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.”

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?

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

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.

Sesamoid Pain

The main joint of the big toe (great toe) forms the inside edge of the ball of the foot There is one sesamoid bone on each side of the base of the big toe, the tibial and fibular sesamoids. They look like small navy beans. They are embedded in the tendon of the Flexor Hallucis Brevis muscle just under the base of the big toe. These sesamoid bones are similar to a knee cap in that, they float around and are connected only to tendons or are embedded in muscle (there is no joint). There are 2 grooves on the bottom of your first metatarsal bone in which the sesamoid bones are seated but they are not attached. These little bones serve 2 main purposes. The toe flexor  muscles bend and pass underneath the main joint of the big toe (view pictures), crossing over the hump that is formed by the sesamoid bones. This hump acts as a fulcrum point for the toe flexors, giving these muscles extra leverage and power. They also act as a fulcrum for the short flexor tendon. The sesamoids in the forefoot ease friction, assist with weight bearing and elevate the bones of the big toe.

Causes of Sesamoiditis

These bones are accustomed to massive pressure because of the leverage that is placed upon them. Any type of exertion that propels the body forward and upward involves the Sesamoid bones and tendons. Occasionally they can become irritated. Any activity where pressure is placed on the ball of the foot and the large toe is flexed continuously aggravate the bones and tendons. Catchers in baseball and ballerina’s are famous for getting Sesamoiditis. This is basically an overuse injury so even walking and running can cause it.

Other Factors:

  • Over Pronation (walking on the inside of the foot) adds excessive pressure to the big toes.
  • High Arches: can concentrate more pressure to the big toe. You are more prone if you notice that the big toe has become stiff.
  • Loss of Padding. As a person becomes older they lose some of the padding in the bottom of their feet and become more prone to a sesamoid injury.
  • Arthritis: If it develops between the sesamoid bones and the big toe, there will be friction and pain

Other Causes:

  • Stress Fractures: The sesamoid bones can become fractured from over exertion or any activity with sudden directional changes, like basketball, tennis, or dancing.
  • Traumatic Fractures: Involve a sudden impact. Like jumping off a wall.

Symptoms:

  • Sesamoiditis typically starts with a dull pain under the big toe joint. The sesamoids will feel tender to the touch. Any added weight or pressure to the sesamoids will cause increased pain, usually felt when the heel leaves the ground.
  • Other Symptoms:
  • A catching or popping that is followed by increased pain, which usually subsides after the foot is rested.
  • Swelling and bruising
  • Impaired ability to bend or straighten your big toe
  • When numbness is felt in the web of the first two toes.

Conservative Treatment:

  • Stopping the activity that causes the pain
  • Icing the sole of your foot.
  • Purchase a cushioning pad to relieve the weight.
  • Use cushioning foot orthotics to relieve stress. A custom therapeutic orthotic is highly recommended as it will change your gait if needed, put more stress on the arch of the foot and relieve stress from the big toe.
  • Aspirin or ibuprofen to relieve the pain.
  • Tape the big toe in a downward direction.
  • Consider a steroid shot
  • Pneumatic walker with rocker sole when walking.  2 to 6 weeks may be required.

Fracture of the Sesamoid:

  • Wear a short leg fracture brace, for up to 12 weeks. If pain persists use crutches even with the brace.
  • After 8-12 weeks. If the stress fracture won’t heal and is separated (nonunion fracture). Surgery is most likely the outcome. To avoid surgery doctors will want a cast and limited weight applied to the foot.

When Is Surgery Needed?

When the injury fails to respond to conservative treatment, surgery may be required as a last resort. Your surgeon may recommend removing part or all of the sesamoid bone. If only one sesamoid bone is removed the other sesamoid bone can still provide a fulcrum point for the toe flexors.  Surgeons will avoid taking both bones out if possible because the toe flexors lose necessary leverage and can’t function. Therefore Claw Toe can develop.

If you have had sesamoiditis and/or surgery please share with us your experiences.

Safe and Effective Ways to Remove Calluses and Corns

A callus is a local thickening of skin, characterized by accelerated keratinization, a process by which skin cells lose their moisture and are replaced by horny tissue. Calluses tend to be yellowish in color, picture yellow tented sheets of wax paper. The thicker they are stacked the more yellow the color. The thickening of the skin is caused by constant friction. It’s the body’s way of protecting the sensitive skin underneath. Unfortunately after time calluses can dry, crack and become painful. Most calluses are on the bottom of the foot and are called a plantar callus. Young people develop calluses from activity. Elderly people lose the padding in there metatarsal area and are prone to calluses. Ill-fitting shoes that are tight will increase friction between the toes and cause calluses. Most calluses are not painful and can be treated with a sanding pad.

