TODAY’S LESSON: ORTHOTICS 101

Confused about orthotics? Racks of over-the-counter arch supports, gel pads, or Dr. Scholl’s kiosks at Walmart…. everyone is calling their devices “orthotics”. Here is the truth about getting what you pay for:

Leonardo DaVinci called the foot a “masterpiece of engineering and a work of art.” The foot functions in 3 different planes (anatomical directions) from heel strike to push-off. It has built-in mechanisms to dampen shock, adapt to the terrain, and propel you forward. Your feet do this repeatedly for an average 115,000 miles in a lifetime. In order to accomplish this there are 26 bones and 20 muscles in each foot.

The science of human locomotion is called Biomechanics. In the foot, biomechanics deals with relationships… how the rearfoot and heel relate to the ground at impact, how the rearfoot relates to the forefoot during the step, and then how the forefoot reacts to the ground at push-off. It’s actually pretty amazing stuff, from a scientific point of view. For the person doing the walking or running, however, faulty biomechanics can mean the difference between comfort and pain. In sports, it can lead to muscle fatigue, inefficiency and poor performance. Faulty foot mechanics can also pre-dispose you to certain foot problems such as bunions, hammertoes, or heel and arch pain.

Orthotics are shoe inserts fabricated from 3D models of your feet. They adjust for structural and postural abnormalities in the foot in order to improve function. You might say they’re like eyeglasses for the feet!

Before considering orthotics, a thorough biomechanical exam performed by a trained specialist is imperative. Podiatrists have years of training in biomechanics and are considered the experts in this field.

There are three basic foot types: rigid, semi-rigid and flexible; there are also combinations of the three. Orthotics must be made specifically for your foot type. In order for an orthotic to function properly, it has to control the foot in all three planes from heel strike to toe-off. Only by correcting faulty forefoot and rearfoot relationships in gait, can we allow the muscle engines of the foot to fire strongly and efficiently. STANDING STILL ON A DR. SCHOLL’S KIOSK AND LOOKING AT YOUR FOOTPRINT CANNOT ANALYZE RELATIONSHIPS, CLASSIFY FOOT TYPE, OR DIAGNOSE YOUR PROBLEM.

Yes, some people can find relief in simply supporting the arch or cushioning the foot with gel. Orthotics are different than arch supports. Only orthotics can correct faulty biomechanics and offer treatment protocols that are foot type specific. Orthotics can be preventative as well as performance enhancing, and for many, provide a lifetime of function and comfort.

For more information, visit us at YourFootDoctor.com

Does your child have heel pain?

If you have noticed your child complaining of heel pain, especially with activity, you are not alone. Sever’s disease (aka calcaneal apophysitis) is a common growth plate injury in children, usually seen between the ages of 8 and 12. There is a large zone of growing bone in the back of the heel where the Achilles tendon attaches. Impact and tendon stress from running can cause a bruising and inflammation of that very sensitive growth center. Pain can be located anywhere from the back to the bottom of the heel. We see a greater onset of this complaint in the spring and fall coinciding with seasonal sports such as soccer and football.

Treatment includes rest, ice and anti-inflammatory medicines. Heel cups and pads can help, but your child may benefit from Orthotics. These are prescription inserts for shoes fabricated from plaster molds of the feet. They cup and cushion the heel as well as stabilizing and protecting the growth plate. Most insurances cover orthotics for this condition.

With proper protection your child should be able to continue participating in sports. In more severe cases, decreasing or even eliminating activity for a period of time may be necessary.

A thorough exam by our office can determine the best course of action to keep your child healthy and active!

Visit us on the web at www.yourfootdoctor.com

Dr. Scholl’s Orthotics: Smoke and Mirrors

Dr. Scholl’s Orthotics: Smoke and Mirrors

Have you been to Walmart and seen the kiosk for Dr. Scholl’s “revolutionary foot mapping technology” that promises “custom fit orthotics?” On the TV commercial you see “doctors” behind the machine like in the Wizard of Oz!

In reality, the “foot mapping technology” is a simple pressure pad. One steps on it and is told where they have high pressure areas and then it suggests a “custom fit orthotic”. First of all, a pressure pad can only tell you where there is more pressure when you are standing still. It knows nothing about what neutral position is, which is the ideal functioning position of the foot. This is the position your foot is captured in when a REAL custom orthotic is made. There is nothing “custom fit” about their process. A custom fit would require not only dispensing an orthotic made directly from a mold or 3D impression of both feet, but also a biomechanical exam including gait analysis. This is what allows a patient to wear an orthotic that is made specifically for their foot type AND gait pattern.

