Website introduction from www.painfreefeet.ca

New video on ingrown nails from www.painfreefeet.ca website

New heel pain video on www.painfreefeet.ca website

Diabetes Awareness Month and the 90th anniversary of the discovery of insulin by Banting and Best

I want to thank Elaine Petreman who invited me to speak on "Foot Care and Diabetes" yesterday afternoon at St Mark's Church in Peterborough, ON. Over a 90 minute period I answered many questions posed by the attendees during an interactive presentation. There were many sponsors present at the event. Elaine along with Greg Mather organized a great event. They both volunteer for the Peterborough chapter of the Canadian Diabetes Association and should be commended for helping to educate people about their diabetes. The discovery of insulin was a very important discovery by the medical researchers at the University of Toronto in 1921. Their discovery has saved countless lives around the world.  Unfortunately, diabetic complications such retinopathy(eye), nephropathy(kidney), neuropathy(nerve) and macrovascular(blood vessel blockage) are common problems that occur in diabetics with uncontrolled blood glucose.  The prevention of diabetic foot ulcers can save the heath care system the cost of foot and leg amputations. The work of the Canadian Diabetes Association is important to help educate Canadians of the dangers of uncontrolled diabetes and its complications.

Andy Murray was wearing a protective ankle brace during the US Open

The US Open tennis men’s semi final matches have been entertaining. The afternoon match between Roger Federer and the eventual winner Novak Djokovic was a long hard battle. I am currently watching Andy Murray and Rafael Nadal playing an exciting match. Many of the rallies have been long in duration with some incredible ball placements.
During the match I noticed that Andy Murray was wearing an ankle brace which appeared to be an AirCast A60™ ankle brace. The brace he was wearing was a protective ankle brace. This ankle brace allows him to sense if he is about roll over on his ankles. Andy Murray suffered an ankle roll over injury during the French Open in May 2011. This past ankle injury does not appear to be hindering his play in the US Open.
If you suffer have from an ankle sprains while playing recreational or competitive sports you can understand how your ability to run, start, stop, turn, jump or land is compromised. Assuming no breaking of bones has occurred during the ankle roll over an ankle sprain is caused by a tearing of the ankle ligaments crossing the outside of the ankle joint. The rehabilitation of an ankle sprain requires a number of steps:

1. The rehabilitation process begins by reducing the swelling and pain around the ankle joint using compression, ice and elevation.
2. Once the pain and swelling have been reduced strengthening exercises for muscles around the ankle joint
3. Modified activity can begin.
4. Eventually proprioception exercises are prescribed to reestablish sensors on the ankle ligaments. These sensors give continuing feedback to the brain about the position of the ankle joint while running, turning, jumping or landing.
5. Using a protective ankle brace such as a AirCast A60 can enhance proprioception and possibly prevent an ankle rollover

A protective ankle brace can be prescribed to individuals with a high probability of an ankle roll over due to a laterally unstable foot and lower leg structure. Over the counter protective ankle braces are considered ankle foot orthotics.
In some cases, a custom made ankle foot orthotic can be prescribed if the ankle joint becomes too unstable for an over the counter ankle brace. A custom ankle foot orthotic requires a cast of the foot and lower leg. Custom ankle foot orthotics addresses the foot instability as well as providing protection for the ankle ligaments.
Lateral ankle instability is just one of the indications for the use of a custom ankle foot orthotic. Ankle arthritis, extremely flat feet and drop foot are other indications for an ankle foot orthotic.
Unfortunately, Andy Murray lost his match. The pairing for US Open final is Novak Djokovic and Rafael Nadal. It should be a good match.

The barefoot running craze has created a new category of running shoe termed “Minimalist”

 Running shoes are used by the vast majority of runners. During the past 2 years you may have watched someone barefoot running on the sidewalk, running track or grass field. Barefoot running differs in a number of ways from runners wearing running shoes.

1.      Barefoot runners adopt a different style of running. A barefoot runner will initially strike the ground with the ball of the foot which is followed by gradual lowering of the heel to the ground. This results in the initial impact force being greater underneath the ball of the foot but is reduced by the gradual lowering of the heel to the ground.  

