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!

Tarsal Tunnel Syndrome (TTS)

Definition: “Tibial Nerve” one of the two major divisions of the sciatic nerve, it courses down the back of the leg to terminate as the medial and lateral plantar nerves in the foot; it supplies the hamstring muscles, the muscles of the back of the leg (the dorsiflexors and invertors of the foot), and the plantar aspect of the foot, as well as the skin on the back of the leg and sole of the foot. Provided by Medilexicon

The Tibial Nerve courses down the inner ankle in a space referred to as the “Tarsal Tunnel” The tarsal tunnel is protected and covered by a thick ligament called the flexor retinaculum. The Tibial Nerve is called the “Posterior Tibial Nerve” as it enters the ankle and is the largest nerve to serve the foot. Most sensations felt in the bottom of the foot are from the Posterior Tibial Nerve. There are also tendons and blood vessels that travel through the Tarsal Tunnel. Tarsal Tunnel Syndrome (TTS) is the same as Carpal Tunnel Syndrome of the wrist. In that both cases a nerve is pinched or compressed in some manner or form.

Tarsal tunnel syndrome happens when the Posterior Tibial Nerve is compressed within the Tarsal Tunnel.

  • Flat Footed feet are prone to developing Tarsal Tunnel Syndrome (TTS).  A flat foot leans inward toward the inner ankle, therefore more pressure is applied to the tarsal tunnel.
  • Any type of swelling or inflammation in the ankle or foot can compress the nerve. Examples: Sprained Ankle, diabetes, water retention in the foot, arthritis, swollen tendon, etc.
  • Any type of abnormal growth that invades the space within the tarsal tunnel. Examples: Cyst, bone spur, Varicose Vein, etc.

Common Symptoms of TTS:

  • The pain can radiate from the ankle up but most likely from the ankle downward and into the foot. Most cases report pain in the bottom of the foot towards the outside portion. This may include a burning, numbness, tingling or shooting pain.
  • Pain typically increases when pressure is applied from prolonged usage such as standing or walking.
  • Tarsal Tunnel Syndrome is often mistaken for Plantar Fasciitis, we will discuss this later.

A Few Things You Can Do To Self-Diagnose.

  • There are a few telltale signs and steps that you can perform yourself.
  • Are you flat footed and over pronate when you walk:
  • Has the Pain began suddenly or gradually? Either may occur, but gradually is a telltale sign.
  • Try to duplicate the shooting and tingling sensation by tapping lightly on the Tibial Nerve. This method is called Tinel’s Sign. Tap on the nerve with a finger and if pain shoots or a tingling sensation (often referred to as: Pins and Needles) is felt, then this is a sure sign that TTS is present and not Plantar Fasciitis.  Pins and Needles is a sign of nerve pain, Plantar Fasciitis is not nerve pain.
  • Do you see swelling in the ankle area? If so this is a sign of increased pressure on the Tarsal Tunnel area.
  • Having diabetic neuropathy or poor circulation can both cause burning and tingling in the feet and be mistaken for TTS.

Treatment for TTS.

  • Conservative treatment starts with reducing the swelling, this includes icing, elevating the foot, immobilizing the foot by using a walking cast, Taking Ibuprofen or Aleve. Corticosteroid shots may be prescribed by the physician.
  • Changing the walking gait is most often recommended by using a custom orthotic. This will relieve the excessive pressures from being flat footed and over pronating.

When Surgery Is Required

As mentioned above, sometimes there is an obstruction in the Tarsal Tunnel that must be removed surgically. This surgery is referred to as “Nerve decompression”.  Most physicians will still recommend the use of orthotics after surgery, especially if the patient is flat footed.

