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Sunday, August 18, 2013

Orthotics causing Back Pain: A Common Problem with various Solutions

Dr. Blake,

I had posted about sesamoid problem after bunion surgery, and thank you so much for answering my questions.

I am on second pair of custom orthotics and my back was so irritated that I could not function, missed one week of work, could not even stand long enough to make a meal.  I had times that my right side foot and leg just wanted to give up. Went to see a podiatrist hoping for help, he took the time to look at my x-ray before and after surgery, and told me the surgery was well done, except the first metatarsal bone was longer than it's supposed to be, which caused all my other problems.  He said surgery should be the last option, instead we should try pads.
Dr Blake's comment: Functional Foot Orthotics are just that----functional. They make a functional change in your body, and as podiatrists, we ask the rest of the body to please accept the change. When designing orthotic devices for sesamoid pain, two common problems can occur leading to back pain. The orthotic device places your weight too lateral, making you over supinate, leading to back pain. If this is the case, you should feel that the weight is going to your baby toe as you walk through your foot, or even worse, feel like you can sprain your ankle. Typically, the orthotic devices make you straighten your knee too much, and if you have tight hamstrings, the pull on the low back causes pain. These are easy things to change if recognized. Sometimes a simple adjustment can be made to allow you to be more centered or slightly more pronated. It is up to the prescribing provider to recognize what is going on when they watch you walk. Sometimes a whole new orthotic device is necessary. But, it is important to know what most likely caused the problem in the first place, so that you do not repeat the same mistake. 

This is what I felt ever after the surgery but you cannot do much to change the fact and it is affecting so much of my life now, I am horrified to think about another surgery, but other options seem to be running out.
Dr Blake's comment: If the metatarsal is too long, and it is causing all these problems, a temporary fix with orthotics should be able to be made. A long first metatarsal does potentially 3 bad things: supinates you too much (that can be corrected with orthotics), blocks your ability to roll properly through your foot jerking your low back (that can be corrected with orthotics), and straightens your knee too much by limiting normal arch pronation (that can be corrected with an orthotic device). I would always recommend trying to accomplish an orthotic fix for the problem first to make sure everyone truly understands the source of the problem. Then, if surgery makes sense, go for it. 

Your blog taught me more than all of the orthopedics surgeons told me, I really don't know what to do next, my big toe and the rest of four other toes simply don't land on the same level, and I felt the function of nerves and muscles are all affected.

I will seek other doctor's opinions locally, but I am so concerned about loosing foot and leg functions. Do you think correcting the bone(surgery) would help with sesamoid issue long term, or is it even possible to have surgery with sesamoid issue present?
Dr Blake's comment: You need information based on function not x rays right now. Go to a good sports medicine physical therapy that watches you walk. Do not influence them by previous conceived notions. Let me try and tie together your gait and back pain. I am assuming that the orthotic devices corrected for the sesamoid but lead to the back pain. Right? This is so common, I can not tell u!!! But, it may be an easy orthotic fix. Keep me in the loop. 

Thank you so much for your time, and how I wish I lived in California!

Further response from patient:

Thank you so much Dr. Blake!

I had one Acupuncture Dr. and one Orthopedics Dr. both suggested simply try Dr. Schol's full-length gel pad, which I did, I cut out some felt pads according to your website instruction, simply trying to level other four toes with the big toe, and a cutout to accommodate the sesamoid area. So far, have not had any bad pain yet.

I so appreciate your time.

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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.