CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 35 0000. ref SDS 34 0000.
040502 -
040503 -
040504 -
040505 - [On 171110 1042 Hoka Bondi 5 Wide shoes superior cushioning
040506 - and rebound energy, and better width enabled hiking 336
040507 - miles without metatarsalgia pain, so bought 6 more pair to
040508 - rotate shoes every day on 11 to 15 mile hikes. ref SDS 36
040509 - SM4M
040511 - ..
040512 - [On 181122 0921 bought another pair Hoka Bondi 5 Wide shoes
040513 - for $120 priced reduced for "Black Friday", and bought 1
040514 - pair Bondi 6 Wide shoes to test this new model; this will
040515 - extend life of existing 12 pair Bondi 5 Wide shoes to hike
040516 - another 3,000 miles in 2019. ref SDS 43 SM4M
040517 -
040518 -
040519 -
040520 -
040522 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 170829 Doctor Tang explained considerations to switch from Brooks
040902 - Ghost shoes to shoes with stiffer forefoot. He seemed to say stiffer
040903 - forefoot would reduce pressure on plantar plate injury, and so reduce
040904 - pain during recovery with PRP injections. ref SDS 34 9N77 The doctor
040905 - suggested visiting...
040906 -
040907 - On the Run
040908 - 1310 9th Street (9th and Irving)
040909 - San Francisco, CA
040910 - 415 682 2042
040911 -
040912 - http://www.ontherunshoes.com
040914 - ..
040915 - The doctor said that On the Run has a podiatrist on staff, who can
040916 - consult on the best shoes to protect against plantar plate tear
040917 - injuries. He said to mention this is a VA Podiatry referral.
040918 - ref SDS 34 SS8O
040920 - ..
040921 - On 170924 1346 visited On-the-Run and met Eric Meuser, Genral Manager.
040922 - Eric suggested trying Hoka Bondi shoes, and returning on a Friday or
040923 - Saturday to consult with Mark Wachter. ref SDS 35 NC5M
040924 -
040926 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Today, met Mark Wachter CEO of On-the-Run.
041302 -
041303 - mark.wachter@ontherunshoes.com
041305 - ..
041306 - He was with another customer, so waited about 20 minutes.
041308 - ..
041309 - It was fun and educational working with Mark. On mentioning Doctor
041310 - Tang's referral at VAMCSF, Mark explained that the doctor worked for
041311 - him while in medical school for podiatry 20 years ago, or so.
041313 - ..
041314 - Mark initially examined range of motion for both feet. He found
041315 - muscles of ankles and calves are very tight from hiking 13,000 miles
041316 - the past 5 years (60 - 80 miles per week, 200 - 300 miles per month).
041317 - He explained limited range of motion prevents feet from bending
041318 - normally. This contributes to injuries.
041320 - ..
041321 - Mark appreciated complexity of this case...
041322 -
041323 - 1. Wide foot
041324 - 2. Compound injuries - metatarsalgia and right foot plantar
041325 - plate
041326 - 3. Multiple blisters both feet
041327 - 4. Tight ankle and calf muscles limit range of foot motion
041329 - ..
041330 - Mark demonstrated stretching exercises to maintain range of motion in
041331 - feet and ankles. These exercises were previously demonstrated by
041332 - Sharlene at the VA in Physical Therapy on 170425 0830. ref SDS 15 GY5J
041334 - ..
041335 - Mark recommended using a pole stick rubbing it up and down a number of
041336 - times every day to loosen calf muscles, and thereby restore range of
041337 - motion to the feet. This may be intended to reduce stress on
041338 - metatarsals. Prevously Kathy at Fleet Feet recommended using a pole
041339 - stick, reported on 140828 1203. ref SDS 2 HS5I At that time, limited
041340 - range of motion caused by hiking 11 miles per day, was cited for
041341 - causing heel linings to wear out in Hoka Stinson Trail shoes.
041342 - ref SDS 2 ID6J
041344 - ..
041345 - Mark examined orthotic inserts designed by Doctor Tang and ordered at
041346 - VAMCSF on 170623 0830. ref SDS 17 M23H These were received and began
041347 - use on 170725 1636. ref SDS 20 KD8H Summarized background of initial
041348 - favorable results relieving pressure on plantar plate injury,
041349 - ref SDS 20 2268, and later requesting meeting to consider
041350 - modifications for better pain relief from plantar plate injury,
041351 - reported on 170809 1710. ref SDS 27 DV95
041353 - ..
041354 - Mark investigated biomechanics.
