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Do you have a stress fracture?

If you have pain in a specific spot in your foot or lower leg that you barely noticed at first but is getting worse over time, yet decreases when you rest, you may have a stress fracture. A stress fracture is a tiny crack in the bone, typically so small it cannot be seen by X-ray for 4-6 weeks. Unlike other fractures that are caused by a single event, stress fractures are caused by repetitive activities such as walking and running that exceed the bone’s ability to recover.

Although anyone can experience a stress fracture, people that are involved in high impact sports like basketball, volleyball and running are most at risk. Stress fractures also often occur in people who were not previously active, who start an aggressive exercise routine.

“March fractures” are a type of stress fracture that often occur in people who are participating in basic training. Long marches in boots they are not accustomed to and a new level of exercise can cause March fractures and in some cases the bones may actually break.

If you have flat feet, high arches or weakened bones (i.e. from osteoporosis) you’re at an increased risk of suffering a stress fracture.

Here are the most common treatments for stress fractures:

Rest – Most stress fractures take six to eight weeks to heal.  Stay off the affected limb. And resist the urge to resume your activities until your doctor says you can bear normal weight. Participating in an activity too quickly may cause larger, harder-to-heal stress fractures to develop. Re-injury can also lead to the stress fracture never healing properly.

Reduce stress on your foot and leg – A stiff-soled shoe, a wooden-soled sandal, or a removable short-leg, fracture brace shoe may help to protect your feet until the fracture heals.

Apply a cast – Stress fractures in some bones take longer to heal. Your doctor may apply a cast to your foot to promote healing and remove stress on your leg.

Ice regularly – Icing the injured area 3 or 4 times a day for 10 minutes at a time will help to reduce swelling and relieve pain.

Resume activity slowly – When your doctor approves, slowly progress from non-weight bearing activities to your usual activities. If you like to run, pay careful attention to how quickly you add time and distance.

Consider custom foot orthotics – Custom foot orthotics can ease pain when you are recovering and reduce the risk of the stress fractures recurring. Canadian Certified Pedorthists will advise you if a custom foot orthotic is right for you.

When it comes to stress fractures, prevention is always best. Here are some tips to help you remain fracture free:

  • Don’t wear worn out shoes.
  • Pay attention when walking on uneven terrain.
  • When engaging in any new sports activity, start slowly and gradually increase weekly.
  • Cross-training is important. Instead of running every day, run and bike on alternating days.
  • Maintain a healthy diet. A diet that includes foods rich in calcium and Vitamin D helps the body to recover.

By Jim Pattison, C. Ped (C), Prince Albert, SK

Compression therapy can help your body recover

If you are recovering from a surgical procedure, participating in a running race, taking a long flight or have a job that requires you stand for long periods of time, compression therapy can help your body recover. Compression socks, stockings, pantyhose and bandages help move blood up your leg towards your heart.

Compression therapy falls into two main categories: medical and performance. Although both categories frequently use the same products, the outcome and purpose are often vastly different.

Medical Compression

Medical compression garments are typically used to aid with issues or deficiencies relating to the veins or to aid the recovery from minor and major surgical procedures. Most medical compression garments and devices are prescribed by a physician and have a specified degree of compression.

Compression socks are the most common medical compression garments. They are frequently used to prevent deep vein thrombosis (blood clots deep within the body) when flying and to reduce fatigue from standing or working on your feet for long periods of time. Compression socks are also used to limit pain and discomfort from varicose veins.

Another common use of medical compression therapy is in post surgical recovery, such as Achilles Complex surgery or circulatory related surgery. Many people use devices such as Game Ready and Cold Rush systems and compression to decrease recovery time and get back to activity sooner.

Performance Compression

Performance compression garments are used to increase the connection between the mind and the muscle, and increase an individual’s abilities before, during and following activity. Performance compression is seldom prescribed by a physician but it is frequently recommended by physiotherapists and athletic therapists

Performance compression can greatly aid in running activities – from compression socks which aid in distance activities to calf sleeves which minimize the effects of shin splints. Performance compression can also be beneficial in the gym as it increases physical performance and decreases muscle soreness. Knee sleeves and elbow sleeves help with lifting, squatting and pressing movements and compression shorts reduce hip and hamstring discomfort.

Like medical compression, performance compression can also be used to aid in recovery, with devices such as Game Ready and Game Legs.

