My Mother/Father just won’t pick up his/her feet!

It’s a tough situation, your mother or father begins to trip because they can’t pick up their feet and you know sooner or later they are going to break a hip or worse. What makes the matter worse is that they won’t listen to reason because their worried about losing their independence. What to do? Tripping is often caused by the shoes that they wear. Dr. Carol Frey, director of the Foot and Ankle Center at Orthopedic Hospital in Los Angeles, conducted a year-long study regarding safe footwear for seniors. Her research showed that in many cases shoes that are generally considered “safer footwear” were often to blame for falls that caused injuries. Dr. Frey studied 185 men and women over 55 who had fallen and injured themselves during a one-year period. Among those 65 and older, shoes were frequently at fault for the falls that resulted in the injuries. Your parent’s shoes could be contributing to their stumbling.  Athletic shoes are mainly to blame. Sixty percent of those wearing sneakers when they fell said they fell because their shoes “caught or dragged” on the floor and 40 percent said their athletic shoes were “too slippery.” What shoes should older people wear? Doctors recommend:

Never wear shoes with slippery or worn outer soles. Also avoid shoes with smooth leather or plastic soles, which can be slippery on carpets, wood and tile floors, and wet surfaces. Some athletic shoes made with synthetic soles, which may be ideal for exercising in a gym, can be extremely slippery on a damp or wet surface. Remove any tripping obstacles, even a low lying rug can be tripped on.

Avoid wearing shoes and slippers that are loose or ill-fitting.

When walking on carpets, avoid wearing shoes with heavy rubber lugs that can catch on carpets, especially when they are worn by people who barely pick up their feet when they walk. The rubber tips on the toes of running shoes can also cause a stumble on a carpeted surface.

For an all-around shoe, consider walking shoes, which provide good traction and support but do not have heavy soles or rubber over the toes.

Although shoes with a lot of cushioning can make you feel as if you are walking on air, they can also make an older person unstable and are best avoided unless they are at risk of diabetic foot ulcers.

Shoes that tie are safer than shoes that slip on the feet. Laced shoes can be adjusted to accommodate orthotics, braces and swelling of the feet. For those who lack dexterity, consider replacing cloth laces with elastic ones that hold the shoe firmly on the foot, but stretch enough to allow shoes to be slipped on and off without tying or untying the laces.

The wrong shoes can mean falls for the elderly. Experts recommend shoes that lace up and have light rubber soles, and warn of possible hazards of the ones shown below. Slippers can fall off. Shoes with smooth leather soles can slide. Running shoes with thick rubber soles that extend over the toe area can stick to the carpet and cause falls. If your parent can’t bend over to lace the shoe consider Velcro straps.

Leg muscle weakness, illnesses, medication side effects, vision problems and problems with proprioception (proprioception is the ability to know where your body’s position and movement is in relation to the environment) are common factors that can lead to balancing problem in the elderly. Mary Tinetti, MD says, “The nerves in their feet are not giving their brains the message of where they are.”  “A cane or walking stick gives input to your brain of where your feet are through your hands,” she adds. Balance can be measured by the time patients can stand on both feet in tandem stance (heel to toe) and on one foot (single stance); normal is greater or equal to 5 seconds. A walker may provide similar input to the brain. But those whose balance is compromised enough to require a walker may not experience the same level of effect. But walking devices may be a hard sell to older adults. They’re associated with aging and dependence in an elderly person’s mind. Judy Stevens, Ph.D., epidemiologist at the National Center for Injury Prevention and Control says, “The best way to motivate older adults is to appeal to their desire to remain independent, rather than to talk about the dire risks of falling.” Allways consider physical therapy, strengthing can lead to years of independence for your parent.

Foot Facts

The foot contains 19 muscles, 107 ligaments and tendons, 26 bones with 33 joints.

The foot contains @ 25 % of all the bones in the body. If foot bones are out of alignment, then the whole body is out of alignment.

Most people have one foot that is larger than the other. The average male shoe size is 10. The average women’s shoe size is 8.5, this has gone up two sizes in just four decades. Feet are at their largest in the evening, this is also the best time to get fitted for shoes. A person’s foot will increase two sizes longer when they stand up.

In our lifetime we will walk the equivalent of more than 4 times around the earth. @ 115 thousand miles.

In an average day of walking 8,000 to 10,000 steps, we displace the weight of a fully loaded cement truck on our feet. Each time our heel leaves the ground our toes carry the weight of ½ our body weight. When running the pressure on the feet can be as much as four times the runner’s body weight.

An adult averages 4,000 to 6,000 steps in a day. Walking is the best exercise for your feet. Standing is by far, more taxing, because just a few muscles are under continuous strain. The average woman walks three more miles in a day than the average male.

Problems in the feet are a precursor of things to come, many conditions such as arthritis and diabetes first show their symptoms in the feet. Only a small percentage of the population is born with foot problems, but 75 out of 100 Americans will experience serious foot problems in their lifetime.

90% women wear shoes that are too small for their feet. Because of high heels (a 2½-inch high heel can increase the load on the front pad by 75%) and ill-fitting shoes they are 4 times more likely to experience foot problems than men. Another symptom, more than half the women in America have bunions, a common foot deformity in which the joint that connects the big toe to the foot gets larger and juts out.

Foot fetishes are more popular or profitable than foot health, there are more websites having to do with foot fetishes than with foot health. Heel pain and ingrown toenails are the most common problems searched for on the internet. Approximately 5% of Americans will have ingrown toenails in a given year.

It is normal for a child to take its first steps between 10 to 18 months but the average that it occurs is 13 to 17 months. A child’s feet will grow rapidly for the first year, by the age of 12 their foot will be 90% fully grown.

By the mid thirty’s the padding in the bottom of the foot thins out. This is why foot pain can develop from standing for lengthy periods. Read more – Metatarsal Pain

Corns and calluses will affect approximately 6.5% of the population. Read more – Safe and Effective Ways to Remove Them.

Soles of feet contain more sweat glands and sensory nerve endings per square centimeter than any other part of the body. In a pair of feet, there are 250,000 sweat glands which can excrete up to a half-pint of sweat a day.

When a toenail is torn off, it takes 5 to 6 months for a new one grow back.

According to the Guinness Book of World Records:  Madeline Albrecht was employed at the Hill Top Research Laboratories in Cincinnati, Ohio, USA, a testing lab for products. She worked there for 15 years and had to smell literally thousands of feet and armpits during her career. She has sniffed approximately 5,600 feet.

The record for the world’s largest feet belongs to Matthew McGrory who wears US size 29 1/2 shoes. There is a video showing him putting shoes inside of his shoes.

Akshat Saxena from India, holds the world record for having the most toes with 10 digits one each foot!

About 20-30% of the world’s population have Morton’s Toe, a foot condition in which the second toe is longer than the big toe. Once considered a mark of intelligence and beauty. Read more – Morton’s Toe

Approximately one in four Americans have flat feet.

Plantar Fasciitis (heel pain) Over 2 million Americans seek treatment) each year. Approximately 10 percent of the US population in a lifetime.

During pregnancy, hot weather and teenage years, toenails grow faster.

The Plantar Wart virus can enter cuts in the feet and take hold. The feet can also contract many diseases from communal showers: Planter Wart, Athletes foot, Ring worm. Approximately 5% of the US population has fungal foot infections in a given year.

It is common for the elderly to have foot conditions that cause pain and disability which can lead to loss of mobility and independence.

For @ 7 million Americans arthritis is the number one cause of disability. It limits everyday dressing, climbing stairs, getting in and out of bed or walking. Osteoarthritis is the most common type of arthritis in the United States affecting an estimated 20.7 million, mostly after age 45.

Diabetes usually attacks the foot first with Peripheral Nerve Damage and other complications. Approximately 56,000 people a year lose their foot or leg to diabetes. Read more – Diabetes and the Foot.

Peripheral Vascular Disease a disease of the arteries, affect the feet and legs, when severe leads to ulceration, infection and sometimes amputation.

Most injuries reported from people 17 or older are ankle sprains, @ 60%.

Tarsal Tunnel Syndrome – a pinched nerve going to the foot is a very common reason for feeling pain and burning in the feet. Read more – Tarsal Tunnel

75% of Americans will experience foot problems at one time or another in their lives and @ 19% of the population will have 1.4-foot problems each year.

Stone Age people used animal skins to protect their feet. The ancient Romans were the first to make specific left and right shoes. The first pair of boots were created for Queen Victoria back in 1840.

In Britain shoe size is measured in Barleycorns, this unit of measurement stretches back to King Edward 2nd in Anglo-Saxon times. He declared that the diameter of one barely corn- one third of an inch- would represent one full shoe size.

Tendonitis Recovery

The Achilles tendon is one of the longest tendons in the human body, it connects the calf muscles to the heel bone. This tendon is often referred to as the heel cord. Forces on the Achilles tendon are great, up to 12 times a person’s body weight when sprinting. The Achilles tendon is approximately 6 inches in length and is the thickest tendon in the body, because it is connected to the most powerful muscle group in the body. Tendons as a whole don’t heal well, because there is not much blood flow to them. The heel cord gets its supply from one blood vessel known as the posterior tibial artery which branches out into many smaller vessels that feed the entire tendon. You can feel the tendon work when you stand on your tippy toes.

The Achilles heel has always been a vulnerable part of the body as portrayed in a Greek Myth over 2,000 years ago. The Nymph Thetis wanted her son to be a great warrior that could not be injured, so she held her young son by the ankle and dipped him head first into the River Styx. The magical waters make Achilles body impenetrable, except for the ankle where the water did not touch. This eventually leads to his demise when Paris’s arrow penetrates Achilles’s heel and mortally wounds him. So when someone says, “That’s his Achilles heel.” They mean that is his vulnerable spot.

Achilles Tendinitis:

Over use or over stretching the Achilles tendon can lead to tears in the tendon. Once this happens inflammation and pain set in. High impact sports (jogging, basketball, tennis, etc.) and age will contribute to tendonitis. As we get older, blood flow can decrease to the Achilles tendons making them prone to injury. If an individual is inactive the Achilles tendon becomes weaker and is also prone to Achilles Tendinitis. If you feel pain in the heel area, stop all activities that bring further pain. Rest the Achilles tendon. This is a slow healing injury and may take 3 months or longer. If you wish to continue exercising try bike riding, swimming or other activities that don’t require propulsion by the foot. Icing the tendon will reduce swelling and aid in the healing process. Over the counter medication Advil, Aleve will also reduce swelling and pain. Stretching exercises are recommended once the swelling subsides.

How do I know I have Tendonitis?

Squeeze the tendon on the sides between your finger and thumb, if the pain is more intense than when pressing on the tendon from the back, this is a sign of tendonitis. If pain is felt upon wakening, the pain may improve and then worsen as activity increases, is another sign.

How can I help the healing process?

A walking cast will take the pressure off the Achilles heel, this is used briefly as to avoid weakening of the calf muscles and tendon (cost is @ $40.00). Wearing a Dorsal Night Splint allows the tendon to heal while you sleep, they can be purchased for @ $23.00.