041356 - ..
041357 - Walked up and down the store floor first in existing Hoka Sintson 3
041358 - shoes with existing VA supplied orthotic inserts. Mark then had me
041359 - walk up and down barefoot. Mark seemed to say the gait is normal.
041360 - This was good news.
041362 - ..
041363 - Explained that in 2015, biomechanics review in Podiatry at the VA
041364 - found early lift off on the left foot, possibly related to left knee
041365 - injury and surgery causing degenerative arthritis decades earlier,
041366 - reported on 151215 1000. ref SDS 3 6R7G MRI at VAMCSF found
041367 - significant left knee osteoarthritis, reported on 160805 0800.
041368 - ref SDS 9 PSWR Mark's report today, may reflect favorable results
041369 - from PRP injection treatment to restore cartelage in the left knee,
041370 - resolving osterarthritis, performed by Doctor Tucker on 170726 1600.
041371 - ref SDS 21 4Y8K
041373 - ..
041374 - Mark recommended trying an orthotic insert from his inventory. He
041375 - seemed to say today that he designs and makes all orthotic inserts
041376 - sold at On-the-Run.
041378 - ..
041379 - From an extensive inventory on display in the store, Mark selected a
041380 - pair of orthotic inserts. This was a multi-layered insert, similar to
041381 - the pair worn today, per above. ref SDS 0 E06N Marked worked quickly
041382 - and extensively for 20 minutes or so modifying the right foot insert
041383 - with a beveled hole to relieve pressure on plantar plate injury.
041385 - ..
041386 - This was similar to design discussed with Doctor Tang and Doctor
041387 - Hewitson at VAMCSF Podiatry. At that time, Doctor Hewitson indicated
041388 - tensil stresses at the cut out proved overwhelming in prior trials,
041389 - reported on 170523 0930. ref SDS 16 5N3G
041390 -
041391 - [On 160101 0700 after suffering pain on multiple hikes at
041392 - location of right foot plantar plate, and since right foot
041393 - orthotic insert was modified with deeper and wider cutout
041394 - on 171202, per above, ref SDS 39 6L5O, decided the
041395 - increased size of the cutout was causing tensile pressure,
041396 - so removed this set of Stable Elite orthotic inserts; cut a
041397 - small opening in bottom of the right foot insert using the
041398 - new set of Stable Elite orthotic inserts also received
041399 - today, per above, ref SDS 39 3W5G, and placed these inserts
041400 - in the Hoka Bondi 5 Wide shows. ref SDS 7 6S82
041402 - ..
041403 - Further related subsequent experience attempting this type of
041404 - solution, cutting out a section for both the long toe and plantar
041405 - plate from a supplemental blue cushion insert. This scheme worked
041406 - well for 1 hike. On a hike the next day, suffered such severe pain at
041407 - right foot plantar plate that had to remove the blue insert that had
041408 - the cut out, reported on 170808 in case study on 160101 0700,
041409 - ref SDS 4 SYPQ This episodic experiment was reported in a letter to
041410 - Doctor Tang the next day on 170809 1710. ref SDS 27 DV9Q
041412 - ..
041413 - Mark explained he would address this issue by cutting a much smaller
041414 - hole and with precision at the plantar plate location. He located the
041415 - plantar plate on the ball of the right foot by pressing with his thumb
041416 - until I responded that the pressure point caused pain, similar to
041417 - Doctor Hewitson on 170213 1133. ref SDS 12 HL5M On locating the
041418 - plantar plate, Mark applied white material from a jar. He placed the
041419 - orthotic insert over the foot, and this caused a white mark on the
041420 - insert at the platar plate location. Used a tissue to remove the
041421 - excess marking material from the foot.
041423 - ..
041424 - Mark pointed out the arch for this set of multi-layered orthotic
041425 - inserts is slightly offset toward the heel. Not sure the
041426 - biomechanical theory he presented.
041428 - ..
041429 - Mark measured the feet and then brought out Hoka Bondi 5 Wide size 9.5
041430 - shoes shown on the box label. The label on the shoe tongue says 9.5
041431 - 2E. Historically my size has been 9.5. These seemed too tight, so he
041432 - tried size 10 2E. These fit well for width, but we agreed they were
041433 - too long. We tried size 9.5 again. This time Mark loosened the laces
041434 - at the toe line. They then seemed to work well.
041436 - ..
041437 - Mark suggested keeping the bottom 2 laces loose, to prevent pressure
041438 - on metatarsals, thereby reducing risk of metatarsalgia injury. He
041439 - tied a loop between 2nd and 3rd set of eyelets to aid in snugging the
041440 - laces above the 2 laces and keeping laces below loose.
