Will Custom Orthotics Help? How much do custom orthotics cost?

Here is a question from someone considering custom orthotics:

Hi there,

I have high arches and have not been able to find an arch support that works well for me. I don't experience pain but rather weakness/numbness or just the sensation that something is "off".

Hoping to get an evaluation and possibly orthotics.

Wondering, what is your rate for a clinic appointment in San Francisco and general cost for orthotics.

Many thanks,

ML

Hello ML,

Thank you for your inquiry!  I am sorry to hear that you have been having so much trouble finding arch supports that have worked for you, but I will be happy to help.

In many cases, numbness and weakness may be attributable to issues that may not even respond to over-the-counter shoe inserts or custom orthotic therapy. Of course, we would determine that during your evaluation.

I can assure you that I will not make custom orthotics for you unless I am certain I will help. We offer a money back guarantee on custom orthotics and in more than 10 years I've only had one pair returned. Just so happens that the pair was returned from a teenage girl who refused were anything other than flip-flops. 

The guarantee is as follows: you can use the custom orthotics for one full year. If after one year, you don't believe the orthotics have been helpful in alleviating your discomfort, helping you maintain an increased activity level, helping you run faster, or you are unhappy with the custom orthotics for any reason whatsoever you may return them for a full refund of the orthotic fee. The only condition or "fine print" is that you must return them to me within 370 days of delivery. That way you have a full year to try them out.

I do house calls so I will come see you and will cast you for custom orthotics at home during the initial evaluation, if custom orthotics seem appropriate. Seeing you at home can help facilitate evaluation because we can look at all of your shoes to help determine whether or not any of the shoes you are currently wearing may be contributing to the problem.

The rates are as follows: 

New patient evaluation: $500. The appointment is usually about 1 hour to 90 minutes. No additional fees if they you have lots of questions and the appointment runs longer.

Custom orthotics: $487. This includes the a Biomechanical exam, plaster casting to create molds of your feet for the custom orthotics, and the actual production of the custom orthotics.

I will return to your home one week after the casting to deliver the custom orthotics, fit them to your shoes, and discuss the process of break-in. There is no additional charge for the second house call appointment when I deliver the custom orthotics. The cost of the follow-up is included in the orthotic fee.

Please let me know what works best with your schedule so we can find a time that doesn't disrupt your work schedule. 

I look forward to meeting you. 

Sincerely, 

Dr. Christopher Segler

Doc On The Run

www.DocOnTheRun.com

How Custom Cycling Orthotics Decrease Knee Pain Caused by Forefoot Varus

Knee pain is one of the most common complaints among cyclists. If your knee is aching when you finish the climb over Mt. Tam or a long ride out through Marin, it may be because the foot is slightly out of alignment.

In the simplest of terms, your foot is "locked" in place to the pedal by the cleats. if your forefoot is tilted lightly in relation to the rearfoot (a condition called "forefoot varus" or "forefoot valgus") then your leg may tilt slightly when you pedal.

This tilting of the knee can cause the knee cap (or "patella") to track out of alignment. When the knee cap tracks incorrectly, the cartilage on the inside of the knee cap can become irritated and inflamed. This type of knee pain when biking is called "patellofemoral syndrome."

This short video describes bicycle pedaling biomechanics as it relates to knee pain and conditions such as forefoot varus that can be easily corrected with custom cycling orthotics.

Dr. Christopher Segler is a sports medicine podiatrist, cyclists, and 6-time Ironman triathlon finisher. His practice focuses on cyclists, runners, and triathletes in San Francisco, Marin, and the East Bay. He is currently training for Ironman France. If you have a question about pain while cycling, you can call him directly at 415-308-0833. Learn more about house calls for athletes at www.DocOnThRun.com and learn more about foot and ankle pain at www.AnkleCenter.com .

Will orthotics help heel pain when running?

This morning I received an inquiry from a runner in Marin who is training for the Dispea. He asked a common question:

"I have severe left heel pain especially after a 5-8 mile run. I am training for the Dipsea. Advice? Should I consider orthotics?"

Answer:
Custom orthotics can certainly help to alleviate many forms of heel pain including the most common type which is plantar fasciitis. Custom orthotics in fact are one of the best ways to slow do pronation and decrease stress to the large ligament on the bottom of the heel called the plantar fascia. If you over-pronate and repeatedly tug on the plantar fascia as your arch height changes, you get inflammation of the plantar fascia... known as plantar fasciitis.

A long run can place a tremendous stress on the plantar fascia and the heel bone. Most people with plantar fascitis will have pain in the bottom of the heel on days following running. Usually the pain is worse with the first couple of steps when they get up out of bed. They can also get a sharp pain in the heel when they start walking after sitting at a desk for a while.

Custom orthotics are one of the best treatments for this type of running-related heel pain. But that doesn't necessarily mean that it is best to get custom orthotics and keep running. You must get an evaluation with a running focused podiatrist first.

The concern is that you might have something worse than plantar fasciitis. In this case, the runner reports heel pain that is "severe" following long runs. Plantar fasciitis would usually be worse (and more annoying) the day after a long run, but not necessarily severe. It would be important to get x-rays and take a look at the heel bone (calcaneus) to be certain that you are not at risk for stress fracture in the heel bone (calcaneal stress fracture).

It is also possible that there is a cyst in the heel bone that is causing the problem. In the simplest of terms, a calcaneal cyst is a hollow or fluid filled pocket that develops within the heel bone. When running, the walls of the cyst can flex slightly causing pain and inflammation in the heel bone itself. In some cases the heel bone can flex so much that it cracks or fractures. This is actually much worse than a calcaneal stress fracture.

With a quick set of x-rays and an exam by an experienced running podiatrist, heel pain can be effectively treated. With all of the conditions that effect the heel, the sooner the best treatment is chosen and starts, the faster you will finish your goal race, wether it is the Dipsea, the Vineman or the San Francisco Marathon.


Dr. Christopher Segler is an Award Winning Foot & Ankle Surgeon, 5-Time Ironman Finisher and a sports medicine podiatrist who makes house calls for busy runners, triathletes and active professionals in San Francisco, Marin, the East Bay and the Peninsula. If you have a question about running related heel pain, you can call him directly at (415) 308-0833. You can also learn more about custom running orthotics at AnkleCenter.com and DocOnTheRun.com.

Stay Fit. Go Long. Run Fast. Be Strong.

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