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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)


Preventing & treating common foot skin conditions: Blisters, Corns, Calluses

Blisters, corns and calluses are common skin conditions that are irritating for many people. The following sections will explain what they are, how they develop, and what to do to prevent and treat them!

What are the differences?

Corns develop from a twisting or pinching friction over a longer time, calluses develop from pressure over a longer time and blisters develop from rubbing at a larger area over a shorter time.

Visibly, corns have a dot in the middle, calluses are thickened skin and blisters have liquid between the skin layers, which protrudes out.

How they develop?

These skin conditions develop due to friction/rubbing or pressure between the foot and another surface. This surface could be the ground, the bottom of a shoe or even the sides of a shoe.

When these skin conditions develop on the bottom of the foot, this is typically from the mechanics of the foot. A common area for a corn or callus is at the ball of the foot. This is typically due to a collapsed metatarsal arch, which creates more pressure to the metatarsal heads (bones at the ball of the foot). Another common area is callusing or blistering on the inside of the hallux (big toe). This is typically from a collapsed arch leading to excessive pressure at this area while pushing off of the back leg.

Another reason for friction or pressure at the bottom of the foot is an external pressure point inside the shoe. Look for any foreign objects in the shoe and under the insert to prevent excessive friction or pressure from these objects.  

When these skin conditions develop on the sides or top of the foot, this can develop from either the mechanics of the feet or shoe fit. A common area for a blister is at the back of the heel, which can be from excessive heel motion. This heel motion can be due to excessive pronation (rolling in) or supination (rolling out), or from improper shoe fit causing the foot and heel to move around. Another common area for a blister or callus is the side of the arch. If the arch is collapsing excessively, it can rub on the side of the shoe, which may be also related to shoe fit.

There are many other ways that shoes and foot mechanics can lead to blisters, corns or calluses, but these are the more common areas.

Prevention

To prevent blisters, corns and calluses from developing, look for supportive shoes that fit properly, use the proper support when necessary and monitor for high pressure areas. Before these skin conditions develop, high pressure areas can be seen through redness or pain. If there is an indication of a high pressure area, a Canadian Certified Pedorthist can help to determine which shoe would be best for you and if support is recommended.

Treatment

To treat blisters, corns and calluses, the pedorthic treatments are similar to prevention:  supportive and properly fitting shoes, and orthotics to prevent the cause of the friction and/or pressure. Speak to your local Canadian Certified Pedorthist to specialize the treatment for your specific complaints.

Once the friction and/or pressure has been relieved through the proper shoes and support, there are other treatments to help remove the skin conditions. A podiatrist, chiropodist or footcare nurse can help to remove these skin conditions when necessary.

By Julia Hayman, C. Ped (C)


Physical Distancing Foot Health

During this new era of physical distancing, here are a few suggestions to help improve your foot health:

  • Morning stretches – If you aren’t having to rush in the morning, take a moment before or after breakfast to perform foot exercises that will give you a jump start on your feet feeling great all day. The exercises are similar to those typically prescribed for Plantar fasciitis or a Metatarsalgia injury such as rolling your foot on a massage ball, gently stretching the toes back to produce a soft pull on the bottom of the foot and simply writing the alphabet with your toes to give your feet and ankles some nice gentle movement.
  • Compression stockings – No better time than the present Pandemic to get your socks out! Most compression stockings are intended and designed for daily use and they provide many benefits for your feet and overall health such as improved circulation by helping the blood pump up the legs and back to the heart. If you experience even mild amounts of swelling, compression socks may be a useful tool to keep your legs feeling fresh and comfortable. Working remotely allows your attire to remain undiscovered during all your Zoom meetings, so switch it up and experiment with different textures and styles of compression socks.  A Pedorthist can guide you toward the styles and lengths that will suit your needs best.  
  • Donate unwanted shoes – We tend to accumulate many pairs of shoes over time and forget the reason why we don’t wear them. Use your time while self isolating to organize which shoes are bothersome and which shoes are for keeps. You should be able decide within 20 minutes of wearing the shoe around the house if it belongs in the discard pile. Take a look at the sole of the shoe, if you see that the soling has worn down or there are lots of compression lines/folds in the sole you may be in need of a replacement. You can also check the overall stability of the shoe by trying to bend or twist the shoe. If it easily folds with the stress of your hands then generally that shoe is not going to provide your feet with any support. Pack them up and donate! But don’t toss out all your dancing shoes, when the pandemic is over you may need them to celebrate!
  • Take a footwear inventory – With extra time on our hands, many of us have made intentions to become more active. Different activities tend to have different demands for footwear. Make sure you have a shoe for each type of activity to ensure prevention of falls and injuries. Review your footwear for; work, leisure, indoor, wet environments (pool, kayaking, boating) winter and summer weather. 
  • Exercise – It is the most excellent way to keep your feet and body in your best health. While indulging in a self-distancing round of golf, you may notice your custom orthotics do not fit properly in your golf shoes. Or, while gardening, your gardening shoes might lack support.  If you experience any pain or discomfort in your feet or lower limbs schedule a consultation with a Canadian Certified Pedorthist.
  • Foot Pampering – Lastly, this is an excellent time to pamper your feet. Start with having someone check the soles of your feet for any red flags or concerns such as a corns, blisters or cuts. A mirror will also allow you to quickly check the bottom of your feet if you are on your own.  An Epsom salt bath is a great way to relax, followed by a foot massage with a tennis ball, foam roller or your hands.

