Orthotics...

quozl

Hi,

can anybody recommend a good person to see about getting evaluated for orthotics?

I've been injured since January, and even with no running, and just 30 miles fast walking to/from work a week I still have some recurring plantar fasciatis and tendonosis in my ankles.

I've a half inch or so leg-length descrepency. I was hoping to avoid orthotics but this is starting to take the piss. I want to get back to running, but I can't even walk properly pain-free.

Any recommendations?

clem

I got mine fitted at the physio beside Fagans in Drumcondra. Have you considered chi "injury free" running. I done the course in September and they reckon orthotics are not the answer. Good posture is.

comer_97

how has your running been since the course? I would love to know because I am on to my second set of orthotics.

I got the first ones from a physio using footmax and they caused me more injuries and I went to a podiatrist who saw them and said they are just completely wrong for your feet and knee in particular. I got another set done with him and my knee has improved although I get twinges when I run any distance. I just want an answer and to be able to run too.

So my advice is go to a good podiatrist for them. I can recommend Joseph Kelly in Tallaght.

Peckham

clem wrote: »

I got mine fitted at the physio beside Fagans in Drumcondra. Have you considered chi "injury free" running. I done the course in September and they reckon orthotics are not the answer. Good posture is.

I'm currently reading a book on chi running. Would be interested in doing a course - where did you do one?

run_Forrest_run

can I just offer a piece of advice on orthotics:

Please make sure that you actually need orthotics or maybe they are only masking the problem. I am saying this because I have had a lot of experience with lower back pains lately (still in the middle of it!) and went to various physios and one guy said I needed orthotics.

Anyway, I went ahead and paid a lot of money got them. I rested for a while, continued with some physio work and many months later I am still getting the pain.

I have gone to various physiotherapists and then to an osteopath. I did receive some relief from the osteopath but after all this I learned a lot about the bio-mechanics of the human body and sometimes all it takes is an osteopath or chiropractor to address the underlying root problem.

Please be aware of some physiotherapists (and some lads not even qualified!) who always jump to orthotics as the solution just because they are getting commission from the manufacturers.

As I said, I am still suffering from lower back pain and coccyx pain so I am really miffed after spending hundreds of euro and still no relief.

I am now due to see a rheumatologist so hopefully he will shine some light on my problem.

run_Forrest_run

clem wrote: »

I got mine fitted at the physio beside Fagans in Drumcondra. Have you considered chi "injury free" running. I done the course in September and they reckon orthotics are not the answer. Good posture is.

I totally agree with you clem.
A lot of the time the whole area of orthotics can sometimes be used as a scam and a means to extort money from the unsuspecting patient! I've learned this the hard way

Peckham

run_Forrest_run wrote: »

Please be aware of some physiotherapists (and some lads not even qualified!)....

ALWAYS go to a Chartered Physiotherapist. Those that are "not even qualified" are not Physiotherapists, they are probably Physical Therapists. The big difference between them being 4 years of university training versus a series of weekend courses!

Unfortunately the title isn't protected as it is in other professions, so in theory anyone can set themselves up as a "Physiotherapist"...but those who use the Chartered Physiotherapist title are members of the ISCP, so are fully trained and you get the protection of the ISCP using their services.

run_Forrest_run

Peckham wrote: »

ALWAYS go to a Chartered Physiotherapist. Those that are "not even qualified" are not Physiotherapists, they are probably Physical Therapists. The big difference between them being 4 years of university training versus a series of weekend courses!

Unfortunately the title isn't protected as it is in other professions, so in theory anyone can set themselves up as a "Physiotherapist"...but those who use the Chartered Physiotherapist title are members of the ISCP, so are fully trained and you get the protection of the ISCP using their services.

fair enough but it still does not instill much confidence. I have also gone to chartered physiotherapist and he just just spinning me another yarn as a means of making money for himself when he really didn't know what the problem was.

