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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


Tips from a Pedorthist: Fall Prevention

Fall prevention should be a top priority for those prone to injury or for those who have mobility concerns. Falls can cause major disruptions to someone’s life, as it can affect  where a person lives safely to how much they can do for themselves around the house. Falls account for 85% of all injury-related hospitalizations for seniors and can result in serious bodily harm. Over 50% of people incur significant and impactful life changes due to falls. 

Some of those injured may not return home or live independently after a bad fall occurs. Broken and fractured bones may be involved in falls; ankles and hips are areas that are prone to breaking. Follow the fall prevention tips from a Canadian Certified Pedorthist to avoid a major accident occurring to you or to a loved one.

Fall Prevention Tips

With people spending more time at home, it is important that you examine your house and your loved ones’ houses carefully for potential tripping or falling hazards. Since over 50% of falls take place at home, it is important to narrow your chances by taking the time to examine each room with the help of family and friends. Physiotherapists and Occupational Therapists can also help with this, but there may be a cost for this service.

Consider the following tripping hazards around you and take the necessary precautions to prevent anyone from falling:

  1. Electrical cords

Electrical cords that are not anchored down in a safe fashion are easy to trip on. Please check that they are necessary and then anchor them down so that they are not a tripping hazard.

  1. Obstructions in high-traffic areas

Obstructions of boxes or piles of clutter in hallways impede traffic and create other safety hazards. Spend some time making the house more organized so that these problems are dealt with and there is more room to move safely.

  1. Floor mats

Small floor mats that are curled up at the edges or have lost the rubber backing are just waiting to take you down! It is time to repair those you choose to keep or replace older mats with newer and safer ones.

  1. Footwear

Knitted slippers without a non-slip sole underneath or socks make it easy to “skate” on linoleum or hardwood. Please put a non-slip sole on these slippers or invest in a pair of slippers or shoes that have a non-slip sole on them for ease of safely getting around the house.

Often people with swollen feet are unable to wear shoes so they end up wearing socks, which is an especially dangerous way to get around. Swelling decreases the agility and mobility in the lower limbs so this person has less chance to stop a fall before it happens. It is recommended that people with swollen feet wear a form of non-slip slippers at the very least to avoid major falls. Adjustable sandals, slippers with a closure or even light weight shoes can provide better stability for walking around the house.

When a person goes outside, it is important that they have the appropriate footwear. Shoes and boots that have the appropriate tread pattern is important. In the winter, having a tread pattern that extends to both sides of the sole is important because those edges help to gain a grip on packed snow and ice. Examine the soles for increased wear on either side. Areas on the sole that are very worn down make them unstable to wear and make it easy for the wearer to fall. Ensuring sidewalks and steps are cleared of snow and ice is also an important area for preventing issues.

  1. Home modifications

Many people wake up in the middle of the night to quickly get to the washroom. The person may not be fully awake and thus is prone to problems. In addition to the recommended non-slip footwear, appropriate lighting and furniture placement will help with fall prevention at night. Physiotherapists or Occupational Therapists can work with people to examine other options that would help in terms of arranging furniture or coming up with alternative solutions that may reduce the need to rush in the middle of the night!

Seeking Professional Assistance

Fall prevention is a topic that has multiple aspects; a team approach can be required to come up with a comprehensive plan, depending on a client’s needs. Concerns about eyesight can be addressed by an Optometrist or Ophthalmologist. Concerns about balance and medicine need to be addressed by a doctor and a Pharmacist. Concerns about footwear can be addressed by a Canadian Certified Pedorthist. Physiotherapists and Occupational Therapists can give exercises to help people navigate safely without falling. There is a whole lot more that can be done in assessments to evaluate the risks and to put a process in place to help prevent falls.

To find a Canadian Certified Pedorthist in your area visit https://www.pedorthic.ca/find-a-pedorthist/

By Jim Pattison, C. Ped (C)


Diabetes Awareness Month and Fall Prevention Month in Canada

Many of us have heard the old adage, “An ounce of prevention is worth a pound of cure.” We eat our dark leafy greens and lean protein to ward off heart disease and wear helmets to minimize head and brain injury upon impact. We even have products applied to our cars to prevent premature corrosion of its metallic parts. Some may say, awareness of these issues is half the battle.

