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Prevention is best for foot health

Every day I see a wide range of patients with a variety of foot problems who are experiencing foot pain, decreased mobility or both. Although they are keen to do whatever it takes to ease their discomfort, many of them are frustrated when I explain that their foot condition could have been avoided. Foot problems and foot pain are widespread problems in Canada but very few people are born with foot problems. The majority of problems develop because people, either knowingly or unknowingly, fail to care for their feet properly, and wearing ill-fitting shoes is one of the main culprits.

As our base of support, our feet take a lot of pounding. But feet are not as sturdy as they appear. Each foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles which means there are a lot of elements that can be injured if they are not supported and cared for properly.

Wearing well-fitted, supportive shoes during childhood is an important defence against future foot troubles. Babies’ feet are made of soft cartilage which slowly hardens into bones over the years. The soft structure of their feet combined with the rapid growth they undergo means children’s feet are particularly vulnerable to ill-fitting shoes and tight socks.

Although a good start is important, feet cannot be neglected through adulthood and continuing to wear properly fitting shoes is essential. Many people don’t realize that feet change shape and size as they age so it’s important to continue to get your feet measured even after they are full grown. People of all ages experience foot problems but foot problems are four times more common in women than men and high heels are the primary cause. High heels are often pointy and unnaturally force weight on to the balls of women’s feet causing forefoot and arch pain to develop along with the formation of corns and calluses in areas that are rubbed and pinched. To protect women’s feet, Canadian Certified Pedorthists advise women follow the 80:20 rule – wear supportive footwear 80 per cent of the time and the other 20 percent of the time can be spent in less supportive footwear.

Foot pain can impact your entire life as it can limit your ability to do the things you love. To ensure foot pain never slows you down, wear supportive, professionally fitted footwear all the time. When it comes to foot health, prevention is definitely the best approach.

By Laura Allen, C. Ped (C), Fergus, ON

Staying Active with Arthritis

If you’re living with the daily stiffness and pain of arthritis, exercising is probably the last thing you feel like doing. However, if you have arthritis, getting regular exercise is critical as it reduces joint pain, increases strength and flexibility, reduces fatigue and helps you maintain a healthy weight. If you join a group exercise class or take up a low impact sport with a friend, exercise will also improve your social life.

Depending on your personal situation and interests, there are dozens of different activities you can participate in to ease the effects of arthritis. Speak to friends and visit your local community centre to determine which activities are in your area. Chores like vacuuming, gardening and walking are great exercise too – you don’t need to enrol in an organized activity. Just remember, before starting a new activity or intensifying the frequency of an existing one, speak with your doctor to make sure the activity is right for you.

To provide maximum benefit and decrease your pain, you need to include an assortment of range of motion, strength and endurance activities in your weekly exercise program. Range of motion or stretching exercises ease stiffness, improve balance and strength and help keep your joints flexible. If arthritis is affecting your lower limbs and impacting your mobility, consult your healthcare provider or a fitness expert about stretches that will help such as hip, knee and ankle bends, leg lifts, and toe spreads.

Strengthening exercises help to make your muscles and surrounding tissue stronger which helps to decrease stress on your joints and support your bones. There are lots of strengthening exercises to choose from including gardening, hiking, cycling, yoga, tai chi and climbing stairs.

Endurances exercises strengthen your heart and lungs which will improve your cardiovascular health and increase your energy levels. Brisk walking, swimming, jogging, dancing and tennis are just some of the endurance activities you can choose from.

When you are living with arthritis exercise helps to increase your mobility. However, you need to build up your activity levels gradually and rest when you experience pain. If arthritis is affecting your feet or lower limbs, wearing supportive, orthopaedic footwear for all of your activities is critical to maintain your comfort, protect your feet and improve your balance. Speak to your local Canadian Certified Pedorthist about your personal exercise program and he/she will recommend and professionally fit the footwear that is best for you.