My main concern with physiotherapists is that they always tend to feel they can solve your problem (as long as it's not something like a slipped disc!).
Seriously, the people I've been to were happy to keep working away, not really caring whether it fixed the problem or not....I have yet to hear a physiotherapist say 'eh, sorry but I don't know what the problem is so there is no point in seeing me for treatment'.
..again I am saying this based on my own experience...I could nearly write a short book on it at this stage

Domer

Just to put the record straight...

There are a number of practitioneers out there calling themselves Physical Therapists or Physiotherapists who are neither chartered nor registered. You should always be aware of the credentials of whoever is treating you.

That said, there is such thing as a Registered Physical Therapist. This is a practitioner who has obtained a Diploma that was the result of a 3 year intensive course run by the Institute of Physical Therapy in Stillorgan and is a member of the Irish Association of Physical Therapists. The course is far from a couple of weekends as alluded to above. It is an intensive course, and also requires several hundred hours practical experience prior to graduation. All work conducted by a Registered Physical Therapist is covered by VHI, Quinn and Vivas. For more information on Physical Therapy please go to www.iapt.ie.

Regarding Orthodics, do your homework and ensure whatever practitioner you use has good credentials and good qualifications. They also need to be trained in gait analysis and correct procedures for fitting and measuring orthodics.

And to fully disclose, I am a Registered Physical Therapist. I do not fit orthodics, but have worn a pair for the past number of years.

kmick

I can give you a name if you PM me - don't want to be accused of advertising. He is a Physical Therapist that does orthotics. They are very good as well - my wife has a pair of Orthotics from him.

quozl

Thanks for all the replies.

I've got a recommendation for somebody near me who looks well qualified.

I'm probably going to continue to give it a bit longer however and hope it improves, I was just feeling very pessimistic about it sitting at my desk with some nasty PF pains on Monday, after just walking to work.

I'd very much like to avoid orthotics, I didn't used to need them to walk before injuring myself (through stupidity), so I'm hoping to get back to that state.

I think it's only taking so long to heal as the walking constantly aggravates it.

Very annoying.

Anyway, thanks again for the advice guys, and I did have one of those elusive physios who declined to take any more money for treatment and told me it'd just take time to heal. They are out there

Bagheera

Domer wrote: »

Just to put the record straight...

There are a number of practitioneers out there calling themselves Physical Therapists or Physiotherapists who are neither chartered nor registered. You should always be aware of the credentials of whoever is treating you.

That said, there is such thing as a Registered Physical Therapist. This is a practitioner who has obtained a Diploma that was the result of a 3 year intensive course run by the Institute of Physical Therapy in Stillorgan and is a member of the Irish Association of Physical Therapists. The course is far from a couple of weekends as alluded to above. It is an intensive course, and also requires several hundred hours practical experience prior to graduation. All work conducted by a Registered Physical Therapist is covered by VHI, Quinn and Vivas. For more information on Physical Therapy please go to www.iapt.ie.

Regarding Orthodics, do your homework and ensure whatever practitioner you use has good credentials and good qualifications. They also need to be trained in gait analysis and correct procedures for fitting and measuring orthodics.

And to fully disclose, I am a Registered Physical Therapist. I do not fit orthodics, but have worn a pair for the past number of years.

That's fair enough, but also note that the World Confederation for Physical Therapy recognises Chartered Physiotherapists as the sole professional body for Physical Therapists in this country.

As with any profession, there are good and bad. I would run a mile from any professional if they told me that orthotics would fix all my problems. I am a Chartered Physiotherapist and prescribing orthotics is the exception rather than the rule in my daily practice. I certainly don't think I can fix everything and I refer to other individuals as appropriate.

run_Forrest_run

Bagheera wrote: »

That's fair enough, but also note that the World Confederation for Physical Therapy recognises Chartered Physiotherapists as the sole professional body for Physical Therapists in this country.