For all that your feet do, it is a great time to give them some much needed attention!

By Kathy Simpson, C. Ped (C)


Hiking Shoes: The Good and the Bad

There is a plethora of footwear on the market today, and while fashion is a substantial factor in people’s footwear selections, the function of footwear must also be taken into consideration. As a pedorthist, I often see patients who are in pain because they have focused on footwear fashion rather than function during busy days at work and recreational activities. For example, one of the most frequent problems I see in my patients are people wearing a slip-on casual shoe for their after-work walks. Any form of prolonged walking requires functional footwear.

Hiking has become a growing hobby during this pandemic, leading to more Canadians exploring this beautiful country and its infinite hiking trails. During my own hikes, I can often tell who is a seasoned hiker and who is a beginner based on their footwear. The major difference: hiking shoes. But are they really necessary? This article will dive into the good and the bad of hiking shoes.

High-end footwear companies invest heavily in research and testing their footwear to ensure that they are effective for the activity they are marketed to. For this reason, it is important to consider building a footwear wardrobe that features both fashionable footwear for when we want to look our best as well as functional footwear for when we need our body to perform. One or two shoe types are not appropriate for all activities. I too often see patients that have injuries, aches and pains because they took their casual shoe or sneaker out for a hike. Trust me, your sneakers prefer the sidewalk and the backyard, leave them at home! For hiking, you need a proper hiking shoe or at the very least a sturdy walking/running shoe. It really comes down to what type of trail you are challenging!

Hiking Shoes: The Good

Hiking shoes are designed and engineered for protection from the elements. They feature a stiff rugged outsole (the rubber on the bottom of the shoe) that is designed for gripping various surfaces including dirt, rocks, mud and water and protecting your foot from stepping on sharp rocks. If you’ve ever walked a rugged trail in a typical pair of sneakers you know too well what it feels like to step on a sharp rock!

Another key feature in hiking footwear is that they have increased ankle support. The difference between a hiking shoe and a hiking boot is that typically the boot will have more ankle support. Hiking boots go above the ankle while hiking shoes stay below the ankle (similar to your sneakers). Choosing between these two types of hiking footwear depends on the terrain you are hiking on and your personal injury history. When hiking on uneven surfaces it is common to have quick twists and rotations of the ankle. The higher the boot goes above the ankle the more protection it provides from twisting or spraining an ankle. But don’t be fooled, this extra support is not going to prevent injury 100% of the time.

Hiking Shoes: The Bad

Remember that rigid outsole that is protecting you from sharp rocks? Well, the trade-off for this is that because of the thick rigid outsole, your feet (and your brain) cannot feel the ground as well as when you are barefoot. This means your brain is getting fewer signals from the feet to help try and figure out if you stepped on a flat surface, angled surface, or a sharp rock. Your brain (and therefore the muscles in your foot and ankle) has to react to the forces interacting between the hiking boot and your foot, rather than between your foot and the ground. This causes a very brief delay in your brain’s response (and therefore the contraction of muscles) which means your muscles have to contract faster to compensate for this lost time. This can increase the chance of a twisted ankle if your brain doesn’t have enough time to react to the uneven surface.

