Why Aren’t My Custom Foot Orthotics Relieving My Plantar Fasciitis ? 

Introduction

If you suffer from foot pain and/or plantar fasciitis it can be hard to get answers. Finding that you can’t comfortably do things that make up a normal healthy routine is frustrating. Spending significant amount of money on healthcare to ease your pain and finding that it isn’t helping you  is double frustrating. The combination of pain, mild disability, uncertainty and mounting healthcare costs is a cocktail of factors that can start to feel quite discouraging.

I regularly meet people who have become seriously motivated to resolve their plantar fasciitis and foot pain, but who are also quite jaded with the process of failed treatments. One of the most common frustrations that plantar fasciitis and foot pain patients encounter is buying expensive custom orthotics or insoles and finding that they just aggravate the pain. If you have experienced this are a number of possible reasons why custom foot orthotics have not have worked for you..

Too Stiff 

All professions and all developers of technology make mistakes, learn from those mistakes then move on, those who prescribe custom orthotics are no exception. We only need to look at the medical devices and procedures of the last few centuries to see all the scary mistakes we make along the way.

Extremely hard, ridgid custom orthotic insoles are one of the mistakes that we are able to look back on and roll our eyes. It is sometimes hard to conceive how naive people were when they come up with certain ideas.

The first reason why hard, inflexible custom orthotic insoles are a healthcare booboo is that the human arch is a flexible dynamic living structure. 

The second reason very stiff custom orthotic insoles are a healthcare booboo is that our flexible arches evolved to interact with flexible dynamic uneven terrain. 

An inflexible custom orthotic insole reduces the complex, dynamic relationship between arch and ground to a hard immobile lump. This situation. isn’t much better than the concrete those orthotics are designed to protect you from.

I have met countless people over the years who has simply concluded that custom orthotic insoles were simply not for them after an experience with devices that were as flexible as a tv remote. Many of those were people with plantar fasciitis who found unsurprisingly that a pair of orthotics as flexible as a tv remote made them feel worse. Many of those same people have had ‘aha’ moments once they felt what a flexible orthotic can do for them. 

Too Soft 

These days there is somewhat of an opposite trend towards foam insoles and orthotics that are too flexible. Many store bought insoles and even many custom orthotics are too soft and squishy to correct your foot position under weight bearing. As a plantar fasciitis sufferer it’s important to develop your own understanding about these matters.. so I will pose a question for you to answer using your own sense of things. If an arch support is ‘a device that supports your arch when it bears your whole body weight’ … do you think that it will do that successfully if it’s so soft that it can be flattened out with the tip of your finger ? 

If your insoles or custom orthotics can be depressed with the tip of your finger they won’t be able to support your entire body weight moving at speed 10 thousand times a day. If your insoles or orthotics don’t hold your arch up they won’t take stress off your plantar fascia.

Too Much Scar Tissue

Plantar fasciitis is a repetitive strain injury pure and simple. When the bodies tissues come under sustained overload they have defense strategies to fall back on. If a bone comes under sustained excess load it develops a callus that reinforces it structurally, when the bodies soft tissues are exposed to repetitive strain they develop scar tissue that reinforces them structurally. 

We know from looking down expensive microscopes that plantar fasciitis sufferers have damaged collagen fibres and scar tissue in their plantar fascia. Custom orthotics are a great long term solution for plantar fasciitis sufferers because they support natural foot mechanics and relieve strain in the tissues of the foot. Custom orthotics do not break up scar tissue though!. Many people who are prescribed custom orthotics for plantar fasciitis don’t get a change in their symptoms because the scar tissues hasn’t gone away. Even a great pair of custom orthotics can even go as far as irritating the scar tissue and causing you more pain.

The solution to this issue is found in working with a practitioner who knows how to break up the scar tissue. Most find that once they have the scar tissue associated with their plantar fasciitis broken up that wearing their custom orthotics brings fast symptom relief.

Incorrect Prescription 

There are many subtle and not so subtle options and choices to be made when prescribing custom orthotics for the plantar fasciitis sufferer. Options like arch height, heel posting, heel pads, metatarsal pad placement and top cover choice all have an impact on the likelihood of a custom orthotic relieving plantar fasciitis symptoms. 

Custom Orthotics for back pain, hip pain, knee pain and ankle pain/sprained ankles are a far less sensitive issue than orthotics for plantar fasciitis, this is because their benefits are inferred through the correction of biomechanics alone. 

A custom orthotic prescription for plantar fasciitis pushes directly against the injured tissue it seeks to help, this means the potential for irritation is greater than an orthotic that is intended for knee pain, back pain or hip pain. The immediacy of the relationship between custom orthotics for plantar fasciitis and the tissue they intend to help means the prescription needs to be just right! 

Poor Transition 

Transitioning into custom orthotics as an adult is a big thing! A lifetime spent moving around on hard flat surfaces places very specific and unnatural demands upon the joints, muscles and connective tissues in the lower body. Changing all this by suddenly fulfilling the bodies ‘biological need’ for arch support etc. can shock the bodies tissues into absolute chaos. The type of chaos that potentially ensues when we throw a pair of orthotics in our shoes for the first time involves muscles pain, joint pain and pain associated with irritations of scar tissues and facial contractions. For the plantar fasciitis sufferer it can mean their symptoms get worse and they may develop new symptoms in other tissues of the leg. 

There is a way to mitigate the risk of feeling worse due to a failure of the foot to adapt. An incremental transition into custom orthotics!!! In clinical practice we usually start people off wearing orthotics sometimes for as little as one hour per day and build slowly from there. Many of our patients don’t exercises in their orthotics for a month or longer. 

Being Half Arsed 

Concrete, paving and tarmac are for your feet what sugar is to your teeth!! Industrial, homogenised and intrinsically unhealthy. In the modern world our feet crave support and shock absorption to reduce the constant strain of hard surfaces… that’s where custom orthotics come in for plantar fasciitis sufferers. The ever present stress of hard surfaces creates an ever present need for custom orthotics to be worn. I meet heaps of people who only wear their orthotics in their training shoes, or only in their walking shoes, most of them haven’t had the kind of relief they were hoping for. 

The more consistent you can be in wearing your custom orthotics or insoles for plantar fasciitis the better they will serve you. Part of the secret to this for most people is to own a second pair of orthotics that fit their business of dress shoes. Ideally you should aim to wear your orthotics about 90% of the time. 

If you want to go bare feet on the beach or on grass you will always have permission to do that as it’s the absolute best thing for the wellbeing of your feet. 

Conclusion 

If you have a history of tooth decay or obesity then we can be pretty confident when we say you need to permanently reduce your refined sugar intake… somewhat of a medical ‘no brainer’. We can be equally confident when we say that if you have had plantar fasciitis and you live in an urban environment you need orthotics.. For this reason I strongly recommend that if you are struggling with your custom orthotics in any way don’t give up…. get some help and advice on how to make them work for you !!! 

 

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