Minimal Shoes, Support and Orthoses

Minimal Footwear, Orthoses and Supportive Footwear 

 

There can be some controversy on custom foot orthoses and some statements that they weaken the feet. There is a belief that minimalism is one approach and the other is to believe in supportive and durable footwear. My goal is to provide information on both to allow one to make the best decision for their individual health needs. 

 

The reality is that some activities which require repetitive movement, such as walking or running, on a regular basis, can lead to tissue overuse. People who wear minimal shoes have come into my office with injuries and those who run in minimal shoes still do end up with injuries.

There have also been people who wear supportive footwear and still end up coming into my office with injuries. The point here is that footwear is part of the puzzle and not the entire puzzle. Strength and rehabilitation of the entire kinetic chain, along with footwear will yield better results, than footwear or orthoses alone. 

To break things down from a treatment approach, when there is an injury, the ability to maintain some relative load on the tissue is part of rehab. Allowing this to take place by also dissipating the amount of complete load on the tissue can be mitigated by taping, orthoses, supportive footwear or bracing.

What support and orthoses can do is help one maintain a quality of life or continue their life to help lessen the load on the injury so it can get stronger from exercising and maintaining some load on the area. Orthotics do not zap the strength out of the foot, In fact,  there are studies that suggest strength is improved when orthotics are  combined with exercise. 

 

What the Research says :

The study “Effect of foot orthoses and short-foot exercise on the cross-sectional area of the abductor hallucis muscle in subjects with pes planus: a randomized controlled trial”, found orthoses combined with short foot exercises increased the strength in the toe flexor and abductor hallucis. This proves that orthoses do not diminish foot strength.

In another study orthoses used in isolation without strengthening does not strengthen the feet. Which I do agree with. Orthotics alone are not meant to strengthen the foot. They are meant to help unload forces on an injury in conjunction with strengthening. 

Some injuries are quite severe, but for most conditions suitable for orthoses, pain reduction is possible. For those who work on their feet all day, or an avid active person who can resume exercise with a reduction in pain, an orthotic can be a great option for them. 

An example of a study which demonstrates how runners benefited from an orthotic was a study “ Effects of foot orthoses on Achilles tendon load in recreational runners”. 

The results indicate that running with foot orthotics was associated with significant reductions in Achilles tendon load compared to without orthotics. The unloading allows the runner to continue their activities while they rehabilitate. This should be weaned off in time.

Also, if one stayed in that device long term there would be changes that could in fact weaken the area and shorten it. So another part of the puzzle is to properly use the devices and have the proper prescription for the injury and foot type.

If someone was injured I would not advise them to continue standing, walking or running for prolonged periods of time in a minimal shoe. That being said, when strengthening the foot I would advise being barefooted or in minimal shoes. There is a time and placenfor minimal footwear. The longer the high load activity there is, muscle and physical failure happens and that is where injuries are most likely to arise. 

I think minimal footwear is great for deliberate strengthening, or the odd time running on the grass or sand. However, pounding the pavement, rehabbing an injury or setting personal bests may not be best sought out in minimal footwear. 

 

How you can try utilizing support prior to getting orthotics:

 

An easy way to see if you would benefit from support when combating an injury is to try some taping and padding. We can provide this for you. Over the counter insoles can also be used to see if there is any small improvement. There is generic support in these and they are not custom with posting or specific prescriptions needed for certain injuries, but can provide some help. 


To summarize, I am not against minimal footwear. Track spikes are very minimal. I do think some minimal footwear for deliberate proprioception/ foot strength is okay to wear. However, for prolonged walking, standing and running, especially when injured, can benefit from more supportive and protective footwear tools.  

Foot and Ankle Tendinopathy Treatment Toronto

Tendinopathy and Treatment

 Not all tendon pain is the same and depending on what stage someone is at, their progress in rehab can be catered to their individual needs. For instance, someone who has very recent tendon  pain, is treated differently than someone who’s had tendon pain for over three months. It is very important to have a thorough examination done in order to determine the root cause of the issue as well as a proper diagnosis.

Type of Tendon Injuries

Tendons can have different types of injuries and pathologies. For instance, there can be a reactive tendon, which is usually within the acute phase and that normally is within the first few weeks of onset. 