What do Tires and Feet Have in Commorn

There are a lot of moving parts in a foot, 26 bones to be exact. So pronating and supinating can have many variations. I am using this comparison because most people have a car and should be able to relate. I am going to compare a foot to a tire on a car. On a foot is a shoe and on a car is a tire. Both show wear signs after so much use. Imagine the two front tires as the car’s feet.  If you view the tires from the front of the car and the insides show more wear than the center or outside of the tire, this would be pronation. If the tires show wear towards the outside more than the center or inside, this would be supination. If the tires wore evenly throughout this would be neutral or normal. The fixes are similar. With tires you would get an alignment. With feet you get an alignment by using orthotic inserts. Just like a tire you don’t fix this only because your shoes are wearing out faster. If tires are wearing badly it puts unnecessary strains on the suspension which in turns wears it out faster. When feet are out of alignment they put unnecessary strain on the feet, ankles, knees and back. Minor pronation and supination probably won’t be painful but when pronation or supination is severe, it will lead to pain especially as a person ages. Just like our foundation article (another post on our blog). It all starts from the feet up. There are many varieties of shoe inserts to treat the problem. When a foot pronates it is most likely – flat footed. When the foot supinates it most likely has high arches. High arches are harder to find corrective inserts because they are less common. It is not always easy to just purchase an insert off the shelf and resolve the issue, like I said, there are a lot of moving parts in a foot. A foot can start off supinating and end up pronating. The surest way to get a corrective orthotic is to get one that is made from a mold of the foot and having direct conversation with a licensed specialist. The Pedorthist can determine from the mold if the foot pronates or supinates but most important, the specialist will can help resove other issues, like heel pain, activity level, corns, bunions, etc. A tire doesn’t feel pain but our body does.

The Good, The Bad, and The Ugly of High Arched Feet

The Good:

High arched feet are powerful and have been said to be common in great athletes that play a sport where fast direction change in needed, stopping / accelerating and jumping. Examples would be football, basketball and tennis. High arched feet tend to supinate (putting wear and tear on the outside of the shoe at the heel strike, then rolling inwards to the big toe. This creates less shock absorption which makes for quicker cuts and starts when running. In most cases supination is easily corrected with therapeutic insoles that support the arches and correct the supination issue in the walking gait.

The Bad:

People with high arches are prone to muscle fatigue in the legs, ankle pain, knee and back pain, mainly due to the fact that their feet are less shock absorbing. High arched feet have been found to be no better than flat feet.  Remember when the army wouldn’t take a soldier if he was flat footed. Thinking that they couldn’t march for long distances. That has changed. In recent studies they have found out that flat footed people have equal or less injuries than that of a high arched person. Flat Footed people tend to get injuries on the inside areas of the feet and legs where high arched people tend to get injuries on the outside of the leg, this is because most high arched feet supinate.  High arched feet are more prone to shin splints and stress fractures

The Ugly:

View the picture of the saddle bone deformity (common with high arches) on the foot. It’s not pretty and can be painful. Usually the person is told to live with the condition unless it becomes painful. The Lump that forms on the top of the foot is a buildup of bone on top of bone, usually at the metatarsal joint.  Usually pain is caused by pressure being applied to the lump from shoes that are tight. When your arch juts upward it hard to find shoes that don’t apply excessive pressure. We will show you a way to tie your shoes that will help. People with high arched shoes have to be careful in the shoes they buy, typically slip on boots (cowboy boots) and shoes that have elastic straps can create even more pressure. If you have pain from a saddle bone deformity, remove the pressure from tight fitting shoes. Let’s say you wear sandals for a couple days and the pain is still there. There is a test called “Tinel’s sign”, it involves taping the protruding bone with a thump like tap. If it is just a minor dull pain it should heal itself, if you feel a tingling pain (nerve pain) on top of the foot that can go down into the toes, then there is pressure on the peroneal nerve.  This is when a foot surgeon should be consulted. If surgery is required, this takes about an hour and the recovery time is @ six weeks.

How did I get High Arches?

They are typically inherited and should run in the family. If you develop one foot with a high arch this is most likely from a neurological condition and should be treated promptly.  Some conditions that can cause high arches are Spina bifida, Stroke, Cerebral palsy, Charcot-Marie-Tooth disease, Muscular dystrophy and a Tumor on the spinal cord.

Symptoms of a High Arch!

  • Pain when standing, walking or running due to the extra stress on the metatarsals (bones at the top of the foot)
  • High arched feet are prone to having “Claw Foot” toes curl back and have the appearance of a claw.
  • High arched feet are prone to “Hammer Toe” the middle of the toe is up and the end of the toe lays flat against the ground, giving the appearance of a hammer.
  • Corns and calluses that form on the ball or side of the foot, or the heel
  • Heel spurs often develop from hard impact
  • The arch tends to be stiff with limited flexibility
  • Prone to Ankle Sprains
  • Calf Muscles tend to be tight
  • Cramps in the Plantar Fasciitis/bottom of the foot

How to tie shoes that will relieve Stress on the Saddle Bone:

There are two pictures above that show the lacing procedures. The First one requires starting out with a normal cross pattern and then going vertical on the second loop. Some people say it is better to go vertical on the third loop or to go vertical on the second and third loop. You will have to experiment to find out what works best. The second picture starts with a normal cross pattern then skipping the 2nd left lace hole and going to the third and then repeating this step with the right lace on the 3rd hole. Therefore alternating each lace from left to right. Again experiment with both of these styles until you find one that is comfortable and yet firm.