What is a Rupture of the Achilles Tendon?
A rupture occurs when the tendon partially tears or completely tears in two. Often a snapping sound is followed by an intense pain. The pain usually subsides quickly followed by aching in the lower back leg. You may be able to bear weight on the injured leg but will not be able to stand on your toes. Another test “The Thompson Test” requires the person to lie on their stomach then their calf muscle is squeezed. If there is no movement or flexion in the foot, then the Achilles tendon is injured. As a rule of thumb, surgery is recommended for a complete tear and nonsurgical treatment for partial tears.

How will the doctor treat a ruptured Achilles tendon?

If the tendon is completely separated, “tendon transfer” surgery will be performed. This involves a cut just above the heel, the two tendon ends are then sutured together and the cut stitched. This requires @ six weeks of immobilization. There is less than a 5% injury recurrence rate.   A partial tear is usually operated on if you are younger and more active. Older people are often treated with a cast for up to 12 weeks, followed by rehabilitation. Partial tears are sometimes treated like complete tears, with surgery and casting. A heel lift is usually used for 6 months to one year following removal of the cast. Rehabilitation to regain flexibility and then to regain muscle strength are also instituted following removal of the cast.

Foot Orthotics

There are basically two types of orthotics that a podiatrist will prescribe, functional and accommodative.

The Accommodative Orthotic:

The purpose is to cushion and relieve pressure. Often prescribed for the diabetic foot. The diabetic foot is prone to ulcerations from pressure points and calluses. They are also used to relieve foot pain coming from a multitude of causes, heel pain, plantar fasciitis, metatarsal pain in the ball of the foot, etc. Since they are made from a mold of your foot they can be made to control foot functions also. Take for example: a person walks on the inside of their foot (pronates), the orthotic can be made to adjust the heel strike allowing for a better weight distribution. The accommodative orthotic is also designed to absorb shock. This helps with pain reduction in the foot, ankles, knees and back. These custom orthotics tend to be softer and thicker since they are made to absorb shock. They are often made of foams and rubber materials. Since they tend to be thicker, roomy shoes must be worn, such as sneakers. Many times a Therapeutic Shoe is advised because they are wider and deeper just for this purpose. The last thing you need is a diabetic rubbing his/her toe against the shoe, forming a blister. The accommodative insert is usually full length and is meant to replace the original shoe insert.

 

The Functional Foot Orthotic:

This custom orthotic is used to alter the gate of an individual by adjusting the way the foot hits and rolls across the ground. In doing this a person’s walking gait is altered. The functional orthotic is made to apply arch support for flat footed and high arched feet. They are made to correct over pronation and over supination. They are made to relieve pain in areas such as the heel, the arch, the front foot pad, toes, ankles, knees back etc. and specific problems, hammer toe, curly toe, Morton’s toe, plantar fasciitis, etc. Functional Orthotics tend to be made of more rigid materials (thermoplastics, polypropylene, composite fiber) and are typically thinner. They can be rigid, semi rigid depending on their purpose, such as walking or running. The functional orthotic will likely take more time to feel comfortable and usually require a break in period. Take for example a person has been flat footed their whole life and now arch support is applied, it will most likely hurt at first.

A store bought insert can be purchased for as little as $20.00 where as a custom insert can cost upwards of $300.00. Typically a manufactured charges $85.00 to the doctor and they mark it up to the patient. Most doctors say they have great success rates with patients. How are they made? They are made from a mold of your feet, newer methods include laser imaging of the mold, with a C&C machine carving out the shoe insert to an exact copy of your foot. This is all overseen by a Licensed Pedorthist, a person who is trained at making Orthotics. The Pedorthist will make sure that the insert lies in a way that will change the walking gait.

Why are inserts becoming so popular?

If you talk to someone over 50 they probably played in a sport and did not have any foot padding less than a shoe insert. I recently talked to someone who is 57 and he played basketball through college. When asked about shoe inserts he reported, “When I played in the 60’s and 70’s we had two choices, “Converse white or black, high top or low top.” I have always had foot pain, I wish they had some kind of insert to help.” So you have a twofold buying spree, baby boomers who want to remain active are feeling the pain and parents who see there are ways to correct their children’s feet at an early age. Many people are also taking their health into their own hands because of the rising cost health insurance. One person stated, “I went to the doctor and received a $350.00 shoe insert which my health insurance didn’t cover. I loved the way they worked but was reluctant to buy another pair because of the cost. Then I found out I could order them online and save $200.00. The only knowledge I needed was to explain the purpose of what I wanted. Inserts for walking with flat feet, which they already knew from the imprint of my foot mold.”

VENOUS/LEG ULCERS

Approximately 80% of leg ulcers are venous ulcers. Venous are usually located above the ankle and below the knee. The appearance is dark red with granular composition and dead tissue is common. Venous Ulcers can be big or small, wet or dry, painful or not painful, odorous or not odorous. Leg veins includes many valves that prevent blood from flowing backwards towards the foot as it is being pumped upward towards the heart. This is called “Venous Reflux” When a person is standing the pressure of the blood in the legs (Venous Pressure) equals the weight of the blood column between the foot and the right atrium. This pressure should be in the 80-100 mmHG range. When a person is walking the foot and calf muscles increase the flow of blood upwards. When the valves in the veins are damaged the blood is oscillating/slushing around instead of being pumped upwards. Picture some of the blood falling downward towards the foot, when all should be going upward towards the heart. The added pressure from the blood falling backwards eventually elongates the veins. The blood is not oxygenated as it should be. The skin will eventually break down allowing bacteria to infect areas below the skin. When an ulcer appears many will apply creams and ointments hoping to heal the area but the real cause comes from underneath, lacking blood supply.

 

Other Factors that can contribute or cause “Leg Ulcers”

  • Diabetes
  • Smoking
  • Kidney Failure
  • Poor circulation, often caused by arteriosclerosis
  • Specific Medications
  • Pressure caused lying in one position – Wheelchair or bedridden
  • Prone because of Genetics
  • Sickle Cell Anemia
  • High Cholesterol
  • Heart Disease
  • High Blood Pressure
  • Lymphedema (a buildup of fluid that causes swelling in the legs or feet)
  • Inflammatory diseases including vasculitis, lupus, scleroderma or other rheumatological conditions

Treatment: Healing rates of up to 70% at 12 weeks can be obtained and when combined with a program to prevent ulcer recurrence can dramatically improve patient outcome. Effective symptom control either with dressings or analgesia can improve quality of life and patient tolerance of compression therapy. The higher the level of compression the patient can tolerate the lower the recurrence rate. Compression Stockings are the mainstay of venous ulcer management. Gradual compression, with greatest pressure (about 40 mm Hg) at the ankle, tapering off to lower pressure (about 18 mm Hg) below the knee. Various compression bandage systems and stockings can be used. If numbness, pain, tingling occur seek medical advice.

Runners are Prone to Plantar Fasciitis and Blood Clots

As we get older we are prone to aches pain and injuries. Older for runners could be as early as 40 years old or sooner depending on how hard you run. Below we have good information on how to prevent and/or treat blood clots and plantar fasciitis. Two major factors that can affect a runner at any age.

Article Cause and Effect of Plantar Fasciitis

There are over two million cases of plantar fasciitis treated in America every year. It is one of the most commonly treated symptoms addressed by a podiatrist and is slightly more prevalent in women than men. Most cases are reported from people between the age of 40 and 70. The planta fascia runs from the heel bone to the toes. This is a long ligament and is very strong as it supports the arch and springs the energy created by walking/running from the heel to the toes. Just like a carbon fishing rod it is very strong and will flex from up and down but stretch it length wise and the fibers will tear. When this happens pain and inflammation are felt, usually around the heel and arch area at the bottom of the foot.

 

Symptoms of Plantar Fasciitis:

  • Pain in the morning on the bottom of the foot, near the heel, that will subside after a brief period of walking.
  • Typically the pain develops gradually, but after several weeks, the pain escalates and doesn’t diminish. Most often described as a sharp pain in the heel or arch although some people describe it as a dull pain.
  • Tenderness is felt when pressure is applied to the heel pad or the arch. Most often there is no swelling or bruising.
  • The pain is greater after exercising than during the exercise.

Read the rest of the article here:  https://www.mondaymedical.com/blog/cause-and-effect-of-plantar-fasciitis/

Plantar fasciitis In Runners By Patricia Pande, MClScPT, CSCS, CPed

The literature cites a number of causes of plantar fasciitis in runners, including long plantar arch alterations, rearfoot pronation, and magnitude of plantar loads. Plantar fasciitis in runners can also be associated with fasciosis.

Muscle atrophy. Several studies suggest an association between plantar fasciitis and muscle atrophy, particularly of the intrinsic foot muscles. Chang et al found that forefoot muscle volume, assessed using magnetic resonance imaging (MRI), was significantly lower in the affected limbs of patients with unilateral plantar fasciitis than in the healthy limbs.16 In another MRI study, Cheung et al found that rearfoot intrinsic muscle volume was lower in experienced runners with chronic plantar fasciitis than in healthy runners, while forefoot muscle volume was similar between groups. Kibler et al also found that runners with plantar fasciitis had significantly worse ankle plantar flexion strength than healthy runners; this weakness could be related to muscle atrophy or to reflex inhibition with increased load on the plantar fascia.

Although these studies do not confirm muscle atrophy as the cause of plantar fasciitis or that strengthening exercises will relieve symptoms, research does suggest that intrinsic muscle activation from forefoot contact to toe off may reinforce ligamentous structures. Further studies are needed to evaluate the effectiveness of exercises to improve muscle activity and orthotic interventions to support the foot for generation of muscle power.

Plantar loads. Recently, Ribeiro et al found lower loading rates in runners with acute plantar fasciitis (pain for more than four months) than in chronic cases (diagnosed a mean of 1.5 years earlier, presenting with fascial abnormalities but no acute inflammation or pain). However, loading rates in all runners with plantar fasciitis were higher than in healthy runners. The authors hypothesized that the lower loading rates in the symptomatic runners than in the chronic group were due to a pain-avoidance response, and that higher loading rates in the chronic plantar fasciitis group were due to the loss of a protective mechanism against pain in the degenerated tissue, as well as a reduced ability to attenuate shock.

Similarly, Pohl et al found that maximum instantaneous load rate was significantly higher in female runners with a history of plantar fasciitis than in control runners. Changes in tissue stiffness and fat pad atrophy may contribute to higher loads and may further complicate treatment by reducing lubrication and shock absorption Furthermore, loads related to the running surface may also contribute to plantar fasciitis.

Running pace and volume. There is conflicting information about the impact of running pace and volume on the risk of injuries, including plantar fasciitis. A study by Knobloch et al found that marathon runners have a lower risk of plantar fasciitis than runners of shorter distances, which suggests faster pace may be a risk factor and higher volume may be protective. However, other prospective studies have linked lower extremity injuries, including plantar fasciitis, to higher running volume. Whether due to pace or volume, the resulting stress may overload tissue.