2.      A runner wearing running shoes will initially strike the ground with their heel or mid-foot which is followed by a gradual lowering of the forefoot to the ground. This results in the initial impact being greater underneath the heel followed by an increase in force underneath the forefoot as the heel lifts off the ground.

3.      Barefoot runners have shorter stride length between left and right foot strikes.

4.      Runners wearing shoes who are heel strikers will generally have a longer stride length between left and right heel strikes.

5.      Muscle activity also differs in a barefoot runner vs. a runner wearing shoes. The calf muscles via the Achilles tendon which inserts into the back of the heel controls the lowering of the heel to the ground.

6.      In contrast, a runner wearing running shoes who heel strikes will gradually lower the forefoot to the ground. The anterior shin muscles via the tendons that insert into the top of the foot control the lowering of the foot to the ground.

Running injuries are always a concern whether the runner wears shoes or goes barefoot.

Most of the running injuries that have been documented in the medical literature have occurred in runners wearing running shoes. To date there have no studies documenting the types of injuries resulting from barefoot running.  Nevertheless, it is possible to predict the injuries that might occur due to barefoot running.

1.      Increased impact underneath the ball of the foot might cause stress fractures in the metatarsals or blistering/callus formation on the plantar skin.

2.      Achilles tendonitis may occur due to calf muscle overuse or tight calf muscles.

In the past 25 years, the running shoe industry has developed different categories of running shoes in response to the types of running injuries that have occurred due to faulty lower extremity mechanics.

The four general categories of running shoes are:

1.      Cushioning,

2.      Mild stabilization,

3.      Moderate stabilization and

4.      Maximum control.

The cushioning shoe is recommended for a runner requiring maximum shock absorption. The cushioning shoe will be appropriate for a runner with high arches. The maximum control shoe is recommended for a runner with very flat feet requiring support in the arch.

Vibram 5 Fingers

The minimalist running shoe is a new category recently introduced by the running shoe companies in response to the interest in barefoot running. The minimalist shoe has been developed to help protect the foot and cushion forefoot impact. The running shoe companies are promoting the style of barefoot running (short stride and forefoot strike) coupled with forefoot protection using the minimalist running shoe. There are four examples of minimalist running shoes pictured.

The minimalist shoe can be recommended to a runner wanting to adopt a barefoot running style with the proviso the runner has no faulty lower extremity mechanics.

www.painfreefeet.ca

New Balance 10 Minimus Women's

New Balance 10 Minimus Trail Men's

New Balance 10 Minimus Men's

Is my child's in-toeing serious?

I have treated many children with foot problems over the past 26 years. One of the childhood foot problems that I have treated is in-toeing. In-toeing occurs in about 2 out of every 1000 children.
Many parents become concerned when they see their child’s feet pointing inwards while walking, especially if it is associated with tripping. Other concerns include the abnormal shoe wear on the outside of the toe box due to scuffing of the toes while walking, the child complaining of being tired after walking or the child asking to be carried instead of walking.

My goal as a chiropodist/podiatrist is to inform the concerned parent that in-toeing almost always self corrects as the child grows towards adulthood.

If you watch the majority adults walk you will notice their feet will point straight ahead or outward. In-toeing ("pigeon toes") describes a position where the feet turn inward instead of pointing straight ahead during walking or running. In-toeing happens from birth to adolescence due to a delay in rotational or torsional unwinding during a normal bone development. There may be a prior family history of in-toeing. Prevention is not usually possible because the causes are due developmental or genetic reasons.
There are three causes of in-toeing:

1. Internal femoral torsion (also called femoral anteversion) occurs when the femur or thigh bone has an inward twist in the shaft of the bone.
2. Internal tibial torsion occurs when the tibia or shinbone in the lower leg has an inward twist in the shaft of the bone.
3. Metatarsus adductus occurs when metatarsal bones in the foot are bent inward like the shape of a kidney bean.