Yes, some people can find relief from and over-the-counter arch support. Claiming to provide custom orthotics without the biomechanical exam and gait analysis is nothing more than smoke and mirrors. Don’t believe everything you see on TV!

Visit us anytime at YourFootDoctor.com

Beware of "Toning Shoes"

Beware of “Toning Shoes”

The makers of those widely touted and over-hyped toning shoes continue to make claims that their shoes can create more shapely butts and tonier legs all without a workout. That's partly why toning shoes — which often have a rounded sole like a rocking chair, to stretch the wearer's leg muscles with each stride — represent the fastest-growing segment of the $17 billion-a-year athletic footwear industry.

Sketchers, the market leader, now has Pro Football Hall of Fame quarterback Joe Montana touting the shoes in an effort to attract men. Powell predicts that sales will explode 400% this year, to more than $1.5 billion.

Claims that toning shoes can significantly contribute to a person's fitness are "utter nonsense," says Barbara de Lateur, distinguished service professor of physical medicine and rehabilitation at John's Hopkins School of Medicine in Baltimore. De Lateur and other doctors warn that toning shoes create their advertised benefit by destabilizing how a person walks and say that wearing the shoes can result in strained Achilles tendons. De Lateur also says the shoes can be a particular problem for older consumers or those who have difficulty keeping their balance. The shoes have also been implicated in broken ankles as well as exacerbating knee problems in those people with pre-existing problems or knee instability.

There are elements of truth to the ads, according to doctors who have questioned the effectiveness and safety of toning shoes. But many of the doctors want more independent studies on the shoes, rather than industry-financed research. Other doctors, such as de Lateur, say they have seen enough to conclude that the shoes mostly represent hype.

The best shoe for extended periods of walking or exercise is still a well constructed athletic shoe, with a good balance of support and cushioning.

So, get out there and walk for exercise, but don’t fall prey to gimmicks and hype. Remember the Earth Shoe?!

You can always find good advice by visiting YourFootDoctor.com where “Healthy Feet Go Places!”

Don’t Let Foot and Ankle Injuries Hold You Back!

As the summer approaches, many Americans are hitting the gym (and the pavement) to burn off the winter pounds and get into bathing-suit shape. But even more Americans are looking for a way to combat what many experts have targeted as the greatest threat to our health in the 21^st century: obesity. Obesity has been linked to many of the leading causes of death and disability in America, from cardiac disease to diabetes to cancer. The combination of unhealthy fast foods and an increasingly sedentary lifestyle has left both adults and children with, on average, 17 pounds of extra weight. Those extra pounds can have many adverse effects on the feet and ankles as well. The reasons are simple; the more weight you carry, the more stress you place on the load bearing surfaces of your body and the more problems you will incur. But foot and ankle problems shouldn’t keep you from reaching your ideal, healthy weight.

The consensus among experts is that the most effective route to weight loss stems from a combination of healthy diet and an appropriate exercise program. A common “excuse” for not taking up and exercise program, or sticking to it, is the pain and difficulty that can result. Many of these aches and pains are located in the lower extremity, the knees, hips, ankles, and feet. But this should not ultimately be a deterrent to a successful exercise program. There are many options for exercise that can remove some, or all of the load placed on the lower extremity, yet still provide an excellent cardiovascular workout. Biking, swimming, rowing, and the elliptical machine all remove much of the joint stress of running while providing a comparable workout. Easing into an exercise program is important to avoid injuries as well as to keep from becoming discouraged by physical and psychological setbacks. Stretching, both before and after exercise, as well as warming up slowly is important to avoid muscle strains. Wear appropriate shoes for the activity. I recommend a reputable sport or specialty athletic shoe store. The staff will understand your goals and your foot type to fit you better. Shoes can be pricey, but consider them an important part of your athletic “gear”, just as you would a tennis racquet or golf clubs. Also, be sure to see your general physician to ensure that your cardiovascular system is healthy enough to undergo the increased strain from exercise.

Losing weight will both improve your overall health and decrease your incidence of foot and ankle problems. Foot and ankle issues should not stop you from reaching your goals. If you develop foot or ankle issues during your new exercise program, be sure to come in and let us help you. You can find us at www.yourfootdoctor.com .

Have a happy and healthy Spring and Summer!