041442 - ..
041443 - Walking around the store in the Bondi 5 wide shoes seemed like walking
041444 - on pillows. I walked out of the store and up and down the parking lot
041445 - to further test the shoes. There was with significant rebound energy
041446 - pushing the foot off the pavement, and there was metatarsalgia pain
041447 - level 0 across the forefoot. I was stunned, amazed and very pleased,
041448 - because prior versions of Bondi shoes were stiff and hard, like
041449 - walking on wood, reported to Hoka on 160527 1002, ref SDS 8 ZL6J, and
041450 - citing an 11 mile hike on 160222, shown in case study on 160101 0700.
041451 - ref SDS 4 B17I Evidently, Hoka has upgraded product specifications
041452 - for Bondi 5 Wide. This makes switching back to Bondi a plausible
041453 - solution to try, so offered to buy the shoes and the inserts.
041455 - ..
041456 - ..
041457 - [On 170930 shown in case study 160101 0700 reporting 9 mile
041458 - hike, Hoka Bondi 5 Wide 2E shoes have excellent rebound
041459 - energy in heel cushioning, and forefeet cushioning prevents
041460 - pain from metatarsalgia. ref SDS 6 XRVQ
041462 - ..
041463 - [On 171110 1042 Hoka Bondi 5 Wide shoes superior cushioning
041464 - and rebound energy, and better width enabled hiking 336
041465 - miles without metatarsalgia pain, so bought 6 more pair to
041466 - rotate shoes every day on 11 to 15 mile hikes. ref SDS 36
041467 - SM4M
041469 - ..
041470 - [On 171114 1225 wore 1st of 6 pair Hoka Bondi 5 Wide shoes
041471 - on hike and noticed immediately they are much stiffer and
041472 - harder with no rebound energy, than the shoes purchased at
041473 - On-the-Run on 170929 1010, ref SDS 35 TZ5H, and which
041474 - enabled hiking over 300 miles, which justified purchasing 6
041475 - more pair on 171110. ref SDS 38 AM9L
041477 - ..
041478 - [On 171208 1218 Hoka marketing specifications list a range
041479 - of cushioning - Responsive, Balanced, Plush. Bondi 5 shoes
041480 - are all manufactured with plush cushioning that feels like
041481 - "walking on pillows." Since Bondi 5 shoes worn today on
041482 - 171114, are stiff and hard with no rebound energy,
041483 - ref SDS 38 AM9L, there may have been a manufacturing error
041484 - using the other 2 cushioning mid-sole materials.
041485 - ref SDS 40 T45F
041487 - ..
041488 - [On 171221 0910 1st pair Hoka Bondi 5 wide shoes wore out
041489 - hiking over 650 miles, ref SDS 41 SM4M, Hoka advertising on
041490 - Internet shows 3-types of cushioning - Responsive, Balanced
041491 - and Plush; all Bondi 5 shoes are sold with only plush
041492 - cushioning, which is specified as "Maximum cushion for a
041493 - pillow soft feel" so purchased another pair to make 7 pair
041494 - - to rotate for daily 11 - 15 mile hikes. ref SDS 41 YW5M
041496 - ..
041497 - [On 180122 in case study 160101 0700 wore 2nd pair Hoka
041498 - Bondi 5 Wide 2E size 9.5 and received on 180115, hiked 11
041499 - miles fast all the way, because shoes equal or better,
041500 - i.e., excellent, cushioning and rebound energy than shoes
041501 - purchased today at On-the-Run. ref SDS 7 VTPX
041503 - ..
041504 - [On 181122 0921 bought another pair Hoka Bondi 5 Wide shoes
041505 - for $120 priced reduced for "Black Friday", and bought 1
041506 - pair Bondi 6 Wide shoes to test this new model, and to
041507 - extend life of existing 12 pair Bondi 5 Wide shoes.
041508 - ref SDS 43 SM4M
041509 -
041511 - ..
041512 - Mentioned that the arch in the orthotic insert feels odd or uneven
041513 - along the full length of the arch.
041515 - ..
041516 - Mark then changed his mind, saying another thought just occurred for a
041517 - better orthotic insert treating the plantar plate problem. He went
041518 - into the backroom area. Minutes later he returned with another set of
041519 - orthotic inserts that are not multi-layered...
041520 -
041521 - Satallite Elite
041523 - ..