Structural variables. Thickening of the plantar fascia has been associated with plantar fasciitis, and may arise from a combination of bending, compression, and shearing forces from muscle weakness or from degenerative thickening. Wearing et al found that thicker fascial structures were associated with a lower arch in patients with plantar fasciitis but not in healthy controls; it is still not clear whether this finding suggests that having a low arch causes the disability or results from gait adaptation.

Root’s theory that foot type contributes to plantar fasciitis remains controversial. The fact that the spectrum of foot types does not form a bell-shaped curve complicates the argument, as does the prevalence of subject-specific kinematic variations. Additionally, the connection between foot structure and plantar fasciitis is unclear.  Some researchers found a lower arch index with increased range of dorsiflexion in female runners with plantar fasciitis than in their healthy counterparts, but others suggest this relationship is not easily defined due to the foot’s adaptability to prevent injury. Nielsen et al found no increased risk of running-related injury in novice runners with moderately pronated feet. Additional well-controlled randomized prospective studies of homogenous running groups are critical to furthering our understanding of these factors.

Biomechanics. Kinematics and kinetics during walking in individuals with plantar fasciitis differ from healthy volunteers, and clinicians should consider the possibility that these or related differences may extend to running. The coupling mechanisms between the hindfoot, tibia, and arch during running are well-documented, but the relationship between segments of the foot is not clearly understood. Still, it is important for clinicians to be aware that treatments or interventions focused on a single aspect of the foot can also affect other aspects of the kinetic chain.

Clinical applications

The American Physical Therapy Association’s clinical practice guidelines for treatment of plantar fasciitis combine stretching, activity limitation, iontophoresis, night splints, and prefabricated or custom inserts. The American College of Foot and Ankle Surgeons recommends initial treatment with ice, stretching, ergonomics, off-the-shelf arch supports, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, with progression to custom foot orthoses and physical therapy if little or no improvement after six months.

Inserts must be able to absorb ground reaction forces, particularly in runners. Prefabricated and customized EVA (ethylene vinyl acetate) orthotic devices were associated with similar levels of pain relief in patients with noncomplicated plantar fasciitis after eight weeks. Interestingly, another study found reduction of plantar pressures at the heel associated with two types of EVA sham orthoses (flat and contoured) were similar to those associated with custom foot orthoses—a finding the authors attributed to the attenuating and pressure-redistributing properties of EVA. The findings of Pfefffer et al also support the use of less rigid orthotic devices in this patient population; felt and silicone or rubber were more likely to be associated with symptom relief than more rigid devices.

The use of orthoses to control or supplement motions has been the traditional mainstay of treating runners and nonrunners with plantar fasciitis. Research has demonstrated that orthotic devices are associated with kinetic and kinematic effects in healthy runners. One study showed a decrease in forefoot to rearfoot coupling angles with the use of foot orthoses, and another showed a change in rearfoot eversion angle and eversion velocity in female distance runners.Mündermann et al found that molded foot orthoses and molded and posted foot orthoses both reduced vertical loading rates and ankle inversion moments in healthy runners. However, researchers have not yet determined whether similar biomechanical effects can be expected in runners with plantar fasciitis, or to what extent those changes might affect patient symptoms.

Recent studies in which workload or strain causes pain in connective and muscular tissue support interventions to reduce kinetic effects on such tissue. Nigg’s Preferred Movement Pathway theory stresses force reduction and advocates self-selection based on comfort; however, this and other similar theories need vigorous scientific inquiry.

Conclusions and recommendations

Clinicians should advocate for the cost-effective, judicious use of foot orthoses for runners with plantar fasciitis, in accordance with the present body of knowledge, which suggests such devices should:

  • be comfortable
  • provide shock absorption
  • not increase torque at other lower extremity joints
  • fit well in the shoe without hindering use of the toe flexors and intrinsic muscles
  • be semicustomizable for patient comfort; and
  • address any compensatory adaptations.

Future studies should continue to assess the kinematic causes and effects of plantar fasciitis in the running population, along with factors that predict positive response to treatment.

Patricia Pande, MClScPT, CSCS, CPed, is a physical therapist, pedorthist, strength and conditioning specialist, and founder of FootCentric.  Read the whole article here: http://lermagazine.com/article/plantar-fasciitis-clinical-considerations-in-runners

Let’s Talk about Blood Clots

Below you will read how runners, especially those who are traveling to an event are prone to blood clots.

By Amanda Zaleski, MSc; and Beth Taylor, PhD                                                          There are several published case studies of athletes who have experienced deep vein thrombosis (DVT), pulmonary embolism (PE), or both following athletic competition or physical activity. Tao and Davenport, for example, reported on a female triathlete who was diagnosed with DVT and PE after competing in a half Ironman triathlon. After competing in the triathlon she traveled five hours by car the following morning. She subsequently experienced symptoms of left lower extremity swelling and pain, accompanied thereafter by dyspnea and lightheadedness on exertion. There are also several published cases of DVT and PE occurring after marathon running. Mackie and Webster described two male marathon runners who developed DVT and PE approximately one week after running a marathon; in both cases, DVT was misdiagnosed initially (either as a muscle strain or Baker cyst).

The myriad benefits obtained from regular sustained exercise are undeniable. However, such case reports indicate that, in at least a small fraction of otherwise healthy avid exercisers, there may be an augmented risk of DVT following endurance exercise.

Car, bus, train, or air travel by an athlete who has recently engaged in endurance exercise may shift the hemostatic balance, increasing the risk of venous complication.

Research has established that strenuous endurance exercise, such as marathon running, activates the coagulatory system (clot formation) by immediately increasing markers of coagulation such as thrombin-antithrombin complex (TAT), prothrombin fragment 1 and 2, and D-dimer. In response, the fibrinolytic (clot breakdown) system (eg, tissue plasminogen activator [t-PA] antigen and activity) activate in coordination with the coagulatory system following exercise, such that changes in coagulation are paralleled by an activation of fibrinolysis to preserve hemostatic balance. In other words, in healthy athletes, postexercise clot formation is approximately equal to clot breakdown. This phenomenon, by which both markers of coagulation and fibrinolysis are increased in the bloodstream, is termed “hemostatic activation.”

While exercise-induced hemostatic activation is not detrimental for most individuals, factors incident to marathon running may disproportionately activate the coagulatory system, increasing the risk for venous thromboembolism (VTE) and contributing to reports of DVT, PE, or both—all of which have been reported after prolonged strenuous endurance events in otherwise healthy athletes. Given that marathon participation has increased 40% over the past decade, with 550,637 finishers in 2014, this has implications for the increasing numbers of athletes who compete in endurance events.

Risk factors for VTE

Benefits of regular sustained aerobic exercise are indisputable. Paradoxically, endurance training and competition expose athletes to factors that may increase their risk for VTE. Virchow’s triad is composed of three factors—venous stasis, endothelial cell injury, and hypercoagulability—that augment blood clot risk. Endurance athletes are exposed to a combination of these factors; they experience repetitive microtrauma, endothelial damage, and dehydration during competition, followed by periods of inactivity, immobility, and stasis while traveling to and from athletic events or recovering from the event.

The superimposition of car, bus, train, or air travel on an athlete who has recently engaged in endurance exercise, for example, may shift the hemostatic balance in athletes postcompetition, thereby increasing the risk of VTE in certain individuals. The MEGA trial reported that any travel by car, bus, train, or plane longer than four hours increases risk of DVT twofold, and, indeed, there are several published case reports and substantial anecdotal evidence on the Internet detailing athletic individuals who have experienced VTE after the combination of competition and travel. To the best of our knowledge, however, we are the first group to examine the effect of prolonged exercise and air travel on thrombotic risk factors.

We examined 41 time-qualified runners participating in the 2010 Boston Marathon who either flew more than four hours (travel group) or drove less than two hours (control group) to the race. We obtained blood samples to assess coagulation (TAT, D-dimer, P-selectin, and microparticles) and fibrinolysis (t-PA) the day before the marathon, immediately after the event, and the day after the marathon following the flight home.

Baseline TAT, t-PA, D-dimer, P-selectin, and microparticle levels were not different between travelers and controls. Immediately following the marathon, all markers of coagulation and fibrinolysis were significantly higher than baseline, indicating that hemostatic activation had occurred. However, among individuals who flew more than four hours, the increase in coagulation factor TAT from baseline to after the race in the travel group was nearly double the increase seen in the controls (5 ± 4 to 12.9 ± 15.6 mg/L vs 4 ± 1.2 to 6.1 ± 1.2 mg/L; p = .02).

Similarly, exercise-induced increases in D-dimer, a clinical biomarker of DVT, were also significantly greater immediately after the marathon in the travel group of athletes than in controls (142 ± 83 to 387 ± 196 ng/mL vs 85 ± 26 to 233 ± 95 ng/mL; p = .02). In fact, six of the runners in the travel group (vs no local controls) had D-dimer values that exceeded the clinical threshold for preliminary diagnosis of DVT (> 500 ng/mL).

Most notable, however, was that marathon-induced increases in the fibrinolytic factor t-PA did not differ between control and travelers, indicating a hemostatic shift toward a more procoagulatory state in athletes who flew to Boston and ran the marathon. Moreover, the increase in the TAT response was greatest in the oldest runners (p < .01), and older subjects also had greater P-selectin values (a marker of inflammation) than younger subjects, indicating that age appears to moderate the coagulatory response to endurance exercise in combination with cross-country air travel.

These data provided the first evidence that the combination of marathon running and air travel disrupts the hemostatic balance and favors a coagulatory response, which appears to be exacerbated with increasing age. Other factors specific to endurance athletes that could additionally exacerbate VTE risk include oral contraceptive use, presence/family history of a clotting disorder, sex, injury, bradycardia, atrial fibrillation, or previous history of VTE.

Compression socks during a marathon

Researchers obtained venous blood samples from marathon runners the day before the event, immediately after the event, and 24 hours later.

The Evidence-Based Clinical Practice Guidelines from the American College of Chest Physicians suggests the use of properly fitted compression socks to mitigate blood clot risk in high-risk populations. The use of compression socks, or mechanical prophylaxis, to maintain hemostatic balance has been studied with participants at rest and has been shown to be effective in reducing VTE in some clinical populations (eg, patients with a previous history of DVT or recent surgery),26 but contraindicated in others (eg, patients with arterial insufficiency).27

Awareness of VTE in endurance athletes has grown significantly in the past few years, and, consequently, running associations and events are increasingly urging athletes to wear compression socks during flight and competition to diminish DVT risk.2 Although these informal (albeit common-sense) recommendations are grounded in evidence derived from clinical populations, the efficacy of compression socks to attenuate marathon-induced hemostatic activation has been tested only recently.