As with any profession, there are good and bad. I would run a mile from any professional if they told me that orthotics would fix all my problems. I am a Chartered Physiotherapist and prescribing orthotics is the exception rather than the rule in my daily practice. I certainly don't think I can fix everything and I refer to other individuals as appropriate.

the guy who I (foolishly) went to claimed the Orthotics would improve my times, cure the back pain etc..now I didn't believe everything he was saying but I was hoping it would help the back and hip pain..this guy gets almost everyone he sees to get the orthotics...now I realise he was a total cowboy and I only hope others don't get stung by this guy..I know I can't name and shame but let's just say if you are in the Cork area you may have heard of this guy.

daymobrew

Peckham wrote: »

I'm currently reading a book on chi running. Would be interested in doing a course - where did you do one?

Catherina McKiernan does one in Castleknock.

Peckham

daymobrew wrote: »

Catherina McKiernan does one in Castleknock.

Thanks - I had found that on a google search and signed up for a course at the start of Feb.

radar0976

I was getting alot of hip pain in the back of the hip and thought that orthotics were the answer. I spent €350 on a pair and while they gave me some relief they were far from solving the problem. Since then I have gone to my GP who reckons it might be mild arthritis brought on by alot of road running. Subsequently I went to an osteopath who said my hip joint was locked. She unlocked it with some manipulation and it has been hugely improved since. She looked at the orthotics and said that they would only cause my hip to lock up again by putting me into the position that would cause it. It seems to me that practitioners who are not a qualified physio / osteopath / chiropractor and are pushing you to buy orthotics from them with the hard sell should be viewed with caution as the are essentially a money making franchise. In my case I felt that my practitioner was not listening to me and did not solve the root problem. I have since been proved correct. All he wanted to do was sell me orthotics whether that was the right solution or not. My practitioner was listed as a "Sports Therapist" - whatever that means!

Basically what I am saying is beware of someone selling you orthotics too quickly or at a very high price. I feel I have been ripped off. Make sure you find the root of the problem first and see some improvement without the orthotics before you commit to buying them.

Incidentally I am back running after 4 months out with NO orthotics and all is well.

Racing Flat

Quozl,
How are you getting on with the plantar fasciitis? You have it a long time...
Firstly, I think you are right not to wish to rush into orthotics - they may help but there is no guarantee. I would try one or two things prior to even thinking about orthotics. You are porbably aware by now what plantar fasciitis is but in case you're not - the plantar fascia is like a layer of thick skin inside the foot which runs from your heel bone to the ball of the foot/toes. It holds your foot tendons in a supported position allowing them to function correctly by getting the correct leverage etc. It also effectively forms the arch of your foot. However this can become a source of pain, usually just in front of the heel bone on the sole of your foot. It is usually sore on palpation (when you push your thumb into it) and may be sore on walking. It may become sore due to a one off injury, or perhaps due to overuse, or maybe if something changed e.g. you suddenly started training/increased your mileage or intensity/changed your training shoes/started training on a different surface...So the best thing to do is get rid of the source - ie revert to your older type of shoe/training surface and only gradually introduce new things...prevention is better than cure. But now that you have it, to try and get rid of it, a few options...Because it is a soft tissue, like other soft tissues it is made up of elastic and fibrous fibres which are generally aranged in an organised fashion, often parallel to each other along the line of force exerted on the fascia, i.e. lined up. when it gets injured the plantar fascia may be replaced with scar tissue which tends to knot up (trying to form a secure fix) rather than lining up in an organised fashion. This is one of the reasons treatments such as massage can be effective - they aim to break down the scar tissue, so that the healing tissue can then line up in the correct fashion. At the plantar fascia you can do this yourself by placing a golf ball on the floor and then placing the sore spot over the golf ball and move the sore spot over the golf ball for 10minutes or so. It may be slightly uncomfortable but don't go too hard. Try this every second day for a week, and hopefully there will be an improvement. If this is not effective, I would try 'unloading' the plantar fascia (the pain comes because when you put your weight on your foot the arch or fascia stretches causing pain, so if you can 'unload' the arch/fascia so that it is not stretched as much when you put your foot down, it may be less painful and also give the fascia a chance to heal). To do this I would use tape/sports strapping (I am a Chartered Physiotherapist).As you may not have access to this, the next best thing may be a temporary orthotic. As has been posted above, orthotics can be very expensive. This is because they are individually made, as a cast is made of your own foot, so any imperfactions in your arch/biomechanics can be picked up and orthotics can be designed to correct these faults. I did say theoretically. That's because the orthotic will only be as good as the cast taken - so whoever does the catsing needs to know what they are doing. I do not do this myself but even if I did, before getting a patient to fork out so much money I would first look for evidence that an orthotic may be effective. To do this I would get the patient to buy a non-custom made orthotic, ie the types you can get in any chemist that go from your heel to the ball of your foot - medial longitudinal arch supports. They should only cost 10-20Euro and I must admit I think they can be just as effective as the custom made ones. Orthotics are definitely overprescribed as far as I am concerned, and if anyone ever prescribes you these ask them why. e.g. if you have back pain and your practitioner says orthotics will get rid of it ask them why? Chances are they'll say you're flat footed. If so, you have probably been flat footed all your life. Hence if this is the source of your back pain, you should have had back pain all your life! Ask the practitioner why the flat footedness would suddenly give back pain. If you're not staisfied with the answer I would recommend getting the cheaper non-custom made ones as a trial first - if they make aome improvement then maybe the custom-made ones will be better again, if they make no difference, I'm not sure whether the custom made ones will - but then I'm not an expert in orthotics.