A reactive tendon is called reactive due to the cellular response going on within the tendon.

Reactive tendons can also be one in which there is  a direct blow to the tendon.  An example would be if someone hit the Achilles tendon on a bike pedal. Reactive tendons are injuries brought on by a sudden increase in load beyond what the tendon can tolerate. 

 

Degenerative tendons are those where that reactive phase has gone on for a longer duration of time. This is usually the type of pathology that goes on when a tendon injury is longer than 3 months time. The cellular response that occurs in the reactive continues which causes disruption to the tendon matrix, making it degenerative in nature. On a cellular level there are actual physical changes to the cells in the tendon. They become flattened and this makes pockets of degeneration within the tendon. The good news is that there are still healthy tendon cells around those areas of degeneration, which can be loaded and help maintain the health of the tendon. 

 

The other type of tendon injury is not in the actual tendon, but located in the structure around the tendon. This is the tendon sheath called the paratenon.. This is differentiated by pain that’s brought on by movements that would cause a lot of friction but not loading. An example of this would be cycling for a prolonged period of time. That is because the flicking movement of the ankle can cause friction gliding at the paratenon to the tendon causing pain and swelling. It is very important to know the difference because if treated the same way as a tendon, that can actually increase the severity of one’s symptoms. Paratenon is treated quite differently from tendinopathy. 

 

Paratenon Irritation and pain is not brought on by load, it is brought on by friction. If someone went out for a run with a tendon injury,  normally that pain warms up and starts to feel better during and then tends to feel worse after. With a paratendon injury pain can happen with Running from the friction movement of the ankle. It would get worse as a run progresses.

 

Treating a tendon sheath injury is complete rest and offloading. That would also include a chunky heel or wedge heel lifts in order to mitigate how much friction happens. With a tendon injuries and we don’t really want to completely unloaded we want to 

progressively load it in a manner that the tenant can tolerate.The only time complete rest is needed is when there is a complete tendon rupture. 

 

Typically things to note about a tendonapathy is that it can handle heavy and slow loads.  It cannot handle what will provoke pain and make it worse which is fast movement and explosive movements, which requires energy storage and release. Those type of movements would be if someone really goes through calf raises completely fast.. With that being said, energy storage and release movements will have to be rehabilitated later on in the phase of treatment in order for someone to return back to the activities that require those type of movements.

 

Isometrics are great to start with for pain relief and improving the strength in the muscle and tendon. Isometrics of movements where there is no change in range of motion. It is a sustained contraction.The duration of time that is recommended is 45 seconds to 1 minute followed by five repetitions with anywhere from 1 to 2 minute rest between.

Isometrics can be tolerated daily. Then within time one gradually goes through full range of movement. Those type of movements we call concentric and eccentric movement.

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Things that can help  tendon pain include anti-inflammatories, exercise, load modifications,  orthotics let’s and supportive footwear. Things like extracorporal shockwave is also great to help as a modality however it does not take the place of a progressive treatment program.

Load management can be modified so that a person can still maybe do the exercise hey like doing,  but finding a happy medium of what the tendon can tolerate. So that may be a run walk program or walking shorter walks splitting up walks of two shorter durations in a day or taking rests during the walks. 

 

I hope you have found this helpful. A kind reminder that you do not have to struggle and I would be more than happy to help you conquer your tendon injury.

Toronto Chiropodist Tips For Travelers

A good Toronto chiropodist is always making sure that your feet are in good health. It doesn’t matter where you are or whether you’re working or playing. Taking advantage of our suggestions is especially important when you are traveling.

It doesn’t matter whether you’re enjoying some leisure time or focusing on business. These tips from our foot clinic in downtown Toronto help to ensure you enjoy your trip.

  • You’ll need appropriate footwear. Choosing shoes for your vacation means taking into account the climate and the activities you want to be doing. Make sure to choose shoes that are appropriate for things like sightseeing, hiking and walking and bring along at least two pairs. Closed toe and heel shoes are a necessity, even if you’re going to a place that’s warm. Traveling overseas means hygiene could be an issue. That’s why you’ll need some footwear beyond sandals.
  • Preparing for the climate also means you should use sunscreen on your feet. This is important if you’re going to a hot place and you will be on the beach barefoot. Make sure to use it on the tops and sides. It’s recommended that you use a product that has an SPF of 30 or higher. A good Toronto chiropodist will also recommend a product that blocks both UVB and UVA rays. It should also be water resistant. Sunblock is also very effective at blocking the sun’s rays. This is known as zinc oxide and is safe for the water ecosystem and is all natural.