These three causes of in-toeing can be identified by performing a series of measurements which involves taking six different measurements of the angles of the feet, legs, and hips when the child is in various positions. A gait analysis is also performed to observe to position of the knee cap and while walking or running. This combination of examinations allows for detection of the three causes of in-toeing.
Is in-toeing serious?
The tripping associated with in-toeing is the parental concern that usually initiates an office visit. Apart from this concern, children with in-toeing are generally healthy and have no limitations in their activities or sports. Parents can expect their child to live a normal, active, and healthy life. Some young children with in-toeing may have problems getting shoes that fit, because of the curve in their feet. A shoe fitting problem might make parents consider treatment for their child. In very rare cases, some children have a severe twist in the leg bone (tibia) or thigh bone (femur), which can be a concern because it looks bad or causes tripping, but as mentioned before in-toeing can self correct by adulthood. In a very tiny proportion of children with in-toeing, surgery may be required to correct in-toeing due to severe internal femoral or tibial torsion.

In summary, the vast majority of children who have in-toeing will gradually self correct until their feet point straight ahead as they develop into adults. The tripping associated with in-toeing also reduces over time.

Please follow the link to find further information on the causes and treatments for in-toeing at www.painfreefeet.ca

I have shin splints, what does this mean?

I decided to write about shin splints after discovering it was the most read topic on my website this past month. On reflection, I should not really be surprised, because spring weather leads to increased physical activity and overuse injuries.

Shin splints are common among runners, race walkers and individuals who participate in soccer, football, lacrosse and dance. Shin splints are a non specific diagnosis for lower leg pain. One common cause of shin splints is periostitis. Periostitis is an inflammation of the periosteum. The periosteum is a dense connective tissue covering the shin bone or tibia. Periostitis results from an overuse injury that usually develops gradually over a period of weeks to months. Periostitis can also occur after one excessive bout of exercise. The periosteum serves as an attachment site for the muscles originating on the tibia. Muscle overuse causes the periosteum to pull away from the tibia causing inflammation.
Periostitis of the tibia has also been classified as medial tibial stress syndrome. Medial tibial stress syndrome is associated with an overuse of the anterior and posterior tibial muscles. Both of these lower leg muscles have attachments via tendons to the foot bones. The origin of these two muscles is where you will complain of pain. The locations of pain are the lower inside half of the tibia and, less commonly, the upper outside portion of the tibia.  You will usually notice the pain when you start exercising and it decreases or goes away as you continue to exercise. Your pain maybe worse after you stop exercising or it will bother you the next morning.

The pain from periostitis of the tibialis posterior muscle is located on the lower inside half of the tibia. Abnormal foot and lower leg alignment can cause excessive flattening of the foot that requires excessive work from the posterior tibial muscle to help stabilize the arch. This stress causes microtears and inflammation in the periosteum attached to the lower inside half of the tibia. Custom foot orthotics paired with the appropriate running shoes is quite successful in treating posterior tibial muscle periostitis due faulty foot mechanics.

Pain from periostitis of the anterior tibial muscle is located on the upper outside portion of the tibia. Anterior shin splints often occur in both legs. Anterior shin splints is caused from over-training or improper training, especially, if your running program includes a lot of excessive downhill running or a sport requiring rapid starts and stops.
You may also have an imbalance between the weaker anterior muscle group and the larger and stronger posterior group. Tightness of the calf muscles may further aggravate this condition. These stresses result in microtears and inflammation in the periosteum attached to the upper outside portion of the tibia. Successful treatment includes modified rest with changes in your training program. Physical therapy to address muscle weakness, tightness and imbalance is paramount. Foot orthotics will be indicated if abnormal foot mechanics are the cause of the muscle tightness or imbalance.
In some cases of periostitis there can be a progression to micro-fractures or stress fractures along the tibia. Generally there is not a sudden break of the bone but usually you will complain of a gradual increase in pain until it becomes quite severe.

There are a number other causes of lower leg pain that can mimic periostitis. They include: tendonitis, a partial muscle tear, growth plate inflammation, referred lower back pain, lower leg muscle imbalance, a leg length difference and compartment syndrome.
Compartment syndrome can occur in muscles originating from the tibia. Muscles are surrounded by fascia which allows for a separation between adjacent muscles. This fascia does not stretch. Pressure within the muscles can increase due to activity. The fascia does not allow the pressure to diminish. This can lead to muscle damage and pain. If you have shin splints a proper diagnosis via a thorough history and physical examination is essential to rule out causes other than periostitis.

