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The Food-Foot Connection

With March being Nutrition Month across Canada, we decided to dig a little deeper and interview a Dietitian to explore how healthy eating can improve our overall health and more specifically, the health of our feet. Dietitians are the trusted professional when it comes to reliable evidence-based food and nutrition advise as Pedorthists are for footwear and orthotics.

Tomorrow, March 18th, marks the eleventh year of celebrating Dietitians in Canada. In keeping with this celebration and helping to shine the spotlight on the profession, Pedorthist Derek Gilmer interviewed his wife Alia Khudhair-Gilmer, a Registered Dietitian.

 

Q: As a Pedorthist our role is to help manage and treat many foot conditions caused by chronic or acute inflammation by providing support and reducing mechanical stress on affected tissue in the feet. Are there specific foods that will help reduce inflammation or foods to avoid that cause inflammation?

A: While there is no definitive “anti-inflammatory diet” there are definitely foods that help us fight many diseases including arthritis, heart disease and diabetes.  Foods such as fruits and vegetables provide phytonutrients which help reduce inflammation in the body.  Studies suggest that people with Rheumatoid arthritis could benefit from eating more Omega 3 fatty acids (found in salmon, sardines), while other studies suggest that foods high in uric acid (found in red meat, alcohol) will increase painful inflammation in patients with Gout, a type of arthritis.  Refined grains, sweets, junk food, soda pop and excessive intake of saturated fats, found in red meat, can increase inflammation.  Increased inflammation will cause increased pain in the feet by increasing the swelling and pressure on sensitive nerve endings. 

 

Q: We see many clients for Pedorthic care who have problems with their feet due to diabetes. A Pedorthist will help provide protection and off load high pressure areas to assist with helping heal foot ulcers. What role does diet play in managing diabetes and supporting wound care? More specifically, how can diet aid in the healing of ulcers?

A: The most important factor in preventing diabetic foot ulcers is to have optimal blood sugar.  Having a balanced diet that includes vegetables, fruit, whole grains, lean protein and some healthy fats, along with limiting high sugar foods is key to managing good blood sugar levels.  Proper blood sugar control will help reduce foot problems such as neuropathy.  Diabetic neuropathy is nerve damage, specifically nerve damage in the feet caused by long term high blood sugar levels and is a serious complication of diabetes.  As for managing a pressure ulcer, increased protein and fluids, along with a balanced diet are required for optimal wound healing.  

 

Q: Pedorthists receive referrals from physicians to help heal and manage stress fractures in the feet and to help prevent injuries from occurring with people who have osteoporosis. What type of diet should someone with osteoporosis consider? And will this help prevent fractures and other injuries from happening?

A: Osteoporosis is associated with increased risk of fractures, including stress fractures in the foot.  Ensuring you are having adequate calcium intake and vitamin D from food or/and supplements is important in reducing the risk of fractures.  Calcium rich foods include milk (cow’s milk or alternatives such as soy milk or almond milk), yogurt, cheese and green leafy vegetables.  There are also many products on the market that are fortified with calcium and vitamin D.  Living in Canada most people don’t get enough vitamin D “the sunshine vitamin”, in my practice I always recommend a vitamin D supplement for anyone who is 50 years or older. 

Help celebrate Nutrition Month by loving the food you eat and making healthy food choices that have the potential to improve your overall wellness from head to toe. To learn more about Dietitians and nutrition visit www.dietitians.ca, to find a Canadian Certified Pedorthist in your area please visit www.pedorthic.ca/find-a-pedorthist/

 


Compression Therapy and Pedorthics

Pedorthists are often on the front line when it comes to seeing patient’s legs and feet, being the first professionals to observe and assess biomechanical and circulatory issues. Many patients do not show their legs or feet to their physicians, and may not realize that issues such as swelling, discolouration and varicose veins can benefit from compression therapy. Canadian Certified Pedorthists, or C. Ped (C)’s, may be certified in fitting compression stockings and custom garments, and can help to make sure that patients are receiving the best treatment to alleviate their circulatory issues.

