Podiatrists, yes/no? Quackery?

[Oldandfat]

Anyone have any experience? I’ve had heel pain for a bit. Long wait for a doctor so I was able to see a podiatrist.

Was assessed, measured, etc and he wants to sell me 550 inserts for my shoes. “Treat the cause not the symptoms”.

I,got a snake oil vibe after I left.

These guys are doctors right? Or are they more like chiro?

In the US, podiatrists are doctors, with similar (but narrower) training to MDs. It sounds like either you have a very unusual case of PF, or the one you went to has prioritized a business model over actually diagnosing and treating patients.

Why would this be considered an "unusual" case, in your opinion? Would podiatrists not normally recommend inserts for PF, or is it the seeming lack of prescribed corrective exercises?

My guy said I “could” go to PT and do stretches and what not, BUT it wasn’t fixing the cause (arches, alignment, support) just treating symptoms.

Sounds like the cart before the horse.

Usually fallen arches and alignment issues are due to weak musculature and/or tendinopathy.

But weak musculature can be caused by lack of support ( he talked about not walking around barefoot). He noticed my shoes were untied and thus no support.

He did talk about stretching and strengthening, and also cortisone shots (not good) and Advil, etc. but according to him it all boiled down to the proper foot support.

[Renascent]

Anyone have any experience? I’ve had heel pain for a bit. Long wait for a doctor so I was able to see a podiatrist.

Was assessed, measured, etc and he wants to sell me 550 inserts for my shoes. “Treat the cause not the symptoms”.

I,got a snake oil vibe after I left.

These guys are doctors right? Or are they more like chiro?

In the US, podiatrists are doctors, with similar (but narrower) training to MDs. It sounds like either you have a very unusual case of PF, or the one you went to has prioritized a business model over actually diagnosing and treating patients.

Why would this be considered an "unusual" case, in your opinion? Would podiatrists not normally recommend inserts for PF, or is it the seeming lack of prescribed corrective exercises?

My guy said I “could” go to PT and do stretches and what not, BUT it wasn’t fixing the cause (arches, alignment, support) just treating symptoms.

Sounds like the cart before the horse.

Usually fallen arches and alignment issues are due to weak musculature and/or tendinopathy.

But weak musculature can be caused by lack of support ( he talked about not walking around barefoot). He noticed my shoes were untied and thus no support.

He did talk about stretching and strengthening, and also cortisone shots (not good) and Advil, etc. but according to him it all boiled down to the proper foot support.

Not my place to speak for someone else, but I gathered that @Philbert was implying that he made his own support device instead of buying one.

Also, as a person who practically lives in Vibrams outside of work (the Onitsuka Mexico 66 is my other daily driver), there is a school of thought that believes too much support is detrimental to the "natural function" of the foot. In other words, "use it or lose it."

If your shoes are doing all the work of maintaining an arch for you, then the muscles of the feet/ankles/tibia/fibula/bicep femoris/etc. don't have to -- and so they won't. Much like the toe spacers I'm wearing as I type this, inserts are intended to be a tool while you remedy the situation, rather than serving as the solution itself.

https://www.ncbi.nlm.nih.gov/books/NBK5 ... %20highest.

If the muscles of your spine are not strong or stable enough to provide support to your spine, and you wear a brace to provide that support, what becomes of the muscles?

[Oldandfat]

Anyone have any experience? I’ve had heel pain for a bit. Long wait for a doctor so I was able to see a podiatrist.

Was assessed, measured, etc and he wants to sell me 550 inserts for my shoes. “Treat the cause not the symptoms”.

I,got a snake oil vibe after I left.

These guys are doctors right? Or are they more like chiro?

In the US, podiatrists are doctors, with similar (but narrower) training to MDs. It sounds like either you have a very unusual case of PF, or the one you went to has prioritized a business model over actually diagnosing and treating patients.

Why would this be considered an "unusual" case, in your opinion? Would podiatrists not normally recommend inserts for PF, or is it the seeming lack of prescribed corrective exercises?

My guy said I “could” go to PT and do stretches and what not, BUT it wasn’t fixing the cause (arches, alignment, support) just treating symptoms.

Sounds like the cart before the horse.

Usually fallen arches and alignment issues are due to weak musculature and/or tendinopathy.

But weak musculature can be caused by lack of support ( he talked about not walking around barefoot). He noticed my shoes were untied and thus no support.

He did talk about stretching and strengthening, and also cortisone shots (not good) and Advil, etc. but according to him it all boiled down to the proper foot support.

Not my place to speak for someone else, but I gathered that @Philbert was implying that he made his own support device instead of buying one.

Also, as a person who practically lives in Vibrams outside of work (the Onitsuka Mexico 66 is my other daily driver), there is a school of thought that believes too much support is detrimental to the "natural function" of the foot. In other words, "use it or lose it."