By the way, there are a few mentions above about practitioners being on commission form the orthotics firms. This is not the case with Chartered Physiotherapists as it is against the Rules of Professional Conduct to accept such commission. In relation to some of the posts above about practitioners seeing you again and again and not caring about whether you get better, this saddens me but as someone pointed out you'll get good and bad practitioners as with all walks of life. One piece of advice, if going to see a practitioner, they should tell you what they think is wrong with you. They should be able to explain the source or mechanism of pain. Without scans and investigations (and even with these sometimes) they cannot be certain, but they should at least be confident that they think they know what the source is. Only if they know this will they know what treatment to do. If they fob you off, or you don't understand the explanation, ask again until you understand. The number of friends I have who have gone to people with back pain and afterwards I ask them 'What's the diagnosis?' - the majority of the time they don't know! I find this staggering. So ask your practitioner 'What's the diagnosis?' As for practitioners seeing people over and over - this is not on. The way I operate is at the end of the assessment I tell the patient what I think is wrong, what needs to be done and that there should be a definite improvement within a session or 2. If there is no improvement after 1-2 sessions I will refer them on for further investigations. If there is an improvement - even if it's only 5-10% we know we are on the right track and so treatment will be continued. The first question every time the patient comes back is 'How is it?' and get the patient to tell me whether it's the same better or worse since the last time and and if better, what percentage it has improved by. If it stops to improve or is not fully resolved within 6-8 sessions (whichever comes first) I will refer them on as before. Using this approach, the majority of patients will be resolved in 6-8 sessions. Many more will be referred on for investigations as they may have a problem that physiotherapy is not appropriate for. Essentially if your back pain is due to a stiff joint, then loosening up that specific joint will make the pain go away. But also, any other treatment e.g. massage, acupuncture etc etc will not be effective as it is not getting at the specific stiff joint. Similarly if you have a tight muscle causing pain, doing something to loosen up the joints won't be effective but massage for the tiight muscle will. So the diagnosis is essential - the tretament will be obvious once you have a diagnosis. Sorry I've gone on a bit here - bit of a hobby horse!

In summary Quozl, try the golf ball, if that's no good get some arch supports from a local chemist. Failing this might be worth gooing for further investigations considering it's gone on so long and it's so frustrating.
Good luck.