A corn is an area of skin which has become thickened due more to pressure than friction. Corns are small and round in shape. Corns press into the deeper layers of skin and can be painful. Corns can be confused with calluses because they are often inside or underneath a callus. Three Types of corns:

  1. The first is a hard corn, recognized by its dry, horny appearance. Hard corns frequently occur on the top of the smaller toes or on the outer side of the little toe. Tight shoes tend to apply the most pressure in these areas. Hard corns are the most common and usually appear within a callus. Having a hard corn feels like having a small pebble held under the skin, held there by a callus and then walking on it.
  2. A soft corn is described as such because of its softer and rubbery texture, this is because of moisture from sweat. They most commonly develop between the fourth and fifth (baby) toes.  Usually the least painful of the three unless they become infected.
  3. The third type is a Seed corn, the most often occur on the ball of the foot underneath a callus but can also occur near or on the edge of a nail. Like seeds spread upon the ground they usually appear in clusters. They are small and are recognized by a white plug in the skin. They also can also be painful.

How Can I Treat my Corns and Calluses?

We are going to recommend a few treatments, I want to state clearly that anyone who has an infection or is Diabetic should only see a physician and or podiatrist and none of these treatments involve a person cutting, scrapping or digging with a sharp object.

File down the calluses and corns by using a file or pumice stone (emphasis on gently). This should be done after soaking your feet.

After bathing use a moisturizing cream (Goal is to soften those calluses and corns). Podiatrist recommend one that contains urea.

There are sleeves for toes that relieve pressure. Splints can be used to create separation between the toes, this will allow corns to heal. For calluses, use cushioning pads and shoe insoles to relieve the pain and help the healing process

Do Not Use Salicylic Acid: People have success with it but podiatrists claim that if the foot is kept wet from the moisture of sweat the acid keeps working. There are cases when the podiatrist sees the patient when the acid has eaten its way down to the bone or tendons.

8 Homeopathic remedies recommended by Readers Digest:

  1. Castor Oil and Apple Cider Vinegar: Fill a basin with hot, soapy water, then add a cup of apple cider vinegar before soaking your feet in the water for at least 15 minutes. Calluses should be softened enough to be filed with a pumice stone. For corns, dab some castor oil on after soaking your feet. Corns should peel away after about 10 days of the treatment.
  2. Vitamin E or A : Before bed, use a needle to prick a vitamin E or A capsule, then rub the oil into your corn. After letting the oil sit for a few minutes, put on a white cotton sock and head to bed. Repeat nightly until the corn is gone.
  3. Lemon: Before going to sleep, cut a slice of lemon peel about an inch long and the width of your toe. Place the pith over the corn, securing with a bandage and covering with a white cotton sock overnight. Continue each night until the corn disappears.
  4. Onion: In a glass container, pour white vinegar over a slice of white onion. Leave the container in a warm place during the day, then cover the corn with the onion before you go to bed. Use a bandage or bandage tape to hold it in place while you sleep. If the corn is not soft enough to be removed in the morning, repeat the treatment nightly until it softens more.
  5. Bread: Soak a half a slice of stale bread in apple cider vinegar and secure it to the affected part of your foot with adhesive tape. Wrap with plastic wrap and slip on a cotton sock. Your corn or callus should disappear by morning.
  6. Castor Oil: For corns on toes, place a non-medicated, O-shaped corn pad around the corn. Use a cotton swab to dab a few drops of castor oil onto the corn, then cover with adhesive tape to keep it from moving. Wear old socks in case the castor oil leaks through.
  7. Aspirin: Crush five or six uncoated aspirin tablets and mix with equal parts apple cider vinegar and water. Once you’ve added enough to form a paste, rub it onto a corn or callus, using a bandage to hold it in place. After at least 10 minutes, the bump should be loose enough to gently rub off with a pumice stone.
  8. Epsom Salts: For calluses, toss a handful of Epsom salts into a basin of warm water, then soak feet for about 10 minutes. Once the dead skin has softened, use a callus file or pumice stone to rub off the top layers. Continue to grind the callus down a bit each day after a bath or shower. It might take a few weeks, but trying to remove the whole thing at once will make the callus worse if you grind too deep.

