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Alleviate Arthritis Pain with Custom Orthotics

There is a special need for orthotics for patients with arthritis. Depending on the patient’s needs, custom orthotics may help alleviate pain and discomfort in several ways including:

Shock Absorption

Generally, custom orthotics created for patients with arthritis are softer and made from different materials than other orthotics. This construction difference is designed to optimize shock absorption and decrease the shock going into the foot. Shock in the foot is something that aggravates pain in the affected area.

Orthotics for patients with arthritis are more likely to be accommodative orthotic – they are softer with a little more “give” in them. The more rigid orthotics tend not to absorb shock and pass it along to the sore joints in the foot. It is less of a functional orthotic – one that is to hold the arch or another area of the foot up. 

Decreased Pressure on Sore Spots

If the patient’s foot has a sore spot, the custom orthotic may be created with an area of the orthotic dug out or “excavated” in the area (shown) where the foot is sore to decrease the pressure on the affected area.

Reduced Toe Joint Motion

If the arthritis is in the toe joints (metatarsal joints), a stiffer material may be put under those joints to stop them from bending or bending as much. If the motion in a joint can be slowed down or stopped, pain in that area can be reduced or eliminated. At the left is a photo of a device called a Morton’s Extension. A more rigid shell is placed on the orthotic and the piece at the toe stops the big toe from bending. If a person has arthritis in that joint, keeping that joint from moving will reduce or eliminate the pain when walking. This can be a carbon fibre plate that is put in the shoe or included in an orthotic

There are many options available to you if you have arthritis to help keep you more active and involved in healthy exercise. Contact your local pedorthist to see how custom orthotics might benefit you.

By Jim Pattison, C. Ped (C)

 


Tell-tale Signs You Might Need Orthotics

Orthotics are a great way to deal with mechanical issues in your feet that may be causing or will cause pain. Without a trained eye, how can you determine if orthotics can be beneficial? Here are some visible and pain signs that may indicate the need for orthotics.

Visible signs

Arch collapse

There are three arches in the foot, but there are two that are more commonly supported with orthotics. The third ends up being supported with an orthotic, but is typically not the main focus.

Collapse of the medial arch, or the arch on the inside of the foot, is the more common reason to wear orthotics. This collapse can occur while standing, or as a low arch with or without standing, which is called pes planus. With this medial arch collapse, it strains structures under the foot, as well as the supporting structures around the ankle, which travel up to the lower leg. The effect can travel higher up the body, because when the medial arch collapses, the lower and upper leg rotate inwards excessively, which strains the knee, hip and back structures. The way you can visibly see this collapse is by looking at this arch while standing. If you cannot place a couple fingers under your arch, this may indicate an arch collapse. Another part of the body to look as is the ankle. With a medial arch collapse, this ankle can be shifted inwards. This ankle shift may not always be present as you can have the collapse without the ankle shift.

The metatarsal arch (arch at the ball of the foot) is another common arch that is supported with orthotics. With this metatarsal arch collapse, it places excessive pressure to the bones at the ball of the foot and the structures surrounding the ball of the foot. A couple signs that may indicate this arch collapse are clawed toes and callusing under the ball of the foot. To visibly see this arch collapse, look at the “pad” at the ball of the foot. If this pad is a straight from one end to the other, or the middle part bulges out further, this can indicate an arch collapse.  

High Arch

A high medial arch is the other extreme to the low arch, which can also benefit from orthotics. A high arch can hinder shock absorption and strain the structures on the outside of the foot and lower leg. To visibly see this arch, there are a few signs to look for. There may be a bump on the top of the foot, which can make it hard to fit into shoes. Callusing may be visible under the ball of the foot, only under the outside and inside bones. Also take a look at the shoes, as they may be worn down along the border of the outside of the heel.

Pain Signs

 

Pain can be another indication that orthotics may be needed. The more common pain areas that can be related to the foot mechanics are the foot, knee, hip, or lower back.

The more common areas of foot pain are at the heel, arch and ball of the foot. Depending on the severity of the pain, it may occur in the morning when you first step out of bed, at the end of the day or while performing a specific activity.

Knee, hip and lower back pain may develop from the feet as the lower and upper leg responds to actions at the foot. Because pain may also be related to other factors higher up, other professionals such as a physiotherapist or chiropractor may be recommended to add to the treatment protocol.

Back pain may also be present due to a leg length discrepancy. When one leg is shorter than the other, the hips are not aligned properly and can affect the lower back. There are different types of a leg length discrepancy, which can both be addressed with an orthotic. Talk to your local Canadian Certified Pedorthist to see if a leg length discrepancy may be present.

If the visible signs are present w

ithout pain, orthotics or an over-the-counter insert may be beneficial to prevent pain in the future.

Book an appointment with your local Canadian Certified Pedorthist to determine how orthotics can help you!

By Julia Hayman, Canadian Certified Pedorthist


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)


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