Custom made Orthotic Inserts:

The most effective thing that I have found is that orthopedic inserts preferably custom made usually will resolve all issues. Our licensed Pedorthist will examine the mold of your foot and then call you. From the mold they can deduct you walking gait and arch height. From the conversation they can discover where your pains are. Take for example that you have heel pain. They can make the heel soft or have a soft area that transfers weight around the center of the heel. Not all high arches are the same so having an insert that will support your arch is crucial in relieving the stress that come with a high arch. Next consider “Therapeutic Shoes”. Stride Lite has the beautiful shoes that you can wear on any occasion. The advantage is that they have extra depth. This allows room for custom shoe inserts. The smallest percentage of people have high arched feet so most shoes don’t accommodate high arches adequately.

Our Pedorthist is a licensed professional who has specialized training.

Ohio Revised Code Title 47 Chapter 4779.01 Orthotist, prosthetist and pedorthist definitions.

(A) “Accommodative” means designed with the primary goal of conforming to the anatomy of a particular individual.

(B) “Full-time” means not less than one thousand six hundred hours per year.

(C) “Inlay” means any removable material on which the foot rests inside a shoe and that may be an integral design component of the shoe.

(D) “Orthotics” means the evaluation, measurement, design, fabrication, assembly, fitting, adjusting, servicing, or training in the use of an orthotic or pedorthic device, or the repair, replacement, adjustment, or service of an existing orthotic or pedorthic device. It does not include upper extremity adaptive equipment used to facilitate the activities of daily living, finger splints, wrist splints, prefabricated elastic or fabric abdominal supports with or without metal or plastic reinforcing stays and other prefabricated soft goods requiring minimal fitting, nontherapeutic accommodative inlays, shoes that are not manufactured or modified for a particular individual, prefabricated foot care products, durable medical equipment, dental appliances, pedorthic devices, or devices implanted into the body by a physician.

(E) “Orthotic device” means a custom fabricated or fitted medical device used to support, correct, or alleviate neuromuscular or musculoskeletal dysfunction, disease, injury, or deformity.

(F) “Pedorthics” means the evaluation, measurement, design, fabrication, assembly, fitting, adjusting, servicing, or training in the use of a pedorthic device, or the repair, replacement, adjustment, or servicing of a pedorthic device.

(G) “Pedorthics device” means a custom fabricated or fitted therapeutic shoe, shoe modification for therapeutic purposes, prosthetic filler of the forefoot, or foot orthosis for use from the apex of the medial malleolus and below. It does not include an arch support, a nontherapeutic accommodative inlay, nontherapeutic accommodative footwear, prefabricated footcare products, or unmodified, over-the-counter shoes.

(H) “Prosthetics” means the evaluation, measurement, design, fabrication, assembly, fitting, adjusting, servicing, or training in the use of a prosthesis or pedorthic device, or the repair, replacement, adjustment, or service of a prosthesis or pedorthic device.

(I) “Prosthesis” means a custom fabricated or fitted medical device used to replace a missing appendage or other external body part. It includes an artificial limb, hand, or foot, but does not include devices implanted into the body by a physician, artificial eyes, intraocular lenses, dental appliances, ostomy products, cosmetic devices such as breast prostheses, eyelashes, wigs, or other devices that do not have a significant impact on the musculoskeletal functions of the body.

How Severe Are My High Arches? A simple test!

The Coleman Test. If you have high arches your feet will tend to supinate, meaning most of the weight is carried on the outside of the foot. The Coleman Test involves standing on and allowing the big toe and the next two toes to hang over the edge. To repeat. Heel on the block and toes hanging over (one foot at a time), have someone watching. If look at pictures (from the rear) of a supinated foot you will notice that if you were to draw a line from the bottom of the heel and upward through the calf, the line would go outward and then up. In a normal foot the line should be straight. When the foot is placed on the block as mentioned, the plantar will flex down with the toes and the rear heel line will become straight. This is good news, this means that a custom orthotic insert will greatly help the situation. Which should mean less foot, ankle, knee, and back pain. If the line doesn’t become straight, this means that the hind foot is rigid. See a podiatrist, they will usually start with orthotics and stretching exercises. If this doesn’t have significant results then surgery might be considered.