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Author Topic: Orthotics make it worse  (Read 2607 times)

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Offline Alyce

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Orthotics make it worse
« on: September 06, 2005, 12:40:44 AM »
Hey Everyone,

I've been told by a second opinion OS that as a result of the failed microfracture, and the size of the lesion, 15mm x 9mm x 6mm, that my only option is a PKR replacing the patella only.  He also recommended new orthotics.

I have been wearing custom orthotics for 5 years.  These were the type that you put your foot in cushy stuff, and three weeks later you have them.

These new ones are made by a company called FootMaxx, in Canada.  You walk over a pad, and they analyze your gait, amount of pressure, etc.  I got them and wore them for 1 hour, and had excruciating pain in a new place in my knee and in my back.  I wore them for 2 more days, with it getting worse.  I know that there is a break in time.  I have suffered from chronic back pain as a result of the way I now walk/limp.  I've been in PT for 3 months for my back, and it is just starting to get better.

So I am not real thrilled at having that pain made worse.  I guess that I was just looking for a "magic bullet."  Now I have these $600 things sitting in my closet. 

I am very sesitive to subtle changes in sock thickness etc.  I can only wear my pegasus running shoes.  I have too much knee and back pain with any other pair of shoes.

Any thoughts?

Many Thanks,
Alyce
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline blackbeltgirl

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Re: Orthotics make it worse
« Reply #1 on: September 06, 2005, 12:55:45 AM »
With new orthotics, they may require a "breaking in" period.  Even though you have worn orthotics in the past, if these are significantly different you need to give your body a chance to adapt.  15 minutes at a time, 2-3 times a day at first.  Then 30 minutes.  It should take about 2 weeks to work up to wearing your orthotics all the time.

COnsidering you're already in pain, you may want to go back to the old ones until you feel better - at least as good as you felt before.  Then start breaking in the new orthotics.  Do you have flat feet, or high arches?  Orthotics for flat feet are generally made by taking a plaster cast of the foot - with the patient laying prone on her stomach.  The goal is to support the existing arch, but not force too much arch for the body to handle.  Your original orthotics, made by stepping into foam, would actually mold your foot in an overpronated position (assuming flatfeet), and can eventually cause more harm because they allow your foot to continue overpronating.

You should also seek a 2nd opinion.  From your message, you have a relatively small lesion.  If your OS is considering replacing the patella, it must be on the back of your patella.  YOu should ask about OATS or ACI as alternatives.  Other people have a 2nd attempt at microfracture before trying anything else.  I haven't spent much time checking out the option of PKR, but I didn't even know they could replace the patella.  It's great to have that option, but you may want to research alternatives before making such a final decision.

Good luck.
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline Alyce

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Re: Orthotics make it worse
« Reply #2 on: September 06, 2005, 01:08:08 AM »
Thanks so much for your input.

I have very flat feet, an iin order for my patella to turn forward, my foot is at a 30 degree angle.  When I am bare foot, my back pain is minimal, with the orthotics, the knee pain is better, but the back pain is much worse.

It is just so frustrating!  I am trying anythin to avoid a PKR.  4 different OS's have said that all other forms of resurfacing are out because of the size of the lesion, and the fact that it is all around the underside of the patella, with exception of 2mm of the very center.

I am so sick of these shoes!  I have actuallly worn them to a funeral and a wedding.

Thanks again for your response.  I almost feel as though I've tried everything.  I'm pretty tough, but am getting close to giving up.

Alyce
Patella shaving & Lateral Release 6/2002
Reattachment of Lateral Retinaculum & Microfracture 6/2003.
Both procedures failed.  Reattachment was successful.
Lesion remains 15mm x 9mm x 6mm
Tibial rotational osteotomy May 2009
LPFL rebuild May 2009
Surgery for Baja Patella February 2010

Offline blackbeltgirl

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Re: Orthotics make it worse
« Reply #3 on: September 06, 2005, 01:14:36 PM »
That's weird that the OSs think the size of your lesion is the limiting factor.  Yours is pretty small in the grand scheme of things, since they're still measuring it in mm.  Mine are measured in the multiple centimeters, and I've got a number of resurfacing options available to me.  The underside of the patella may be what makes it trickier, but I know they have had some success with ACI on the patella.  Not sure about OATS.  You may want to see one of the cartilage restoration experts.  Where do you live?  I"m sure someone on the baord can help you find the OS with the experience to handle your situation.

As to the very flat feet - you will probably have a hard time adjusting since your older orthotics were probably not the best.  Stepping into the foam doesn't mold your natural arch - it molds your natural FALLEN ARCH.  You will definitely need to give your body a chance to adjust.  The right orthotics should help you re-align everything from the ankles to the spine.  But you don't want too big a change too fast.  I hope you're able to recover from the "quick switch" and go back to easing into the new orthotics.  Hopefully that will allow your body to gradually adjust, and keep everything properly lined up.  YOu may also want to consult with a chiropractor in the short-term, to ensure that your spine is well aligned as you make the switch.

Good luck.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)