If your shoes are doing all the work of maintaining an arch for you, then the muscles of the feet/ankles/tibia/fibula/bicep femoris/etc. don't have to -- and so they won't. Much like the toe spacers I'm wearing as I type this, inserts are intended to be a tool while you remedy the situation, rather than serving as the solution itself.

https://www.ncbi.nlm.nih.gov/books/NBK5 ... %20highest.

If the muscles of your spine are not strong or stable enough to provide support to your spine, and you wear a brace to provide that support, what becomes of the muscles?

So basically my guy is a quick then? I dunno. More confused now.

Chiro will tell me the pain is cause of my spine. Naturopath will sell me ground frog nail tea. Doctor will prescribe pills. PT will stretch. Seems whatever is causing my issue is more or less what the specialist says it is.

What are the spacers for? Are they helping?

[Renascent]

So basically my guy is a quick then? I dunno. More confused now.

Chiro will tell me the pain is cause of my spine. Naturopath will sell me ground frog nail tea. Doctor will prescribe pills. PT will stretch. Seems whatever is causing my issue is more or less what the specialist says it is.

What are the spacers for? Are they helping?

Yeah, I guess you could say the spacers are helping. Despite being "duck-footed" for most of my natural life (the byproduct of being a latchkey kid with no athletic background prior to my thirties -- genetics be damned), I don't have the worst feet possible. I started getting weird sensations in the upper portion of the left foot after what I suspected was piriformis syndrome (or a general glute issue) a few years back. Weird sensations in the big toe -- and the fear of "turf toe" along with the possibility of developing a bunion -- led me to start looking into the musculature of the feet. My squats sometimes suffer as a result.

Toe spacers seem to work best when you're wearing them while carrying your weight as you would in daily life. In other words, they're almost pointless if I'm idle; I should be doing calf raises with a slow eccentric, climbing stairs, sprinting, banded ankle inversion shit, and so on, to get the maximum benefits.

Funny thing about tight calves is that I always assumed muscle tightness should manifest as some kind of noticeable discomfort, which doesn't appear to be true. I've never had Achilles issues, but I've had tight peroneals shut down the lower leg while driving. Spent a week working through Foot Drop once. Tight calves can restrict nearby structures, and prevent your ankles from functioning as they're "supposed" to -- degrees of rotation are involved, unlike hinge joints (knees or elbows).

I was being mildly flippant when I suggested that your podiatrist is an outright quack. I think what Philbert said is more accurate -- the dude probably makes the bulk of his money by selling inserts and orthotics rather than diagnosing a mobility issue and suggesting specific exercises. If he pushes the exercises as the primary solution, then his potential income (and his influence) gets shunted to the PT he refers you to.

This seems to be a caveat when dealing with a lot of medical professionals, in my opinion. They may not be idiots -- or even quacks -- but they may place an emphasis on one thing or another that might not correlate very strongly with your issue.

With that said, if I were you, I'd take @mgil's suggestion, and seek out a PT. Everybody's body is different -- a unique sum of ratios, if you will.

This podiatrist seems to want to sell you Pepto-Bismol for a stomach ache, without worrying about what you've eaten recently.

[mgil]

My own N = 1 regarding most foot problems:

I dropped cushy sneakers years ago. I primarily wear Merrell Trail Gloves and sometimes Vapor Gloves. These are minimalist shoes with a wide toe box, zero toe drop, and a very short stack. I have to limit my Vapor Glove use because of my hip getting cranky, but switching to this type of shoe, about 8/9 years ago, cleared up most of my feet problems.

I had one PT, at a PT mill, ask me about my shoes regarding arch support when I was rehabbing a torn Achilles. I told her I don’t have a problem with them to which she countered that my shoes don’t have any arch support.

My arches are fine and far from fallen. Dunno why she asked when the reason for my Achilles tear had to do with fast extensions and flexion of the gastrocnemius under load with no warmup (a bad idea). Nonetheless, finding a good PT is useful also.*

*A good PT tends to attack the problem by strengthening and movement (I hesitate to use the word stretching). The last couple of go-rounds have taught me a good deal about how to approach issues and not be afraid of doing very small exercises that are massively difficult at first.

[Allentown]

Vapor Gloves.

+1 to the shoe, no comment on foot problems or arch solutions but I plan to keep getting these when mine wear out.

[Philbert]

Anyone have any experience? I’ve had heel pain for a bit. Long wait for a doctor so I was able to see a podiatrist.

Was assessed, measured, etc and he wants to sell me 550 inserts for my shoes. “Treat the cause not the symptoms”.

I,got a snake oil vibe after I left.