See a podiatrist: There are many videos on U-tube showing Podiatrists removing corns and calluses. They most often us a scalpel and grinder. The scalpel blade looks like a ¾ inch pen knife.

Now That I Have Gotten Rid Of Them, How Do I Keep Them from Coming Back?

  • First and foremost get proper fitting shoes. Therapeutic shoes with inserts are recommended. They are Ultra Depth, this will allow the fitting of a shoe insert and should illuminate the top of the toes from rubbing on the shoe. Therapeutic shoes are now more stylish and reasonably priced than ever.
  • Buy Therapeutic shoe inserts: These can be bought off the shelf or made from a mold of your feet. These inserts will cushion the friction and pressure of your walking gait. You won’t believe the difference between a custom insert and an insert that comes with a standard shoe. When I first compared, I thought, “I have been walking on tissue paper”.
  • Avoid wearing high heels.
  • Keep your feet moisturized.

Metatarsal Pain

Metatarsalgia (Met-uh-tahr-SAL-juh)

Metatarsalgia is pain in the ball of the foot. It is called stone bruise for good reason, it feels like you stepped on a sharp stone and then a 300 LB person stepped on that foot. The degree of pain varies and it can be tender to the touch. Pain is caused by inflammation at the end of the metatarsal bones which is above the ball of the feet. There are five long metatarsal bones that extend above the arch of the foot to the toe joints. The first and second metatarsal bones absorb the majority of this force. Most Metatarsal pain is between the third and fourth metatarsal heads (view pictures). Pain is felt when weight is applied to the ball of the foot and worsens when the walking gait transfers the weight to the toes. People with high arches and long second toes are prone to metatarsal pain. The longer second toe absorbs more weight during the gait and aggravates the metatarsal joint. If the pain is in the big toe it is often from osteoarthritis. Metatarsal pain is mostly an overuse pain. It is most common in athletes, runners, women who wear high heels and overweight or obese people.

Symptoms:

  • 80% of the time symptoms develop slowly as it is an overuse condition. 20% of the time it is from an extreme overuse condition. Take a father who plays basketball with his son for example. The next day he might wake up and feel extreme pain in the balls of his foot/feet.
  • Pain in the ball of the foot and or in the second, third, or fourth toes
  • Increasing pain when walking on hard surfaces
  • Pain that increases when flexing the feet
  • A tingling or numbness that can be felt in the toes
  • When standing or moving there is pain but when sitting pain decreases

Healing Time of the injury include:

  • Lifestyle of the patient
  • Medical history of the patient.
  • How long the injury has been inflicted.
  • Severity and frequency of the pain
  • The person’s medical history and is there pain elsewhere?
  • The person’s gait, does the patient put excessive weight on the injured area from pronation?
  • Is surgery required?

Treatments may include:

  • Anti-inflammatory drugs, such as Ibuprofen or Aleve, are useful in pain relief.
  • Appling ice to the area up to several times a day. Do not apply ice directly to the skin.
  • Doctors may subscribe Steroid injections to reduce pain and swelling. Remember to ease into recovery often steroids mask the pain and patients are eager to over evert the injury.
  • Foot orthotics with metatarsal pads work well especially for people with high arches and arthritis pain and will be likely be prescribed to all, with or without surgery.
  • Shoes with Cushioned heels that absorb shock.

Note: if pain is persistent see a doctor it could be a stress fracture in the toe. Be aware that forefoot pain is the most misdiagnosed in podiatry. Other mitigating circumstances: Hammer Toe, a pinched nerve, etc.

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.

According to podiatrytoday.com –  Over the past two years, our team of doctors has treated more than 2,000 patients with plantar fasciitis. This has allowed us to try multiple conservative and surgical options. We have concluded that certain conservative options seem to make significant improvements.

If I have one conservative option to offer patients on a consistent basis that has the most impact in their recovery from heel pain, it would be Achilles and gastrocnemius stretching. We usually will ask patients to perform both calf and Achilles stretches for five minutes three times per day. We teach the patients these stretches on the initial visit.