How Compression Can Help

Compression therapy is used to help with circulatory problems arising from the venous or lymphatic systems in the leg. Compression can help to improve the effectiveness of the valves within the veins and can therefore improve blood circulation.

People with all levels of discomfort can benefit from compression socks or stockings, from swelling brought on by long work shifts, to traveling on long flights, to problems arising from varicose veins, to post-surgical issues, deep vein thrombosis and more serious venous and lymphatic diseases. Venous ulcers also often require specialized compression therapy, although patients needing this level of support may receive their compression treatment through their specialist or at a hospital.

When a patient is mobile, the calf muscles work as a secondary “heart,” meaning that they pump the blood back up the legs after it has circulated into the feet. When there is damage within the veins, or lack of mobility of the client, the calf muscles are not working to effectively help the blood flow back up the legs against the pull of gravity. This is also where compression therapy can be of benefit.

Compression Fit

It is essential that patients are properly assessed and fitted for compression therapy garments, as socks or stockings that are too tight or ill-fitting can cause more problems than they solve. These can range from mild compression in a knee-high sock to full pantyhose that provide compression throughout the full length of the stockings.

Compression is available in a wide range of styles, sizes, and levels of compression. A C. Ped (C) that is trained in compression therapy fitting can help to ensure that the proper garment is being dispensed to the patient. There are also many options when it comes to fitting patients that have major edema or swelling. These can include stockings with zippers on the side, custom bandaging that is wound around the leg, or a custom-made stocking that is created based on measurements taken from the patient.

Levels of Compression

Socks and stockings for compression therapy have their compression levels measured in millimeters of mercury. The higher the level of compression, the tighter the garment will be when it is donned. Over the counter compression is usually measured at 8-15mmHg or 15-20mmHg, and prescription compression is usually 20-30mmHg, 30-40mmHg or 40-50mmHg.

Over the counter compression socks do not have a custom fit for the patient, meaning they can be purchased based on shoe size, and are found in a variety of locations. Prescription level compression is custom measured and sized for the patient. Since garments can be custom made for the patient, clients must see a certified professional to provide this type of sock or stocking to them. Since these compression socks or stockings are called “prescription,” a prescription from a physician is required in order to fit and dispense these garments.

Ideally the compression socks or stockings will have graduated compression, meaning they have a higher level of compression at the ankle than they do at the calf. This can help reduce the diameter of the vessels and can help ensure the valves within the vessels are working effectively and improving blood flow up the leg.

Other Uses for Compression Therapy

Compression socks are also becoming popular within the athletic community, although scientific evidence proving their effectiveness is sparse. Essentially, if compression socks are comfortable during activity, such as a long run, and the athlete feels they help to alleviate muscle soreness, then there is no reason they can’t be worn for sports.

Patients that have diabetes are cautioned when it comes to compression, and it’s recommended that the pedorthist works together with the patient’s physician to ensure that the risk factors are mitigated. Although compression can greatly benefit the issues that arise from having poor circulation, there are increased risks associated with wearing a sock that would be causing pressure or friction on the skin that may go unnoticed by the diabetic patient. Ideally the stockings in this case would have extra padding, flat seams, and a custom fit.

Canadian Certified Pedorthists that are certified in compression therapy fitting can help clients with many situations that arise from poor circulation in the legs.

For more information about the Pedorthic Association of Canada or to find a Pedorthist near you visit pedorthic.ca.

Janelle Coultes, B.Sc., C. Ped (C)


Pedorthics: More Than Just Orthotics

When you hear the word ‘Pedorthist’, what do you think of? Perhaps you’ve never heard the term before. Or maybe you associate it with the people who made your custom foot orthotics. By definition, a Canadian Certified Pedorthist is trained in the assessment of lower limb anatomy and biomechanics. They are experts in designing, fitting, and modifying custom made orthotics and orthopaedic footwear. They’ve studied and have successfully completed the requirements put forth by the Canadian College of Pedorthics of Canada. However, it doesn’t stop there. Many Pedorthists go on to get further training to offer additional products or services and to work on specialized health teams.

