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If I wear orthotics do I need expensive shoes?

Recently, when I was fitting a patient for custom foot orthotics, he asked me if his orthotics would only work in expensive shoes. This is a common concern for many of my patients especially for those who are living on a fixed income.

Although foot orthotics are only as good as the shoes they are worn in, this doesn’t necessarily mean the shoes have to be expensive. In fact, “expensive” does not always equal “better” when it comes to shoes.

For orthotics to function optimally they need to be worn in shoes that have appropriate supportive features, including:

Firm heel counter – The heel counter is the back of the shoe that strengthens the overall shoe, especially the area that cups your heel. A firm heel counter helps to hold your heel in place as you walk, keeping your foot in the right place on the orthotic.

Firm density midsole – A firm density midsole provides a solid foundation which is essential for your orthotic to work properly. To test the midsole density of your footwear, press your fingernail into the midsole. If should feel soft. Next, try to compress the midsole down, the way your body weight will try to compress it. It should stay firm and not compress.

Minimal twist/torsion – Shoes should never twist. If they do you’re not getting the support you need. Hold the heel of your shoe in one hand and the forefoot in the other hand and try to twist your shoe as if you’re wringing out a cloth. Your shoe should not twist easily – there should be resistance through the middle portion of the shoe.

Wider base of support – This is essential for many people as it provides more support under the entire foot, to give you a solid base. If your shoe sole is too narrow, particularly through the arch or middle portion of the sole, you may not be getting the support you need. You may feel unstable while you’re walking, somewhat like walking on a skate blade. In addition, a wider base of support allows your foot orthotic to sit flat within the shoe.

Removable footbed – If you require foot orthotics, a removable footbed is essential as it will allow your orthotics to fit into your shoes.

Whether you require foot orthotics or not, you should consider wearing shoes that have the supportive features described above as they may help to protect your feet and prevent injury. Bargain basement shoes that don’t have these features are not advisable if you are going to be on your feet for any length of time. If you have a limited shoe budget it is better to purchase one pair of properly-fitted, supportive shoes than a few pairs of flimsy, ill-fitting footwear. Just remember, when it comes to footwear, expensive does not necessarily mean better. It is most important that your shoes are giving you the support and cushioning that you require.

Canadian Certified Pedorthists are footwear experts. If you have any questions about your footwear book an appointment with your local Canadian Certified Pedorthist.

By Anne Putnam BSc., MSc., C Ped (C) Saskatoon, Saskatchewan

What are your socks made out of?

SocksSocks may only peak out from the bottom of a pair of pants or be hidden entirely in a pair of boots but they are an important part of our wardrobe. Socks keep our feet warm and dry and protect them from painful, and potentially serious, rubs and ulcers. Although you may not give much thought to your socks, you should take them seriously. One of your biggest considerations should be the material your socks are made from.

Cotton socks are by far the most popular because they are inexpensive and easy to find. However, cotton absorbs sweat, saturates quickly and dries slowly which means once your feet get wet they will stay wet. Also, cotton doesn’t have insulating properties so cotton socks won’t keep your feet warm and cold feet are uncomfortable, can lead to blisters and provide a great environment for fungus to grow. If you’re going to be wearing your socks for a prolonged period, or will be participating in a sport or active hobby, cotton socks are not the best choice for you.

There are a wide variety of synthetic socks available today including polyester, acrylic, nylon, spandex and polypropylene. Synthetics are durable, quick drying, keep their shape, provide a snug fit and help wick moisture away to keep your feet dry. Although synthetic socks are a good choice for your time spent playing a sport, they may not keep you cool in the heat and they can lose their insulating properties when they get wet.

Wool socks have come a long way from the scratchy, itchy styles worn in years past. Today’s Merino wool socks are soft and thin. Unlike cotton, wool is thermostatic, which means it keeps your feet warm when it is cold and cool when it is warm. Wool also repels water and absorbs up to 30 per cent of its weight in water so wool socks will help keep moisture away from your skin. If your feet are dry, less bacteria will grow and there will be less odour. The downside of wool is it is more expensive than cotton and dries slower than synthetics. Balance the higher price with the benefits by purchasing one or two pairs of good wool socks for active, outdoor activities.