By Anthony Harper, C. Ped (C), Burlington, Ontario

Head back to school with proper shoes

As the summer holidays draw to an end and your child begins to prepare to head back to the classroom make sure you put shoe shopping on your back to school “to do” list. Properly fitted, supportive school shoes play a vital role in the healthy development of your child’s feet and lower limbs so it’s important to spend time selecting the best pair for your child’s needs and foot type.

Whether your child has strong fashion views and a clear sense of the shoes they want, or despises shopping and resists all trips to the mall, set some ground rules before you depart for the shoe store and don’t back down when you arrive.

As children’s feet are still developing and they wear their school shoes all day every day, purchasing shoes that fit properly are essential. Have your child’s feet measured to determine the correct size and then check there is half a thumb’s width of space when they put the shoes on. Different shoe brands and styles fit differently so feeling how your child’s foot fits in each shoe is essential. Although it is tempting to buy shoes that your child will grow into it is not advisable as shoes that are too big provide a sloppy fit and poor support which may aggravate, or even cause foot problems.

Laces or another type of adjustable closure help create a snug fit, ensuring the shoes provide your child’s feet and lower limbs with the support they need. When shoe shopping look for closures that are best for your child. If your child isn’t comfortable tying laces or is unlikely to take the time to make sure they are tied properly, select shoes with adjustable Velcro closures.

During recess and lunch, children like to run and play so a pair of sturdy running shoes are by far the best choice for school. There are numerous styles and colours of children’s running shoes available today to accommodate all young preferences. Although you will want to take into account your child’s colour and style taste, make sure you only buy shoes that feel comfortable the first time your child tries them on. Shoes do not stretch and mould to feet over time so if the running shoes are too tight or rub in any way, they are not the right pair for your child.

Well-fitting, supportive shoes will let your child’s feet develop naturally and help prevent long term foot problems that may slow them down in later years. If your child is reluctant to buy running shoes that are best for their development, strike a compromise. Buy a pair of sturdy, supportive shoes for school days and a fashionable, flimsy pair for special occasions.

By Shawn Duench, C. Ped (C), Waterloo, Ontario

Do you walk like a duck or a pigeon?

I know very little about birds but I’m often asked “do I walk like a duck?” and “do I walk like a pigeon?” Walking like a duck means walking with your toes pointing outwards. Walking like a pigeon is the opposite, walking with your toes pointing inwards. Although these sound like funny questions, they actually provide me with a good starting point for any pain or mobility difficulties a patient may be experiencing.

During a patient’s initial pedorthic consultation, I conduct a gait assessment, which is an analysis of how they walk. Although I watch how the patient walks, I am really analyzing why they walk the way they do.

Walking like a duck or a pigeon can stem from alignment problems in the hip and lower leg. Depending on how the knees and feet are aligned and function mechanically, will determine how severely the toes turn outwards or inwards and the overall impact the condition has on a patient’s function. Leg and hip alignment problems can lead to lower back, knee, and foot pain as the body tries to compensate. Walking with toes pointing out or turned inwards can also cause arch and heel pain, bunions, hammertoes, arthritis and neuromas, which is a burning sensation between the toes and in the ball of the foot.

If you walk like a duck or a pigeon ask your family physician for a referral to a Canadian Certified Pedorthist. Canadian Certified Pedorthists have extensive training in the assessment of lower limb anatomy and muscle and joint function so they will determine why you walk the way you do. Once your Pedorthist has completed a thorough assessment of your individual condition, he/she will recommend a customized treatment program to help keep you healthy and pain free. Treatment may include custom foot orthotics, different or modified footwear and possibly recommendations for physiotherapy or chiropractic treatment.

By Mike Neugebauer, C. Ped (C), Port Coquitlam and Langley, BC.

How long does it take to adjust to a new orthotic?

Every day I see individuals with a wide range of conditions, from very simple and straightforward to very complicated, involving a wide scope of medical practitioners. I also see patients who have never had orthotics to individuals who are being assessed for their tenth pair of orthotics.