Here are some other tips that you can use to look after your feet when you are around water. Keep in mind that being around a pool or lake exposes them to different hazards than your usual routines.

Keep Towels Private

Microbes and other bacteria like the one that causes athlete’s foot fungus can stay on towels for hours. That means they can spread from one swimmer to another when you share towels even amongst family members.

Watch Your Footwear

Footwear like flip-flops aren’t meant for walking long distances.. They don’t supply proper support while walking on a beach during your vacation. Any kind of open heel or open toe footwear increases your chances of getting injured too. It’s best to wear footwear that encloses the heel and toe and supplies good arch protection.

Wash Your Feet

Here’s a final tip from your Toronto chiropodist. Wash your feet thoroughly afterwards if you decide to go barefoot in pool areas or public beaches while you are on vacation.

Your Foot Clinic in Downtown Toronto Supplies Summer Tennis Tips for Foot Health

Our foot clinic in downtown Toronto is always ready with warm weather advice for foot health when it comes to outdoor sports and activities.

Some of the activities you might participate in like tennis can present challenges because of the types of movements they require.

Health and Conditioning

The best possible foot health and proper conditioning are important. Conditioning for this sport requires joint stability, leg strength and flexibility. Wearing the proper footwear that protects your feed is also critical.

Here’s an overview of some of the movements that can cause issues and what you can do about them.

There are several different movements in tennis that put a lot of stress on your feet and can cause soft tissue damage.

  • Strong impact activities like extending and lunging put a lot of pressure on the heel and forefoot. That can cause the potential for muscle strains and different types of foot trauma.
  • Strains and sprains can be caused by crossover steps and sideways sprints.
  • Hops and short jumps can even cause bruising and stress fractures as well as blistering.

Your foot clinic in downtown Toronto also points out that the surface you play on can dictate the amount of stress on your feet. Clay and grass tend to yield more so they’re much easier on your limbs. Harder surfaces like public courts put more stress on your legs and feet.

Choosing The Right Tennis Footwear

Choosing shoes that have good ankle support is important if you’ve twisted or sprain your ankle in the past. You’ll also need to pick the footwear for tennis that’s appropriate to the kind of surface you’re playing on.

Popular Surface

For example, one of the most popular surfaces is the hardcourt. This is also the most demanding on any outsole. When you’re choosing a pair of shoes, look for a modified herringbone pattern. These provide an excellent blend of give and grip while you are on the court.

Padded Socks

Our foot clinic in downtown Toronto also likes to suggest padded socks. These have a well-defined toe and heel so they fit properly. They also have a cushioned sole that’s usually made of terry fabric. Always choose padded socks that are made for the specific activity you want. Look for ones that are made of acrylic blend or acrylic fibres.

Our Foot Clinic in Downtown Toronto Provides a Bursitis Primer

Our foot clinic in downtown Toronto sees a number of cases of bursitis every year. The fluid-filled sacs cushioning your muscles, tendons and bones around your joints are affected by this painful issue. Although bursitis is commonly located in the hip, elbow and shoulder, it’s also common at the tip of your big toe and your heel.

Your foot has what’s called a bursa. Those are fluid-filled sacs shielding tendons and bones from getting damaged. When these become inflamed, bursitis can follow.

It is often found in the joints performing repetitive tasks. Symptoms include:

  • Pain when touching the affected area and discomfort when running and walking.
  • Warm red skin over the area that’s been affected by bursitis.
  • Sharp pain when standing up on your tiptoes.

Toronto orthotics that supply arch and heel support reduce the discomfort from bursitis. Orthotics can also help with other issues like bunions. Ones that come with a wide toe box reduce pressure on the big toe that can cause this problem.

There are risk factors. For example, you stand a greater chance of getting bursitis as you age. If you have an occupation or a hobby where you put pressure on a particular joint or undergo repetitive motions, your chances of developing this problem increase. There are other conditions like gout, rheumatoid arthritis and diabetes that increase your chances of developing bursitis. The same can be said for being overweight.

