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Friday, May 25, 2012

Heel Pain: Simple Orthotic Adjustment

Blogging on Friday is Biomechanics for the Podiatrist

Hi Dr. Blake,
Sorry for the delay in getting back to you.  The updated orthotics are an enormous improvement, did a few Dipsea training runs with lots of steep up & down, heels much more comfortable afterwards.  Would love the ones I left with you to be just the same way.
I got a VM from the clinic earlier in the week that they are ready for me to pick up.  Do I need to try them out?  If so I can schedule an appt in SF.  Otherwise, if it would be possible to send them to the Marin Clinic I could swing by and pick them up on a Friday.
Let me know, and thanks so much for your help!
Barbara


 So what happened to make this patient feel so great. Barbara came into my office with 2 pairs of orthotic devices from another doctor, and with a chief complaint of heel pain. The orthotic devices she had stabilized her feet well both walking and running. So, what was the problem? These orthotic devices had a plastic shell and a plastic rearfoot post. She also landed hard on her heels both walking and running. You could defintitely hear her coming. I classified at least part of her heel pain from impact stress. I removed both the plastic rearfoot post, and as much of the plastic under the heel area from the orthotic plate. I had put on a softer Birkocork rearfoot post. I then placed a small circular memory foam (1/8 inch soft plastazote) under the heel. I then replaced her vinyl topcover with full length 1/8 inch Spenco. She had tried this over the last month and thus the email. I am ready to do the same with the 2nd pair I have. 
Here is an example of a non posted orthotic. Image I removed both the post and most of the plastic material under the heel.
Here the same orthotic above has a soft, but durable, Birkocork post applied. An attempt at transferring the weight from the heel to the arch is also being attempted.

The Blue Dot under this first metatarsal is identical to the shape of the memory foam under the  heel. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.