Second in line for conservative options is a close tie between physical therapy and orthotic use. We have found that the combination of stretching, physical therapy and orthotic use has helped over 80 percent of our patients recover without further need for care. The average time to recovery has been less than two months and no further treatment has been necessary in over 90 percent of this initial group.          http://www.podiatrytoday.com/issue/2108

Pain Relief: Bandaging the arch helps but does not last long. Products that support the arch are your best bet. A custom made orthotic made from the mold of your foot will supply cushioning to the heel area and support the arch. Highly recommended is a night splint this will prop the foot up in a 90 degree position, situating the plantar tendon in a shortened position, making it possible for the tears in the plantar fascia to heal. These braces are relatively inexpensive.

Pain Relief: Using Advil or Aleve will help ease the pain but if these don’t work the doctor will most likely, administer an injection of a corticosteroid directly into the fascia tendon. Typically two shots are given anywhere from two weeks to a month apart. The steroid will most likely relieve the pain but do not overexert the fascia because the steroid shot is not healing the tendon, only addressing the pain. The good news is that only around 3% of cases require surgery.

Diabetes and the Foot

Definition of  “metabolic disease”  a syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to an increased risk of cardiovascular disease and type 2 diabetes often called also insulin resistance syndrome. From Merriam-Webster Dictionary      http://www.merriam-webster.com

“Metabolic syndrome” – is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes. From the staff at the Mayo Clinic    http://www.mayoclinic.org

“Neuropathy” – means nerve disease or damage and affects the nerves in your toes, feet, legs, hands, and arms.

“Peripheral neuropathy” A common, often misdiagnosed disorder that results from damage to the peripheral nervous system. Symptoms include numbness, weakness, tingling and/or burning in the toes or fingers. https://www.foundationforpn.org

Why does nerve damage from diabetes usually start in the feet? These nerves travel the farthest from the brain and spinal cord.

There are too many types of peripheral neuropathy to list. We are going to concentrate on “Sensory Neuropathy” because this is most likely the first one that a person with diabetes will develop. Sensory neuropathy affects the nerves that control what a person feels, like pain or an itching sensation. Again we will pertain to the feet since it will most often occur there. Some symptoms that a person might feel are: Numbness and tingling of the feet, Loss of sensation, like poking the bottom of the foot with a pin and not feeling pain. Loss of balance, especially in the dark.

Why do diabetics tend to get foot problems?

In the diabetic foot, glucose reacts with the collagen in the connective tissue. The short version is it causes both inelasticity and toughness in the foot’s connective tissue. This creates stiffness and weakens the muscles in the foot. Pressures on the foot that used to dissipate throughout the foot while walking are now accumulated to specific areas, causing blisters sores and ulcers.

Serious problems can begin when the diabetic foot or areas of the foot becomes numb. The diabetic skin cracks easier and if goes unnoticed can easily become infected. There are many people who started out with sores, blisters and have ended up with an amputation.

“I’m Pre-Diabetic” or “I have Type II Diabetes”.  Unfortunately it doesn’t matter, there is equal prevalence in types I and II. Only 5 percent of the diabetics in this country are type I. However time does matter – people are most likely to develop diabetic foot problems with over 20 years of being diabetic. Approximately 15% of the people with diabetes have consequential foot problems but that’s still millions of people, there’s @ 29 million people with diabetes in the USA.

Let’s not talk about preventing diabetes. You could fill a library with the books that have been written and I’m sure you have read that about 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking (I’m talking about type II diabetes). Please don’t Google “Diabetic Foot Photo” unless you have a strong stomach, although the pictures will probably do much more for change in lifestyle than all the books written?

Care for diabetic neuropathy in the foot:

Clean Daily – Soaking of the feet should be avoided, use lotion to moisturize the feet, avoid letting lotion seep between the toes.

Cut Toenails: We don’t want a sharp edge to cut another toe. Cut and file appropriately and gently file calluses

Wear Shoes/Slippers to Protect the Feet: Wearing thick, soft, seamless socks can help prevent skin irritation.

Shoes: Wear ones that fit well and allow the toes to move (Ultra Depth/Therapeutic Shoes Preferred). Break new shoes in gradually.