041524 - The inserts have a "metatarsal bar" protrusion in the middle of arch,
041525 - and above the metatarsals, similar but smaller than the same design
041526 - applied in VA orthotic inserts received on 170725 1636. ref SDS 20
041527 - 225N These small protrusions may correlate with Doctor Tucker's
041528 - suggestion for adding a metatarsal bar to help prevent metatarsal and
041529 - plantar plate injuries, reported on 170727 1747. ref SDS 22 517O
041531 - ..
041532 - This insert is multi-layered with feet resting on a very thin, black,
041533 - polymer material, which is glued to approximate .25" white
041534 - styrofoam-like base material that rests on the inner sole of the shoe.
041536 - ..
041537 - Mark grooved a small, beveled opening in the bottom of the right
041538 - insert. It does not penetrate through the white layer of sole
041539 - material. This new design provides a small transitional area that
041540 - reduces pressure on plantar plate during hiking, and thereby enables
041541 - healing. Think intent was to reduce tensil stress on tissue adjacent
041542 - and surrounding plantar plate, per above considerations. ref SDS 0
041543 - MH4O He explained the arch is more normal.
041544 -
041545 - [On 171113 1610 received 2nd set of Stable Elite 40
041546 - orthotic inserts, but without cutout to relieve pressure
041547 - on plantar plate injury. The foot surface is brown,
041548 - rather than black, and material looks different.
041549 - ref SDS 37 YN9K
041551 - ..
041552 - [On 171202 1000 visited On-the-Run and exchanged the
041553 - inserts so we now have 2 sets of the newest design for
041554 - Stable Elite 40 orthotic inserts. ref SDS 39 UM4K
041556 - ..
041557 - [On 171202 1000 visited On-the-Run and Mark increased the
041558 - width and depth of the cutout for relieving pressure on
041559 - plantar plate injury. ref SDS 39 6L5O
041561 - ..
041562 - [On 171206 1330 felt pressure on right foot plantar plate
041563 - area right foot, while hiking up steep hill Crystal Ranch
041564 - Road, reported in case study on 160101 0700. ref SDS 4
041565 - SRVT
041567 - ..
041568 - [On 171210 1150 decided cutout on 171202 was too big,
041569 - causing tensil pressure on plantar plate area, so hiked
041570 - using new Stable Elite 40 orthotic inserts received from
041571 - On-the-Run on 171202, and which have no cutout to relieve
041572 - pressure on plantar plate, testing whether plantar plate
041573 - healed; again felt severe pressure on plantar plate area
041574 - during hike, so after hike used electric drill to make
041575 - small cutout to relieve pressure on plantar plate and
041576 - will test next day, reported in case study on 160101
041577 - 0700, ref SDS 4 SUPP
041579 - ..
041580 - [On 171211 1230 did 11 mile hike without doing Crystal
041581 - Ranch Road 4-mile loop with steep hills, and only slight
041582 - pressure on plantar plate, indicating smaller cutout
041583 - created in right foot of new Stable Elite 40 orthotic
041584 - inserts provides effective relief for plantar plate
041585 - injury, and without causing tensil stress injury,
041586 - reported in case study on 160101 0700, ref SDS 4 SUWP
041588 - ..
041589 - [On 171229 1010 bought another pair, making 3 sets
041590 - Satallite Elite orthotic inserts, purchased from
041591 - On-the-Run shoe store. ref SDS 42 JI6K
041592 -
041594 - ..
041595 - Trying this solution felt very good walking around the store in the
041596 - Hoka Bondi size 9.5 2E shoes with the alternate inserts.
041598 - ..
041599 - Mark proposed wearing special dual lined socks. He advised this
041600 - design helps reduce blisters, which have been a continuing problem,
041601 - including for the hike at 0430 this morning through Golden Gate park,
041602 - reported in case study on 160101 0700. ref SDS 4 XRWU
041604 - ..
041605 - This was resisted - for one thing we have 20 pair wool socks. Wearng
041606 - 2 pair would nominally comprise "dual lined" effect. Setting this
041607 - $300 investment aside, requires spending another large sum to replace
041608 - them.
041610 - ..
041611 - Another is mere comfort in that the socks Mark offered are ankle high.
041612 - This felt odd, having never worn this fashion.
041614 - ..
041615 - Mark was very kind. He included the one pair of socks at no charge
041616 - in order for customer to gain experience with a new scheme.
041618 - ..
041619 - Mark then turned to the blisters.
041621 - ..
041622 - He treated blisters on the right foot, particularly the bottom of the
041623 - foot beneath the big toe with...
