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Chronic Foot & Ankle Pain: Can a Pedorthist Help?

Are you someone who experiences chronic pain in your feet or ankles? Perhaps the pain is a result of an injury, or perhaps the cause of the pain is unknown to you. Either way, it’s a good idea to visit your local pedorthist to see what can be done to alleviate your pain and help you to resume an active healthy lifestyle.

I have seen many clients over the years with chronic foot and/or lower limb pain. They come to see me in the hopes that I can do something to help them deal with the issues they are experiencing. Each time I encounter a patient with chronic pain in my clinic, I do my best to develop a tailor-made solution to the problem that works for the client. Here are some of the issues I have seen, and the treatments I have recommended.

Problems Pedorthists Encounter

  • One client came to me with sore heels after falling off a granary and landing 12 feet below on the ground. Once the breaks in the heel bones had healed up and the rehab specialists had done what they could, pain persisted in the patient’s daily activities. I was able to make a pair of supportive foot orthoses with cushioning that helped relieve the heel pain. This allowed the patient to return to work with a lot less pain.
  • I saw a client who had bunions and pain at the ball of the foot when walking. This was a chronic condition because the condition was a longstanding one and the patient’s doctor was uncertain how best to proceed. Foot orthoses at the ball of the foot were made and I gave advice about appropriate shoes to wear; both helped to relieve the pain.
  • Another client had a bad case of plantar fascitis that started in the summer while wearing heavy work boots and walking a lot. I gave the patient advice about icing and stretching the foot and doing appropriate exercises. This treatment plan, along with a pair of foot orthotics, made a huge difference for this case.
  • A client came in with a complicated case of gout, and because they were unable to take the standard medicine for gout, there was swelling in the foot that gave plantar fasciitis symptoms. My clinic provided the patient with a modified pair of shoes that were wide enough to accommodate the forefoot and deep enough to accommodate the swelling in the foot. The shoes had a positive toe rocker built into them and this helped the patient walk more comfortably. Dietary modifications put in place by dieticians and fellow gout sufferers along with changing his medicine has helped relieve the swelling and some pain.
  • Finally, a client came to my clinic with a complicated chronic pain syndrome with swelling that gave plantar fasciitis symptoms. In this case, a custom orthotic did help to relieve the one area of plantar fasciitis pattern pain, but not the rest of the foot. The rest needed to be treated by other specialists. Since a lot of re-injury was occurring while the client was asleep, a cast boot was supplied to be worn at night for injury prevention.

Pedorthists as Part of a Team Approach

As you can see in a few of the examples above, pedorthists can be an important part of the treatment one receives for foot and lower limb problems, particularly problems of chronic pain. The Pedorthist may not have all the parts of the solution though. In order to effectively deal with problems, sometimes a team approach might be needed between a doctor, a physical therapist and others to assess your situation and do what they each can to help. This team approach is usually the best way to see results quickly and help you to return to work and normal activity.

Once the root cause is established, there is much that a pedorthist can do as a part of a team to help get you back on your feet and help you to resume an active healthy lifestyle.  Doctors are best suited to casting broken bones, dealing with secondary injuries and giving pain relief. Physiotherapists are best suited to help rehabilitate people with some exercises and treatments like diathermy, ultrasound and cold laser therapy.  When all the parts are put together, the results are better than just the parts put together!

If you are suffering from chronic pain in your feet, ankles or legs, go see a pedorthist near you for help –just visit Find a Pedorthist to locate one near you today!

By Jim Pattison, C. Ped (C)


In a Pickle: Preventing Pickleball Sport Injuries

What do you get when you cross tennis with badminton AND table tennis? PICKLEBALL!

I’m hearing lots about it from my clients these days. Contrary to its name, Pickleball does not involve pickles of any kind. It is both a recreational and competitive sport played on a badminton-sized court, with a net set at 34 inches high in the middle, a wiffleball-like ball, and double-sized ping pong-like paddles. It can be played in singles or doubles, much like tennis, and on indoor or outdoor courts.

