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Foot Care (Podiatry) (Expert Forum)
posterior tibialis pain with orthotics
Answered by
Yena H Do, DPM - skin allergies, foot/ankle trauma, foot pain, bunions, Hammer toe, compartment syndrome, foot surgery
Cambridge Podiatry
Cambridge - MA
Questions in the Foot Care (Podiatry) forum are answered by Dr. Yena Do. Topics include: Athlete's feet, Bunions, Flat feet, Foreign body, Fractures/foot pain,Fungal infections, Hammertoes, Instability, Morton's Neuroma, Nail fungus, Pediatric curly toes, Pediatric in-toe gait (pigeon toe), Plantar fasciitis/heel pain, Sesamoiditis,
Shin splints, Warts.
posterior tibialis pain with orthotics
by crocop, Jul 02, 2009 04:40PM
Recently, I was prescribed orthotics (I've worn them for years, this was a new pair), and the lady who made them added what seems like a high arch. They have been causing my posterior tibial tendons to flare up, and the only relief I get is from removing them. She insists I need this support, but my other orthotics from years past have not had such a high arch, etc. I have a leg length difference, and had to convince her to put a lift on one side. I have the sensation of pressing down on the inside of my foot/ankle as I walk. She now has me using a lateral post, but I still have the tendon pain, and it will not go away while i wear the orthotics. Are they worng for me? Is the arch too high? Thanks in advance.
Doctor's Answer
by Yena H Do, DPM, Jul 03, 2009 05:33AM
, Jul 03, 2009 05:33AM
orthotics should not hurt...especiallly if you have worn them before.
i would give it another week. if you continue to have pain, speak to the clinician again.
if she refuses to help you, get a second opinion from a podiatrist who is experienced in biomechanics and orthotic casting.
typically for tibiallis pain, a patient should be casted with plaster for orthotics. there should be a deep heel cup with a medial and lateral flange. a lateral post would make you put more strain on the inner ankle and tibialis tendon. i am not sure if this is a good modification for you. if you were plaster casted with the foot at neutral, it would capture your natural arch b/f you put weight on the foot. so, it really wouldn't be too high for you.
i would give it another week. if you continue to have pain, speak to the clinician again.
if she refuses to help you, get a second opinion from a podiatrist who is experienced in biomechanics and orthotic casting.
typically for tibiallis pain, a patient should be casted with plaster for orthotics. there should be a deep heel cup with a medial and lateral flange. a lateral post would make you put more strain on the inner ankle and tibialis tendon. i am not sure if this is a good modification for you. if you were plaster casted with the foot at neutral, it would capture your natural arch b/f you put weight on the foot. so, it really wouldn't be too high for you.
Member Comments (3)
by crocop, Jul 03, 2009 07:28AM
To: Yena H Do, DPM
Hi Yena, thanks for your reply. I wasn't plaster casted for these, she did a foam impression while I sat. The purpose of the lateral post was to try and shift my weight towards the outside of my foot, because I had the sensation of landing with more of my weight on the inside of the foot as I walked. Do you think this means the arch is not high enough, or too high?
by Yena H Do, DPM, Jul 12, 2009 07:46AM
, Jul 12, 2009 07:46AM
plaster casted orthotics are better fitted than foam impression ones. a medial flange would help take weight off the inner portion of the foot better than a lateral post. typically, a lateral post shifts more weight to the inner foot area. if you pronate a lot and have tibialis pain, a ritchie brace or arizona brace would hold the medial ankle more upright, whereas an orthotic has limits for doing so. it would be difficult for me to assess your orthotics w/o seeing them. if they continue to hurt, i would get it re-evaluated. again, orthotics shouldn't hurt after a few weeks.