Some C. Ped (C)s take additional courses in assessment for over the counter and custom bracing for the feet, ankles, and knees. These Pedorthists can help you to find the right bracing option for you if you are living with conditions such as osteoarthritis, patellofemoral pain syndrome (runner’s knee), joint instability, or recurrent ankle sprains. Bracing can be beneficial in reducing pain and increasing support and comfort during activities of daily living, work, and sport.

Another area Canadian Certified Pedorthists can get further training in is in fitting compression therapy or compression socks. Has your doctor prescribed compression socks for you? Be sure to see a compression therapy fit specialist. They’ll know how to properly take measurements for custom socks or stockings. Compression socks and stockings can help to reduce leg pain by reducing swelling and improving blood flow. Compression therapy isn’t for everyone, so it is important to clearly communicate with your doctor and Pedorthist about any underlying health conditions.

Pedorthists play a key role in collaborative health care teams both in public and private settings. They can be a part of diabetic care programs and working with foot care nurses, vascular surgeons, and prosthetists. They can play a key role in return to work programs engaging with case managers, physicians, and social workers. Or, they can work within the comprehensive rehabilitative team with physiotherapists, occupational therapists, sport medicine doctors, and more. Canadian Certified Pedorthists who work within these teams gain specialized knowledge and are instrumental in the overall patient experience.

This month on the Pedorthic Association of Canada blog we’ll be talking about everything but orthotics. We’ll elaborate on topics such as compression therapy and custom bracing. Also, in celebration of Nutrition Month in Canada, we’ll be highlighting nutrition and its impact on foot health with a collaboration by a Canadian Certified Pedorthist and a Registered Dietitian. Check back here and follow us on Facebook for more foot health tips and information.

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


How to Break in Your Custom Foot Orthotics: Pedorthic Tips & Tricks

Custom foot orthotics are fabricated to meet everyone’s unique structural and biomechanical needs. The old saying holds true in that often one needs to “break something in” before feeling completely comfortable or satisfied with a product/device.

What does it actually mean to break-in” your new custom foot orthotics?

In the Pedorthic profession one of the most common questions we hear is “how long will it take to get used to these orthotics”. Unfortunately, this is never a straightforward answer as everyone adapts on their own time. For most, your feet, knees, hips and back have been functioning in a specific movement pattern for years. The human body often needs time to adjust to its “new” alignment.

Therefore as a Pedorthist, it is best practice to educate all patients on the process of breaking in their custom foot orthotics. This not only enhances patient compliance; it increases the chances of relieving your pain and meeting overall treatment plan goals!

What does it feel like to break-in your new custom foot orthotics?

When you get a new pair of orthotics the sensations can be surprising. For some, your new custom foot orthotics may feel unusual at first, as though you are standing on a hard, round ball and applying a lot of pressure to the various arches of your feet. Perhaps you feel a little bit taller? Perhaps your feet feels more congested in the shoe than usual? For others, they may feel fantastic right away like you are walking on clouds or could run a marathon. Remember, whether they feel strange under your feet or if you feel great right away, it is still recommended to break-in the orthotics.

What are some break-in tips and tricks?

1) Start slow!

Wear your custom foot orthotics for a few hours on the dispense day; gradually increase the wear time by 1-2 hours daily over the first week. This is very important as you want to prevent any unnecessary discomfort or injury. It is important to remember not to be discouraged if you do not get used to them right away. It can take up to a month before you feel completely comfortable wearing your custom foot orthotics for a full day.

2) Know your body.

If you are feeling any new pains in your toes, ankles, knees, lower back, or your hips take the orthotics out and start fresh the next day and reduce the wear time. Overuse of the custom foot orthotics may result in discomfort through the arch or small blisters. Keep an eye out for red spots as they are an early sign of friction that could lead to a blister.

4) Dont forget about your footwear!

It is best to start wearing custom foot orthotics with new or relatively new shoes. If there are any previous wear patterns this may reduce the functional effectiveness of the orthotic.

Properly fitting footwear is essential for the orthotic to work correctly. Look for shoes with appropriate width and depth. As a rule of thumb, the deeper the better. Try them in multiple pairs of your shoes. During this process, you will likely find that you find greater comfort in one shoe brand/style than another.  Keep this in mind when shoe shopping in the future!