041624 -
041625 - 2nd Skin Dressing Kit
041627 - ..
041628 - This blister prevented completing hike through Golden Gate Park. Had
041629 - to return half way through and return to VA, only 8 miles, reported in
041630 - case study on 160101 0700. ref SDS 4 RZ5K
041632 - ..
041633 - Mark explained this prevents and treats blisters.
041635 - ..
041636 - He applied dressing to the big blister on the bottom of the right
041637 - foot and the big toe.
041639 - ..
041640 - He advised this works immediately to relieve pain from existing
041641 - blisters, and acts to heal blisters, even when hiking.
041643 - ..
041644 - This indicated can do regular hike tomorrow rather than stand down
041645 - for blisters to heal, which halted hiking this morning.
041647 - ..
041648 - Asked Mark to write a letter explaining what was done, and
041649 - considerations that drove decisions today.
041651 - ..
041652 - Mark asked the staff to work up an invoice.
041653 -
041654 - On the Run
041655 - 1310 9th Avenue
041656 - San Francisco, CA 94122
041657 - 415 682 2042
041658 -
041659 - Email: info@ontherunshoes.com
041660 -
041661 - http://www.ontherunshoes.com
041663 - ..
041664 - Luba Designs Inc.
041666 - ..
041667 - Date............................. 170929 1151 AM
041669 - ..
041670 - Invoice.................... 1125/01/12/40437
041671 -
041675 - ..
041676 - Regular Sale by 6 Wachter, Mark
041677 -
041678 - 1. 2nd Skin Dressing Kit................... $ 12.95
041679 -
041680 - 2. Stable Elite 40......................... 69.95
041681 - Orthotic inserts modified - right
041682 - insert by Mark to relieve pressure on
041683 - plantar plate injury
041685 - ..
041686 - Seems to have metatarsal bar on both
041687 - inserts.
041688 -
041689 - [On 171113 1610 received 2nd set of Stable Elite 40
041690 - orthotic inserts, but without cutout to relieve pressure
041691 - on plantar plate injury. The foot surface is brown,
041692 - rather than black, and material looks different.
041693 - ref SDS 37 YN9K
041695 - ..
041696 - [On 171229 1010 bought another pair, making 3 sets
041697 - Satallite Elite orthotic inserts, purchased from
041698 - On-the-Run shoe store. ref SDS 42 JI6K
041700 - ..
041701 - 3. Hoka Bondi 5 Wide shoes Size 9.5
041702 - in cool grey midnight navy
041703 - 1016604 CGMN 9.5........................ 149.95
041704 -
041706 - ..
041707 - Subtotal................................ 232.85
041708 - Sales tax............................... 19.80
041710 - ..
041711 - Total................................... $252.65
041712 -
041713 - ***REFUNDS***
041715 - ..
041716 - Returns for store credit or exchange must be unworn,
041717 - include original packaging, and be processed within 14
041718 - days.
041720 - ..
041721 - Post expense ledger...
041722 -
041726 - ..
041727 - Thanked Mark, and said will be in touch on this experiment. He
041728 - appreciated that many schemes have been tried the past 4 years, and
041729 - said he will continue to work with the customer to find an effective
041730 - solution.
041732 - ..
041733 - He commented on my leaving that I hike more than most of his
041734 - customers. Mentioned breifly medical benefits, reviewed previously
041735 - with Cardiology at VAMCSF on 170412 1000. ref SDS 13 I35I
041737 - ..
041738 - Mark noted that diet plays a role in coronary health.
041740 - ..
041741 - Mark submitted a letter saying...
041742 -
041743 - 1. Date.............................. 170929
041744 -
041745 - 2. Mr Welch came to On the Run and was helped by Mark Wachter.
041746 -
041747 - 3. Here is what I saw, and what we did.
041749 - ..
041750 - 4. I noticed that Mr Welch had not been stretching and was very
041751 - tight on the back of the leg.
041753 - ..
041754 - 5. We recommended a stretch stick to help him go through the full
041755 - range of motion.
041757 - ..
041758 - 6. He told me about the plantar tear. After some trial of
041759 - different arch support we used a product called elite that had
041760 - a met bump to open on med head so the heads lay flat. We also
041761 - cut away on the underside of the arch support to give the
041762 - plantar tear additonal room so it does not bottom out on the
041763 - base of the orthotic.
041764 -
041765 -
041766 -
041767 -
041768 -
041769 -
041770 -
041771 -
041772 -
041773 -
0418 -