The most common question I hear during an appointment is “how long will it take me to get used to my orthotics”. Unfortunately this is never an easy question, nor a straight forward question, to answer as everybody adjusts to orthotics in their own time. However, it usually takes about two weeks to get used to wearing an orthotic.

When my patients come for a fitting appointment, I make sure I have the contact and control I am striving for, the foot feels comfortable on the orthotic and the orthotic fits into the patient’s footwear. During the break in period for your first pair of orthotics, things will feel different day to day as your soft tissue gets used to having pressure in different places and the tissue gets used to being in a more mechanically efficient position.

To comfortably break in a new orthotic, I recommend my patients wear it for an hour on day one, two hours on day two, and continuously progress each day so that by the end of the two weeks, they can wear the orthotic comfortably all day. Due to the nature of soft tissue, a number of people are able to comfortably wear their orthotics right away. The break in period is very much a “listen to your body” time. If things are feeling good, wear them longer each day, even all day.

The second most common question I get is, “How do I know if I need an adjustment?” If you have never had an orthotic, it can be difficult initially to know if an adjustment is needed, especially during the first two weeks as your body needs time to get used to it. And even after two weeks, your foot may still need some time to adapt. The best way to know if an adjustment is needed is the duration of your discomfort. I tell my patients if an area is in pain for one day but it is not painful for the rest of the week, something prior caused the inflammation and the orthotics aren’t the cause. However, if you have pain every day of the week following the onset of the initial discomfort, the soft tissue is interacting with your orthotic incorrectly and it needs to be adjusted.

Orthotics are great devices but they do need a break in period to become comfortable. If your orthotic is causing you discomfort after two weeks, contact your Canadian Certified Pedorthist and book an appointment to see if any changes are necessary. As orthotics are custom made to fit your feet perfectly it is not unusual to require some adjustments in the early days.

By Steve Stredulinsky, BSc KIN, C. Ped (C), Abbotsford, BC

When Should I See a Pedorthist?

I have worked as a Canadian Certified Pedorthist for 10 years but I continue to be surprised by the number of patients I see who have delayed pedorthic treatment for months, needlessly living with pain or decreased mobility. When I ask these patients why they waited so long, many say they believed the pain and reduced activity were simply things they had to live with.

If you are unsure if you should book a consultation with a Canadian Certified Pedorthist, ask yourself the following questions:

• Are you experiencing pain in your heels, forefeet, toes or ankles?
• Are you suffering from unexplained pain in your back, hips or knees?
• Are you living with diabetes or arthritis?
• Is discomfort in your lower limbs preventing you from participating in all the activities you would like?
• Do you have difficulty finding footwear that fits comfortably?
• Are the wear patterns on the soles of your everyday shoes uneven?
• Have you experienced a serious foot or lower limb injury?

If you answered yes to any of the above questions you should definitely seek pedorthic treatment.

As foot orthotic and orthopaedic footwear specialists, Canadian Certified Pedorthists provide a wide range of services to help patients with an extensive array of foot and lower limb conditions. They undergo extensive training in lower limb anatomy and biomechanics to ease pain and increase mobility. Your Pedorthist will:

• Assess your feet and lower legs and evaluate how you walk or run
• Educate you about your foot or lower limb condition and the recommended treatment
• Provide custom-made foot orthotics or over-the-counter devices if appropriate
• Professionally fit you with orthopaedic footwear that is appropriate for your foot type and condition
• Modify footwear to accommodate problem areas

To arrange a consultation with a Pedorthist in your community, book an appointment with your family physician and ask for a referral to a Canadian Certified Pedorthist. When you go for your initial assessment with your Pedorthist wear a pair of shorts or loose pants that can be rolled to your knees and take your everyday/work shoes and sports shoes if appropriate. Also remember to take your physician’s referral.

Your Pedorthist will quickly get you on a treatment program to ease your pain and get you back doing the activities you enjoy.

By Paul Mäkinen, C. Ped (C), Halifax, Nova Scotia

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