Originating in a Washington backyard in the mid-1960s, the sport has steadily made its way across the USA since then, growing in popularity so much that today, in the United States alone, the sport boasts an estimated 3.1 million players. As Canadian “snowbirds” visited the US and returned to Canada they brought the sport home with them. In 2017, Canada had an estimated 60,000 registered players, and that number is growing. The sport has gained popularity mainly because it is so easy to learn the skills necessary to play. There is a huge selection of YouTube videos demonstrating just that!

Pickleball, A Sport for All

Pickleball Canada’s slogan, “A Sport for All” is supported by the Sport & Fitness Industry Association statistics: 75% of those who play Pickleball eight or more times per year are 55+ years old, while it’s the 35-54 age group that plays casually (1-7 times per year), proving that it is no longer a sport played in retirement communities alone. There are now Pickleball clubs and facilities in all Canadian provinces and territories. It is played in North America, United Kingdom, India, Spain, Finland, France, Belgium, and New Zealand, so the sport enjoys healthy international competition. Players with diverse sporting backgrounds (sometimes never having been very active before) participate for a whole host of reasons, one being the social element of the game.

Potential Injuries from Pickleball

Of course, with increased participation in any sport comes an increase in the risk of injury. In my Pedorthic clinic, I see the number of Pickleball-related sport injuries on the rise. There are several internal risk factors that predispose someone to a sports-related injury. They include age, gender, body composition (% body fat), history of previous injury, muscle and joint fitness, anatomy, and skill level. Pair some of those factors with external factors such as other players, inadequate equipment, and unpredictable conditions of the playing surface, and you’ve got yourself a recipe for injury.

Like other court sports, the most common Pickleball injuries in the lower body are ankle ligament sprains from rolled ankles, Achilles tendon strains/ruptures from quick stop-starts or changes of direction, plantar fascia strains from overuse, ligament sprains at the knee due to change of direction, and pulled hamstrings from overextension. Upper body injuries like broken wrists and concussions are typically connected to falls on the court.

Despite the risks, many Pickleball-related injuries can be prevented. Here are some Pedorthic tips for preventing and recovering from Pickleball-related injuries:

Footwear

You may think that the most essential piece of equipment to be able to play Pickleball is a ball and paddle. Ask anyone who has played more than one game and they’ll tell you that it’s what is on your feet that is most important. Regular running shoes are the worst option for court sports of any kind. The soling and flared midsole (the part between the sole and upper) can catch on the surface of the court and cause forces to be applied to the foot and leg that are sometimes not well received by the small ligaments and tendons mentioned above.

Before your first Pickleball experience, get yourself a shoe designed specifically for use in court sports. Court shoes are designed specifically for the surface they are being used on, so when shopping for this type of footwear it is important to know whether you’ll be on hardwood or hardcourt. It is also crucial to get the correct size. You do not want to feel insecure in the shoe, like you’re sliding around, but you will want some space around the toes. A ¼-½” space beyond your longest toes is a good amount. To avoid disrupting circulation, tie your shoes securely but not too tight.

Before, During and After the Game

Before a game it is important to get the muscles and joints warmed up. Many Pickleball players will start with “dinking”, sort of like rallying in tennis. You can do some stretching that focuses on the back of the leg (Achilles/calf, hamstrings) and the front of the leg (quads). During the game you’ll want to use your larger muscle groups; bend at the knees and hips (like in a squat) to avoid injuring the lower back.

Sessions can be long, lasting upwards of three hours, so make sure to hydrate throughout and have a snack on hand. After the game you can do some more stretching. You can incorporate balance, stability, and strength exercises to condition for your next session.   

Orthotics and Bracing

You may also benefit from using orthotics (custom or off-the-shelf) or bracing. Orthotics and bracing can help with stability, increasing the information received from the surface you’re on through your feet, and supporting the structures of the feet. Even small modifications made to the liner of your shoe can contribute in a big way towards a more comfortable, injury free, Pickleball experience.