These guys are doctors right? Or are they more like chiro?

In the US, podiatrists are doctors, with similar (but narrower) training to MDs. It sounds like either you have a very unusual case of PF, or the one you went to has prioritized a business model over actually diagnosing and treating patients.

Why would this be considered an "unusual" case, in your opinion? Would podiatrists not normally recommend inserts for PF, or is it the seeming lack of prescribed corrective exercises?

Usually, healing this takes a combination of support, cushioning, rest, stretching, strengthening, and time. I noticed that it was never clarified if 550 is a model number or price in Canadian $. If it is the model number then my assessment was overly harsh. But my own experience with PF was agonizing morning heal pain-> Dr. google -> a contraption made of old socks, duct tape, and a bootlace-> complete recovery without any modification to footwear. And I agree with Mgil: weak arches are caused by poor arch support like obesity is caused by the seats being too small at McDonalds.

550.00 CDN is the total price including casting, custom molds, and follow up “support”.

Was unable to find your duct tape contraption but it sounds like something to “lift” the toes up while you stretch, and/or calf raise? (Am using a rolled up face towel)

Supposedly tight calves are a cause.

Google Srassburg sock plantar fasciitis. I may be spelling it wrong. I didn't want to buy one because I am a tinkerer and was a student at the time. It works by keeping the sole of the foot gently stretched at night. If you have pain in the morning when you get up this usually helps. I had one short relapse within the first year and no problems in the 10 years or so since.
And Renascent described my view on your podiatrist very well It is the "I have a hammer, that looks like a nail" school of professional behavior. GPs are supposed to avoid this, but many of them are too bogged down in metrics and productivity standards.

[Renascent]

My arches are fine and far from fallen. Dunno why she asked when the reason for my Achilles tear had to do with fast extensions and flexion of the gastrocnemius under load with no warmup (a bad idea). Nonetheless, finding a good PT is useful also.*

Forgive my nosiness, but what were you doing when the tear happened? I'm curious, just to get an idea of what would've constituted a proper warmup.

[mgil]

My arches are fine and far from fallen. Dunno why she asked when the reason for my Achilles tear had to do with fast extensions and flexion of the gastrocnemius under load with no warmup (a bad idea). Nonetheless, finding a good PT is useful also.*

Forgive my nosiness, but what were you doing when the tear happened? I'm curious, just to get an idea of what would've constituted a proper warmup.

I was out grocery shopping in the early morning on a pretty cool (and raw) New England day. It was probably around 50F and pretty decent rainfall.

When I exited the store, I thought I’d be clever and ride the shopping cart like a scooter to avoid stepping in the large puddles in the parking lot. Alas, on the third push or so, I felt and heard too loud pops in my lower left leg while pushing. Also immediate pain.

So then I hobbled to the car using the cart now like a walker, loaded the car up, and drove home. Note that the car was a manual, so I was stuck trying to operate the clutch with my heel, which didn’t work. Then I got home, got some help unloading the car. I think I waited until Monday (this probably happened on Sunday) to get it looked at, since this was the height of the pandemic and I had no desire to fuck around with normal ER services at the time.

I think it was simply too much dorsiflexion and too quick. Luckily, the tear wasn’t completely through the tendon, but the doctor hinted on this thing being a time bomb of sorts. At this point in time, that tendon seems to be okay and I still have more ROM in that ankle than the right (multiple sprains over decades).

[Oldandfat]

Anyone have any experience? I’ve had heel pain for a bit. Long wait for a doctor so I was able to see a podiatrist.

Was assessed, measured, etc and he wants to sell me 550 inserts for my shoes. “Treat the cause not the symptoms”.

I,got a snake oil vibe after I left.

These guys are doctors right? Or are they more like chiro?

In the US, podiatrists are doctors, with similar (but narrower) training to MDs. It sounds like either you have a very unusual case of PF, or the one you went to has prioritized a business model over actually diagnosing and treating patients.

Why would this be considered an "unusual" case, in your opinion? Would podiatrists not normally recommend inserts for PF, or is it the seeming lack of prescribed corrective exercises?

Usually, healing this takes a combination of support, cushioning, rest, stretching, strengthening, and time. I noticed that it was never clarified if 550 is a model number or price in Canadian $. If it is the model number then my assessment was overly harsh. But my own experience with PF was agonizing morning heal pain-> Dr. google -> a contraption made of old socks, duct tape, and a bootlace-> complete recovery without any modification to footwear. And I agree with Mgil: weak arches are caused by poor arch support like obesity is caused by the seats being too small at McDonalds.

550.00 CDN is the total price including casting, custom molds, and follow up “support”.

Was unable to find your duct tape contraption but it sounds like something to “lift” the toes up while you stretch, and/or calf raise? (Am using a rolled up face towel)

Supposedly tight calves are a cause.

