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Alleviate Arthritis Pain with Custom Orthotics

There is a special need for orthotics for patients with arthritis. Depending on the patient’s needs, custom orthotics may help alleviate pain and discomfort in several ways including:

Shock Absorption

Generally, custom orthotics created for patients with arthritis are softer and made from different materials than other orthotics. This construction difference is designed to optimize shock absorption and decrease the shock going into the foot. Shock in the foot is something that aggravates pain in the affected area.

Orthotics for patients with arthritis are more likely to be accommodative orthotic – they are softer with a little more “give” in them. The more rigid orthotics tend not to absorb shock and pass it along to the sore joints in the foot. It is less of a functional orthotic – one that is to hold the arch or another area of the foot up. 

Decreased Pressure on Sore Spots

If the patient’s foot has a sore spot, the custom orthotic may be created with an area of the orthotic dug out or “excavated” in the area (shown) where the foot is sore to decrease the pressure on the affected area.

Reduced Toe Joint Motion

If the arthritis is in the toe joints (metatarsal joints), a stiffer material may be put under those joints to stop them from bending or bending as much. If the motion in a joint can be slowed down or stopped, pain in that area can be reduced or eliminated. At the left is a photo of a device called a Morton’s Extension. A more rigid shell is placed on the orthotic and the piece at the toe stops the big toe from bending. If a person has arthritis in that joint, keeping that joint from moving will reduce or eliminate the pain when walking. This can be a carbon fibre plate that is put in the shoe or included in an orthotic

There are many options available to you if you have arthritis to help keep you more active and involved in healthy exercise. Contact your local pedorthist to see how custom orthotics might benefit you.

By Jim Pattison, C. Ped (C)

 


Tell-tale Signs You Might Need Orthotics

Orthotics are a great way to deal with mechanical issues in your feet that may be causing or will cause pain. Without a trained eye, how can you determine if orthotics can be beneficial? Here are some visible and pain signs that may indicate the need for orthotics.

Visible signs

Arch collapse

There are three arches in the foot, but there are two that are more commonly supported with orthotics. The third ends up being supported with an orthotic, but is typically not the main focus.

Collapse of the medial arch, or the arch on the inside of the foot, is the more common reason to wear orthotics. This collapse can occur while standing, or as a low arch with or without standing, which is called pes planus. With this medial arch collapse, it strains structures under the foot, as well as the supporting structures around the ankle, which travel up to the lower leg. The effect can travel higher up the body, because when the medial arch collapses, the lower and upper leg rotate inwards excessively, which strains the knee, hip and back structures. The way you can visibly see this collapse is by looking at this arch while standing. If you cannot place a couple fingers under your arch, this may indicate an arch collapse. Another part of the body to look as is the ankle. With a medial arch collapse, this ankle can be shifted inwards. This ankle shift may not always be present as you can have the collapse without the ankle shift.

The metatarsal arch (arch at the ball of the foot) is another common arch that is supported with orthotics. With this metatarsal arch collapse, it places excessive pressure to the bones at the ball of the foot and the structures surrounding the ball of the foot. A couple signs that may indicate this arch collapse are clawed toes and callusing under the ball of the foot. To visibly see this arch collapse, look at the “pad” at the ball of the foot. If this pad is a straight from one end to the other, or the middle part bulges out further, this can indicate an arch collapse.  

High Arch

A high medial arch is the other extreme to the low arch, which can also benefit from orthotics. A high arch can hinder shock absorption and strain the structures on the outside of the foot and lower leg. To visibly see this arch, there are a few signs to look for. There may be a bump on the top of the foot, which can make it hard to fit into shoes. Callusing may be visible under the ball of the foot, only under the outside and inside bones. Also take a look at the shoes, as they may be worn down along the border of the outside of the heel.

Pain Signs

 

Pain can be another indication that orthotics may be needed. The more common pain areas that can be related to the foot mechanics are the foot, knee, hip, or lower back.

The more common areas of foot pain are at the heel, arch and ball of the foot. Depending on the severity of the pain, it may occur in the morning when you first step out of bed, at the end of the day or while performing a specific activity.