Conservative treatment for tibial periostial injuries usually consists of modified activity, ice, immobilization, compression and elevation, physical therapy, foot orthotics, appropriate footwear, and proper training techniques. However, the most important part of the treatment is educating you on the tissue(muscle, tendon, fascia, ligaments, periosteum and bone) injury process. I discuss the concept that everyone has a unique biomechanical yield point where tissue injury occurs, even if you have the best training technique, footwear and equipment.  In other words, you have to listen to your body and give yourself enough time to recover from any tissue injury (minor or major) before you resume exercising. If you continue to exercise without adequate tissue recovery, the tissue injury yield point becomes lower when compared to the previous exercise session. This means even less activity can more tissue damage. This is why less activity can make your shin splints worse if tissue recovery is not allowed to occur during a rest period.  For more information on the treatment protocol for shin splints please visit www.painfreefeet.ca

What are the benefits and risks of wearing MBT™ footwear?

In this blog, I will discuss the benefits and risks of wearing MBT™ footwear if you have a specific foot and lower leg problem.  To help answer this question, I have summarized feedback from various chiropodists and podiatrists from Canada and the USA gathered by Dr. Chris MacLean, Director of Biomechanics at Paris Orthotics Ltd in Vancouver, BC.

Some of the benefits of wearing MBT shoes are definitely due to the rocker shaped outer sole.  A pilot study in 2005 by Department of Orthopaedic Surgery at the Edinburgh Royal Infirmary used pressure sensing insoles inside of MBT footwear while the study participants were either standing or walking. They compared the pressure readings in the MBT™ shoes to pressure readings inside of a flat soled running shoe. The study specifically compared the peak pressures of the heel, midfoot, ball of the foot (forefoot) and toes between the two shoe groups.

Results of this study showed:

1.       MBT’s decreased peak pressures in the forefoot and midfoot when walking,

2.       MBT’s decreased peak pressures and in the midfoot and heel when standing,

3.       Peak pressure was raised in the toes in MBT’s in both standing and walking conditions,

4.       The most dramatic difference was during standing, where the MBT shoes increased peak pressure in the toes by 76%, and lowered peak pressure in the midfoot and heels by 21% and 11% respectively and

5.       The most consistent finding, when both standing and walking, was decreased pressures in the midfoot in MBT’s.

These results of the Department of Orthopaedic Surgery at the Edinburgh Royal Infirmary study are consistent with the feedback that Chris MacLean gathered on the benefits of wearing MBT footwear. 

What foot problems can benefit from MBT footwear?

1.       Stiffness in the big toe joint(hallux limitus)

2.       Bunions

3.       Heel pain or plantar fasciitis

4.       Pain in the forefoot( metatarsalagia)

5.       Decreasing weight away from the ball of the foot

6.       Painful callus on the ball of the foot

7.       Inflammation of the joint capsule in the forefoot

8.       Neuroma ( irritation of nerves between the metatarsal bones of the foot)

9.       Foot osteoarthritis

10.   Someone who mostly stands while they work.

In my last blog, I discussed the effects of wearing MBT footwear. I have summarized these effects.

1.       Wearing MBT shoes increased the activity of many of the lower leg and thigh muscles while subjects stood or walked wearing MBT shoes. 

2.       Wearing MBT shoes is similar to balancing on a wobble board.  Wobble boards are used for rehab after an ankle sprain which helps to strengthen muscles around an injured ankle joint and promote balance.  Postural sway increased while wearing MBT shoes. 

3.       Wearing MBT a shoes while walking caused an increase in ankle joint dorsiflexion (dorsiflexion of the ankle happens when you move your foot towards your leg) from initial heel contact through to midstance (midstance is the time when your swinging leg is even to your weight bearing foot and leg). Increased ankle dorsiflexion at contact to midstance makes your calf muscle stretch more while walking as compared to subjects wearing the New Balance shoe.  If you have tight calf muscles the use of MBT footwear may cause strain on the tendo Achilles resulting in tendinitis.