Our group recently examined the safety and efficacy of compression socks worn during a marathon on hemostatic activation immediately following the 2013 Hartford Marathon in Connecticut. We randomly assigned runners (n = 20) to a compression sock group or a control group at the initial screening. The runners reported to the marathon exposition the day before the event. We obtained venous blood to measure coagulatory factors (TAT, D-dimer), a fibrinolytic factor (t-PA), and hematocrit (Figure 1). We also obtained blood immediately after completion of the marathon in the main medical tent approximately 100 m from the finish line and within 24 hours of the race finish.

Runners in the sock group (n = 10) were compression sock naïve; they received their socks (19-25 mm Hg at the ankle) at the marathon expo and were instructed to wear them to the race start and throughout the duration of the marathon . Runners in the control group (n = 10) were instructed to wear their typical athletic socks, but refrain from compression sock use during training, the marathon, and on the day after the marathon.

Plasma concentrations of D-dimer, TAT, and t-PA did not differ between groups at baseline. Consistent with findings from previous studies, we observed parallel increases in markers of coagulation and fibrinolysis immediately following strenuous exercise, specifically, exercise-induced increases in D-dimer, TAT, and t-PA. Of note, these parallel increases of coagulation and fibrinolysis did not differ between recreational Hartford marathoners and elite Boston marathoners who trained more and performed faster, reinforcing the negligible impact of differences in training history and race time on exercise-induced hemostatic activation. Average t-PA across all three time points was lower in the compression sock group than the control group (p = .04).  Similarly, average TAT across all three time points was lower in compression sock group compared with the control group, with a trend toward statistical significance (p = .07); however, plasma D-dimer did not differ between the groups across all three time points (all p > .2).

Because runners were not wearing compression socks at baseline, and there were no differences in hemostatic markers at baseline between groups, the findings related to t-PA and TAT suggest a significant effect of wearing compression socks on immediate and 24-hour post marathon hemostatic markers—specifically that overall hemostatic activation following a marathon was lower with compression socks than with typical athletic socks. Most importantly, compression socks did not appear to adversely influence markers of hemostasis during a marathon and thus they appear safe for overall use in runners.

Given that prolonged travel (greater than four hours) activates the coagulatory system, and many marathoners travel long distances to an event, the use of compression socks as a preventive measure should be considered, assuming they are tolerable and properly fitted.However, the efficacy of compression socks still remains to be tested in combination with travel, as the athletes in this study traveled local, short distances to and from the marathon.

We caution that there is a need for larger studies, as well as studies of hemostatic alterations following a marathon in combination with other risk factors (eg, oral contraceptive use, prolonged travel, and genetic predisposition for VTE). We maintain a DVT registry of athletes who have had a history of VTE after competition to better identify individual risk factors that may contribute to this phenomenon.

Performance, recovery and VTE risk

Runners in the sock group were given compression socks and instructed to wear them throughout the duration of the marathon.

Athletes wear compression socks for a variety of reasons beyond reduction of blood clot risk, and thus their influence on noncoagulatory outcomes deserves further mention. Compression socks are increasingly popular with athletes due to perceived enhancement of exercise performance and recovery. To date, the research regarding the efficacy of compression socks to enhance performance, aid in recovery, or both has been equivocal. This is partially due to the difficulty of conducting placebo-controlled trials and the use of subjective qualitative reporting as primary outcome measures. Studies that have measured objective physiological markers of muscle damage (ie, creatine kinase, a marker of muscle damage, and lactate, a metabolic byproduct) have been limited and inconclusive, perhaps because the studies are vastly heterogeneous in terms of a) the type of compression garment used (eg, whole body, sleeves, knee-high compression) and b) the modality of exercise being tested (eg, resistance or aerobic).

Hypothetical mechanisms underlying performance and recovery benefits of compression socks differ depending on their timing of use (ie, during or after exercise), but are similar in that all theorize that the mechanism of action targets components of Virchow’s triad.

Compression socks worn during exercise are thought to reduce microtrauma and enhance venous return by applying an external circumferential pressure gradient that reduces swelling space, improves blood flow, and in turn improves performance.

Compression socks worn during recovery are thought to accelerate metabolic waste clearance, attenuate edema and swelling, and improve oxygen delivery to muscle.

A recent meta-analysis incorporating 12 studies found a favorable effect of compression socks for enhancing recovery from muscle damage, based on creatine kinase and reduced severity of delayed onset muscle soreness. However, of the studies included in the meta-analysis, not one sought to examine the influence of compression socks in response to a sustained aerobic event (eg, marathon or triathlon), making the interpretation of the findings difficult to apply to endurance athletes.

A separate systematic review concluded the available literature does not fully support or refute the use of compression socks for improving performance or recovery. For example, three studies found no difference in running performance while wearing compression socks,while one demonstrated improvements in running speed and performance.

To the best of the authors’ knowledge, there are only two randomized controlled trials that examine performance and recovery in marathon runners.4 One found compression socks worn for 48 hours after a marathon were associated with a 5.9% improvement in functional recovery (ie, time to exhaustion on a treadmill two weeks after a marathon). The other reported that compression socks worn during a marathon did not result in better race performance or lower markers of exercise-induced muscle damage, as assessed via serum myoglobin and creatine kinase concentrations before and after the event.

Conclusion

In conclusion, with the exception of one study, the data do not appear to reveal any adverse consequences of compression socks, and in some cases suggest socks may result in psychological advantages that translate into performance gains. Assuming that socks are properly sized, marathoners can consider compression socks a sports garment that has preliminary evidence to support its use for preserving hemostatic balance during exercise and hastening recovery from exercise, but not for enhancing performance.

Runners should be aware of manufacturer specifications and proper sizing techniques. Although a minimum threshold of pressure applied at the ankle is not yet clearly defined in the literature, compression socks should be graduated (ie, lower pressure at the ankle gradually increasing to higher pressure at the knee). Lastly, socks should be sized according to calf circumference, not shoe size, to avoid excessive pressure at the calf and to potentially increase the risk-benefit ratio. By following these specifications, athletes may be reassured that compression socks likely do not harm athletic performance and recovery, which is critically important given the time and effort associated with training and performance.

Amanda L. Zaleski, MS, is an exercise physiologist in the Department of Preventive Cardiology in the Henry Low Heart Center at Hartford Hospital in Connecticut and a doctoral student in the Department of Kinesiology at the University of Connecticut in Storrs. Beth A. Taylor, PhD, is the director of exercise physiology research in the Department of Preventive Cardiology in the Henry Low Heart Center at Hartford Hospital and an associate professor in the Department of Kinesiology at the University of Connecticut. Her interest in blood clot risk arose from the experience of her older sister, who experienced a DVT and PE after running a half marathon and flying home to Seattle, WA, from Hartford, CT.

Disclosure: Amanda Zaleski has received funding from the CT Space Grant Consortium Graduate Fellowship, Hartford Hospital, and the American College of Sports Medicine NASA Space Physiology Grants for her ongoing research to examine risk factors associated with VTE in active individuals. In addition, she discloses product sponsorship from 2XU Compression Socks.

More Reading On Compression Socks And Do They Really Work? By Kelly Dunleavy O’Mara

“There is no doubt that many runners trust compression garments,” said Ajmol Ali, a PhD in the Sports and Exercise Science Department of Massey University. Ali has conducted a number of studies on the garments with mixed results.

For decades, medical-grade graduated compression socks have been used to combat deep vein thrombosis, or the formation of blood clots. By increasing the circulation and blood flow, research has found the socks to be effective for bed-ridden and inactive patients.

RELATED: Did Meb’s socks help him PR?

Research on the effectiveness of compression garments in athletic pursuits, though, has been hit or miss.

“Very little evidence exists (ie. two to three studies out of 15-plus) from a sport and exercise perspective that compression garments improve performance when worn during exercise,” said Rob Duffield, a professor at the School of Movement Studies at Charles Sturt University.

One study found that when 21 male runners did two step tests – one with compression socks and one without – they were able to go slightly longer wearing the compressions before exhaustion. There have also been some small increases seen in anaerobic threshold, particularly in cycling, and in jumping performance. The theory is that the tights prevent oscillation of the muscles sideways and promote muscle efficiency.

But, Ali noted that many of the studies that have found increases in performance did not use a placebo or control, making it nearly impossible to tell if the increases were really from the compression or from the athlete’s perception of the compression.

And, countless other studies have found no differences in running times, VO2 max, oxygen consumption or heart rates between athletes wearing the socks and those who weren’t.

“Most of the research shows that there are no performance benefits,” said sports physiology professor Elmarie Terblanche, from Stellenbosch University in South Africa.

Terblanche, however, said that most studies are done in the lab. She recently conducted the first real-world study, following athletes running the Two Oceans ultra-race in South Africa. What she found was that the athletes who raced in compression socks, versus those in regular knee-high socks or those without either, had significantly less muscle damage and were able to recover more quickly, with some even ready to train again three days later. Those wearing the socks also ran on average 12 minutes faster.

“Considering that they ran one of the most difficult ultras in South Africa, this was significant,” she said.

Terblanche recommends that athletes wear the socks for long sessions and for the 24 hours following. While she acknowledges her study can’t be considered conclusive, because there’s always a chance for a placebo effect in the real world scenario, the recovery findings are in line with other research.

Multiple studies, including one done by Ali, have found decreases in muscle soreness and perceived fatigue. Some possible increases in blood flow and lymph removal during the recovery period have also been found – though other studies found that wearing the socks after workouts had no greater recovery effect than taking an ice bath.

It was the recovery benefits that won over Chris Solinksy, the former American 10,000m record-holder, who wore compression socks when he became the first American to break 27:00 two seasons ago.

“I found I was able to come off the workouts much, much quicker,” said Solinksy. He wears the socks during hard workouts and races, and finds he recovers faster. He also originally thought he raced faster in them, but that proved not to necessarily be true.

Solinksy isn’t too worried, though, about how exactly it works or what the science says. He knows he likes it.

“I’m kind of a simplistic barebones type of runner,” said Solinksy.

RELATED: What’s up with Solinsky’s socks?

For athletes to get the full benefit, the compression needs to be graduated (tighter at the ankle and decreasing to the hip), fit the individual, and have 22 – 32 mmHg of pressure. There haven’t been any differences found in brands. And, Terblanche said she hopes to study next how compression garments hold up with use.

To a degree, if there’s no harm done – as long as it’s not too tight or irritating or causes blisters – then it hardly matters whether the benefits are in the athlete’s head or not.

“If athletes like wearing them, and feel that the garments are helping their performance and/or recovery (whether it is a true effect or simply a placebo effect), then I don’t see any harm in recommending them,” said Ali.

About The Author:

Kelly Dunleavy O’Mara is a journalist/reporter and former professional triathlete. She lives in the San Francisco Bay Area and writes for a number of magazines, newspapers, and websites. You can read more about her at www.sunnyrunning.com.

I think it is safe to say that if you are a serious runner who is over 40, custom Orthotics and Compression Stockings are a good investment. Both of them won’t cost as much as a good Driver for Golf. Personally I can state that I wear custom orthotics and run, mostly on a treadmill, I do have less foot and knee pain. I don’t travel to compete but I will start wearing compression socks on any long drive or flight. I feel that this will be a safe practice to start. After reading these articles, how do you feel about foot orthotics and compression stockings?