Knee, hip and lower back pain may develop from the feet as the lower and upper leg responds to actions at the foot. Because pain may also be related to other factors higher up, other professionals such as a physiotherapist or chiropractor may be recommended to add to the treatment protocol.

Back pain may also be present due to a leg length discrepancy. When one leg is shorter than the other, the hips are not aligned properly and can affect the lower back. There are different types of a leg length discrepancy, which can both be addressed with an orthotic. Talk to your local Canadian Certified Pedorthist to see if a leg length discrepancy may be present.

If the visible signs are present w

ithout pain, orthotics or an over-the-counter insert may be beneficial to prevent pain in the future.

Book an appointment with your local Canadian Certified Pedorthist to determine how orthotics can help you!

By Julia Hayman, Canadian Certified Pedorthist


Meet a Pedorthist – Jenna Dibblee, C. Ped (C)

While pursuing an education in athletic therapy, Jenna Dibblee, C. Ped (C), found herself struggling with sidelining athletes due to pain or injury. She always strived to find a safe solution to allow participation. Her interest in bracing led her to start job shadowing a pedorthist during her undergraduate studies in Kingston, ON. Learning from a mentor opened her eyes to a field she was unaware of at the beginning of her educational path.

After receiving her pedorthic certification, Jenna began working as a pedorthist in Ottawa, making custom orthotics and specializing in orthopedic bracing. At the same time, she worked at Carleton University as a certified athletic therapist with the varsity rugby team. Since then, she has moved to Port Perry, ON where she works seasonally as an athletic therapist at Ontario Tech University, and part time at BioPed Lindsay as a pedorthist.

Jenna finds her work very rewarding, especially when patients with knee osteoarthritis try on an unloading knee brace and notice instantaneously decreased pain. “The looks of shock and tears of relief are well worth the investment,” she says. Jenna always tries to make a lasting connection with her patients. “We have the privilege to spend adequate one-on-one time with patients so that they feel heard and that their concerns are addressed.” She finds that patients are appreciative when pedorthists focus on patient education.

Her clinic having reopened since the beginning of the COVID-19 pandemic, Jenna’s appointments are now scheduled further apart to allow for thorough disinfecting and sanitizing procedures. Staff at her clinic are all equipped with appropriate personal protective equipment and patients are screened prior to and upon arrival.

Jenna hopes to one day pursue her master’s degree in rehabilitation sciences so she can teach and inspire future students in the applied health care field.


Footwear Help for Leg Length Differences

Leg length differences are not uncommon in adults and children. Most of these differences are small enough that nothing needs to be done with them because the body is able to compensate. With children it is possible to see one leg be longer than the other and the difference to go away with the next growth spurt. Adults are not so lucky and it’s possible to have a sudden change in leg length because of vehicle accidents, falls and other bone breaks.

If the leg length difference (LLD) is significant it can cause a person to walk unevenly. LLD can also be a source of pain in the leg, hip and back on one side. The usual way to measure these differences is to get the length between the hip and the inside ankle bone called the medial malleolus. There are two types of LLD:

  • The first is called “functional” and it is one where tightness in the back and pelvis pull up more on one side and make the leg shorter. The best way to treat that type is with therapy and exercises to get the muscles and pelvis alignment to go back to normal.  Normally such a leg length does not need a shoe or heel lift.
  • The other is called “anatomical” and this is where one of the bones in the leg or thigh is shorter than the one on the other side. In such a case, the way to treat that is to put a lift in the shoe or under the heel to bring the legs to equal length. 

When a lift like this is put in a shoe, it is expected to make a difference in the uneven walking and pain in a short time. To put a lift inside a shoe, it needs to be 1/4″ thick or less.  These lifts can be transferred from shoe to shoe as needed.  View a photo of a heel lift to the left.  It is about 1/4” thick at the back and tapers to nothing at the front.     

If the lift needs to be larger than ¼” thick it is usually permanently applied to the bottom sole of the shoe because otherwise the foot will not fit inside the shoe along with the lift.

If you have a leg length difference consult a Canadian Certified Pedorthist to help keep you more active with less pain. 

