A 43 yo otherwise very healthy, athletic male was seen complaining of pain in his arches when standing more than 10 minutes. He is fine when walking, running - as long as he is moving. When he stands there is pain to the point where he must sit down. He came in with three pair of orthotics (2 semi rigid and one accommodative, all well fitted) from other podiatrists that do not help and indeed make his pain worse. Biomechanically he has a modest forefoot varus bilaterally and no leg length discrepancy. No joint pain elsewhere. He does calf stretches regularly and is not tight there. He appears to be neurologically intact. He reports that he does have a positive marker for an autoimmune disease but does not know which test it was and the results are not available. In the absence of other symptoms I'm not sure that is relevant.
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Had I been the first to see him I would have made orthotics, accommodated the FF varus and given him calf stretching exercises. Given his history that would likely have failed. Any ideas?
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