. Over the years, I have just about given up hope of ever being pain-free again. Let me know what you think. I am sorry for the long email.

Let me answer all of your questions in this order.

  1. Do I need prescription from a doctor?  NO you can call my office at 858-268-8525 and schedule an appointment.
  2. Am I a good candidate for your type of custom orthotics?  YES.  You responded well to the soft, foamy kind scope made.  I believe my skills in making orthotics far surpass Scope.  Not only do I mold them myself but I also make them myself…..no helpers, no machines and no assembly lines.  I also have the advantage of knowing and actually listening to your history so as not to repeat past mistakes.
  3. You charge $427 for one pair of orthotics.  Is that the total cost or is the an office visit charge too?  Before making the orthotics I personally take your history, inspect your old orthotics to see what features you like or don’t like so I can consider incorporating the good features into your new orthotic, take copious measurements to ensure comfort and fit, inspect and evaluate your condition to make 100% sure there is not some as of yet undiagnosed condition that might be causing this problem and if necessary a video-computer walking gait analysis.  I then take the molds/foot impressions myself on the same day.  The cost for this is $427.  I will also make any other necessary recommendations or suggestions for imaging or treatment if I feel your condition might be solved through some other method.

It is not unusual for me to see patients that have been prescribed custom orthotics that are not helping.  Sometimes the answer is not making another orthotic.  It is imperative that I examine you and find the cause of your pain.  Take this case for example:  A young man and his parents came in too see me wanting orthotics.  His history showed he had already tried orthotics, failed, PT, cortisone injections and months in a walking boot.  When I reviewed his MRI I found a 1cm cyst growing in his ankle exactly where the pain was.  This young man had been misdiagnosed.  Instead of making orthotics he was referred for arthroscopic surgery to remove the cyst.  Orthotics would have been a complete waste of their time and money. 

I don’t and will not know if there is any other mechanism that might help you unless I do a thorough evaluation.  I hope this all make sense to you and that I answered all of your questions. If you have any follow up questions please email them directly to me.  If you call 858-268-8525 my office will schedule you for your appointment.  I look forward to helping you.

If you have any questions regarding your pain or custom orthotics please email info@sdri.net or to schedule an appointment call 858-268-8525

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