Orthotics for plantar fasciitis

by Bessie
(Bradenton FL, USA)

I bought some orthotics from Good Feet for what they say is plantar fasciitis. I wear the harder one as long as I can then switch to the softer one. I took yesterday off from wearing them and realized the pain from the orthotic is greater than the original pain which is still there when not wearing any inserts. I don't know how long I should continue wearing them. I am stuck between docs right now, still trying to get an MRI of both feet. I am the one who has the conversation about baxter nerve entrapment. The guy at good feet said these have a lifetime warranty and adjustments can be made as needed. Suggestions please.

Thanks,
Bessie Mae

RESPONSE

Hi Bessie,

In broad general terms, an orthotic will generally help plantar fasciitis, if it is the proper type of orthotic for a given individual and will not be very helpful for Baxter's nerve entrapment. It can also be helpful for tarsal tunnel, but generally the improvement will be gradual and the orthotic has to be worn all the time, day in and day out. It works by preventing the foot from flattening out (pronating). Excessive pronation causes a compression on the tibial nerve as it passes through the canal on the inside of the ankle. Once there is too much compression on the nerve, you start to get nerve like pain on the bottom of your foot. Tarsal tunnel pain does not have to be limited to just the heel.

If the store bought orthotic you purchased is making matters worse than either you do not have plantar fasciitis, or the orthotic is the wrong one for you.

Probably no point in wearing it if your foot feels better without the insert in your shoe.

If you actually have a true Baxter's neuroma then I could see where the hard orthotic might actually make your foot worse, as walking on that hard surface of the orthotic could actually aggravate the nerve.

If the orthotic can be adjusted, ask the salesman to add a cushioned top cover to the orthotic as that should give you some additional support as well as additional heel cushioning.

I am not saying this will solve your problem because I am on the other side of the internet and have no idea what your foot looks like nor do I have any idea of the type of orthotic you are wearing, so I am just making one big "guess" here.

As I said in my previous post, if your doctor suspects a heel neuroma (Baster's nerve entrapment) then he or she should institute some specific treatment for it and see if that alleviates your pain. That approach may even be more specific than an MRI. If for example, denatured alcohol injections reduce your pain then you know you probably have a heel neuroma as this type of treatment will not help any other conditions in the heel.

If the doctor suspects a tarsal tunnel, then trying a cortisone injection in the area may go a long way in reducing symptoms and that too would help make the diagnosis of tarsal tunnel easier. In this case I would then recommend wearing whichever orthotic is the most comfortable as long as the device is actually supporting the foot and reducing pronation.

That is the approach I take in my practice. If after trying certain treatments based on a presumptive diagnosis, the patient still has pain, then I order an MRI. The only exception to this scenario is if there has been trauma, or I can palpate a mass.

In fact, most insurance companies will not authorize an MRI until some type of treatment has been tried and then failed.

So if you are basing every thing on the results of an MRI and one in not forthcoming any time soon, then you are just wasting time.

Marc Mitnick DPM
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