You may already know that November is Diabetes Awareness Month and Fall Prevention Month in Canada. The premise behind these campaigns is to raise awareness and educate the Canadian public so that prevention is top of mind and the prevalence of Diabetes and falls is reduced. As Canadian Certified Pedorthists, these two areas are close to our heart. The Pedorthic Association of Canada acknowledges awareness and prevention in these areas as a key element of living a long, healthy life. We see on a daily basis how foot care and proper footwear choice can help protect you from the damaging effects of both.

Diabetes Awareness Month

In 2018, Statistics Canada published results from a 2017 survey that stated, “7.3% of Canadians aged 12 and older (roughly 2.3 million people) reported being diagnosed with diabetes.” Diabetes Canada suggests that 90% of Canadians living with diabetes have been diagnosed with Type 2. They list the following ways to reduce your chances of developing complications due to Type 2 Diabetes:

  • Keep your blood sugar within your target range
  • Avoid smoking
  • Keep your cholesterol and other blood fats within your target range
  • Keep your blood pressure within your target range
  • Take care of your feet
  • Regularly visit with your doctor, diabetes team, dentist and eye-care specialist

We talk a lot about Diabetes in the pedorthic clinic due to its ability to disrupt the network of nerves responsible for sending and receiving messages to and from the brain (known as peripheral neuropathy) and its impact on the normal wound healing process, especially in the legs and feet. The risk of foot ulceration, for example, can be reduced with well-fitting footwear, full-contact custom foot orthotics, and daily inspections of your feet and shoes. This includes making sure your feet are clean and dry before putting seamless socks on and, before putting them on, sweeping your hand inside your shoes to make sure there are no foreign objects like keys, golf balls, pins, or bunched up socks hiding inside. I’ve personally found some of these things inside clients’ shoes that they wore to the clinic!

Canadian Certified Pedorthist have hands-on training in the manufacturing of custom foot orthotics. We also have the skillset to make adjustments, modifications or accommodations, and add or remove padding to your orthotics or footwear to dissipate the pressure and friction that can lead to ulcers. Most C. Ped (C)s have open access to a lab, frequently right onsite, and will have essential materials and equipment on hand to make those vital changes when needed.

Fall Prevention Month

Fall Prevention Month states that 20-30% of seniors will fall each year and is the leading cause for injury-related hospitalizations each year. These falls often result in injuries such as bruises, muscle strains, ligament sprains, and/or broken bones. To reduce the risk of falling in your home, stairs and floors should always be clean and free of objects. Make sure indoor and outdoor areas where you are walking are well lit and that you remain aware of your surroundings. Footwear should be fitted by a trained professional such as a C. Ped (C) and be chosen for the activity and surfaces it will be used on. Canadian Certified Pedorthists conduct a detailed gait analysis (in other words, we watch the way a person walks) in each assessment and for every patient we see. We consider this an essential part of our assessment giving us valuable information especially with patients who have balance issues. Loss of sensation in the feet, such as with peripheral neuropathy, can also be a cause of falls. If you are experiencing changes in how your feet are feeling talk to your doctor right away.

Fall prevention awareness isn’t just for older adults either. Falls are the leading cause of hospitalization for children aged 0-9 years. I was watching a viral video the other day; a young man got down on one knee to propose to a young lady in front of a seasonal display of pumpkins. Before he could get any words out a child of about 4 or 5 years walked by proudly carrying two small pumpkins and tripped over the extended foot of kneeling man. The child picked up her pumpkins and the young man apologized and carried on with his plan. Fortunately, no one was seriously injured but it just goes to show how easy it is for a fall to occur. We are all responsible for protecting each other and ourselves.

Stay tuned during the month of November as we share educational pieces, tips, and videos connecting pedorthic treatment to diabetes awareness and the prevention of falls.

To find a Canadian Certified Pedorthist in your area, please visit https://www.pedorthic.ca/find-a-pedorthist/

By: Jaime Nickerson, C. Ped (C)


Footcare for the Great Canadian Winter

Now that summer is over and the cooler months are here, it can be tempting to neglect your feet over the winter because they are more out of sight. Out of sight shouldn’t be out of mind; doing this is not the best decision for the feet or the rest of the body!