By Jim Pattison C. Ped (C )

 


Gardening and Foot Health

Gardening can be a messy hobby. It requires many hours outdoors with unpredictable weather – especially as we head into fall and prepare our gardens for winter. Here are some tips to keep your feet protected and feeling great in the yard.

  • Choose your footwear carefully – Even if you believe your shoes will get dirty, wear good, supportive shoes and avoid sliding on flip flops, crocs or someone else’s shoes because they’re convenient. When you’re gardening you need to be careful to protect your feet from potentially sharp objects, insects and the sun. Some people prefer to designate an older pair of running shoes for every day gardening use. If this is the route you choose, it is important to choose a shoe that still provides your feet with some cushioning and support and keeps your feet feeling great. A Pedorthist can help you with this!  A Pedorthist can also “improve” your old runners by helping to designate an insole or orthotic that will provide your feet with the proper support to keep you stable and strong. This simple maneuver can help your knees and back feeling great, even after a long day in the yard!

 

  • Avoid prolonged time in worn out, rubber or steel toe boots – Once the dirty digging and grass cutting tasks are over, it is best to switch to a more supportive shoe for the rest of your yard work. Spending prolonged time in rubber or wet footwear can lead to excessive moisture and may lead to blistering and even a wound. Footwear features that may be best for gardening are; Gortex or other water resistant technology, orthotic friendly design, seamless materials and durable soling to wear around the yard. When you do need to wear a steel toe shoe or boot or even rubber boots, remember that often even an off the shelf insole inside of these can increase the cushioning and support and help with shock absorption and creating a stable base.

 

  • Avoid prolonged positions that may create pain. Try squatting with one foot flat on the ground and the other leg with the knee planted on the ground. This is known as the golfer’s squat. If this is much too difficult, another option can be a foldable, adjustable stool. Whatever position you take, it’s best to avoid over flexing your toes. This can put immense strain on your arch, toes and calf muscle. Wear shoes with firm soles to resist excessive flex in the sole during squatting.

 

  • Lastly check your feet after a full day of gardening. A rock in the shoe that may go unnoticed may irritate your feet. It is important to shake out your footwear after a long day in the garden. No matter how messy your garden is, keeping your feet dry and clean is important to prevent blistering and wounds to your feet.

 

By Kathy Simpson, C. Ped (C)


Meet a Pedorthist – Laura Pantano, C. Ped (C)

In her years after high school, Laura Pantano, C. Ped (C), was unsure what career path to take. She went to college for dental assisting, but after completing the program she decided to apply to Brock University’s Kinesiology program. Having grown up playing soccer and sustaining a few injuries along the way, Laura was always interested in researching ways to improve her recovery. After graduating, she was offered an apprenticeship at a pedorthics clinic. Though this opportunity did not work out, Laura was set on a career path and studied to get a diploma in pedorthics.

After receiving her PAC certification, Laura worked for four years in the clinic where she completed her final educational placement. There, she learned practices for fabrication and casting. After that, Laura found an open position for a pedorthist at a local prosthetic and orthotic clinic near her home in the Niagara region. She was thrilled at the opportunity to work alongside prosthetists and orthotists and has since been caring for a range of patients she never imagined. “From custom made knee ankle foot orthosis (KAFO) devices to prosthetic limbs through osteointegration, the diversity of the patient population that comes through our doors is immense,” Laura says.

Laura has been integrating the latest scanning and 3D printing technology into foot orthotics. Her company is developing a device using 3D printing that is just as good, if not better than the traditional fabricated foot orthotic. “We have a great team of technicians that I work alongside and hopefully by 2021 I can start dispensing (the new orthotics) regularly,” Laura says.

Laura tries not to bring her workday – good or bad – into her home. “Since we spend the majority of our time outside of our families, I give mine my full attention when at home,” she says. Laura has three children, two of which are twins. In her spare time, she loves to play soccer, although her league is currently shut down due to the COVID-19 pandemic. Since the pandemic began, she has taken up long distance running. Laura also loves being outdoors with her children, riding bikes, going to the beach, hiking, and playing in their backyard.


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