If you are considering MBT footwear you probably should have good balance, good muscle flexibility and an intact nervous system.  

These are problems that are considered too risky to use MBT footwear:

1.       Achilles tendinitis or peroneal tendinitis(these tendons are found on the outside of the foot and are damaged during ankle sprain),

2.       Poor balance,

3.       History of ankle sprains,

4.       Loss of nerve transmission to the lower extremities such as diabetic neuropathy,

5.       Neurological deficits such as multiple sclerosis,

6.       Stress fractures especially while standing and

7.       Knee problems

Before you consider buying a pair of “Toning or Physiological shoes you should be aware of the risks and benefits of wearing these types of shoes.  Most if not all of the research has been conducted using MBT footwear, therefore, the MBT footwear benefit and risk profile cannot be applied to the other “Toning and Physiological” brands of footwear.

In my next blog entry I will discuss the topic of minimalist running shoes used for barefoot running.
www.painfreefeet.ca

MBT™ footwear: A chiropodist’s view of the “Physiological” footwear.

Over the past year,  I have been asked on several occasions to express my opinion on the benefits and risks of wearing  unconventional footwear such as  MBT™ (Masai Barefoot Technology) shoes , Sketchers “Shape Up”™ shoes and other similar shoes.  

I have reviewed research presented at scientific seminars, talked to a MBT footwear medical representative and I have also received feedback from a few patients over the past year who have used MBT shoes or other similar shoes.  In this blog I will discuss the design of MBT footwear and its effects on the thigh and lower leg muscles while standing and walking in MBT footwear.  I will also discuss the effects on ankle joint motion while walking in MBT footwear.

MBT footwear was developed in Switzerland in 1996 and came to North America in 2003.  The unstable MBT shoe has been promoted as the original “barefoot” function shoe. This shoe has a rounded sole starting from the heel and continues to the toe and a cushioned sensor under the heel area that creates a natural degree of instability. This instability is felt from both the back to front directions and from inside to outside directions. The basic concept behind the unstable shoe is to transform flat and hard surfaces such as concrete sidewalks into uneven surfaces such as grass or sand. The design of the MBT footwear has been promoted to provide some of the benefits of barefoot walking.

The features of MBT footwear are thought to specifically activate, strengthen and condition the smaller neglected extrinsic foot muscles that originate in the lower leg and attach via tendons into the foot.  This muscle activation is thought to occur while standing or walking in MBT footwear.  By activating these neglected muscles, posture and gait could be improved and the loads or stresses on the lower limb joints may be reduced to help prevent injuries and reduce pain.

MBT footwear has been studied by a few university based biomechanics research laboratories. It is important to note the findings of these research papers can only be applied to MBT shoes and cannot be compared to similar type shoes such as Sketcher™ “Shape Up” shoes because of the shoe design differences.   

In 2005, the University of Calgary Biomechanics laboratory conducted one study observing the effect on muscle activity while subjects just stood while wearing MBT shoes. When we stand, the muscles in our legs and thighs are active to prevent us from buckling at our hips, knees and ankles. The results of this study demonstrated an increase in the activity of many of the lower leg and thigh muscles while subjects stood wearing MBT shoes.  These results seem to be consistent with the muscle activation benefits as promoted by the makers of MBT shoes.  The researchers also measured postural sway of the upper body while standing and wearing a MBT shoe.  Postural sway is the phenomenon of constant displacement and correction of the position of the center of gravity within the base of support.  In layman’s terms this describes our ability to keep balanced without falling over. Using a MBT shoe is similar to balancing on a wobble board.  Wobble boards are used for rehab after an ankle sprain which helps to strengthen muscles around an injured ankle joint and promote balance.  Postural sway increased while wearing MBT shoes compared to a New Balance shoe. 

In 2005, the University of Calgary Biomechanics Laboratory conducted a second study where they compared subjects wearing a New Balance 756 running shoe and subjects wearing MBT shoes while walking.  The investigators measured the differences in muscle activity and ankle joint motion.  They found increased muscle activity in the subjects in the MBT shoe group versus the subjects in the New Balance shoe group. Again these results were consistent with the muscle activation benefits as promoted by the makers of MBT shoes.  