It’s easy to forget about going out to exercise when the winter weather arrives as it is easier to stay inside where it’s warm and cozy! The problem is that sitting around all day can lead to foot and ankle swelling. Without your calf muscle pumping, the blood circulating through your body starts to pool in your feet and ankles. If you must stay inside, then be sure to do a few basic foot and leg exercises, as advised by your Canadian Certified Pedorthist, to keep your blood flowing. The key message is to stay active and continue your exercise routine during the winter.

Winter Footwear Selection 

It is important to consider what you are going to be doing for activity and select the right shoe or boot for the job. There are different types of footwear with a variety of fancy features on the market. It does not matter if you are walking to work on snow-covered sidewalks, hanging out at the rink, snowshoeing or cross-country skiing, it is important to choose proper winter footwear that keeps your feet warm, dry and protected. Wintertime shoes should have ample padding and warm lining but still be roomy enough as to not cut off circulation in the feet and toes. Having some space around your toes allows warm air created by your body temperature to circulate in that space. Avoiding synthetic materials and other non-breathable fabrics can help control foot sweat; too much perspiration could create an extra chill that can lead to frostbite on the coldest of winter days. A Canadian Certified Pedorthist can assist you in finding the best pair of shoes for you.

Your Pedorthist will advise that it is important to wear shoes with good grip and strong arch supports, like custom foot orthotics, so that you do not slip or fall. It is also very important that the feet remain dry when it is wet and cold out. Make sure that the shoes or boots you wear fit when wearing thicker and warmer socks. The socks should fit well to prevent blistering and should help keep moisture from sitting on your skin. Socks that wick away moisture from the foot will help keep your feet warm and will help reduce the chances of frostbite when you are outside for an extended period. As it is difficult to avoid wet or cold feet completely, it is important to remove wet footwear as soon as possible and get the feet dry and warm as soon as possible.

When you go out in the cold, be sure to allow time for extra stretching as winter weather can make you less flexible and therefore prone to more injuries to your feet and the rest of your body. Also, when you are out walking and running, shorten the stride length to help increase stability when you go over slippery and icy patches.

Winter is a time when humidity is lower, and skin can dry out. Work to keep your skin moisturized to avoid problems that come with dry skin such as painful cracking, calluses and other rough spots.

Winter Footcare for People with Diabetes

Have you been diagnosed with diabetes? In winter, foot care for people with diabetes becomes more important. There are potential problems that can arise from moisture, cold, and dryness. Here are some tips to keep top of mind:

  • Lower temperatures can enhance neuropathy and numbness. This can lead to sores, blisters, and trauma to the foot.
  • Keeping feet warm and dealing with dry skin is of utmost importance
  • Dry feet can lead to cracking followed by skin breakdown. This breakdown can lead to wounds and infections. Daily foot inspections, cleaning and moisturizing the feet with foams or lotion formulated for the feet of people with diabetes can help prevent issues seen in this area.
  • As always, people with diabetes must maintain control over their blood sugar levels
  • There is no let up in the need to keep nails trimmed straight across and not rounded. Trimming may be done after bathing when the nails are softer. Seek help from a licensed provider if you are unable to do this yourself.
  • Footwear for people with diabetes in winter should follow basic principles of comfort, fit, and protection from the elements. It is more important for people with diabetes that seasonal footwear should provide adequate padding, room and protection from wet and cold temperatures.
  • The toe box of your footwear should be square or rounded to allow all the toes to wiggle freely. Avoid footwear that has seams whenever possible.
  • It is almost impossible to avoid dampness in shoes and socks over the winter, so it is important to remove wet shoes and socks as soon as possible. Allowing dampness to sit on your feet leaves them susceptible to fungal and bacterial infections. Try to carry an extra pair of socks for emergency situations. Make sure that shoes are thoroughly dry before wearing them again. If they’re not fully dry, choose a new pair to help keep your feet healthy and clean.

For further information, please consult a Canadian Certified Pedorthist. You can find one in your area by visiting https://www.pedorthic.ca/find-a-pedorthist/.

By Jim Pattison, B Sc., C. Ped (C)


October: A Focus on all things Pedorthics

This month we’ll be focusing on all things pedorthics. Still not clear on what a Canadian Certified Pedorthist does or what pedorthic treatment involves? We’ll be covering all of this and more. Here are some answers to some commonly asked questions to get you started!

What is Pedorthics?