Google Srassburg sock plantar fasciitis. I may be spelling it wrong. I didn't want to buy one because I am a tinkerer and was a student at the time. It works by keeping the sole of the foot gently stretched at night. If you have pain in the morning when you get up this usually helps. I had one short relapse within the first year and no problems in the 10 years or so since.
And Renascent described my view on your podiatrist very well It is the "I have a hammer, that looks like a nail" school of professional behavior. GPs are supposed to avoid this, but many of them are too bogged down in metrics and productivity standards.

I,find,every “professional” has a solution to my problem. Podiatrist has a hammer so my issue is a nail. Chiro has a screwdriver so….. kinda like “don’t ask a barber if you need a haircut.

Same with PT no? Their solution is stretch and strengthen (not a bad idea.)

My gp will prescribe drugs and tell me to stop doing whatever caused the pain.

Others will tell me it’s “in my head” and ask for a citation and a peer reviewed study.


For what it’s worth, I bought a new pair of shoes (nothing fancy, just new) and I’m pacing them up now.
I’m also stretching my calves. Pain is going away. So far so good.

I will go to a shoe store locally and buy a “nice” pair or two and have them properly fit.

Those Strasberg socks…. Does it actually stay put? Looks like the toes would pull the sock down??
It’s basically mimicking one of the plantar stretches, but does so while you sleep. 20-30 bucks shipped so really nothing to lose.

[Philbert]

Anyone have any experience? I’ve had heel pain for a bit. Long wait for a doctor so I was able to see a podiatrist.

Was assessed, measured, etc and he wants to sell me 550 inserts for my shoes. “Treat the cause not the symptoms”.

I,got a snake oil vibe after I left.

These guys are doctors right? Or are they more like chiro?

In the US, podiatrists are doctors, with similar (but narrower) training to MDs. It sounds like either you have a very unusual case of PF, or the one you went to has prioritized a business model over actually diagnosing and treating patients.

Why would this be considered an "unusual" case, in your opinion? Would podiatrists not normally recommend inserts for PF, or is it the seeming lack of prescribed corrective exercises?

Usually, healing this takes a combination of support, cushioning, rest, stretching, strengthening, and time. I noticed that it was never clarified if 550 is a model number or price in Canadian $. If it is the model number then my assessment was overly harsh. But my own experience with PF was agonizing morning heal pain-> Dr. google -> a contraption made of old socks, duct tape, and a bootlace-> complete recovery without any modification to footwear. And I agree with Mgil: weak arches are caused by poor arch support like obesity is caused by the seats being too small at McDonalds.

550.00 CDN is the total price including casting, custom molds, and follow up “support”.

Was unable to find your duct tape contraption but it sounds like something to “lift” the toes up while you stretch, and/or calf raise? (Am using a rolled up face towel)

Supposedly tight calves are a cause.

Google Srassburg sock plantar fasciitis. I may be spelling it wrong. I didn't want to buy one because I am a tinkerer and was a student at the time. It works by keeping the sole of the foot gently stretched at night. If you have pain in the morning when you get up this usually helps. I had one short relapse within the first year and no problems in the 10 years or so since.
And Renascent described my view on your podiatrist very well It is the "I have a hammer, that looks like a nail" school of professional behavior. GPs are supposed to avoid this, but many of them are too bogged down in metrics and productivity standards.

I,find,every “professional” has a solution to my problem. Podiatrist has a hammer so my issue is a nail. Chiro has a screwdriver so….. kinda like “don’t ask a barber if you need a haircut.

Same with PT no? Their solution is stretch and strengthen (not a bad idea.)

My gp will prescribe drugs and tell me to stop doing whatever caused the pain.

Others will tell me it’s “in my head” and ask for a citation and a peer reviewed study.


For what it’s worth, I bought a new pair of shoes (nothing fancy, just new) and I’m pacing them up now.
I’m also stretching my calves. Pain is going away. So far so good.

I will go to a shoe store locally and buy a “nice” pair or two and have them properly fit.

Those Strasberg socks…. Does it actually stay put? Looks like the toes would pull the sock down??
It’s basically mimicking one of the plantar stretches, but does so while you sleep. 20-30 bucks shipped so really nothing to lose.

People I know say it worked. My two old socs and duct tape version stayed put just fine.

And the reason everyone has their own solution which happens to be within their specialty is because each of those things works for some patients. For some mild cases, any of them will work, except maybe chiro. For severe cases a combination of all the above (except chiro) may be needed. No steroids though. Many patients will go to a different specialist if the treatment is not working, and the original specialist assumes they are cured. At the same time each specialty is seeing all the people who gave up on the other specialists' treatment, so they "know" that does not work.