Wearing MBT shoes while walking caused an increase in ankle joint dorsiflexion (dorsiflexion of the ankle happens when you move your foot towards your leg) from initial heel contact through to midstance (midstance is the time when your swinging leg is even to your weight bearing foot and leg). Increased ankle dorsiflexion at contact to midstance makes your calf muscle stretch more while walking as compared to subjects wearing the New Balance shoe.

In 2009 researchers at Stanford University conducted a study examining what happened when individuals ran in MBT shoes versus New Balance 658 running shoes.  They found running in MBT footwear led to a greater amount of ankle dorsiflexion from initial heel contact through to midstance.  If you have tight calf muscles the use of MBT footwear while walking or running may cause strain on the tendo Achilles leading to tendinitis.

These increases in muscular activity that have been reported in these studies have led to the “Toning or Physiological” footwear category. A number of shoe companies have developed their own Toning or Physiological footwear to capitalize on the popularity of MBT footwear.  Until research has been conducted on these other “Toning and Physiological” shoe brands you can not apply the MBT research findings to these other shoe brands.

In my next blog, I will outline the lower leg and foot problems that can be relieved by wearing MBT footwear and the lower leg and foot problems that will be aggravated if you wear MBT footwear.

www.footcarewhitby.ca

www.footcarepeterborough.ca

Is your heel pain making you miserable?

The alarm clock radio has just rang and your day is about to begin. You dread your first step out of bed because it is going to be painful but you have perfected a method to keep as much weight off of your painful heel.  You realize the pain will get a little better as the day goes on but you also know that when you get home and sit down but have to get up again its going to be painful!  Does this sound familiar?

If you are reading my blog,  you may already know that you may have plantar fasciitis or heel spur syndrome.  Heel pain occurs because the plantar fascia pulls away from its attachment under the heel bone.  This pulling away occurs with every step you take while walking.  The plantar fascia has role in keeping your foot stable as you lift you heel off the ground while walking. The plantar fascia helps to resist your foot from bending.
To give you an idea of what I am describing, I want you to take your hand and place it with your palm down on top of a table.  Slowly lift the palm of your hand off the table.  The more you lift your palm, the more you will pivot on the tips of your fingers.  Now bend you hand, you will feel a tightening in the palm of your hand.  You have just stretched your palmar fascia.  When you bend your hand this is simulating what your foot is doing when you lift your heel off the ground and the weight is on your forefoot.  This is the time you cause damage to your heel causing pain.
This is a common problem for anyone in their 40" and 50's. There can be many factors which can lead to the "perfect storm" of heel pain.  Over the years, we all gain a little weight,  we don't exercise enough, we work on concrete floors covered with tile or carpet and we continue to use old and worn out footwear.  Sometimes heel pain can occur because we start a new activity that places a lot of bending stresses on the foot that can lead to a painful heel.
In Canada during the springtime we all want to be outside after a long winter.   Warmer weather brings more activity which unfortunately can lead to heel pain.  During this time of the year, we recieve many calls concerning heel pain. There can be many causes of heel pain, but the bottom line is you want  your heel pain to go away.
Your family and friends will most likely have advice on out to get rid of your heel pain, sometimes their advice is good and sometimes it is bad.  If your heel pain has lasted for more than 2 weeks and the intensity of the pain is getting worse you should immediately  seek professional help from a chiropodist/podiatrist or your family doctor.  The longer your heel pain is left untreated, the greater the chance it can become chronic.  The longer you have heel pain the more likely  you will start to change the way you walk leading other problems.  In the worse case scenario, you can develop heel pain in the other heel because you have compensated by putting more weigh on the non painful heel.  Another compensation is developing  a tight calf muscle because you don't want to put any weight on your painful heel.
I routinely see patients with heel pain who have waited longer than 4 to 6 months before they seek treatment or they have followed bad advice.  If you have chronic heel pain it may require a longer duration of  time and a more comprehensive approach to resolve your heel pain.   If your heel pain is not chronic there is usually an easy solution for your heel pain.
If you have heel pain do not let it become chronic and get treatment at the earliest possible date.
www.heelpainwhitby.ca
www.heelpainpeterborough.ca

Is my foot orthotic a custom made device?