Vericose-Ropey-Spider, Veins 

“Varicose” is derived from the Latin word “Varix”, meaning “Twisted”.

Varicose veins are caused by gravity and faulty valves within the vein. When blood flows into the feet the heart has to pump it uphill, against gravity. Within the veins are valves they act as  backflow preventers, in theory the same as a basement sump pump. The sump pump pushes the water upward and past the backflow preventer valve, so when the pump shuts down no water can flow backwards into the basement. The heart never shuts down unless were dead, so imagine the heart pumping blood upward in the leg and a valve is stuck open, some of the blood is always leaking back towards the foot and as a person gets older the heart (pump) and the valves gets weaker. The blood begins to pool in the veins, the veins bulge from the added pressure and transform into varicose veins.

There are other reasons valves (there are many valves in a vein) will becomes faulty, Added pressure, this is why pregnant women, people who are on their feet constantly are prone to them and let’s not forget genetics, you just might be cursed.

The good news is that the varicose veins you see are the outer/superficial veins in the leg. They only carry 10% of the blood. This is why surgery is not always recommended. Many times there is not a health threat but more of a vanity issue. In no shape or form can they be called appealing. The bad news is that 50% of people over the age of 50 have them. Women are 3 – 4 times more likely to get them than men.

The big worry is, if you have varicose veins on the outside/superficial part of the leg, do you have them in what is called the “Deep Veins” that carry 90% of the blood? Deep Vein Thrombosis is when a Deep Vein clots.

Your Doctor will inform you if surgery is needed, sometimes even superficial veins can be painful. There are many different procedures available today.

Many times conservative treatment is recommended, which usually consists of:

  • Lifestyle Changes that is pretty much standard for any illness – Lose weight if you are overweight and exercise
  • Avoid standing to long
  • Avoid sitting to long
  • Avoid crossing your legs
  • Elevate your legs above your heart when sleeping or at your desk
  • Eliminate salty foods
  • Eat more fiber
  • Drink lots of water, this will help prevent blood clots
  • Wear compression stockings, they will relieve swelling and help the blood flow upward towards the heart. This is accomplished by gradient pressure.

 

 

 

Congestive Heart Failure and Compression Stockings.

The heart is a pump that moves blood throughout our bodies. This is called circulation. When the heart becomes weak or damaged it will circulate less blood than needed. When this happens fluid will accumulate in the body, we will talk about the legs in this article. Why do people get Congestive Heart Failure? Many times it’s like a car engine that has 200,000 miles on it. It is just tuckered out and needs to be pampered. If your legs are swollen when you go to the doctor, one of the things they often prescribe are compression stockings. Most likely knee high, these are made for both men and women. For women there are many fashionable sheer, thigh and full length panty hose styles that are also available. It’s important to take measurements in the morning for the size that you need, this is because the legs will be closest to their normal size. Our site shows where and how to take measurements for specific types of compression stockings. How important are compression stockings? Below are real life answers from people that wear compression stockings. Caring.com has a lady whose legs swelled so large that they developed blisters. Here is the story.

What can be done for swollen legs due to CHF?  

11 answers | Last updated: Nov 25, 2015

A fellow caregiver asked… Mom has had congestive heart failure (CHF) for many years. For the past month, her legs are so swollen she cannot bend her knees and now has small blisters forming at the ankles. She has been admitted to hospital many times for an IV diuretic. This usually takes care of the ankle swelling, but now that the whole leg is swollen it doesn’t do anything for the legs. It does, however, help her breathing which is probably why she is getting the IV in the first place. What can be done for the blisters and is this “to be expected” at this stage? Mom is 87.

EXPERT ANSWERS:

17044-latrella strimike

Carolyn Strimike, N.P. and Margie Latrella, N.P. are cardiac nurse practitioners specializing in the prevention of heart disease and stroke. They have over 40 years of nursing experience in Cardiology between them. The main goal of their work is to counsel, motivate and empower women to adopt healthy lifestyle choices.

Leg swelling due to congestive heart failure is very common. The swelling is due to excess fluid that backs up because the heart muscle is weak and cannot pump well. Diuretics are the usual treatment because they help the body get rid of excess fluid. There are numerous diuretics that can be used. If one diuretic is not working they can be used in combination along with other therapies. We would recommend that you consult with a wound care specialist to treat the blisters. Elevating your mom’s legs, limiting salt and fluid intake and wearing support stockings may help relieve the leg swelling which may in turn help the blisters heal.

COMMUNITY ANSWERS:

Kmfk15 answered…

I agree with the above answer, however salt doesn’t only mean table salt. All prepared foods are very high in sodium. Stay away from them. As far as the water blisters go I would see a dr. and he will recommend unna booths, elevation and home nurses for caring for the unna boots Good luck.

Mrs dunn answered…

Your mother’s doctor needs to also review the medications she is taking. The blistering can be a side effect of some common medications used for heart failure. In addition is is not uncomon to find that treating common skin fungus, in many cases with over-the-counter medications can control or prevent such blistering. It will require especial care to make sure that bedding, socks or stockings, and towels are kept scrupulously clean and changed daily.

Magedzaki answered…

Such cases are considered advanced stage of HF, and most probably those pt’s are already on combination diuretics, a matter which must be managed very cautiously, because of diuretic’s side effects(hypotension and electrolyte imbalance) so edema of lower limbs in such cases is helpful for the heart, as it might be considered a deloading factor for the already overburdened heart. The right thing is to consult the doctor about the right management of those extremely fragile patients , and the correct way of managing locally those blisters. dr. maged zaki

Deborah11155 answered…

Need to take care not to use Unna Boots without an ABI (measurement)obtained from MD or WOCN. This treatment should never be used haphazzardly. Also, compression should be used only with MD recommendation, especially with patient in active CHF. The edema (swelling) could travel upwards with the compression, causing increased cardio-pulmonary complications. Deborah T., RN, HCS-C, COS-D, SCHN.

Malind in black 01.jpg Msmalinda1947 answered…

I have CHF, and have blisters forming on both of my legs. Been to the ER room several times, as they got infected. What they did and told me to do, wash the infected areas several times a day, add a antibacteral suave on the wounds, cover in patches, cover that in gauze and then they gave me 2 very strong stretch gauze to wrap my legs very tightly to make the swelling go down. Did that for weeks. Let me tell you, this is NO a easy thing to control. I have scars on several parts of both legs, around the ankles mostly the size of your fists, and yet, little bumps form, and they start a new blister. It took me 2 years to heal from 4 blisters and now, I see another opened up, so back to the treatment, again. Best thing to do, is to keep legs elevated as much as possible, do walking instead of sitting around, and use those compression socks, day and night. It is no easy way, and you probably will never get free of blisters, they seem to make their way back, eventually.

Skee answered…

I have “Lymph Edema” and went through the swollen leg trauma where my legs actually swelled so bad that they would erupt and leak fluid from them.Aside from wearing the tight wraps applied by a Therapist and the method he used in therapy that he performed,elevating the legs did the trick.I now have legs that are normal size as long as I continue to wear the “Compreson Stockings”.

Dakamom answered…

My Mom had CHF for many years. She had the type of swelling Skee described above. The compression stockings are critical, though I am guessing they are already part of your Mom’s regimen. I would absolutely be in touch with her doctor about the level of swelling you are seeing. CHF is progressive, so it may be normal, but it needs to be managed by her doctor.

A fellow caregiver answered…

AS a home visiting nurse I have treated many pts with this problem. It is life long. Therapy involves diuretics, compression, moderate exercise (walking), and leg elevation.

Loulabelle answered…

Could it possibly be Bullous Pemphigoid? I’m a carer and I think one of my clients has been suffering with this for a while. Its an auto immune disease that effects over 70’s and can be brought on through the use of diuretics ( this is when my clients problem first started). The first symptoms may be small patches of itchy skin/ pink rash, before quite large bulbous blisters develop- blisters can occur on arms, legs, armpits or groin, or just one area such as the lower leg- which is currently where my client is suffering with it. Steroid medication such as Prednisolone and steroid creams are said to help, but it is difficult to get the right balance, and, as the disease can last between 1-5 years, the side effects that the steroids could possibly cause may be an issue. My own personal opinion is all the medication including the diuretics she is taking are likely to cause an autoimmune issue due to all the foreign bodies entering her system teamed with the fact she now eats very little, however the medications are all needed for some other aspect of her health so it is just a catch 22 really…

Okiesmom answered…

I had badly swollen legs with blisters forming and draining. I kept my legs clean and used cotton balls and rubbing alcohol to clean them several times a day. They have healed and I have not had a problem with blisters for at least two years.

Along with elevation of the legs, compression stockings are commonly used by people with Congestive Heart Failure to prevent Edema in the legs (water retention). The legs are prone to blood pooling and blood clotting. Compression stockings apply a gradient pressure, this means firmer pressure at the bottom that gradually decreases as the stocking goes up the leg. This effectively forces the fluids upward towards the heart. Pressure stockings are rated in mmHG, what is important is that you understand that the higher the number the greater the pressure. Example: a 30-40 mmHG stocking is stronger than a 10-20 mmHG stocking.

Most commpression hose wearer’s recommend buying a quality brand of compression stockings. The comfort and durability more than make up for any price savings. If your feet and legs have sores, it is advisable to buy a pair with silver in the compression stockings, yes microfibers of silver are woven throughout the stocking, this provides an antimicrobial feature and should help reduce infections.

When Choosing a Compression Stocking Dr. Ichinose (Director of Vein Services at Oklahoma Heart Institute at Hillcrest Medical Center) Advises:

First, all compression socks are NOT created equal. “The quality of the material, the sizing, the durability and the amount of compression or pressure the garment provides all culminate into the final product,” explains Dr. Ichinose. “Some very economical support hose are not sized by careful measurement of your leg.  They are labeled small, medium and large, however the amount of compression provided is not known.”

Dr. Ichinose advises patients to know two important things before selecting compression socks: the amount of compression and the size needed. Your health care provider will advise the compression level you need, as well as measure your leg to make sure you are fitted in a proper compression sock. However, you can also measure yourself for compression socks. In the morning before swelling occurs, measure the circumference of your ankle (around your ankle), the circumference of your calf and the length of your calf (from the knee to the heel sitting with your legs at a 90 degree angle). Use the sizing guide on the compression sock packaging to find the right fit for you. If you have any questions about the compression level appropriate for you, talk to your health care provider. Compression levels range from mild compression to extra firm compression:

Mild compression 15-20mmHg:  Prevention and relief of minor to moderate varicose veins, relief of tired aching legs, relief of minor swelling of feet and legs.

Moderate compression 20-30mmHg:  Prevention and relief of moderate to severe varicose veins, treatment of moderate to severe lymphatic edema and management of active ulcers or post thrombotic syndrome.

Firm compression 30-40mmgh: Ulcer management, post thrombotic syndrome.