If the shoe allows for it, always open up the shoe so that it is easier to don. This will prevent socks from bunching, protect the collar of the shoe (as the orthotic takes up more space than the traditional sock liner) and keep the integrity of the top cover.

3) Break them in before rigorous physical activity.

Do not partake in any rigorous physical activity until you have broken the custom foot orthotics in completely. This means that you are wearing the orthotics for a full week with no discomfort.  If you are playing a sport, always try the orthotics out for a few practices before introducing them to a game situation. If you experience muscle soreness and joint discomfort, these are signs that you have worn your orthotics too much, too soon.

5) Adjustments are normal;  Reach out to your Pedorthist!

It is normal to feel new pressure points and slight discomfort as your body is adapting to the orthotic. If you are having difficulty adjusting to the new orthotics after 3-4 weeks’ time reach out to your Pedorthist and they will be happy to make any changes. Adjustments are normal as everyone adapts differently to varying support levels. Do not attempt to adjust the orthotics yourself (even if you have a garage full of useful tools!). Be patient with the break-in period and the results will be lasting as you move forward in day-to-day comfort.

Chelsea Mathews, C. Ped (C)


Don’t Let Pain Ruin Your New Year’s Resolutions!

It’s a new year, and you are motivated to start a new exercise routine! Don’t forget about your feet; proper shoes and support can be beneficial to prevent pain from developing.

Why Pain Develops When Starting a New Exercise Routine

When starting a new exercise routine, the body may not be prepared to handle the stress. Exercise increases force to the feet, and exaggerates any foot motions already present. These exaggerated motions create more work for the muscles and other structures around the feet. Because the structures in our body are connected, movements of the feet can also affect other structures higher up.

The Importance of Proper Shoes

Why are your shoes important while exercising? They provide support, cushioning and protection for your feet. If you are running, jumping, or even walking for exercise, your shoes can be the difference between pain and comfort.

Support becomes especially important when flat feet or high arches are present. Supportive shoes can limit any excessive foot motions to reduce the stress on the muscles and other structures. Cushioning also becomes important to reduce shock, especially for those with high arches or less flexible feet. Exercise increases the force through the feet, while cushioned shoes help to reduce this.

This support and cushioning can be compromised when shoes become worn out. The support may worsen if the shoe does not wear evenly throughout. Shoes tend to wear out where the most stress is, which may increase abnormal foot movements and increase stress and strain.

The Importance of Proper Support

Support from a custom orthotic or an over the counter insert is different than support from your shoes. Orthotics provide support to hold the foot in a neutral position, while a supportive shoe provides a proper base for stability and prevents the whole foot from shifting from side to side.

Flat feet, high arches, and feet with other alignment issues may need this additional support from an orthotic, especially when pain develops from conditions originating from the mechanics of the feet. Some of these common conditions are plantar fasciitis, Morton’s neuroma and bunions.

Pedorthic tips

Proper Shoes

There are different types of athletic shoes made for specific activities and for the way your feet move. Examples of different athletic shoes are walking shoes, running shoes and sport specific shoes.  Footwear can be further categorized as stability, neutral or motion control. These different shoes are best for the specific foot types that they’re designed for, as flat feet and high arched feet have different footwear requirements.

In addition to finding the correct style of shoe, the fit is also important. Signs of a poor fitting shoe could be redness, calluses/corns, pain and bruising. Finding the right fit in your exercise shoes is very important, as walking around in the store is different than exercising. Once you start exercising, pressure areas may become evident that were not noticeable when trying in the store.

Find your local Pedorthist to determine the best type, style and fit to suit your needs!

Proper Support (orthotics)

When additional support is recommended, wearing custom orthotics or over the counter inserts inside the shoes can be beneficial. They complement the shoe to alleviate pain and reduce excessive foot motions. When pain develops in the feet or other parts of the lower body, the feet may be the cause. To help prevent this pain from developing, a pedorthic assessment can help to determine if you would benefit from custom orthotics or off the shelf inserts.

Add your local pedorthist to the list of professionals to consult before starting a new exercise routine!