Barefoot Running Basics

Barefoot running has seen a rise in popularity over the last few years, though it is of course a much older form of running than the more popular shod running. Barefoot running is thought of as a more natural method of running, where the shoe is not able to influence the biomechanical functioning of the foot. Barefoot running also leads to a more forefoot running style (versus heel to toe running), which causes higher activation of the plantar flexor muscles. We will examine some of the arguments for and against barefoot running, and discuss some steps you can take if you would like to try this alternate training technique.

A quick search for barefoot running online will lead to hundreds of web sites and blogs dedicated to barefoot running. Like most other alternate, against the grain ways of doing things, barefoot runners are passionate about their cause. Getting past the issues that some of the bloggers have with the shoe industry and their ideas on conventional norms, you can get to the core of barefoot running philosophy: get back to doing what we are designed to do. We weren’t born with shoes on our feet, so we don’t need them now.

Empirical studies support many of the claims of the barefoot running crowd, but with the understanding that there are people and conditions where barefoot running is not recommended. A Harvard study (which can be found at www.barefootrunning.fas.harvard.edu) on barefoot running has focused on the importance of forefoot or midfoot strike in barefoot running. Approximately 75% of shod runners strike with the heel first, which several researchers have hypothesized can lead to some repetitive stress injuries. The Harvard team stresses, however, that no studies have proven that forefoot running will lead to fewer injuries than shod heel strike runners. There is also the possibility that barefoot running requires less energy than shod running, and not only because of the decreased weight. A study in the International Journal of Sports Medicine from 2005 (1) found that barefoot running increases the elastic energy storage of the ankle joint, which leads to more efficient running.

There are as many arguments against barefoot running as there are for. The most obvious of these arguments is the lack of protection that barefoot runners have on the plantar surface of the foot. This is especially important for diabetics or those with diminished wound healing capabilities. Barefoot running is less comfortable, and lacks the lateral support provided by running shoes that is important in preventing over-supination or over-pronation. Barefoot running also lowers the distance one can comfortably run, which may explain why we have yet to see elite-level marathoners remove their shoes.

Until more empirical data surfaces it will be difficult to recommend either for or against barefoot running. If you are considering a barefoot running program, be sure to follow some basic precautions. Be sure to run on a uniform, clean surface. Don’t run at night or if visibility is compromised. Take the transition slowly to avoid injury. Many shoe companies have come out with minimal footwear, a thinner more flexible shoe that mimics barefoot running. This is a good option for transitioning to a barefoot running program.

As always, if you develop foot or ankle problems after beginning this new program give us a call and come in for a visit. You can find us at www.yourfootdoctor.com . Enjoy the beautiful weather!

(1) C. Divert, G. Mornieux, H. Baur, F. Mayer, and A. Belli. "Mechanical Comparison of Barefoot and Shod Running." International Journal of Sports Medicine 26.7 (2005): 593-98

Flip-flop Advice for Summer

Flip-flops have for several years established themselves as the summer footwear of choice. Easy to slip on and off, open-aired, and resistant to the sand and surf, flip-flops seem to be the perfect summer shoe. But the damage done to your feet from continued flip-flop wearing may largely outweigh the benefits of this summer staple. Extended wearing has been associated with heel and arch pain, as well as other foot and ankle damage as a result of instability and poor foot protection.

The damage from flip-flops largely stems from the lack of support given to the foot, caused both by the design of the shoe and the materials used. Flip-flops are generally very flat with little arch support, and often cause the wearer to use the toes (either by pinching them together or flexing them upwards) to keep them on. This combination places a high amount of strain on the ligaments of the base of the foot. Extended wearing of flip-flops is a major contributor to plantar fasciitis (heel and arch pain). This is a problem that will generally occur with repeated wearing, but occasional wear can also cause a number of problems. Flip-flops are open-toed, which can cause painful stubbed toes, as well as vulnerability to cuts and scrapes. The thin soles can often fold over at the tip causing loss of balance. Flip-flops have zero ankle support, which can cause ankle sprains or even fractures.

There are advantages to wearing flip-flops in the summer. They can help to avoid burning your feet on hot sand, or cutting the bottoms on pieces of glass or rock. They can help your feet remain dry and avoid fungal infections…a must in public locker rooms and showers. But like any other painful fashion statement, they are best used in moderation.

Enjoy the beginning of summer and the increasingly beautiful weather, and while you’re inside at your computer visit us at www.yourfootdoctor.com !