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Pedorthics and Arthritis: Debunking Common Myths

As Pedorthists, we see patients with all types of medical issues that affect the foot and ankle. Arthritis is one such condition that can create chronic pain and cause problems with walking, standing and balance. Although arthritis is common, affecting about 20 percent of Canadians over age 12, it is not a generally well understood condition. Many myths about arthritis exist, but it’s important to set the record straight so patients can be well informed about their health.

Here are some common myths that many Pedorthists have encountered in our clinics:

Myth #1: Arthritis is an “Old People” Disease

There is a common misconception out there that arthritis only affects older adults. While it is true that people aged 55 and over are four times more likely to have arthritis than younger people, arthritis can affect people of all ages. In fact, arthritis affects three of every 1,000 Canadian children, and three out of five Canadians diagnosed with arthritis are of working age.

Myth #2: There’s Only One Kind of Arthritis

This is simply not true. The term Arthritis is an umbrella term for more than 100 related diseases affecting joints, tissues, or even the entire body. Common forms of arthritis like osteoarthritis and rheumatoid arthritis are what most people think of when they hear of arthritis, but other common conditions such as gout and lupus are forms of arthritis that might not come to mind as often. Carpal tunnel syndrome is another condition related to arthritis, and can be caused by the stress of repetitive motion.

Myth #3: Arthritis Only Affects the Joints

Arthritis can affect much more than just the joints: muscles, tendons, connective tissue, bones and bursa (the fluid-filled sacs around joints). Lupus can also affect organ functioning. Living with the chronic pain of arthritis can also have a profound impact on one’s mental health, and can contribute to depression, anger, disrupted sleep, fever, unexplained weight loss, weakness as well as fatigue. See our blog article for more on Pedorthists and chronic pain.

Myth #4: Exercise Makes Arthritis Worse

Thanks to recent studies, it is now recognized that exercise is essential to manage chronic pain, including arthritis. It may seem counterintuitive, but lifting weights and performing weight-bearing activities on your arthritic joints can actually help. This is because these activities can build muscles, which supports and protects joints in the long run. The best way to exercise with arthritis is by participating in low-impact exercises that encourage range of motion like walking, yoga, tai chi or water aerobics. Talk to a health care professional about joint-friendly activities that suit your interests and abilities.

Myth #5: Arthritis Can’t be Prevented

We may not know everything about arthritis, but we do know that healthy lifestyle choices like proper diets, exercise and maintaining a healthy weight can help reduce the risk. Studies have shown that among women, having excess weight increases the risk of arthritis in the hips and hands, while in men it increases the risk of gout.

If you work behind a desk all day, or have a job that requires repetitive motions, you can take simple steps to avoid pain and inflammation in your joints, which could lead to arthritis. Take frequent breaks, get up and move around, use proper form when lifting or moving items, and make sure your workspace is set up in an ergonomic way. It is also important to wear proper footwear to improve shock absorption and reduce impact on the joints.

Myth #6: Medication is the Only Treatment for Arthritis

Many people suffering from osteoarthritis may take acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation, but this isn’t the only way to manage one’s symptoms. Some try physical and occupational therapy, while others may have surgery to remove some or all of an affected joint.

When it comes to arthritis in the feet, ankles, knees and hips, Pedorthists can offer alternatives to medication to help improve mobility and flexibility in lower limb joints through the use of custom-made orthotics and footwear. Custom orthotics can improve the alignment of the lower body, reducing abnormal stresses on the joints. They can also provide optimal cushioning to improve shock absorption and reduce pressure on any painful areas of the feet. 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 forefoot.

If you suffer from arthritis, it is important to educate yourself on the condition and the myths surrounding it so you can manage your condition and live your life to the fullest. Talk to your health care provider and visit your local Pedorthist to discuss ways to improve your mobility and range of motion by using custom-made orthotics and footwear. Click here to locate a Pedorthist near you today.

By Heather Orosz, BSc, 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 

Dostal, E. (2012, March 9). 8 Myths About Arthritis—Busted! [Blog post]. Retrieved from https://www.prevention.com/health/g20482654/8-myths-about-arthritis-busted/

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

Rogers, E. (2018, September 5). 8 Myths About Arthritis Debunked [Blog post]. Retrieved from http://www.everythingzoomer.com/health/longevity/2018/09/05/8-myths-about-arthritis/

Statistics Canada. (2017). Table 13-10-0096-06, Arthritis, by age group. Retrieved from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009606


Foot Health Awareness Month

May is our favourite month as it is Foot Health Awareness Month!  

A 2014 study revealed that nearly 75% of people over the age of 18 have experienced foot pain. Nearly half of those surveyed said they would be more active if they could get rid of the foot pain, yet only a third of them said they had talked to a healthcare professional about their pain.

Canadian Certified Pedorthists hear again and again from patients that they delayed booking an appointment because they thought the pain was something they had to live with. To help you avoid months of unnecessary foot and lower limb pain, this month, we’re going to be sharing many tips on how to keep your feet healthy as well as how to relieve different types of pain.

But first we want to make sure you know what Canadian Certified Pedorthists do and how they can help you.

What is a Pedorthist?

Canadian Certified Pedorthists – C. Ped (C) – are foot orthotic and orthopaedic footwear experts. They are trained in the assessment of lower limb anatomy and muscle and joint function. They help reduce foot and lower limb pain through the use of footwear selection and modification and by designing, fitting and modifying custom foot orthotics. In short, they improve your mobility so you can continue to live a healthy active life.

Canadian Certified Pedorthists work alongside physicians, nurse practitioners and other healthcare providers. To find a Canadian Certified Pedorthist in your community visit www.pedorthic.ca/find-a-pedorthist/

Come back frequently this month to find out more about pedorthists and learn foot health tips.


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

 

 


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