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Wednesday, October 2, 2013

Back and Foot Correction: Email Correspondance

This is an email from a patient whom has done well with her orthotic devices to stabilize her lower extremity, but now seem to be having problems. 

I have recently had an odd thing happen with my feet/orthotics. Over the last several months I have had increasing problems with my right hip/ITB. Rolling on the styrofoam roller helps but won't get rid of it. Used trigger point therapy in upper quads; that helped  but didn't get rid of it. Ended up with very sore muscle around fascea lata (sp?). Then hip itself got sore. Found that if I went barefoot, it went away. Did that (as much as I could) for a few days. Noticed that my left achilles was very tight and sore...maybe got stretched too much going flat-footed?
Of course I had to wear shoes but did better wearing the sandals, without orthotics.

A couple days ago, my lower back started to hurt so I tried to wear orthotics more.  In my work, I am on my feet for up to two hours at a time; sometimes it's only once a day but other days I do it a couple times, but with breaks in between. Yesterday, I hit a wall. My hips were so sore and then my left medial gastroc muscle started spasming. It  also seemed to come from the crease in my knee in the back. This feels a lot like what happened initially (which included my popliteus muscle), many years ago in my right leg, that lead to my plantar fasciitis. Which my orthotics seemed to cure.

Problem now is that if I wear any shoes at all, it is painful/difficult to walk using the affected leg, left one. Orthotics in tennis shoes of course are worse than wearing my sandals which have fairly good arch support but less than orthotics. But even the sandals make that muscle cramp. 
I am taking it easy, both with my back and my feet....using ice and naproxen.

The only other thing I had been doing differently just before this calf muscle event was trying to stay aware of not locking my knees. I thought I had licked this one years ago but last week a Pilates coach said I was still doing it. So I have been trying to keep knees slightly bent when I think of it.

I remember once you told me that my feet sometimes hurt, (it feels like the arch in my orthotic seems too high) because my back is shifting and there is something wrong up there, rather than my feet being the cause of that kind of pain.

I am wondering if you have any insights as to why I might be currently experiencing this increase of pain in my calf when I use any kind of arch support? 


Hey Tina, sorry for your dilemma. One possible cause is that a branch of the sciatic nerve, coming off your back, going behind the knee into the calf, and finally the arch is irritated. You may have been slightly irritating with the knee hyperextension, and perhaps you have a slightly bulging disc.When these nerves hurt, it is hard to wear arch support which presses into them. I would see a physiatrist, like Dr Irene Minkowsky, to look at the whole neurological chain from spine to toes and see if there is a simple place to start treatment. I hope this helps. Rich

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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.