What were your symptoms? Pain in my left big toe that got worse as I walked. I thought my shoes were the culprits, putting pressure on the end of the toe because the shoes weren't quite long enough. Then I got new shoes with plenty of room and it got better, but would still hurt toward the end of a walk and I could see a little swelling between the long bones (metatarsal?) of my big toe and next foot. I'm up to 11 miles at a time now and I was concerned that I might do myself some permanent damage if as I walked further and further.
Turns out my foot is slightly deformed. The long bone going toward my toe is a little too short and too high, so it's misaligned with my big toe. Over the years, the bone has developed a little spur on it and that's what's aggravating the tissue around it and the space between that bone and the toe bone is a little too small. The orthotic fix is to take the weight off the toe joint and distribute it elsewhere.
What kind of physician did you see? I went directly to a podiatrist (have a PPO plan that lets you self-refer). I would recommend seeing a specialist if at all possible, at least if they're all as good as this woman was.
Does insurance cover it? Mine did, 100%. The doctor said the cost would be about $350 without insurance. However, the orthotic itself apparently lasts 5 to 10 years, although the cushiony covering on top has to be replaced every 1000 miles or so (sounds like an oil change, doesn't it?) Also for the 3-day in Los Angeles, UCLA Medical Center is making them for the walkers at their cost. And people who aren't covered by insurance could plan ahead and use a healthcare spending account if they have one, saving on taxes at least.
What is it like to get fitted? Very easy. The doctor used plaster bandages (kindly dipped in warm water) and just smoothed them around my feet. They harden in no time, you wash the excess plaster off your feet and off you go! Fitting took about 5 minutes, but the whole visit was about an hour with x-rays and all.
How does it influence what shoes you buy once you have to use an orthotic? I'm getting what my doctor calls a casual orthotic which you can put into any casual shoe. If it's like the one she showed me in the office, it looks a lot like a Spenco insert and is supposed to fit into any sport shoe as well as some casual shoes (like Bass loafers). She suggested taking the orthotic along when trying on shoes but didn't mention anything about type of shoe. I'll ask when I pick the thing up (3 weeks). You can also get dress shoe orthotics which are narrower and not as supportive.
Finally - This isn't what drove me to the doctor, but it turned out to be a different problem than I thought it was - I've had a lot of trouble with my heels, particularly the left one. Without TONS of stretching, the bottom of my heel toward the back was very sore, so much so that it was occasionally hard to get started walking after I'd been sitting for a while. I attributed the problem to tight hamstring muscles because hamstring stretch exercises eventually relieve it. After the doctor watched me walk up and down her office hallway in my bare feet, she observed that my right leg is longer than my left. I've never had any back pain and had no idea about this. The doctor thinks my heel soreness symptoms actually come from the sciatic nerve. After thinking about what she told me, I also concluded that the hamstring could also be getting excessive stress from my poor little left foot trying to reach the ground all the time. This problem is also what caused me to roll on the outside of my foot. The left foot, trying to reach the ground, was landing on the left side first. The left orthotic will take care of this problem too with a little lift on the left foot.
My doctor is pretty conservative and very sympathetic to people who are training for event like the 3-day. She thinks the orthotic and a light dose of anti-inflammatories (1 Ibuprofen morning and night, every day until the walk) and icing my foot after a long walk, will get me through the walk OK and then I can decide if I want surgery to correct it more permanently. This problem is common enough that she had a chart on her wall showing it and what they do during the surgery, which is an out-patient procedure and you can walk the same day (can't run for a while, though).