The word pedorthics (ped-or-thics) comes from the Latin word for ‘foot’ (ped or pes) and Greek word for ‘straight’ or ‘correct’ (ortho). The first known use of the word pedorthics was in 1974 when it was defined as “the art and practice of designing, making, and fitting therapeutic shoes for relieving painful or disabling conditions of the feet.” (Merriam-webster.com) The definition has evolved to also include other appliances such as custom foot orthoses (orthotics, orthotic inserts) and modifications to off-the-shelf devices and footwear.

What is the history of Pedorthics in Canada?

It’s estimated that footwear has a 40,000-year-old history and pedorthics has been practiced in some form or another since long before it was defined in the dictionary. Pedorthics, as a profession in Canada, is still relatively young. 

The Pedorthic Association of Canada (PAC) was established in 1990 under the mandate to promote the study, practice, and knowledge of pedorthics in Canada. The College of Pedorthics of Canada (CPC) was later established to protect the public by administering a Code of Ethics and Standards of Practice for all who hold a title a CPC designated title. CPC titles include Certified Pedorthic Master Craftsman, Certified Pedorthist (Canada), and Certified Pedorthic Technician (Canada); in short form they appear as C. Ped MC, C. Ped (C), and C. Ped Tech (C), respectively. To hold a title with the CPC, one must also be a member-in-good-standing with the PAC. Currently, PAC has about 650 active members.

What background do Pedorthists have?

Canadian Certified Pedothists come from a variety of educational and experiential backgrounds. Many were drawn to pedorthics through a university degree in kinesiology or other health sciences like physiotherapy and occupational therapy. Others may have found their way there by way of working in footwear retail. (I even know a pedorthist who retrained in pedorthics after a career in furniture making!) It is important to note that all those holding a title from the College of Pedorthics of Canada have fulfilled the requirements to hold that title which includes supervised hours, competency exams (written and practical), and regular audited completion of continuing education and ongoing professional development. (Interested in learning more about becoming a Pedorthist? Visit https://www.cpedcs.ca/certification-exams/become-a-pedorthist/)

What do Pedorthists do? What can they do for me?

Pedorthists have a number of tools in their toolbox. They are problem solvers who have a knack for finding creative solutions. There is both an art and a science to the work that pedorthists do. Solutions may be for the purpose of improving alignment for more effective motion, accommodating of painful or prominent areas, or stimulating proprioceptive mechanisms (i.e. your awareness of your body in space and how it’s moving). We’ll be sharing more on specific pedorthic treatments as the month goes on so stay tuned!

Where do Pedorthists work? Who do they work with?

Pedorthists work in a variety of settings. Many are in what is considered private practice working in clinic settings others work in public hospital environments. Some work in a pedorthic-centric space, some work in multi-disciplinary spaces. Some are stationary, based in the same clinic everyday, while others are mobile and travel to provide service to more rural or isolated communities. Many pedorthists are also entrepreneurs having started their own clinics, labs, or retail shoe stores. Whether under the same roof or not, pedorthists pride themselves on being an important part of the health care team and work closely with doctors, nurses, physiotherapists, occupational therapists, surgeons, orthotists, and, perhaps most importantly, the clients themselves, to provide comprehensive care.

How do I get an appointment to see a Pedorthist?

You may start with a referral and prescription from your primary health care provider such as your family doctor, GP or Nurse Practitioner. To find a Canadian Certified Pedorthist in your area visit https://www.pedorthic.ca/find-a-pedorthist/ where you can search by location, name, or organization. Give one a call today! They will be happy to address your questions and welcome you in for a consultation and/ or assessment.

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


Managing Arthritis Day-to-Day: How Canadian Certified Pedorthists can help you improve your quality of life

September is Arthritis awareness month and many Canadian Certified Pedorthists across the country see people every day that struggle with foot and lower limb pain as a result of their arthritis. Arthritis is a collection of conditions affecting the body’s joints and other tissues. It can cause pain and inflammation in joints, restrict mobility and diminish one’s quality of life. There are more than 100 different forms of arthritis, many of which affect the foot and ankle.

Did you know that 1 in 5 Canadians have arthritis and experience pain every day as a result of their arthritis? Arthritis is more common in women than in men (1 in 4 women, compared to 1 in 6 men). Arthritis remains one of Canada’s most prevalent chronic health condition for which there is no cure. According to the Arthritis Society, by 2040 the number of Canadians living with arthritis is expected to grow by 50%. The Arthritis Society also says that in 40% of Canadians living with arthritis, their pain is severe enough to limit their daily activities. This means that significant foot and lower limb pain and discomfort disrupt the lives of millions of people living with arthritis in Canada.

