Question
I had plantar fasciiitis (fasciosis) for about three years despite going through all of the non invasive treatments plus eswt.  Finally two rounds of cryo surgery resolved the pain.  About a year later, I started to experience severe pain by the side of the foot.  I was subsequently dx with posterior tibial tendonitis.  I was in a cast for three weeks, followed by a boot, pt etc etc.  Nothing resolved the pain.  I had a hypocure put in which backed out after 6 or 7 weeks. About 9 months ago, the hyprocure was removed and I had a modified kinder. The accessory navicular was removed and plastic anchor put in to tighten the tendon.  Multiple rips by the insertion of the tendon into the accessory bone were repaired. I was non weight bearing for 4 weeks, followed by a few weeks on cutches.  The doctor made custom orthotics for me. I also went through pt.  Despite the tendon function being good, I had continued pain by the area of the surgery that made it very difficult to wear a shoe.  I was put back in a walking cast two weeks, followed by wearing brace for a few weeks.  The brace was the only thing that allowed me to make it through a day at work.  I finally was given clearance to go back to pt.  I switched to a different pt who agreed that the tendon function and strength were excellent, however the pt said that the foot was not moving normally through the gait cycle.  He switched from strengthening as a goal to graston, manipulation to allow the joints to move more freely.  After a few weeks, the pt said that he was pretty certain that the orthotics that had been made were too aggressive and "jamming the foot up" resulting in abnormal movement.  I decided to go for a second opinion and the new podiatrist agreed that the tendon function was good.  When I did toe raises on the surgical foot, he said that the tendon was working very well.  The second doctor also agreed that the orthotics may be at the root of my ongoing pain.  He suggested that I try the powerfoot pinnacle in good sneakers.  I have been wearing a combination of my sneakers with powersteps, naots and aravon Katie sandals the past two to three weeks and have been PAIN FREE.  

Have you ever come across a situation where the orthotic is too aggressive and actually prolongs post surgical pain?

Answer
You sure have gone through a long ordeal.  Glad you're finally getting relief.  To answer your question, since an orthotic is made to reposition the foot and significantly alter the mechanics, it certainly can be aggressive to the point of causing overcorrection of the problem and causing continued pain.  It can also be a problem on the other end and not be controlling enough.  
Good lucck on your continued recovery,
Andrew Schneider, DPM
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