When you select your socks each morning don’t just consider the style and colour. Think about what activities you will be doing that day and choose the sock materials that are most appropriate. It will make a real difference to your feet.

By Jennifer Gould Andrew C. Ped Tech (C) C Ped (C) Fredericton, New Brunswick

My feet hurt all the time – will custom shoes help me?

If your feet hurt continually you may be wondering if custom shoes will help.

Although persistent foot pain can be eased through pedorthic treatment, custom-made footwear is traditionally reserved for individuals who are physically unable to get their foot into a retail or orthopaedic shoe due to a structural (bony) deformity. These people would not be able to wear shoes if we did not build a shoe around their foot.

While foot pain can be debilitating and finding comfortable shoes may be a challenge, custom-made footwear is not necessarily the answer. To ease foot pain, Canadian Certified Pedorthists employ a variety of techniques including modifying shoes with special design features and high tech materials.

The term “orthopaedic footwear” makes many people shudder, but orthopaedic shoes are no longer the bulky, ugly shoeboxes of the past, there are now styles to suit all ages and fashion tastes. Designed with a number of medically beneficial features and functions to support specific foot conditions, orthopaedic shoes often play an important role in easing foot pain. Orthopaedic shoes can also be modified to accommodate the needs of the individual foot.

Foot pain will not go away on its own and it is not something you have to live with. If you suffer from lingering foot pain or have a specific fit concern, book a consultation with your local Canadian Certified Pedorthist. Your Pedorthist will determine the source of the problem and will advise you about the latest footwear features, styles and materials to best address your individual needs.

By Johan Steenwyk, C. Ped (C), C Ped. MC, Red Deer, Alberta

Winter boot primer

Many people wait until the arrival of the first snow before pulling out their winter boots, and the minute the snow has melted in the spring, quickly move them to the back of the closet until the following winter. Although trying to keep winter at bay for as long as possible may give you a psychological lift, it is important to pull out your winter footwear well before the onset of winter to make sure it doesn’t need replacing.

Here are some tips I share with my patients:

• You may only wear winter footwear for a few months each year but it doesn’t last indefinitely. Boots usually last one to three seasons and they become a hazard when they are out of date. Boots that are well worn can have wear patterns that change how you walk and their soles can become slippery. As boots age, their outsoles harden which means they provide less traction.

• Canadian winters bring a lot of ice and snow so it is important your boots have traction. To minimize slipping, look for footwear that has a more aggressive tread and a sole made with softer materials such as rubber. If slippery conditions are common in your area, or you’re concerned about falling, buy cleats that stretch over your footwear for extra traction.

• Only wear footwear that keeps your feet dry. Wet feet increase the risk of frostbite and fungal or bacterial infection. Select footwear that is waterproof and wear moisture wicking socks to further protect your feet.

• Make sure your boots fit properly. When you are standing you should have approximately 1/4” of space after your toes to allow for warm air to circulate. Your boots should feel secure but still have room for you to wiggle your toes. Pull the flat liner out of the boot and stand on it. If your foot spills over the sides of the liner the boots are too small for you.

• If you need to wear orthotics, only purchase boots that fit your orthotics.

• If you spend a lot of time outside, choose a pair of boots with a colder temperature range than you need as they will provide you with extra comfort and protection.

• In addition to equipping yourself with activity-appropriate, properly fitted boots be sure to wear warm socks all the time. If you have poor sensation in your feet, Raynaud’s disease or diabetes, avoid using hot water bottles and heat pads as you won’t be able to feel if they burn your feet.
Canadian Certified Pedorthist are footwear experts so if you have any concerns about your individual footwear needs contact a pedorthist in your community.

By Jennifer Gould Andrew, C. Ped Tech (C), C Ped (C) Fredericton, New Brunswick

Does tip toeing hurt?

If you have pain running along your inner leg and ankle to your arch and midfoot you may have tibialis posterior tendonopathy, a painful overuse injury. Try standing on your toes. With tibialis posterior tendonopathy it is difficult and painful to get up.