By seeking the advice of a Canadian Certified Pedorthist, or C. Ped (C), your individual needs will be considered to determine which assistive device(s) will be the best solution. A Pedorthic assessment will include taking a detailed history, functional testing and measurements, and, if orthotics or bracing is necessary, a 3-dimensional cast or digital scan of your feet. To find a C. Ped (C) in your area, visit the Pedorthic Association of Canada’s website here.

By Jaime Nickerson, C. Ped (C), B.Sc. (Kin), Dip. Pedorthics 

 

Related Links:

https://www.pickleballcanada.org/

https://www.usapa.org/pickleball-fact-sheet/

https://en.wikipedia.org/wiki/Pickleball

https://thevolleyllama.com/pickleball-injuries/

https://bjsm.bmj.com/content/37/5/384


Running shoes are a vital piece of fitness equipment

Running continues to grow in popularity in Canada. Besides the proven benefits to our mental and physical health, running is popular because you can run almost anywhere and it is relatively easy to squeeze in a run at some point in a busy day. Running also requires very little equipment – all you need is a pair of running shoes. However, this piece of equipment is vital.

If you don’t wear the right type of running shoes or don’t replace them regularly, the health benefits running provides will be jeopardized by a painful overuse injury.  

Running shoes today are specifically designed to support and cushion your feet and help ensure you engage, but don’t stress, the correct muscles, tendons and ligaments while you run. If you’re running in shoes that are worn, you’re at risk for a variety of injuries as your shoes won’t be absorbing the force when your feet hit the ground. This will cause the resulting shock to be sent back through your feet, ankles, knees and hips.

Common injuries that result from running in shoes that are too worn are:

Plantar Fasciitis: Worn running shoes do not provide adequate arch support. This lack of support can cause the thick band of tissue that runs from your heel to your toes to become inflamed, tight or torn. The result is heel pain that can make getting out of bed difficult and make running painful.

Shin Splints: Worn running shoes can cause excess stress to both the inside and outside of your shins. If this stress occurs at a time when you are increasing your running distance or switching from running on flat ground to hills, it can lead to pain, muscle tears, tightness, and inflammation in your shins.

Stress fractures: When you run, your body takes a lot of pounding which can cause tiny cracks in your bones to occur. Shoes that have weakened support and worn cushioning will not provide the protective support your feet and lower legs need to reduce the risk of these tiny fractures.

IT Band Syndrome: Old running shoes combined with sloped surfaces can cause your legs to turn inward when you run. This can cause the IT band, which runs along the outside of your thigh to your shin, to become stiff and inflamed which will result in knee pain.

Runner’s Knee: Worn out running shoes are one of the primary causes of runner’s knee, a painful condition that includes a range of knee injuries.

These tips will help you determine if your running shoes need replacing:

  • Running shoes need replacing every 500 to 750 km. If you’re a heavier build or run on rough terrain they will need replacing more frequently.
  • Write the date you purchased your shoes inside one of the shoes and replace them after a maximum of 1 to 1.5 years. Whether they have had significant use or not, the shoe materials will begin to break down or even harden (from running in the wet) and the shoes should be replaced.
  • Once a month, look at the sole of shoes. If you see any cracks forming or your treads are worn, your shoes need replacing.
  • If you experience new aches or pains when you run, it is a sign that the cushioning and support in your shoes may be worn and it’s time to get a new pair.

Replacing your shoes before they become too worn will help protect you from injury.

Canadian Certified Pedorthists can also decrease your risk of an overuse injury. As foot and lower limb experts, they can assess your individual biomechanics and recommend the most appropriate type of running shoe for you and advise if you will benefit from foot orthotics.