Foot Clinic in Downtown Toronto Prevention Tips

It’s not possible to prevent all types of bursitis. However, you can lower your risk and the severity of the flareups you experience by changing the way you approach certain tasks.
If you already have an effected joint, exercising can help. Try to pinpoint the muscles that can protect this area. Before any strenuous activities, you should stretch and warm up. This is an excellent way to protect your joints from further injury.

Bend Your Knees

At work, it’s important to lift properly. That means bending your knees. It’s also a good practice to take breaks and alternate repetitive motions and tasks.
Bursitis can also be caused by irregularities in your feet. Sometimes a bone spur can develop on the heel that can cause this issue. There are other conditions that can cause bursitis including diabetes, arthritis infections and high thyroid levels.

Questions

We can diagnose this problem at our foot clinic in downtown Toronto. We will ask a series of questions about the type of exercise and sports you enjoy. We also will need to know if your job involves repetitive motion and long periods of standing.

Important Aspects of Children’s Foot Care From Your Toronto Chiropodist

We’re the Toronto chiropodist that wants to look after everyone including your children. Helping them to understand how to look after their feet now can prevent issues as they get older.

It’s important to remember that many adult problems have their beginnings in children’s developing feet.

Here are a few aspects that parent should know about.

  • Walking is good for everyone and that includes children. This is also a great time for parents to watch their offspring’s walking pattens. Notice any problems with their gait including whether the feet turn in or out. Look for other red flags like knock knees. These and others can be successfully treated at our foot clinic in downtown Toronto if they are caught early enough. Otherwise, they can carry over into adulthood.
  • Children love to participate in individual and team sports. Many of these occur outside their schools where getting the proper advice on equipment and conditioning isn’t always available. Parents should be aware there’s usually an amount of turning and running or contact with some games. That’s why protective ankle tape is a good way to prevent any fractures or sprains. Consider having a discussion with your Toronto chiropodist about this.
  • Going barefoot is usually a healthy decision for children but that depends on the surface they are walking on. It’s best to pick ones where there are no natural hazards that can injure the feet. Grass, dirt and sand are good. However, lakes, beaches and pool decks can present some potential risks. Be aware there are even some hazards in your backyard like prickly plants and stinging insects.

Good hygiene is critical. Your children should learn to wash their feet, including between the toes, using lukewarm water and mild soap every day. Socks need to be changed daily and always clean. If your child plays a lot of sports, try to find socks that are made up of acrylic blend materials. They can help protect the feet from both moisture and impact. If it’s possible, you should rotate your child’s shoes every other day.

As your Toronto chiropodist, we feel it’s important that parents help their children maintain a healthy weight by encouraging them to stay active and eat properly. Research points to the fact that obesity can cause structural foot changes that last well into adulthood. Left untreated, these can cause further issues.

Children’s Foot Care Tips From Your Toronto Chiropodist

As a Toronto Chiropodist, we stress the importance of looking after your children’s feet. A few foot care tips like the ones below can help prevent problems.

A Weekly Inspection

Listening to your child is important. However, just because they don’t complain about foot pain doesn’t mean they aren’t experiencing a problem. Children have flexible bones in their feet. They can be twisted and moved out of position without your youngster being aware. That’s why it’s important to look at their feet at least once a week.

Here’s an excellent development tip for toddlers. When a toddler first starts walking, letting them go without wearing shoes inside helps them develop control over their toes. What’s more, walking barefoot on the floor helps to strengthen foot muscles.

Walking Patterns

Take notice of their walking patterns. Look for things like if their feet turn out or in. Look for gate problems and other issues like knock knees. A Toronto Chiropodist can help you manage any of these issues if they get diagnosed early enough.

Your children’s toenails should always be kept trimmed and they should be cut straight across. This helps to prevent ingrown toenails which can be painful. If you notice any symptoms like swelling, redness or pain, you can ease the discomfort by putting a small wad of cotton between the skin and the ingrown toenail.

If your son or daughter has an ingrown toenail, come in and see us. A simple procedure in the office can fix the issue.