Custom foot orthotics (CFO) are prescription medical devices designed to stabilized and control the function of the foot and its alignment with the lower leg. CFO's are used to treat or prevent injury caused by excessive motion or a lack of motion in the foot and lower leg. Your prescription CFO device is tailored to your needs and activities. Your CFO is not just a piece of plastic. Chiropodists/podiatrists are trained to prescribe custom foot orthotics. The prescription CFO is based on the findings from the description your complaint, your medical history,  a detailed biomechanical examination of your foot and lower extremity, a gait analysis of your walking pattern. All of this gathered information is used to formulate a prescription.  Your prescription could include an addition such as an accommodation to relieve pressure that is causing callus on the bottom of your foot.  Some additions can encourage joint motion or prevent joint motion. Ultimately, the prescription foot orthotic device must be tailored to your needs and activities. Unfortunately, you may not have a foot orthotic that is a custom made foot orthotic device.
There are many kinds of in-shoe devices that are referred to as  "Orthotics". You will see advertisements on TV infomercials, exhibits at consumer shows and retail stores for "Orthotics".  Shoe inserts and arch supports are be increasingly referred to as " Orthotics". Foot orthotics  are prescribed and/or dispensed by many varied health professionals including chiropodists/podiatrists, orthopedic surgeons, sports physicians, pedorthists, orthotists, chiropractors and physical therapists.  The general public will have a difficult time telling the difference between a true CFO and an over the counter (OTC) type foot orthotic without asking the right questions.  You must ask you foot orthotic provider if they are going to make your foot orthotic from a 3 dimensional cast of your foot.
The Prescription Foot Orthotic Laboratory Association(PFOLA) has developed technical standards to differentiate between various types of foot inserts(orthotics). The definitions are based on how the foot is evaluated and how the foot was casted.
The following are excerpts from PFOLA technical standards document on foot modeling and device  definitions.  These definitions are sent to extended health insurance providers to demonstrate they are reimbursing you for a true anatomical custom  made foot orthotic which is made from a anatomical volumetric 3 dimensional model.

Foot Modeling Definitions
 
Anatomical Volumetric Foot Model (AVFM)
A digital or physical model that captures a person’s three dimensional(3D) plantar foot anatomy when the foot is non-weightbearing, semi-weightbearing, or fully-weightbearing.
A physical AVFM captures foot anatomy through direct contact to duplicate plantar foot anatomy. The most common examples are plaster of paris casts or foam impressions taken directly from the foot. Any material or method that uses direct capture of the entire plantar foot anatomy creates an AVFM.
A digital AVFM must use actual 3 dimensional (3D) data points taken directly from the foot to duplicate plantar foot anatomy. The most common examples include laser 3D scanners, stereo-digital 3D imaging systems, and pin array systems.

Extrapolated Volumetric Foot Model (EVFM).
A digital model that approximates a person’s 3D plantar foot anatomy through application of mathematical models that extrapolate pressure data, or extrapolate temperature data, or extrapolate light data to form the digital model when the foot is non-weightbearing, semi-weightbearing, or fully-weightbearing. The most common examples are pressure mapping systems, photographs and ink or carbon paper imprinting system. A physical 3D cast of your foot will not have been used to make the EVFM orthotic.

Device Definitions

Anatomical Custom Foot Orthotic (ACFO)
An in shoe device that is made directly from an Anatomical Volumetric Foot Model (AVFM). The AVFM is modified with the appropriate medial and/or lateral arch fill, lateral column expansion, heel expansion, and intrinsic forefoot and/or rearfoot corrections as defined by the prescribing chiropodist or podiatrist. The entire upper surface of the foot orthotic device matches the surface of the modified, or corrected, AVFM.

Extrapolation System Foot Orthotic (ESFO)
An in shoe device that is made directly from an Extrapolated Volumetric Foot Model (EVFM). The EVFM is modified with the appropriate medial and/or lateral arch fill, lateral column expansion, heel expansion, and intrinsic forefoot and/or rearfoot corrections as defined by the prescribing physician. The entire dorsal surface of said custom device matches the surface of the modified, or corrected, EVFM. The ESFO will not approximated the contours of your arch as well as a ACFO. If a close fit to your foot contours is required an ESFO may be contra-indicated.