By: Julia Hayman, C. Ped (C)


Reduce Your Winter Woes and Get the Most Out of the Canadian Winter

Weather. It’s everyone’s favourite topic of conversation in Canada and, while winter doesn’t officially join us until December 21, there have already been traces of winter across the country. As Canadians, we often joke, “Don’t like the weather? Wait 10 minutes and it’ll change.” However true or false that may be, and however much or little you love winter, you always want to be prepared. During the winter season, there are challenges to navigating the ever-changing winter conditions, the demand of holiday parties, and seasonal physical activities that you haven’t done since, well, last winter. All this amounts to one question that Canadian Certified Pedorthists hear a lot, “What do I wear on my feet?”

Get an Assessment

Canadian Certified Pedorthists (C. Ped (C)s) are foot orthotic and footwear experts trained to assess the function of lower limb (feet and legs) anatomy and biomechanics. As C. Ped (C)s, we work with our clients to determine the best solutions for their needs. The first step in the assessment is always to take a thorough history; this includes determining your seasonal needs. Maybe you’re retired and spend the winter months in Arizona. Perhaps you spend every weekend on the black diamond slopes, are a regular at the local outdoor ice rink or can’t wait to try snowshoeing for the first time. Or, are you like many of my clients, friends, and family who want to enjoy winter but have a fear of falling and breaking something? That fear alone is warranted; thousands of Canadians visit the ER every winter due to slipping on ice. The initial assessment will help your C. Ped (C) gauge your winter footwear needs.

 

Traction for your winter footwear is like that of the tires on your car. Factors that affect traction include weight, coefficient of friction (the amount of friction holding two surfaces together), and slip. When my clients, friends or family ask what they can do to increase traction and decrease the risk of falling there are a couple of things that I recommend.

  1. Work on improving balance, strength, and flexibility in safe environments like the fitness studio, a physiotherapy clinic or your home. These elements of long-term exercise and fitness play a key role in reducing injury or recovering from injury.
  2. Do your research when it comes to winter footwear. Just because it’s labeled a winter boot doesn’t mean it will hold up to environment’s specific conditions. A company based out of Toronto has been working on a protocol for testing and a standardized rating system for slip resistant footwear. You can check out their annual ratings at ratemytreads.com.
  3. Invest in a pair of over-the-shoe cleats for added traction. Be sure to remove them before stepping into a building, as they can be as problematic as walking on ice if you try using them on tile floor.

Do’s and Don’ts of Winter Foot Care

Falls aren’t the only winter woes to avoid when it comes to your feet. Here are some other DO’s and DON’Ts to get you started as you prepare to maximize the benefits of the Canadian winter:

DON’T cram your feet into tight-fitting winter boots.

DO make sure there is space around your toes for air to circulate. Your body heats that air and keeps your toes roasty-toasty warm.

DON’T wear wet or sweaty socks or footwear outside.

DO change to dry socks and shoes if you need to go out again.

DON’T wear your hard-soled shoes in cold, icy conditions.

DO choose footwear with out-soles (the part that comes in contact with the floor) that still have some give or elasticity in icy, cold conditions.

DON’T assume last year’s winter footwear will still fit and do the job this year. This is important for kids and adults alike.

DO check the fit and condition of your boots, skates, and ski boots. Check inside the footwear to make sure nothing accidentally fell inside of them while in storage.

DON’T change your running or walking form too much. Many people get too cautious, stiffen up, and cause overuse injuries.

DO reduce your pace and shorten your stride. Take corners as slowly as necessary and try your best to relax.

DON’T wear your stiletto sandals to the holiday party, unless you can be dropped off at the door.

DO have a change of footwear with you whenever possible. Many event spaces have a cloakroom where you can change and store your shoes.

Whether you live and breathe for Canada’s six months of winter or can’t wait for the tulips to pop up again, stay tuned through the month of December as we’ll be sharing more stories, tips, and articles that will get you through winter with happy feet. Are you interested in finding out more about what Canadian Certified Pedorthists can do for you and your family right now? Visit https://www.pedorthic.ca/ or follow Pedorthic Association of Canada on Facebook.

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


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