If you think compression therapy could help you return to activity or improve your performance, speak with your family doctor and ask for a referral to a Canadian Certified Pedorthist. Compression garments are only effective if they fit properly. A Canadian Certified Pedorthist will determine which compression garment is appropriate for you and will professionally fit it.

By Steve Stredulinsky C. Ped (C) Calgary, Alberta

Will rocker soles benefit me?

In recent years there has been a lot of buzz about “rocker soles”. However, there is still a lot of confusion about them and many people don’t know if rocker soles are appropriate for them. I hope this blog clears up some of the confusion.

There are two types of rocker soles. The first is an unstable rocker sole. These soles are designed to introduce instability under the foot, in all directions, so your core muscles have to work harder. These types of shoes are best worn by people who move around a lot and they should only be worn on flat, hard, level, predictable surfaces. People who stand in one spot for a long time or have balance or equilibrium problems (including middle ear problems, stroke, MS and Menière’s) should not wear these soles as they will increase their risk of falling.

The second type is a stable rocker sole like the one shown here. Stable rocker soles fall into two categories: regular stable rocker soleand negative. A regular rocker sole can benefit people who have pain or bone fusions in the ball of their foot or in their toes as these conditions cause them to experience a lot of pain as their toe lifts off during gait. Regular rocker soles replace the lost function of a joint and reduce pressure on the sole of the foot so they are helpful when walking or standing for long periods. If a person has a fused ankle from arthritis or another disorder, a full sole rocker may help them walk more normally and without pain as the rocker sole simulates a normal gait.

A “negative” rocker heel is designed for people with conditions such as foot drop ankle arthritis. A heel with this Negative Rocker Solegeneral shape allows a person with foot drop to put their foot on the ground more slowly and it helps to guide their foot into a more “normal” position if they land on the inside or outside of their heel.

Shoes that come equipped with a rocker sole from the store may be sufficient for some people’s needs. Others may Rocker Sole Additionrequire a Canadian Certified Pedorthist to add more if their pain and loss of function is not compensated for enough with the existing sole. To the left is a picture of a rocker sole that has been added by a Pedorthist.

Rocker sole shoes are here to stay. They offer excellent comfort when walking and hiking and we see new brands emerging with stable rocker soles on them. Rocker soles can help “Baby Boomers” who want to avoid aches and pains while enjoying an active lifestyle.

However, before moving into rocker soles, it is important to consult with a Canadian Certified Pedorthist to make sure you use rocker soles that are appropriate for you. If you’re considering rocker soles, make an appointment with your local Canadian Certified Pedorthist to discuss if they are right for you.

By Jim Pattison, C. Ped (C), Prince Albert, SK

Shoe wear patterns are a guide to future foot problems

A lot of people are aware that feet that roll excessively inwards, causing the arches to flatten (overpronation), can eventually cause pain and mobility issues. However, few people realize that the opposite situation, feet that do not roll in at all (underpronation) can cause serious problems too.

During a normal, healthy stride, when the heel touches the ground, the midfoot and heel will roll slightly down and inwards to absorb the shock of the step. This is known as pronation. However, when the foot does not roll inwards, and in some cases can roll to the outside, a lack of shock absorption occurs. You can compare this to shocks on your car, as you go over bumps in the road, they compress so you don’t feel the full impact. When your foot does not pronate, your body feels the full impact. This continual lack of proper shock absorption can lead to heel pain, forefoot pain, shin splints, knee pain, and lower back pain. Another common issue is reoccurring ankle sprains, especially if your feet roll to the outside.

Underpronation is common with people who have high arches and rigid feet. The best way to tell if your feet do not pronate is to have your gait analyzed. Another quick way to test yourself is to look at the wear on your shoes. Neutral gait, which has a reasonable amount of pronation, will usually show wear on the outside heel portion of the shoe. This occurs due to initial heel strike being on the outside of the heel and is considered “normal”. If you underpronate that wear can continue up the outside of your shoe, all the way to where your fifth toe sits. This occurs because your foot does not roll inwards to absorb impact, and all the pressure stays on the outside of your foot. It is also common to wear shoes out quickly because they take more impact when you walk or run.







Worn by an underponator, this shoe shows wear up the outside.