By Jasmine Basner, C. Ped (C), Barrie, Ontario


Why Lacing Matters

From an early age we’re taught the importance of keeping our shoelaces tied, and if we didn’t listen to this advice we quickly learned why it is not safe to run around with untied laces. Tripping hazard aside, tying your shoelaces is very important as it affects how your footwear fits and functions. Different lacing techniques benefit different foot types. Here are some guidelines to help you determine which technique is best for you:

Standard Feet

If you have standard-sized feet and don’t suffer from any foot issues, the traditional criss-cross lacing technique will likely be most appropriate for you as it will hold your feet snugly in place in your shoes. For this technique to be effective, you need to pull your laces securely, starting with the eyelets at the toe of the shoe and working your way up towards your ankle. If you use the criss-cross technique but continually leave your laces tied so your shoes are loose enough to slip into, the benefits of the technique will be lost and your shoes will not provide the support they are designed to, even if they are the correct size.

Narrow Heels

If your heel slips in the back of your shoes, you can keep it in place by using a lock lacing technique which tightens the shoe around the heel and ankle, preventing your heel from slipping. To do lock lacing, simply lace your shoes as normal to the second from the top set of eyelets. Then, instead of running your laces across the shoe, thread each straight up through the eyelet above it. Next feed each lace through the vertical loop between each of the top two eyelets opposite from each other and tie the laces as normal. This video shows how to do lock lacing.

Wide Feet

If you have wide feet, you’ll want to make as much space as possible in your shoes for your feet. To maximize space, lace your shoes using the eyelets that are nearest to the ankle, leaving the eyelets closest to your toes empty.  This will allow you to tighten the laces properly without restricting the space across the front of the shoe where the foot is widest.  

High Arches

If you have high arches, the top of your feet may become rubbed by the tongue as your arches force your foot against the top of your shoes. To reduce the risk of this, try gap lacing which minimizes the pressure on the top of your foot but still ensures your shoe fits securely. To do gap lacing, simply lace your shoes using the traditional criss-cross technique until you reach the middle of the shoe or the area of your foot which is being rubbed. Instead of continuing the criss-cross pattern, thread the laces directly into the eyelet above them and then continue criss-crossing up the rest of the shoe. This video shows you the gap lacing technique.

Lacing Tips

Regardless of the shape and size of your feet, these lacing tips will help ensure you get maximum benefit from your shoes:

  • Always loosen your laces before you put your shoes on. Forcing your feet into shoes with tied laces will stress the eyelets and the backs of the shoes, creating unnecessary wear.
  • To get the best fit, always start lacing your shoes at the eyelets closest to your toes and tighten the laces one set of eyelets at a time.  
  • When buying shoes, select shoes that have the most eyelets. This will enable you to easily adjust the laces to ensure the shoe best fits your foot.
  • Remember to adjust your laces throughout the day. Feet expand with activity and temperature so you’ll need to loosen your laces as the day progresses.
  • When lacing your shoes, make sure the laces are lying flat as twisted laces may rub the tops of your feet.

Canadian Certified Pedorthists are footwear experts. If you’re not sure which lacing technique is best for you, ask your Pedorthist at your next appointment.

By Heather Orosz, C. Ped (C), Calgary, AB

 

 


Shoe shopping should be done in-person, not online

Online shopping is a wonderful time saving tool that continues to grow in popularity. The convenience of being able to order the products you need at any time of day or night and have them shipped directly to your door is invaluable. However, when it comes to footwear, online shopping is rarely a good decision. 

Wearing properly-fitted footwear is important for your comfort, mobility and overall well being. Ill-fitting shoes can cause numerous problems including bunions, hammertoes, blisters and ulcerations as well as balance issues. In addition to proper fit, wearing the right type of shoe for your individual foot and biomechanics, lifestyle and daily activities is important. Only a professional shoe fitter who is able to see and measure your foot and discuss your lifestyle with you can accurately recommend the most appropriate type and size footwear for you.

Few people realize that our feet can change in size over time. As we age, our muscles and joints relax which can cause our feet to increase slightly in width or length. Aging, sports and lifestyle factors can also lead to the fat pads on the bottom of our feet becoming thinner and calluses, corns, bunions, hammertoes and other sensitive areas developing. All of these factors have a direct impact on the size and style of footwear you require. Having your feet professionally measured at least once a year is important as your shoe size may have changed even if your feet look and feel the same.