Common Types of Arthritis

The two most common types of arthritis include Osteoarthritis (OA) and Rheumatoid Arthritis (RA).  Foot and lower limb pain is often more prevalent among people with certain types of arthritis, including RA and OA of the knee, hip, ankle and foot. Arthritis can affect people of all ages and becomes more common at older ages. While it is more common at older ages, more than half of Canadians with arthritis are younger than 65.

Osteoarthritis is a chronic disease that is caused by inflammation, breakdown, and loss of the cartilage in joints that occurs as one ages. Osteoarthritis affects over 60% of people in our population and is commonly referred to as degenerative arthritis. The prevalence of OA increases with age. Osteoarthritis is the most common type of arthritis affecting millions of Canadians. The joints most commonly affected by OA are the knees, hips, big toes, hands and spine. Osteoarthritis can affect people of all ages. Age is not a cause of OA but the prevalence of OA increases with age.

Rheumatoid Arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It can occur at any age, but tends to develop between the ages of 25 and 60. The joints commonly affected by RA are the small joints of the hands and feet.

Can Orthotics Help with Arthritis?

Pedorthic Treatment for Osteoarthritis:

  • Custom made foot orthotics or over the counter arch supports
  • Recommendation of appropriate and proper fitting orthopedic footwear
  • Off-the-shelf orthopedic footwear with built in rocker sole feature
  • Modifications to other footwear such as rocker sole to help reduce pressure to forefoot

Pedorthic Treatment for Rheumatoid Arthritis:

  • Custom made foot orthotics can help reduce plantar pressures under the feet of patients with RA
  • Off-the-shelf orthopedic shoes with rocker soles
  • Rocker soles modification is beneficial in reducing plantar pressures on the forefoot
  • In shoe accommodations can be used to relieve pressure on specific painful metatarsal heads by removing material from the inside of the shoe directly under the affected area
  • Footwear may need to be modified with Velcro closures, or alternative closures to help accommodate hands/fingers of patients with RA

Pedorthists can offer alternative or complimentary treatments to medication for people with arthritis to help improve mobility and flexibility in their feet and lower limb joints through the use of custom-made foot orthotics and footwear. Custom-made foot orthotics can improve the alignment of the lower body, reducing abnormal stresses on the body. They can also provide optimal cushioning to improve shock absorption and reduce pressure on any painful areas on the feet. Footwear is an important treatment option for reducing pain and improving mobility and function in people with arthritis. Footwear with a firm forefoot rocker sole is particularly beneficial for people with painful arthritis in the forefoot and toes as it promotes forward motion during gait while limiting toe flexion and pressure on the foot.

If you suffer from symptoms related to any form of arthritis, it is important to educate yourself on the condition so that you can help manage it and live your life to the fullest. Talk to your health care provider and visit your local Pedorthist to discuss treatment options. To find a Canadian Certified Pedorthist in your area visit https://www.pedorthic.ca/find-a-pedorthist/

By Amanda Bushby, HBKin, Dip. Ped, C. Ped (C)

 

 

References:

Delzell, E. (n.d.). Feet Hurt? Slip in Some Relief With Shoe Inserts [Blog post]. Retrieved from https://www.arthritis.org/living-with-arthritis/pain-management/joint-protection/foot-pain-shoe-inserts.php

Irish, Lisa. (2018). Rheumatoid Arthritis. Pedorthic Association of Canada Clinical Practice Guidelines (Second Edition).

Loranger, L. (2014, September 1). 7 Common Arthritis Myths Busted [Blog post]. Retrieved from https://www.physiotherapyalberta.ca/public_and_patients/the_you_movement_blog/7_common_arthritis_myths_busted

McColman, M.; Archer, G; Tso, D; Bajic, T; Pagtakhan, E. (2018). Osteoarthritis – Foot and Ankle. Pedorthic Association of Canada Clinical Practice Guidelines (Second Edition).

Arthritis Society. Arthritis Facts and Figures. Retrieved from http://arthritis.ca/about-arthritis/what-is-arthritis/arthritis-facts and figures


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