“The amount of compression provided by a pair of socks will vary depending on the size of the leg in relationship to the size of the garment,” shares Dr. Ichinose. “Patients commonly complain that the compression socks cut into their leg.  Usually it is because a large leg was placed in a garment too small for the leg.”

History of Venosan

History of Venosan Stockings Daniel Kuenzli started Venosan in 1989 and has grown the company at an incredible rate. Just like he pushed a Ferrari 428 Challenge to 239.5mph only 3.3 mph off the winner, at the:
2012 FERRARI CHALLENGE TROFEO PIRELLI COPPA SHELL (Event maximum speed)
The original company was started in a small town in Sweden, St. Gallen by Julius Salzmann in 1883. Today that company is called Salzmann AG and Venosan is a subsidiary. Max Kuenzli, Daniel Kuenzli’s father had been working for SALZMANN since 1945. Then in 1954 a tragic accident changed the Fate of Max and Daniel Kuenzli. Walter Salzmann the son on the founder Julies Salzmann was killed in a plane crash while on his way to a business trip. The business went to his brother and two sisters but they were not actively involved in the company. This is when Max Kuenzli took over management. He also became a shareholder along with the brother and sisters of Walter Salzmann. A new company was founded Salzmann AG St. Gallen. In 1971 Max Salzmann buys all the remaining shares from the Salzmann Siblings. I see Daniel Kuenzli as a Donald Trump kind of success story. Did he start from poverty, no his father was successful, but he took a small fortune and turned into a massive fortune. He also had to start from the ground up, no executive job for him, he started by selling compression stockings from one doctor’s office to the next. I believe that this kind of beginning has kept him grounded (except when he is driving his Ferrari) in 1990 he took over full Management from his father Max although Max remained on as President of the Board of Directors until his death in 1994. Under Daniel Kuenzli’s tutelage Salzman AG has expanded too many other Countries and has approximately 500 employees. In 1993 Venosan opened in the Asheboro North Carolina a state that is famous for their textile industries. One of their greatest accomplishments is that their hosiery has compression qualities but is stylish and sheer. Many times undetectable from standard sheer brands. Most other brands sell the same sock for Men and Women where Venosan often has different fabric contents for men’s and women’s even if they sell by the same name. This is because of their extensive testing and long history of making compression stockings. Why look for other stockings they have been doing this since 1883.

Diabetic Shoe Vs Therapeutic Shoe

These Shoes are virtually the same and often called by other names, such as Orthopedic Shoes, Ortho Shoes, Orthotic Shoes, Ultra Depth, Extra Depth, Depth Shoes, Ultra-Wide, Extra Wide, Sugar Shoes, Medical Shoes, Custom Diabetic Shoes, Custom-Molded Shoes and Orthotic Insert Shoes. A Diabetic Shoe can be all of the above but all of the above can’t always be a Diabetic Shoe. Diabetic Shoes have meet certain manufacturing standards.
1. They must not have any seams with stitching inside that can scratch or tear skin.
2. A Larger Toe Box, this prevents injury from friction.
3. The collar around the ankle of the shoe is padded to prevent blisters.
4. The Shoe offers stiffer protection in the front, to prevent stubbing.
5. Soles are made of a non-skid material for better traction.
6. They are fitted with a special diabetic shoe insert, this insert is smooth and soft to prevent injury to the foot.

If I need an Orthotic Shoe for Knee Pain then why buy a Diabetic Shoe?
1. If you need an Orthotic Shoe Insert you are going to need the Extra Depth and Width.
2. If you have Hammer Toe, Claw Toe, Morton’s Toe, etc. you will need the Larger Toe Box and the no seam feature.
3. Everything else is a bonus.

Understanding Compression Stockings (CS)

How Compression Stockings Work.
Compression Stockings exert graduated pressure on the skin, the pressure is firmer at the foot or ankle and gradually decreases as it goes up the leg. The purpose of this is to force the fluids upward. Picture a long water balloon, if you squeezed at the top it would force the water downward, squeeze in the middle and the water is forced both downward and upward, but squeeze at the bottom and the water will move upward.
When do I need Compression Stockings? There are many reasons but in general, if blood or fluids are settling or pooling in the feet and legs. Varicose Veins and congestive heart failure are common reasons. Sometimes a person is holding water from too much salt intake. Compression Stockings are often used by people who sit or travel a lot. This lessens the risk of a Deep Vein Thrombosis (Clotted Artery).
What kind of Compression Stocking do I need?
There are many varieties from knee high, to thigh high to full panty hose. Knee high are the most common. Consider using the thigh high if your thighs remain swollen after the knee high is used. Many Women wear full length pantyhose. There are open and closed toe varieties. Open toe are used by people who want to wear a sock underneath and some people prefer these because they are easier to put on. There are stockings that just cover the calf, athletes and runners prefer these. CS are made for men and women alike, men usually prefer knee high stockings, and they come in many colors that can be worn just like socks with any outfit. Women CS have a larger variety, including sheer which cannot be differentiated from normal hosiery. There are compression stockings designed for diabetics, these usually contain silver which helps wick away moisture.
Below is a Venosan Chart that recommends different stockings for different issues (Note the higher the number the more compression, a 30 mmHg is stronger than a 15mmHg)
The appropriate compression level for a stocking is based on the symptoms it is trying to alleviate. Use this chart to determine which compression level is best for you.
15-20 & 18-22 mmHg
-Tired, Aching Legs
-Minor Ankle, Leg & Foot Swelling
-Minor Varicosities
-Minor Varicosities During Pregnancy
-Travelling On Long Flights Or Automobile Trips
20-30 mmHg
-Moderate To Severe Varicosities
-Moderate To Severe Varicosities
-During Pregnancy
-Moderate Ankle, Leg & Foot Swelling
-After Sclerotherapy
-Helps To Prevent Recurrence Of Venous Stasis Ulcers
30-40 mmHg
-Severe Varicosities
-Severe Varicosities During Pregnancy
-Severe Ankle, Leg & Foot Swelling
-After VNUS Closure
-After Venous Laser Ablation
-After Vein Stripping
-After Ambulatory Phlebectomy
-Helps To Prevent Recurrence Of Venous Stasis Ulcers

Some products are targeted specifically to treat the symptoms of diabetes, such as SilverlineDB. The other products are listed here based on their compression:
15-20 mmHg
-Legline
-SportsLine
-MicroFiber Line for Men
-MicroFiber Line for Women
18-22 mmHg
-SupportLine for Men
-SupportLine for Women
20-30 mmHg
-Legline
-MicroFiber Line for Men
-Silverline Gentleman
-Ultima
-Ultraline
-Ultraline Silver
30-40 mmHg
-Ultima
-Ultraline
-Ultraline

When Taking measurements for your size, do this first thing in the morning. Fit the Compression Stocking first thing in the morning, this is when your legs will have the least amount of swelling. Never fold the top of the stocking over onto itself, this could double the pressure at the top and can create a restriction if blood flow. Always remove them before bed.
Venosan Recommends These Application Techniques
1. Make sure that neither your feet nor your legs are wet or even damp. Talcum powder can be helpful if necessary.
2. Turn the leg of the stocking inside out down as far as the heel, i.e. except for the foot, the inside of your VENOSAN® stocking must be facing outwards.
3. Use both thumbs to stretch the foot of the stocking open and pull your VENOSAN® stocking over your foot.
4. Grip the upper edge of the stocking and pull it over your heel.
5. Once all the leg of the stocking is above your ankle, reach inside with both thumbs and massage the fabric up your leg with a zigzag movement.
Since your VENOSAN® stockings are made of highly elastic material it is very important that you do not pull the top seam up as hard as you can. The stocking has to be massaged upwards in a series of side-to-side movements as described under 5 above.
Venosan Recommends These Techniques for Taking the Stockings Off
1. Pull the top seam of the leg part downwards as far as your ankle.
2. Push both thumbs between the knitted fabric and your leg and ease it over your heel.
3. Pull the stocking slowly over your foot.

Venosan Recommends This Process for Washing
Regular washing will not damage your stockings.
• You can simply wash your VENOSAN® stockings in the washing machine at any temperature up to 40°C and treat them like any other ordinary synthetic fibre underwear.
• You can reduce the drying time by placing the washed stockings on a thick towel up tightly, and firmly pressing out excess moisture.
• Do not dry on a radiator or in the sun.
• Do not use any fabric softeners, optical brighteners or stain removers (such as turpentine, benzine etc.).
• Clean the silicone bands on self-supporting tops with alcohol regularly to improve adhesion.

Recommended Life Of A Compression Stocking Is Up To Six Months.

Why Should I wear Orthopedic Shoes?

If you are diabetic and have neuropathy you are vulnerable to having wounds on the foot. Many times the person doesn’t even know until it’s too late. I heard of a Podiatrist with neuropathy who stepped on a nail. He didn’t feel or recognize it, until gangrene set in. He ended up with a foot amputation. According to the American Diabetes Association, 600,000 diabetic patients get foot ulcers yearly, resulting in over 80,000 amputations. There can’t be 80,000 people not noticing their feet. The goal is to prevent a sore, ulcer, tear in the first place. Read our article “diabetes-and-the-foot” this will explain why and how this happens to the Feet, usually first.
The Diabetic Shoe is designed to prevent injury from happening in the first place.
Why is this Necessary? Because Diabetics have a difficult time feeling (Neuropathy) & healing (Lack of Blood Flow). Open wounds must be avoided!
For this reason Diabetic Shoes were made to certain Specifications. Diabetics are prone to thin skin which can split. Diabetic shoes have special inserts that relieve pressure points. They mold to the foot and allow areas around a pressure point to absorb pressure, thus reducing the risk of a split. They have a smooth surface (often referred to as shear) which helps prevent the skin from tearing as a result of friction. Diabetic Shoes have a cupped heel area to prevent lateral movement when standing or walking. A “Diabetic Shoe” is often referred to as a “Therapeutic Shoe” or “Ultra Depth Shoe” and can be categorized under “Orthopedic Shoe”. A Therapeutic Shoe is deeper in that allows for a thicker insert and more space for toe movement without friction. This additional space is also used to accommodate toe and foot issues such as hammertoe. The toe box is sturdy, this helps prevent toe stubbing. The Shoe will contain no inside seams that could create a blister of tear skin. The Lining will be smooth and moisture absorbent. They will contain soft padding around the heel area. The soles are skid resistant to help prevent falls.
When should I consider Orthopedic Shoes? If you are non-diabetic you will want these when you have any issue that calls for a “Custom Made Shoe Insert”, especially a full length insert. A ¾ length insert might fit comfortably in an “off the shelf shoe”. If you are diabetic there are several issues to consider. Many say get these if you have a hard time keeping your blood sugar regulated. They are definitely a must if you have foot neuropathy. When a normal foot feels pain from friction and pressure, their feet will hurt and they will stop walking before a blister or sore develops. In a diabetic foot with neuropathy they will just keep walking because they can’t feel the pain. Again “Wounds must be avoided”.