Regardless of whether your feet have changed sized, different brands of shoes fit differently. A size 7 may fit you perfectly in one brand of shoe but a 7.5 or 8 may provide the correct fit for another brand. You can only gauge a shoe’s fit and comfort by trying it on and walking around in it.

When you purchase shoes online, there is no opportunity to measure your feet accurately. Although some online retailers provide a sizing guide these are very general and cannot replicate in-personal, professional measuring. Compounding the sizing issue is the growing problem of vanity sizing. Like clothing manufacturers, some shoe manufacturers label larger products with smaller sizes, which makes it very challenging to order the right size.

Costly returns are another reason buying correct fitting footwear online is difficult. As online shoe retailers are continually searching for ways to decrease returns, they are increasingly selling shoes that are marginally larger than the requested size. Shoes that are too tight are returned but shoppers tend to keep shoes that are too big and use insoles or thick socks to improve the fit. Fast fashion has driven the demand for offshore, mass produced shoes. Although different populations have different shaped and sized feet, mass produced shoes are created for universal sizes. The result is footwear that doesn’t fit anyone well.

When it comes to footwear, save online shopping for the pair of shoes you only plan to wear occasionally. For all of your everyday needs, visit a local shoe retailer in your community and have your feet properly measured. If you are experiencing ongoing foot pain, have mobility issues or are living with diabetes or arthritis, book a full assessment with a Canadian Certified Pedorthist.

By Derek Gilmer, C. Ped (C), Ottawa, ON


Cycling orthotics can improve your performance and your comfort

As cycling doesn’t require you to bear any weight on your feet, you may be surprised to learn that foot orthotics can make a significant difference to both your performance and comfort. How can foot orthotics help in a sport where your feet never touch the ground?

Our central nervous system does not clearly recognize our feet while cycling. When we walk and run the pressure on the band of muscle on the bottom of our feet sends feedback to our brain. However, when we cycle there is little or no change in the pressure on this band of muscle so our bodies are not keenly aware of the part of the body that is responsible for transmitting the power we produce to the bike.

Both over-the-counter or custom-made foot orthotics can solve this problem by creating some contact between the insole of your cycling shoe insole and the arch of your foot. The arch support, provided by the orthotic, helps give your central nervous system more complete or better-quality information about load, position in space or relationship to gravity of your body. This in turn enhances your ability to globally coordinate your actions. Today’s cycling shoes are designed to help you cycle further and faster but they also put significant force on a small, unstable area of your foot. This is why foot orthotics, specifically designed for cycling, can make a huge difference.

Orthotics that are designed for your cycling shoes can look and function differently to orthotics that are designed for weight bearing activities and may not be able to be transferred to other sports shoes. As cycling places stress on the forefoot, cycling orthotics typically have a very low hindfoot profile. Frequently made from supportive, yet light weight material, cycling orthotics are designed to distribute pressure over a wider area, support your arch and re-align your foot structure. A foot that overpronates because of an issue with the front part of the foot, will likely benefit greatly from custom made foot orthotics in a cycling shoe. In addition to making your foot more comfortable, your cycling orthotics will help re-align your lower limb mechanics and therefore maximize the power that is transferred through your feet to your pedals.

If you experience knee, arch or forefoot pain or foot numbness during or after your rides, consult a bike specialist to make sure your bike is properly adjusted to fit you. If your bike fits and you are still experiencing any of these symptoms, book an appointment with a Canadian Certified Pedorthist. Be sure to take your cycling shoes with you to the appointment. Your Pedorthist will assess your foot structure, biomechanics and cycling shoes and then recommend a treatment plan. If foot orthotics are recommended, your Pedorthist will design, manufacture and fit them so you can achieve maximum performance and comfort.

By Shannon Gordon, C. Ped (C), Calgary, Alberta


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