The tibialis posterior is a pencil thin tendon that runs down the inside of your leg and under your foot. It helps to stabilize your foot and keep the longitudinal arch from rolling inwards when you walk or run. Tibialis posterior tendonopathy typically results from wear and tear of the tendon rather than from inflammation. It usually only occurs in one foot but in some instances it can occur in both.

If you suspect you have tibialis posterior tendonopathy begin immediately with rest and ice. Don’t try to run through the pain or continue your normal activities as the injury will get progressively worse and over time your arch will flatten. Look at cross training options to maintain your level of fitness until it is healed. If the swelling and irritation is extensive, ice and rest will not be sufficient. Consult a physiotherapist about rehabilitation exercises.

In addition to working with your physiotherapist, book an appointment with your local Canadian Certified Pedorthist to determine if you need to change your footwear or be fitted for custom-made foot orthotics. Your Canadian Certified Pedorthist will conduct a full assessment of your lower limbs and gait and determine if your individual biomechanics or footwear led to your injury. Custom-made orthotics will provide extra support and reduce the demands on your posterior tibial tendon during activity, and properly-fitted, supportive shoes will help your orthotics perform optimally.

Tibialis posterior tendonopathy needs to be taken seriously and it should be treated immediately. If you think you may be suffering from it book an appointment with a Canadian Certified Pedorthist right away.

By Mike Neugebauer, C. Ped Tech (C) C. Ped (C), Langley/Port Coquitlam, British Columbia

Pedorthic treatment depends on two-way communication

I’m a firm believer in the old adage “communication is a two-way street.” When I started working as a Pedorthist in 1997, I learned very quickly the importance of clearly communicating to my patients when a patient, who came into my clinic with a prescription for custom-made orthotics, asked if orthotics were special shoes.

Although Pedorthists are trained to clearly explain their assessment and treatment plan, as a patient, it is equally important you tell your Pedorthist if you don’t fully understand something. Before you leave their clinic, make sure you completely understand the reasons behind your pain or mobility problems, how pedorthic treatment will help and what you have to do to make it successful.

If you don’t understand pedorthic terms such as “realign”, “uppers”, “fascia” etc. say so. Similarly if you don’t fully understand why you have been asked to change your footwear (i.e. stop purchasing running shoes from a discount store) ask. If you need your Pedorthist to speak slower or use different words say so. There is often a lot of information to digest and confusing terms to understand so it is completely normal to have difficulty taking it all in. It is not unusual for patients to need to be told things three times before they understand.

From a Pedorthist’s perspective, we also need our patients to clearly communicate with us details about their own situation and preferences. Five or six years ago, a lady came to our clinic for help with her heel pain. She was very well-versed and explained exactly what was going on. When I assessed her, she presented all the symptoms of plantar fasciitis. Her arches were fallen and she had a typical flat foot. As is the case with flat feet, her heels were turned outward and her forefoot was turned inward. However, at the end of her appointment the patient told me she only felt comfortable wearing very soft, flexible shoes. This footwear was counter-intuitive to me for the condition I was seeing so I decided to go with the treatment I thought was best.

I fit the patient with a pair of semi-rigid orthotics with deep heel cups and the appropriate inner posting and asked her to start wearing running shoes with added heel and arch support. At her check-up appointment, the patient complained that her knee was starting to hurt and that both the orthotics and shoes were uncomfortable. Based on this, I adjusted the angle of the orthotics and softened both arches, which she said felt better. However, at her next follow-up visit, her symptoms had not subsided and she still said her shoes and orthotics were uncomfortable.

I decided to re-make her orthotics. This time, I used a very soft accommodative material to build her orthotics and there was no heel cup or heel support. I also changed her footwear to a pair of extremely soft walking sneakers. When I followed up with her four weeks later, she had no more pain and she felt very comfortable. It was an important lesson for me to listen closely even when I hear things that are counter intuitive. I really should have listened to this particular patient as she was my mother.

By Deny Dallaire, B.Sc., C. Ped (C), Moncton, N.B.

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