posterior tibialis pain with orthotics

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.

[Yena H Do, DPM]

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.

[crocop]

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?

[Yena H Do, DPM]

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.