Use Diabetic Shoe Inserts: they are smooth and less likely to rip the skin. They are soft which will help prevent skin from cracking. There are generally two types to consider. A flat diabetic insert (Generic) or a custom made diabetic insert (Molded). A diabetic insert is made of a special material that allows the foot to settle downward, into the insert. This allows the pressure points in the foot to settle so that surrounding areas that did not bear weight before, will now, creating a more even weight distribution. This is extremely important to a diabetic because neuropathy can prevent the feeling of pain. Diabetic Inserts have been proven to greatly reduce the development of Diabetic foot complications such as ulcers and lesion’s. When more severe Diabetic Foot Symptoms exist: loss of foot padding, thin skin, sores, Hammer toe, Claw’s Toe, Morton’s Toe, Bunions, Calluses, Red Spots, Blisters, Extreme Foot Neuropath, Diabetic with a Charcot foot, Metatarsal Pain (pain in the ball of the foot), etc., then Custom Molded Inserts should be used. These have been scientifically proven to reduce Metatarsal Pressure by increasing weight distribution and pressure onto the Plantar (Arch) area of the foot. Since they are custom molded to each foot, they supply ample arch support.  There are mixed reviews about relieving pressure stress in the heel area, although they are much thicker and softer than a flat prefabricated diabetic insert and will allow all pressure points to settle further.  That being said, pain is diabetic foot complications generally start in the mid to forefoot area.

If pain, sores, ulcers, etc. develop: See a Podiatrist!

HOW TO FEEL BETTER FROM THE FEET UP!

 Merriam-Webster Medical Definition:   “Supination”: a corresponding movement of the foot and leg in which the foot rolls outward with an elevated arch so that in walking the foot tends to come down on its outer edge.

Pronation”: rotation of the medial bones in the midtarsal region of the foot inward and downward so that in walking the foot tends to come down on its inner margin.

By looking at your shoes can tell you a lot, if the outside of the shoe is worn from the back to the front you are supinating. If the heel is worn on the inside to the big toe you are pronating. Imagine balancing yourself on two broomsticks down the center of your feet, now rotate your weight to the outside of your foot-supination, now to the inside of your foot – pronation.  This is exaggerated but the picture is clear. Many problems can occur because of the way we walk and by added weight that is carried by our feet. If a person’s gait is pronated (over 90% of the people with foot problems over pronate) it is common for them to have claw toes, toes that are curled up, this is because only the big toe carries the weight. If the other toes carried weight they would be forced spread out. People that walk on the inside of their foot are prone to ankle, knee and back pain. The least common issue is supination, where the weight of the body is carried on the outside the foot. People that supinate, are prone to aching arches, knee and back pain, because shock absorption from the feet is reduced. “So, what is the big deal, I was born this way”?  30% of the people have normal feet and gait, out of the 70% left, probably only 30-40% are abnormal enough to cause pain. I personally played baseball, football, basketball and played outdoors from sunup to sundown when I was young- no pain. Looking back, when I reached my mid 40’s I started noticing ankle, knee and back pain. (Read the article – “Build Your Foundation”) https://www.mondaymedical.com/blog   Being out of line didn’t matter before I was 40ish. I can remember my big toe aching sometimes after basketball practice, now I know it was carrying most of the weight. As I approach 60, I notice my ankles and knees kill me if I forget my orthotics on a day of walking or working in the yard. Advil and Aleve help but my orthotics have done wonders. They have actually changed my walking gait. As soon as I walk with my orthotics I can feel my outer toes bearing weight. It is so apparent I notice before I walk 20 ft.

Breaking them in: When I first received my orthotics years ago I was told to wear them a few hours a day and progress more hours every day. This was good advice. The Orthotics supported my high arches for the first time, so I could feel pressure in my arch then to my toes. The toes were fine but it took a couple weeks before my arches were pain free. Now it feels abnormal if I am not walking on them. At first you will notice the distribution of weight in your feet, then you will notice the knees feeling different, like the body weight is wearing on a different part of the knee, finally you’ll notice less back pain.

Build your Foundation

Picture your calf’s and knees resting on a foundation (your feet). If your foundation is supporting all of the weight on the outside (Supination) it throws the middle support column (Calf’s) out of kilter which then wears the cartilage towards the outside of the knee. If you can imagine leveling up the crooked foundation until all the weight is spread even (as in the first picture), the ankles and knees will rotate inward, taking pressure and applying it in the proper location . Not only does this straighten up the whole body through the hips and back. It commonly relieves pain in the knees hips and back. Even if the cartilage is worn down to bone on bone in the knees, it is common to have the knees realigned, to where a cartilage area is now absorbing the wear and tear. This is why we have so many people rave how our inserts have changed their lives. It’s usually a combination of things. My feet feel better, my knees don’t ach as much and my back pain is much better. It all starts with a good foundation!