I have flat feet and have been snowboarding recently (which requires alot of pressure on top of my foot from bindings which clamp down and i guess further flatten the sole of your feet).My boots do not have very good arch support.
I also can bring on the pain when in my boots / bindings and I try and lift the toes of my foot against the boot.

A friend lent me his orthodics which are very pronounced and i had a pain free day from this condition - including a pain free day snowboarding. The only thing is they may be too high for me because they made the soles of my feet ache in a fatigued sort of way, but maybe i need to develop the muscles in my feet more.

I am wondering what is wrong with me. I think i have a Midtarsal fault from what i read on the internet.

is there any point stretching / strengthening? (how might i do this)

Thanks in advance for any light you can shed on this pain. The closest podiatrist is over 90 kms away.

Hi George,

I am not sure about what you mean when you say “those that create your own impression”. To me that means either orthotics that conform to the shape of your foot as you wear them, OR, having prescription orthotics made by an impression of your feet. I will address both issues.

There are orthotics which in most cases are off the shelf orthotics that are in the market place that advertise they will conform to the structure of your foot. On the surface that sounds great, why not have an orthotic that conforms to your foot structure? Here is the problem. In order for an orthotic to conform to your foot structure, the top layer of the orthotic has to be a reasonably soft pliable material which will conform to your foot as you wear the orthotic, and in most cases they do. The problem is also the fact that the top layer is soft and pliable meaning it does not last very long. Depending on the conforming material being used, this type of orthotic will last for a month or two and then wears out. So if you do not mind replacing them every couple of months, then they are probably fine. However, these orthotics are not suited for every type of foot problem out there. They are generally best suited for diabetics who need to protect the bottom of their feet and perhaps for metatarsalgia which is pain on the bones which make up the ball of the foot. Many people are very sensitive there most likely due to lack of fat underneath the bones, so this type of orthotic can be very helpful.

If your question pertains to having prescription orthotics made by an impression of your feet, let me address that issue as well.
There are generally two popular ways to capture a patient’s foot structure. Probably the most common is through a plaster of paris impression of your feet where the foot is held in its neutral position (relative to the ankle and leg) while the plaster dries, so that the final orthotic product basically brings the ground up to the foot so that the patient may walk in a more normal gait. This type of impression is considered the gold standard.

Another type of impression technique is to place the patient’s foot is a box filled with a material that captures the “footprint”, (like footprints in the sand). With this technique the doctor again has to hold the foot in a neutral position and then place the foot in the box to capture the impression. The problem here is that there is a large margin of error because there are too many external factors that will create a poor impression. I personally think doctor’s who use this method are just plain lazy (it takes far less time to do this technique than plaster of paris casting).

Making the matter worse is that many companies on the internet are selling prescription orthotics and advertise that they will send you a casting box to take your own impression of your feet. Well, if the impressions tend to be incorrect when a doctor does it to a patient, one can only imagine what the impressions will be like when the patient attempts it on their own.

Hopefully, I have answered your question.

Marc Mitnick DPM

Hi Valerie,

I disagree with the advice you received. Assuming your pain is from plantar fasciitis (properly diagnosed) and since you spend a good amount of time on your feet, an orthotic would be the first thing I would try. It does not necessarily have to be a prescription orthotic. As I advertise on my site there are now good “off the shelf” orthotics that in many cases will do the job.
ESWT is considered a final treatment prior to considering surgery. Prior to trying ESWT there are a number of things you can try including stretching, night splints, oral medication, cortisone shots, and physical therapy.
My advice, try an orthotic, if that does not give you relief than see another doctor.
Marc Mitnick DPM