Twisted ankles happen to me frequently on hikes. For me it usually occurs when I am distracted by a view, an animal, or a conversation with a friend (and my history of ankle sprains does not do me any favours!). It is also very common for them to occur later in a hike when your brain (not your muscles) is tired. Yes, you can exhaust your nervous system! That is why you probably tuned out somewhere in the last paragraph! Have you ever noticed that when you are hiking on rugged terrain, you are constantly scanning and analyzing the terrain ahead of you with your eyes? This is your brain’s strategy to mitigate risk and find the easiest route. Now imagine walking that same terrain with your eyes closed. I would rather walk rugged terrain with my eyes closed in my bare feet than in my hiking boots because my brain will get more sensory information and I am less likely to twist my ankle.

In Conclusion

So, should everyone stop wearing hiking boots when hiking? Of course not, or, maybe. It depends on the type of trail you are challenging, your personal biomechanics, your personal injury history and how many sharp rocks are on the trail! Personally, I have a history of ankle sprains and I need all the ankle support I can get. I prefer a hiking boot with a highly supportive ankle and an outsole that protects me from sharp rocks but also allows me to feel the ground a bit, and yes, feel the odd really sharp rock. If you are challenging a fairly flat terrain with a well laid out path, you likely need a hiking shoe with a less rigid outsole and could probably get away with wearing a sturdy walking shoe. If you are hiking a serious trail with elevation, rocks, and water, you likely want a hiking boot with the increased protection of a rugged outsole; but remember the trade-off, you need to be mindful of your terrain and use your eyes to give your brain extra information about the trail ahead. Visually scanning your route ahead is more important than stressing about what exact level of rigid outsole and ankle support your hiking shoe features. Your eyes are going to protect you from ankle sprains far better than your hiking shoes.

Be mindful, and enjoy the trails!

by Brandon Nethercott, R. Kin, C. Ped (C)


Five Fails of Summer Shoes

On hot summer days, sandals can be an easy breezy footwear choice. But, it’s important to choose your footwear carefully based on your planned activity and not the weather. Most sandals are not appropriate for long walks or exercise. They’re also not your best bet for activities such as running errands all day, walking the dogs or standing all day at work. Running or walking shoes may be more suited for these kinds of activities to help prevent or reduce foot pain at the end of the day.

Why are sandals not appropriate? Here are five features of sandals/flip flops that aren’t good for prolonged time on your feet:

Thin Base/No Cushioning

Most sandals have a much thinner base than running shoes. This reduces the cushioning and shock absorption of the shoe. If the shoe is not absorbing the shock, this force needs to go somewhere. That somewhere may be your feet or knees. The longer you walk, the more force that accumulates on your feet and knees. With a thicker base, some of the shock is absorbed in the sole. This reduces the force at your feet and legs, allowing them to last longer without pain developing.

No Heel Support

Heel support in your shoes is measured by the heel counter, which is the area directly behind the heel. To test the support at the heel counter, push on the back of the heel. The heel counter should be stiff.

Sandals lack support in this area because most will have a flimsy strap, or nothing at all. The heel counter holds the heel in place and prevents it from moving around. Those who are flat footed may have an issue with excessive heel movement, where this heel support becomes especially important.

Excessive motion at the heel may lead to pain and discomfort in your lower limb, especially after a long walk.

No Arch Support

This arch support can be from a custom orthotic or supportive insole, or from the stiffness of the midsole (thick sole area). The midsole stiffness holds the foot in place and prevents excessive motion around the arch.

Most sandals have a flexible midsole and a flat arch, lacking in support. Some sandals have a built-in arch support, which improves the support in the sandal. Even with this extra support, sandals are still not recommended for long walks due to the other factors explained in this article. 

Straps

Sandals contain straps instead of a full upper (material on the top of the shoe). The limited material on the top of the foot allows the foot to move around more. This could become an issue when on long walks because it would be more likely to roll an ankle. Also, the toes may grip more often to keep the sandal on the foot, which may lead to issues at the ball of the foot. In terms of support, straps don’t do a good job with holding your foot in place, which can be an issue for lower limb pain. This is especially true for those with flat feet because the feet tend to move around more often and need additional support to prevent this motion.

No Toe Protection

The problem with an opened toed sandal during long walks it that it exposes your toes to potential obstructions. As you start to tire on longer walks, you may inadvertently become careless and injure your exposed toes.

Before you walk out the door, think about the type of activity you are doing and adjust your footwear accordingly! If your sandals don’t have any of these problematic features then you’ve chosen well and they may be suitable for longer walks or activities. If you would like specific advice, talk to your local pedorthist for more personalized information!

By Julia Hayman C. Ped (C)


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