Library System Foot Orthotic (LSFO)
An in shoe device that is made from a library of pre-manufactured shells, pre-manufactured corrected positive molds or pre-determined digital shape files (from which shells or molds are milled.) The foot orthotic shape is chosen by matching a library shape with either an AVFM or EVFM. Over the counter(OTC) foot orthotics are LSFO. Some of these LSFO will be used by chiropodists/ podiatrists when an ACFO is not indicated. OTC Powersteps ® orthotic supports are a good example of LSFO that might be dispensed in chiropody/podiatry office.

These industry definitions have helped to differentiate if a foot orthotic is truly a custom foot orthotic. The prospective foot orthotic patient has to be educated to ask the right question. Are you making my foot orthotic from a true representation of the surface contours of the bottom of my foot? Hopefully the answer is yes.

Is your New Year’s resolution going to cause foot pain?

The beginning of a new year is a chance for all of us to start fresh. Some of us will begin to exercise as a new year’s resolution. At the best of times, sticking to an exercise program can be difficult for most people. Injuries to your feet can hinder your ability to exercise and may cause you to give up your new year’s resolution.
I routinely see a number of new patients seeking help for various types of foot and lower extremity ailments after starting a new exercise program. An unstable foot structure coupled with the introduction of new stresses on the foot due to exercise can cause knee, ankle, heel, arch and forefoot pain.
It is important to realize your body tissues have adapted to your sedentary lifestyle. Any new exercise program will cause stretching, pulling, twisting and bending to your ligaments that connect your bones together and the muscles and tendons that move your bone joints. This new activity will change the length of these body tissues causing damage. If you rest these body tissues they will heal and become stronger for the next session of exercise.
If you approach your exercise program without the proper amount of rest and recovery between exercise sessions you can cause overuse damage to your ligaments, tendons, muscles and their attachments to bone. For instance, heel pain can be caused by pulling away of the plantar fascia away from the heel bone. The plantar fascia gets stretched because the unstable foot will bend as the heel lifts off the ground while walking or running. You will complain of pain as your heel hits the ground first thing in the morning. This pain can get worse if you try to walk through the pain.
I am concerned about the proposed new exercise guidelines that were discussed in the Globe and Mail newspaper on Jan 4, 2011.
The Canadian Society of Exercise Physiology has recommended new fitness guidelines for Canadians. Their major recommendation was to spend less time exercising over one week and instead perform several intense bouts of exercise over a very short period of time. This new recommendation may cause injuries in people with an unstable foot.  If you adopt these new exercise guidelines you may be putting too much stress on the ligaments, tendons, muscles and bones of the foot and lower extremity in too short a period of time.  You need to adapt your body tissues gradually to these new exercise guidelines to prevent injury.
Injuries during exercise are usually caused because:
1. you perform too many exercise repetitions in a short period of time;
2. you exercise for too long a period of time in one session;
3. you exercise using too much weight;
4. you don’t take into consideration your body weight;
5. you use walking and running shoes that are to old and worn out, sometimes changing your workout shoes will prevent problems from occurring;
6. you do not allow for enough rest and recovery to help heal damaged tissues before you exercise again.
I advise my patients that everyone has a different biomechanical tissue stress limit based on their body type. In other words, your ligaments, muscles, tendons and bones can be only stretched, twisted, pulled or bent to certain point before a tissue injury occurs. If you have been sedentary it won’t take much activity to cause a tissue injury. The key is to gradually stress your body tissues over time to make them stronger to prevent injury. Professional athletes have built up their body tissues over a long time to withstand the large amounts of stress occurring during their sport. Even a professional athlete has a biomechanical tissue stress limit in their ability to withstand stress. Unfortunately, when a professional athlete has stresses applied to their body tissues exceeding their biomechanical limit the injury consequences can be disastrous.
Remember a new exercise program should be designed to have a gradual increase in repetitions with enough recovery in between exercise sessions. Good luck with your new year’s resolution of exercise.