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I have been struggling with feet issues which have progressively gotten worse. Readers digest version - I developed Plantar fasciitis from over-pronation (left me unable to run for 7months) which resulted in my start with using custom orthotics. I ran free of pain for 7 months and started to develop tingling/numbness in my feet/toes. After 4 months of no change - I went back to a podiatrist who diagnosed Mortons Neuroma (and discovered I also have hammer (mallet) toes). Went through the cortisone shot process, which didn't help (and symptoms have actually gotten worse). Just started the alcohol based shots and have also just ordered new orthotics as this podiatrist stated that I have a leg length difference which wasn't accounted for in my current orthotics (not the same dr). I'm feeling like the focus is on the symptoms and not the root cause (if that is even possible). Any feedback would be helpful. I did notice a topic on the Posture Control Insoles, and found it interesting and wonder about other's experiences and whether it would be worth a try (or wait and see how I do with the new $300 orthotics :-() Any feedback on what others have gone through, how to deal with Podiatrists/questions to ask and any products that have worked would be appreciated. I feel like the focus is on symptoms versus solving the root problem (if that is possible). THANKS!

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I am a podiatrist with a specialty in orthotic therapy and biomechanics. I would avoid the posture control devices - they are just an over-the-counter support with some unproven advertising claims. The medical literature is fairly clear on how orthotics should be prescribed to treat pain under the ball-of-the-foot - including morton's neuroma. Most studies show that the orthotics should conform very tight to the arch of the foot in order to transfer force off of the ball of the foot In addition additional cushion should be added under the ball of the foot to slow velocity and decrease force. The alcohol injections have a 60% - 89% success rate depending on the study you read, and very few complications, so I think that is a good idea. Certainly I would try that before surgery. Hang in there, neuromas are frustrating but usually do respond well to treatment.
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Dr. Huppin - Thanks for the reply and additional information. You have a very comprehensive and informative website. The orthotics I just received look like the ones you mentioned. My previous pair was done via Digital imaging and looked very different (but seem to follow the same "line", but the new ones feel different (closer to the arch)).

For me anyway, the frustration is that it certainly feels like the focus is always on the symptoms and not fixing the underlying cause (fixing the biomechanical (hyperpronation) flaw). So if we fix the issue - doesn't that make all these continued symptoms go away? Am I misunderstanding that hyperpronation is always due to the ankle bone/range of motion issue? I would expect this is a common situation, with the number of products out on the market (including the expensive orthotics) and I do wonder if this leads to the perception of people who make comments insinuating the big markup/profit on the sale of orthotics by podiatrists I do realize that orthotics can solve a variety of issues and there is no "cure" for every situation. (Please don t take offense wasn t the intent).

Thanks again

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No offense taken at all. In general, for biomechanical problems of the foot, the orthotics (along with strengthening and proper training) are usually the best way to treat the underlying biomechanical problem. The funny thing is, newer studies show that orthotics do work for many of these problems, but in a way completely different than was thought a decade ago. For the most part, orthotics work on what's called a "stress relief model" - meaning that they reduce stress on tissue that is being overstressed. So, the prescription will be different for different pathologies, even in the face of the same biomechanical abnormality. This is why it is important to find a practitioner who is up to date on their understanding and practice of orthotic therapy.
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