Should I run in Minimalist Shoes?

When walking heel striking is more efficient. But when we run a mid to forefoot strike can be better. Everyone agrees that when a person is in an all-out sprint, a forefoot strike is best and natural. After watching videos of professional runners and native tribe people running – barefoot striking is better. David Carrier explains in detail why we are one of the few mammals that heels strike when walking. I will elaborate more about what I believe is the confusion on whether a heel striking or mid forefoot strike is best for you.

UNIVERSITY OF UTAH – David Carrier – Professor of Biology ********************

HEELS-FIRST IS LESS WORK THAN WALKING ON TOES, BALLS OF FEET

Feb. 11, 2010 – Humans, other great apes and bears are among the few animals that step first on the heel when walking, and then roll onto the ball of the foot and toes. Now, a University of Utah study shows the advantage: Compared with heel-first walking, it takes 53 percent more energy to walk on the balls of your feet, and 83 percent more energy to walk on your toes.

“Our heel touches the ground at the start of each step. In most mammals, the heel remains elevated during walking and running,” says biology Professor David Carrier, senior author of the new study being published online Friday, Feb. 12 and in the March 1 print issue of The Journal of Experimental Biology.

“Most mammals – dogs, cats, raccoons – walk and run around on the balls of their feet. Ungulates like horses and deer run and walk on their tiptoes,” he adds. “Few species land on their heel: bears and humans and other great apes – chimps, gorillas, orangutans.”

“Our study shows that the heel-down posture increases the economy of walking but not the economy of running,” says Carrier. “You consume more energy when you walk on the balls of your feet or your toes than when you walk heels first.”

Economical walking would have helped early human hunter-gatherers find food, he says. Yet, because other great apes also are heel-first walkers, it means the trait evolved before our common ancestors descended from the trees, he adds.

“We [human ancestors] had this foot posture when we were up in the trees,” Carrier says. “Heel-first walking was there in the great apes, but great apes don’t walk long distances. So economy of walking probably doesn’t explain this foot posture [and why it evolved], even though it helps us to walk economically.”

Carrier speculates that a heel-first foot posture “may be advantageous during fighting by increasing stability and applying more torque to the ground to twist, push and shove. And it increases agility in rapid turning maneuvers during aggressive encounters.”

The study concludes: “Relative to other mammals, humans are economical walkers but not economical runners. Given the great distances hunter-gatherers travel, it is not surprising that humans retained a foot posture, inherited from our more arboreal [tree-dwelling] great ape ancestors, that facilitates economical walking.”

Measuring the Costs of Different Modes of Walking and Running

Carrier conducted the study with Christopher Cunningham, a doctoral student in biology at the University of Utah; Nadja Schilling, a zoologist at Friedrich Schiller University of Jena, Germany; and Christoph Anders, a physician at University Hospital Jena. The study was funded by the National Science Foundation, Friedrich Schiller University of Jena and a German food industry insurance group interested in back pain.

The study involved 27 volunteers, mostly athletes in their 20s, 30s and 40s. Each subject walked or ran three different ways, with each step either heel-first, ball-of-foot first with the heel a bit elevated or toes first with the heel even more elevated.

In his lab, Carrier and colleagues measured oxygen consumption – and thus energy use – as 11 volunteers wore face masks while walking or running on a treadmill. They also walked on a “force plate” to measure forces exerted on the ground.

Part of the study was conducted at Anders’ lab in Germany, where 16 people walked or ran on a treadmill as scientist’s monitored activity of muscles that help the ankles, knees, hips and back do work during walking and running.

Findings of the experiments included:

“You consume more energy when you walk on the balls of your feet or your toes than when you walk heels-first,” Carrier says. Compared with heels-first walkers, those stepping first on the balls of their feet used 53 percent more energy, and those stepping toes-first expended 83 percent more energy.

“The activity of the major muscles of the ankle, knee, hip and back all increase if you walk on the balls of your feet or your toes as opposed to landing on your heels,” says Carrier. “That tells us the muscles increase the amount of work they are producing if you walk on the balls of your feet.”

“When we walk on the balls of our feet, we take shorter, more frequent strides,” Carrier says. “But this did not make walking less economical.” Putting the heel down first and pivoting onto the ball of the foot makes the stride longer because the full length of the foot is added to the length of the step. But that has no effect on energy use.

The researchers wondered if stepping first on the balls of the feet took more energy than walking heel-first because people are less stable on their toes or balls of the feet. But increased stability did not explain why heel-first walking uses less energy.

Stepping heel-first reduced the up-and-down motion of the body’s center of mass during walking and required less work by the hips, knees and ankles. Stepping first onto the balls of the feet slows the body more and requires more re-acceleration.

Heels-first steps also made walking more economical by increasing the transfer of movement or “kinetic” energy to stored or “potential” energy and back again. As a person starts to step forward and downward, stored energy is changed to motion or kinetic energy. Then, as weight shifts onto the foot and the person moved forward and upward, their speed slows down, so the kinetic energy of motion is converted back into stored or potential energy. The study found that stepping first onto the balls of the feet made this energy exchange less efficient that walking heels-first.

Heel-first walking also reduced the “ground reaction force moment” at the ankle. That means stepping first onto the ball of the foot “decreases the leverage, decreases the mechanical advantage” compared with walking heel-first, Carrier says.

In sum, walking heel-first is not more economical because it is more stable or involves fewer, longer strides, but because when we land on our heels, less energy is lost to the ground, we have more leverage, and kinetic and potential energy are converted more efficiently.

Form and Function of the Foot

If heel-first walking is so economical, why do so many animals walk other ways?

“They are adapted for running,” Carrier says. “They’ve compromised their economy of walking for the economy of running.”

“Humans are very good at running long distances. We are physiologically and anatomically specialized for running long distances. But the anatomy of our feet is not consistent with economical running. Think of all the animals that are the best runners – gazelles, deer, horses, dogs – they all run on the ball of their feet or the tips of their toes.”

When people run, why is there no difference in the amount of energy they expend when stepping first onto their heels versus the balls of their feet or toes?

The answer is unknown, but “if you land on your heel when you run, the force underneath the foot shoots very quickly to the ball of your foot,” Carrier says. “Even when we run with a heel plant, most of the step our weight is supported by the ball of our foot. Lots of elite athletes, whether sprinters or distance runners, don’t land on their heel. Many of them run on the balls of their feet,” as do people who run barefoot. That appears to be the natural ancestral condition for early human runners, he adds.

“The important thing is we are remarkable economical walkers,” Carrier says. “We are not efficient runners. In fact, we consume more energy to run than the typical mammal our size. But we are exceptionally economical walkers.”

“This study suggests that one of the things that may explain such economy is the unusual structure of our foot,” he adds. “The whole foot contacts the ground when we walk. We have a big heel. Our big toe is as long as our other toes and is much more robust. Our big toe also is parallel to and right next to the second toe.”

“These features are distinct among apes, and provide the mechanical basis for economical walking. No other primate or mammal could fit into human shoes.” *****************

Let’s answer the question, Should I Heel Strike or Fore Foot Strike?

I think the problem is one person’s opinion of running is different than another’s. If you start walking on a treadmill and slowly turn the speed up, somewhere between 4 and 5 a person will have to abandon the heel to toe walk and then jog with a heel strike or midfoot strike. At this point many say that a heel to toe strike is fine up to the point where the pace makes the runner overextend. If the heel of a running shoe is getting eaten up, it’s a good sign that the runner is overextended. This is where minimalist shoes will help because the runner will have less padding in the heel, so impact pain will force the runner to take shorter strides and land on the mid to forefoot area of the foot. Some People are going at a fast walking pace and trying to perform a mid-foot strike (basically tip toeing while walking). As stated above it is less efficient and is said to put more strain on the ankles. Everyone’s running pace is different but if you are breaking that fast walking pace stride, consider a pair of minimalist shoes (Age plays a part in this). An 8 week study by MD Scot Mullen, performed at the University of Kansas Medical Center, was done in 2015 using 29 runners with 10 years’ experience or more. Runners over age 30 had a tougher time making the transition to forefoot striking with minimalist shoes. 43% of the 30 and over crowd continued to heel strike even at the fastest pace as where only 12% of the adolescents did.  Minimalist shoes are said to strengthen the arches.  Before and after pictures of avid runners support this theory. You can actually see that the runner’s arch has risen over time.

We Know That in Barefoot Running:

  • The stride length is decreased.
  • Heel stress is decreased.
  • Forefoot stress is increased.
  • Knee stress is decreased.
  • Ankle stress in increased.
  • It is more efficient for runners, so they have a lower heart rate.
  • Runners will have increased instances of stress fractures in the Metatarsal Bones. These odds will increase if the runner over pronates or over supinates.

Will Orthotic Inserts Help? Many say it defeats the purpose of strengthening the foot, Some say only if the runner has alignment issues such as extreme over pronation/supination and this should be done with the thought of slowly removing them as the foot becomes stronger. Chances are that they would have to be custom made because minimalist shoes have less space to include them.

So many Opinions: You can probably find just as many studies for and against minimalist shoe running but everyone agrees that if done, it needs to be done slowly and gradually. Some runners start their run with a minimalist shoe for a short distance, then walk back. Others will start with a minimalist shoe and then pull a pair of Orthopedic Inserts out of their pocket to install after certain distances. However it is done, make sure you stop if pain is felt.

 

Should I buy Custom Made Orthotics?

Yes if you have biomechanical or pain issues in the feet. This can be a big issue, paying a price of $500.00 is not unheard of. We will talk about saving money, but first let’s see if you need them.

A Biomechanical Issue: involves something being out of align in the feet, which then throws everything out of whack up through the ankles, knees, hips and back. There can be pain in one or all of these areas. This will require a Functional Orthotic.

Foot Pain: This could be from a multitude of reasons, such as plantar fasciitis, Morton’s toe, corns, calluses, etc. You may try a store bought insert for the specific pain and may get lucky but most of our clients have already tried this with no results. If your symptoms include diabetes or ulcers you most likely need an accommodative Orthotic.

Functional Orthotic: They change the biomechanics of the foot and lower body. This is done by adjusting the orthotic to correct an alignment issue such as excessive pronation or supination. We have many articles in this blog that describe conditions that might need a functional orthotic. Functional Orthotics are used to attempt to get the lower body back into alignment. Since they typically change the walking gate and/or pressure points, they may relieve the pain in the ankles, knees, hips, and back relatively quickly but they will hurt the feet and require a break in period, typically 2-3 weeks.

Accommodative Orthotic: These are used for support and pain relief. They may direct the pain away from a painful area such as a foot ulcer. Accommodative inserts are usually thicker and softer and might require a Therapeutic Shoe (known as an Ultra Depth Shoe). Accommodative shoe inserts are not designed to re-align the foot joints.