The rise in childhood obesity also has an effect on foot health. Studies have found that excess weight that continues through childhood and into adulthood can affect their feet. Encourage them to stay active and supply a balanced meal.

Hygiene

Proper foot hygiene is also critical. Washing your children’s feet when they take a bath can prevent fungal and bacterial infections. Dry their feet afterwards and make sure to get in between the toes. Athlete’s foot thrives on moisture.

Your baby’s feet need special attention too. A Toronto Chiropodist has a good suggestion for new parents. Tight covers around their feet can actually lead to retarded development. Allowing them to kick their legs and feet strengthens muscles. It’s good preparation for walking.

Finally, walking on their toes is normal when your children first start to walk. However, you should talk to professionals if it persists after they turn two.

Toronto Orthotics and Arthritis

Toronto orthotics are specifically designed to align your foot and ankle and make sure they are in the correct position. Foot damage and joint inflammation from arthritis is common. The combination of gait correction and orthotics can help control this type of situation.

Here’s an overview of what you need to know about how arthritis affects your feet.

  • Osteoarthritis generally affects the joint connecting your foot and big toe. However, it can also be found in the ankle and midfoot.
  • Gout generally affects just the feet and quite often only the big toe.
  • Rheumatoid arthritis is quite often seen in both feet. It can also affect the same joints.

As you age, there’s a higher risk of getting arthritis. The joint damage that’s associated with this condition can cause pain, swelling and other physical changes in your ankles and feet.

  • Posttraumatic arthritis occurs after there’s been an injury with the bonelike a fracture or dislocation. Unfortunately, you might not notice anything is wrong for years.
  • Psoriatic arthritis happens in several different joints at once and can include the end of your toes and ankles.

Arthritis can cause stresses and abnormal movements in your feet and other parts of your body. The resulting unusual walking gait can be treated with the right Toronto orthotics.

The Symptoms To Watch For

There are several symptoms that you should be watching out for including pain when you move your foot. Trouble putting weight on one of your feet or difficulty walking and moving are also red flags.

Pain and swelling when you are sleeping or sitting is also another indicator you have arthritis.

Investing in the proper kind of footwear helps. Patients who have osteoarthritis in their feet often benefit from Toronto orthotics and shoes that have a thicker than normal soul and a curved heel.

Research shows that footwear that has this type of sole can reduce the pressure on a big toes joint by a significant amount.

There are some other things you can do to combat this condition. They include:

  • Staying as active as possible. It’s especially difficult for people who have arthritis. Remember that any kind of movement including standing while you talk on your phone and walking the dog counts.
  • Pampering your feet is also a good way to combat this problem. Smoothing calluses and clipping your nails are good practices.

Toronto orthotics are always a good treatment option. However when all else fails you’ll need to learn about surgical intervention.

Returning to Running From Foot and Tendon Injuries

Return to Running From a Tendon Injury

This blog is specifically discussing tendon type injuries. That includes tendonitis, tendinosis and plantar fasciitis. In podiatric medicine, we treat plantar fasciitis as a tendon injury. 

Let say you go for a hard workout, sometimes you do not feel the injury during or after the run. Then all the sudden, you wake up and feel pain. This is sometimes how tendon injuries present. 

 

Managing An acute injury 

An acute injury is when most of the pain and swelling occurs and usually lasts 1 week long. This must be treated with rest, ice, compression and elevation. This phase is important to ween back. What can be done for exercises in this stage is gentle range of motion and very light isometric exercises that does not irritate the tissues/ cause more pain. Anti-inflammatories can also help in this phase. You only want to completely rest the foot for a short amount of time . Too much rest can be detrimental to the tendon health, unless there is a tear or rupture , which brings us to the importance of loading the tissue in the next phase. Remember, exercise is the best form of medicine.

The Subacute Phase 

This is after an acute injury . There still may be swelling and throbbing in this phase. This is where strength must be initiated to help load the tendon to become stronger. However, it must be catered to the individual pathology and not too difficult. If it is too difficult it can relapse to the acute phase. Here it is not suggested to run yet. 

Exercises that may be done in this phase are again, range of motion but more specifically isometric exercises. This allows the tendon / injury to be loaded but in a manner that does not provoke pain. Certain movement that may provoke pain are fast movements or up and down. It is important to strengthen the injury in a movement specific order as particular movements will aggravate the area more. Isometrics can be done each day for 4 sets .