Pronation is part of your natural gait so if you are an underpronator it is very hard to change it. However, there are some simple things you can do to help your body with the lack of shock absorption and reduce your risk of injury, including:

• Wear properly-fitted, supportive shoes and replace them regularly as worn shoes worsen the effects of under-pronation
• Look for shoes that have extra cushioning to provide extra shock absorption
• Use custom foot orthotics or off-the-shelf insoles to help with weight distribution and increased shock absorption

When it comes to underpronation prevention is the best approach. Take a look at the wear patterns on your footwear and if they indicate you may be an underpronator book an appointment with you local Canadian Certified Pedorthist. Your Pedorthist will do a full gait assessment and recommend a treatment program that is appropriate for you.

By Peter Morcom C. Ped (C) Maple Ridge, BC

When should my child see a Canadian Certified Pedorthist?

As a child grows and develops, it is normal for their feet and legs to go through considerable changes. From birth to about 10-years-old, the long arch of the foot is expected to transition from “flat footedness” to “normal”. It is during this slow and gradual process that a child may complain of pain or a caregiver may notice something doesn’t look quite right. It is the role of a Canadian Certified Pedorthist C. Ped (C) to assess and treat the child if necessary.

Some common signs that the child should be assessed by a C. Ped (C) include:

  • Complaints of pain in the foot, ankle, leg, knee, hip and/or lower back (sometimes these complaints are most notable after sport/physical activity or at night time or first thing in the morning)
  • The child withdraws from sport/physical activity due to pain
  • There is a noticeable difference between one foot and the other (e.g., one long arch is lower than the other)
  • The ankles appear to be rolling in or out when standing and/or walking
  • There is excessive wear on the soles of the child’s shoes
  • There has been a rapid and significant growth spurt
  • When the child stands and walks the toes appear to be pointed inward or considerably outward
  • Walking on the balls of the feet the majority of the time
  • When there has been no change in the height of the long arch over time
  • Any muscle, joint or neurological concerns

Treatment for the above concerns vary and are based on additional factors found during the assessment; such as the age of the child, the physical movement of joints, the child’s activity level, the type of sport or activity they participate in and the degree of past or current injuries. Treatment can be used to allow injury to heal or to prevent future problems from occurring.

The most common treatment recommendations include:

  • Over-the-counter (OTC) inserts
  • Supportive footwear worn daily (indoor and outdoor use)
  • Stretching and/or muscle specific exercises
  • Custom made foot orthotics

A combination of two or more recommendations are often required.

A Canadian Certified Pedorthist is a trained professional that can help all ages. If your child is experiencing any signs or symptoms listed above, contact your local Pedorthist to determine if treatment is right for your child. In the end, our goal is to promote a proactive approach to better body mechanics that will allow children to play and grow optimally.

By Vanessa Raffa De Rita C. Ped (C) London, Ontario

Can I wear dress shoes with my orthotics?

If your Canadian Certified Pedorthist recommends custom foot orthotics for you during your assessment it is important to discuss the type of footwear you will be wearing with them. Although orthotics are most effective when worn with sturdy, supportive walking shoes, if you require dress shoes for work (either flats or heels), your Pedorthist can make orthotics for them.

As dress shoes typically do not have a removable liner and are sized to fit snugly on the foot, there is little extra room to fit an orthotic, so Pedorthists make dress shoe orthotics thinner and narrower. This enables the orthotics to fit flat on the base of the shoe and not bulge out the sides. Dress shoe orthotics also usually end just before the ball of the foot so they don’t take up any more room at the toes in an already tight space.

A proper fit is of utmost importance when using orthotics with dress shoes. There should be adequate room at the forefoot of your shoe and your toes should not feel squeezed. Proper fitting dress shoes will have minimal heel slippage and fit snugly around the heel of your foot. Adjustable straps help with the fit of an orthotic in a dress shoe and also help the shoe fit more securely on your foot. A thin strap at the front of the ankle or on the instep of the foot, usually called a “Mary Jane” style, are equally effective. Alternatively, a dress shoe that covers the instep of your foot and has elastic to help your foot slide into the shoe will also work well with an orthotic.

If you require orthotics and only wear dress shoes occasionally there is no need for you to have orthotics made for your dress shoes. Whether your dress shoes are high heels or slip on flats, I recommend you only wear them for short periods of time and not on days when you are doing a lot of standing or walking. The 80:20 rule is good to follow – wear your orthotics in casual, supportive shoes 80% of the time and your favourite dress shoes 20% of the time.

Canadian Certified Pedorthists are foot orthotic and footwear experts. If you have any questions about your footwear, and whether you would benefit from foot orthotics, contact a Canadian Certified Pedorthist in your community.

By Alison Smith C. Ped (C) Moncton, New Brunswick

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