Sometimes an Orthotic could be functional with Accommodative Qualities. The foot is out of alignment but there is also heel pain. Then the Pedorthist will comply with this request by cushioning the insole. Even when buying a custom insert online the chances are low, mostly because they rely on the customer to choose the insert. There are so many variables that it’s almost impossible to get a correct insert. We rely on a licensed Orthotist or Pedorthist. One that has a full time job just doing inserts. Many consider a Pedorthist better qualified than a Podiatrist in making an Orthotic Insert. The big advantage our customers have is that they talk to our Pedorthist after he/she has had a chance to examine your foot mold. Considering the fact that they have done thousands of these, they will already have a good idea of any problems you have, before they call you. Then when you talk to them you have an opportunity to discuss life style, active or sedentary, athletic or casual shoes, corns and calluses, heel and metatarsal pain, claw or hammer toe, plantar fasciitis or tarsal tunnel syndrome, painful areas, etc.

There is a better way and that involves more time and money. Go to your Podiatrist, typically they will exam your foot and your gate, take a mold of your foot and then place an order with a Pedorthist. Yes you will receive a more comprehensive exam but According to Podiatry Today, the typical cost of prescription custom foot orthotics ordered through a doctor ranges from $400 -$600. Ours cost $119.99 for one or two for $149.98. Why are two so much cheaper? Because the mold is already made, therefore there is a great savings. Many people like to have one for running and one for casual or two pairs for 2 different shoes. Orthotics for different uses are made out of different materials. A Licensed Pedorthist has studied foot anatomy and pathology, biomechanics, shoe construction and modification, they are trained in abnormal foot conditions and how to treat them by using custom orthosis. Can a Pedorthist write a prescription? No they are not Doctors. What is an Orthotist? Short version: they are trained to do everything a Pedorthist can, plus fit prosthetics and special braces.

What do our customers look like? Typically they are people that want a quality product and want to save money. They either have Insurance that won’t cover the cost of the Orthotic or their deductible is high. Many have no insurance at all. Often our customers want multiple pairs and it is more cost effective to order from us. People that are home bound use our service because they don’t have to leave the house. Many consider us a one stop shop because we sell additional items that are ancillary to foot pain and swelling: Compression Stockings, Diabetic Socks, Ankle Braces, Knee Braces, Back Braces, and Orthotic Shoes, etc.  The greatest value our customers see, is the value of discussing their issues with a Licensed Orthotist or Pedorthist that have a combined experience of 50 years.

Below are articles posted on our Blog, feel free to read any of them and post you’re comments.

Do I have Plantar Fasciitis?  https://www.mondaymedical.com/blog/?p=78

Do I have Metatarsal Pain?  https://www.mondaymedical.com/blog/?p=85

Do I Pronate or Supinate? https://www.mondaymedical.com/blog/?p=70   https://www.mondaymedical.com/blog/?p=137

Do I have Morton’s Toe? https://www.mondaymedical.com/blog/?p=92

How to treat Corns and Calluses: https://www.mondaymedical.com/blog/?p=101

Do I have Bursitis? https://www.mondaymedical.com/blog/?p=125

How to tell if I have High Arches: https://www.mondaymedical.com/blog/?p=125

How to Treat Tarsal Tunnel Syndrome and how do I know it’s not Plantar Fasciitis? https://www.mondaymedical.com/blog/?p=142

Can Orthotics help with Bunions? https://www.mondaymedical.com/blog/?p=109

I have Sesamoid Pain:  https://www.mondaymedical.com/blog/?p=121

What is the difference between Hammer Toe, Claw Toe, Mallet Toe and Curly Toe? https://www.mondaymedical.com/blog/?p=112

What is the difference between Diabetic Inserts and Custom Orthotics?  https://www.mondaymedical.com/blog/?p=74

Stand if You Can

I became a believer and purchased a stand up desk, I am actually standing now as I write this. I am 57 years young with type 2 diabetes, taking 1000 mg of Metformin daily. My doctor just recently doubled my dose from 500 to 1000, and that’s when I decided to take this disease seriously. My new year’s resolution for 2016 is to lose 30 lbs. I actually started a few weeks early so I have a month’s experience. What does the doctor always say to us, “Diet and Exercise” but my Uncle had a saying that hit the nail on the head, “If you want to lose weight, the first thing you have to give up is you’re Friends!”   Most activities involve eating and drinking, right? Like most diets I started out gung ho, I checked my body mass index 29.16 borderline obese! I have to admit it shocked me, I know I am chunky but I see people that make me look underfed and I mean a lot of people, what is there BMI. I then wanted to find out how many calories that I needed in a day just to maintain my existing weight. To maintain my current weight: 2204 calories a day with a sedentary lifestyle. 2526 a day with light activity which is usually described as 150 minutes of exercise a week. Now it becomes a numbers game. To lose one pound, a body must have a 3500 calorie deficit. So let’s say I’m exercising and eat @ 2000 calories a day, in a week that adds up to 3500 calorie deficit and equates to 1lb a week lost. I’ve been trying to lose 2 lbs. a week (suggested maximum weight to lose safely) so I’m eating @ 1500 calories a day. I’ve actually lost 9 lbs. in 4 weeks but not because I’ve stuck to 1500 calories a day. I think that out of the first 9 lbs. a lot was water weight, I have noticed that I have reached a plateau now. That seems to be the way it works for most people. They will lose a few lbs. and stay stuck at a weight for a week and then drop 2 lbs. overnight. My job is sedentary, I’m in front of a computer all day. I go home and hit the treadmill @ 4 – 5 times a week. I have built up to burning 300 calories in 35 minutes. Then my life becomes sedentary again. I eat dinner with the family, work on the computer a little, watch television and go to bed, pretty boring. Last night my friend called and asked me to meet them down at our local pub to watch the national football championship. I had to decline, when I told him that I was trying to lose weight and get my blood sugar under control he laughed (he is also type 2 diabetic) and replied, “ All you have to do is drink Tequila,  they have found out it lowers blood sugar. I don’t know about that, but what about all the chips and fried food I’m going to eat? I don’t know about you but drinking weakens my will power, I think a large portion of our birth rate could involve drinking in some shape or form. The good news in Ohio, if you can get past the eating a drinking with your friends, there’s not a lot of anything else going on, so it’s easier for me to find time to exercise. In the summer I golf 4 times a week, sometimes 27 holes and according to my doctor, “That’s not exercise, because you ride in a cart”. Even if I wanted to walk it’s not going to happen, the guys I play with love burning through the course in 3 hours and my gambling addiction is stronger than my will to lose weight, I have to admit. Let say that you can’t exercise and your sedentary. How hard is it to eat 500 calories a day less than your break even number? For me it’s not too bad, my biggest problem is portion control. I have always eaten everything on my plate. It just seems strange to me that when I go out to eat with someone and they leave food on their plate, my parents would have blown a gasket, “People are Starving Out there”. I also eat extremely fast. I remember my first date with my now wife, she had a forkful of food and by the time she finished talking, I was done with my meal (this still hasn’t changed in the last 15 years). I have been practicing on slowing down my pace and leaving something on the plate. You’ve probably heard of the 20 minute rule, but I’ll repeat it. It takes 20 minutes after eating for the stomach to feel full. So even if your still hungry after eating your limited calories, if you wait 20 minutes you should feel fool. It seems to work for me, or maybe I just stop thinking about it after 20 minutes. Being Diabetic makes dieting more difficult, we also have to watch what we eat. The big no no’s are sugar, pop, juice, potatoes, rice, bread, beer, alcohol and pasta. God, “Why does Beer have to be loaded with Carbs”? I’ve been doing well on the carb maintenance and my blood sugar shows it. In fact I had a little scare yesterday. I usually check my blood sugar every other morning. Yesterday morning my blood sugar was 95 (fasting) and I didn’t work out the day before. It was The NFL Playoff Sunday.  When I get home from work on Monday,  I feel like I need to check my sugar again, I never do this but I was curious, it’s been 4 hours since I have eaten lunch. My meter shows 61, I think, something must be wrong, check again – 61. I really didn’t feel strange or weird but I eat some strawberries, blueberries and hit the treadmill. Later that night @ 8:30 I drink my protein drink – 30 grams protein and 4 grams of carbs. This morning the meter reads 100, which is good. What I can’t explain and maybe you can help me understand is, why after a 4 hour fast my blood sugar goes low to 61 but after 11 hour fast at night its 100? And the other thing I question is, if I am going to cheat on my diet, it is almost always a Sunday. No work, and the refrigerator is right there. So I cheat on Sunday, don’t exercise and my blood sugar is lower the next morning than when I don’t cheat and do exercise?

Why Stand Up?

They say you can burn an additional 50 calories an hour standing vs sitting. My little mind tells me, 15 minutes on the treadmill is hell, all I have to do is stand for 3 hours a day. I have just discovered the holy grail of weight loss! I order my stand up desk pronto. It is just like anything else, you have to work up to it. I started walking a mile now I’ve built up to 3 miles. Standing is similar. There was no way that I could stand up for three hours straight, my ankles, knees and back were killing me. At age 57 you learn patience. First thing I do is get a pair of custom orthotic shoe inserts. Now I know everything is in alignment and weight distribution is correct. This means a lot as you get older. The orthotics adjust the foot so that the bones in the ankles, knees and back now ride a position that is able to hold the weight correctly. In my case I have a knee with worn cartilage, the orthotic has changed where my knee joint makes contact, virtually eliminating the pain. Next I purchase a anti fatigue pad to stand on, I think this helps. I have found that standing for an hour at a time works well for me. I stand first thing in the morning from 8:00 – 9:00 am then 11:00 to 12:00 pm and then 2:00 to 3:00 pm. Start standing 10 minutes at a time if that is all you can do. We carry a complete line of ankle, knee, and back braces if needed. If you have sciatica that is aching, don’t let it stop you, wear a brace. You’ll find these pains the first hour that you attempt to stand!

What I Have Noticed:

When I climb the steps at work, I am not winded now. I can now stand for @ 3hrs straight. A technique that works well for me is to move a little. When I first started standing I was perfectly still, like a statue. The pain in my knees and hips would become unbearable. Now I’ll rock from side to side, walk in place a little and occasionally take a walk to the coffee pot or water bottle. Doing these little tricks has helped me double my standing time.  I know I have a long way to go but my blood sugar is lower than it has been in years and I’m thinking of reducing my medication back to what it was. When you stand you use muscles and this helps burn excessive glucose, studies say by as much as 30%.  My energy level is much higher, I work around the house much more. I even helped my wife take down the Christmas Ornaments, first time ever! I have been less grouchy, according to my wife.  I am anxious to see if this will manifest to even greater levels when I lose another 20 lbs.

Think of What You Can Do, Not What You Can’t

If I can emphasize one point it would be, “START SOMEWHERE”. Stand for 5 minutes, walk 10 feet. It’s a beginning to build on. I once read, being at rock bottom is a good place to start, you now have the most solid foundation to build on!             Everyone is going to falter. If you fail one day, two days, a week, start the process over again, this is not a race. If you average ½ lb. a week that’s still 26 lbs. in a year.

Good luck and please share exeriences!