After a week of isometric movement, slow heavy eccentric movements are suggested. That can be done every other day with the isometric movements in between them.

As pain diminishes it is good to start implementing the spring like capabilities of a tendon. Tendons have this ability to allow us to jump and release and store energy. So this needs to be trained especially before running. This can be done by doing 2 footed hops say 5 x 1 min with 1 min rest. Wait 24 hours. If there is pain , or increases stiffness in the morning or next day, then that was too much load. What can be done is cutting the load in half by then trying to do 3 x 1 min the next time. These movements can be done every 2 times so there is plenty of recovery time  in between.

 

Once double leg hops is achieved then one moves on to single leg hops with the same protocol. If that is fine, then one can move onto a return to running program. 

Here is an example of the layout.

 

 

During the time of return to run, one may not want to forget the importance of strengthening the tendon and loading it properly. Hopefully one can remember the importance of strengthening so one does not succumb to injuries that can sideline them.

 

Managing Injuries 

Managing Injuries

As a foot specialist and runner, an important factor about injuries is nipping them prior to them becoming a bigger issue. Some people are afraid to rehabilitate in the early stages, however proper rehabilitation in the early stages can speed up recovery. Where doing too much too soon can also interfere with the healing process.

What happens in an injury

Acute phase means a recent time period from when the injury occurred. Inflammation usually happens in the initial time period of an injury and it can be painful.
Inflammation is meant to help heal the tissue by replacing damaged and injured tissue to restore function. Acute phase usually lasts 4-6 days . Here it is important to try reduce pain, reduce inflammation, wearing supportive footwear / braces or taping. Within this time period, most of the emphasis should be placed on rest and reducing pain.

Rest, Ice, Compression and Elevation should be done to help to mitigate pain. Rest is key! Icing the area is helpful in trying to reduce swelling. Compression can be done with wraps, but more easily, compression socks or sleeve are easy to apply and help reduce swelling. Elevation helps with lymphatic drainage, which helps to move inflammation away from the injury site away to be metabolized. This phase is mostly just resting and icing

If no medical contraindications, prescription anti-inflammatories help to reduce the amount of inflammation and pain. It is very important to reduce the overall load on the injured tissue. That includes wearing Birkenstocks, or supportive sandals or shoes in the house, braces or in severe cases, an aircast to reduce the load on the injury. When throbbing reduces, then you know it is okay to carefully start doing rehabilitation exercises. Rehabilitation exercises should be provided by a licensed health care provider, physiotherapist, chiropodist, massage therapist or chiropractor.

Subacute – Intermediate phase 4-21 days

This phase is where rehabilitation exercises are started. Here exercises should be done in a pain free manner. In this phase the healing tissue is immature and fragile. Exercise should be gentle and cause no harm. The tissue may revert back to acute phase if stressed too soon. If that occurs, revert back to PRICE (protection, rest, ice, compression and elevation).  In the beginning low resistance exercises and high reps should be done to help strengthen the site and surrounding muscles. Gentle stretches can also be done in this phase.

The final stage is to prep the body to handle sport specific exercises to handle their activity . It is important to monitor along the way and anything that makes pain again, may have to revert back to earlier stages. That may include resting, icing, compression, protection and easier exercises.

Chronic phase

This is typically when an injury is longer than 3 months. Sometimes, we cannot totally rest out feet. Some occupations require us to constantly be on the move and that may not provide the rest needed to allow an injury to heal. Emphasis should still be focused on reducing the amount of load on the tissue, when possible. To allow it to rest and also do rehabilitation exercises in a manner that does not flare up the tissues or aggravate the tissue. This phase can also respond well with treatment such as shockwave therapy. Orthotics also help in this phase to help reduce the overall strain and load on the tissues.

The main point is to see someone as soon as possible when in an acute phase of a foot injury. Conditions of the feet can be very stubborn, as we cannot completely let the feet rest. Plantar Fasciitis, is one of the more difficult conditions to treat once it has turned chronic. Signs of chronic plantar are first morning step pain and stiffness.

Injuries can be stressful and impact our quality of life. Hopefully these few tips can help you manage a foot injury you may encounter.