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.

A Quick Guide to Toronto Orthotics

Toronto orthotics are shoe and/or heel inserts prescribed and custom-made. These help with a variety of back, foot and leg issues. The ones we prescribe for our patients do a number of things including aligning the ankle and foot. Here’s some other things you should know concerning the best way to break in your orthotics and basic cleaning advice.

Getting Accustomed

Getting accustomed to wearing prescription medical appliances is a process. It’s a good idea to start out gradually and wear the inserts for short time periods. Begin with one hour a day and slowly extend the time you wear them as your comfort level increases. If you begin to feel any pain or irritation, we suggest resting your feet for several hours.


Following this pattern, you should be able to wear your orthotics full-time within three weeks. Here’s another quick tip you’ll find useful. At the end of each day, you should remove the customized inserts. Wipe with a dry cloth to remove any moisture and allow time to air dry before reinserting into your footwear.

Wearing Toronto orthotics At Play

We often recommend this type of treatment for patients with strenuous jobs or those who play sports. In tennis, for example, these special shoe or heel inserts supply motion control and shock absorption. It’s best to get used to wearing these devices in athletic shoes during practices before a game. Research indicates orthotics lessen fatigue on the lower body and actually help stabilize your feet in sports such as golfing.

Relief from Pain and Discomfort

Many people enjoy running and walking. The orthotics custom-made specifically for our patients offer relief from ailments like knee pain, shin splints and lower back discomfort. It stands to reason that you want to know the best practices for cleaning them too. This will help these devices to keep their shape and last longer.

Easy Cleaning Tips

Once you are able to use your orthotics on a regular basis, they will require occasional cleaning. The routine you’ll need to adopt involves several factors like your activity level and weight. It’s a good idea to avoid using cleaning solvents and detergent. Usually, dampening a cloth in a solution of water and soap is all that’s needed to wipe the insert clean.

Simply allow your Toronto orthotics to dry naturally at room temperature and avoid exposure to sunlight or other direct heat sources.

Here’s A Few Toronto Orthotics Tips for Vacation Footwear.

Chris Hastings and Laura Desjardins have years of experience that’s important when you’re looking for the right Toronto chiropodist and Toronto Podiatrist. Their practice covers a variety of services including gate correction with Toronto orthotics. These are the devices fitted that align the ankle and the foot so they are in the right position.

They can look after you at their foot clinic in downtown Toronto. Chris has been a practitioner in Toronto for years. He knows that people living here are planning getaways in the winter months. That’s why Chris and Laura supplied a few Toronto orthotics tips for vacation footwear.

Tip # 1: Match Your Choices with Your Plans

For example, you might be planning some time away from it all hiking in the great outdoors. There are a variety of hiking boots to choose from including lower cut versions with flexible midsoles. These are great when you’re planning on hiking during the day.

The high cut models and backpacking boots are designed for more strenuous trails. Planning on being out in the woods for any amount of time? Look for the boot that has a high wrap going above the ankles for support.

Don’t forget to match up any Toronto orthotics we supply with the size of the boot. These fit correctly when they lie flat at the base of the shoe.

Tip # 2: Get the Proper Fit

Planning a vacation getaway from the cold Toronto weather is better with the right footwear. Fitted for Toronto orthotics? Make sure to bring them along. Getting the proper fit for any of the shoes or boots you need is just as important. They also fit the orthotics to desired footwear of your choice.

Chris and Laura are the Toronto chiropodist and Toronto Podiatrist that can fit you with the right orthotics at their foot clinic in downtown Toronto. They are also happy to supply some tips on fitting your vacation footwear properly.

Later in The Day

Here’s another useful tip. It’s always a good idea to try on new shoes later in the day. Feet tend to swell as the day goes on. Your heels shouldn’t slip around when you try new loafers on either.
The best way to make sure those new shoes you want to wear at the beach fit properly is to walk around in them in the store. Take note of any pressure points like the seams.
Chris Hastings and Laura Desjardins listen to each and every client and supplies Toronto orthotics solutions that work.

Why You Need Good Orthotics

Your feet need to last you a lifetime and that’s the big reason you need good orthotics. Of course, when you come into our foot clinic downtown, we’ll explain it and show you in better detail. One of the first things we tell her patients is hip, knee and ankle and foot biomechanics can be complicated.

It’s best if you stay away from those corrective shoe inserts that you can find at the local mall. No two sets of feet are exactly alike. That’s why the orthotics that we custom design for you are the end result of a professional process.

What They Are

In a nutshell, orthotics are special shoes and custom-made inserts that we design for you. Although they are usually designed to be worn on your feet, they can treat a variety of other issues. Some of our patients come to us complaining of back, leg and, of course, foot problems. Many of these situations can be helped with the right orthotics.

Why You Need Them

These inserts can help with a variety of issues that include:

  • Arthritis. There are two different types that orthotics can help correct Osteoarthritis and Rheumatoid arthritis can he helped with these treatments.
  • Back Pain. There’s even some evidence that back pain can be lessened.
  • Diabetes. People who suffer from diabetes also often have neuropathy. This is part of a condition where they can lose sensation in their feet. Proper fitting custom made shoes can help reduce any stress so they don’t injure themselves.
  • High arches are another condition that can benefit from the right orthotics. Muscles can be stressed in the feet with high arches and that can lead to conditions like knee pain and shin splints.
  • People who have been injured playing sports or in other types of accidents can use extra support.

Big Benefits of Custom Orthotics

The idea behind these accessories is to give your foot a little extra support. The right kind of custom product can add to what the ligaments and tendons in your foot are already doing. Well-designed orthotics give your feet support exactly where you need it.

That means that you get the kind of relief from pain many patients are looking for. These specialized products can also help prevent foot ulcers and injury.

Our foot clinic in downtown Toronto can help you get the information you need about orthotics and other treatments.

Treating Plantar Fasciitis with Shockwave and Orthotics Downtown Toronto

The Nature of Plantar Fasciits

If you are one of those many people who suffer from foot pain, we have solutions for you! I try my best to stay current in the recent advances in academic literature. I want to share some recent findings with you! One of the most common conditions I find in practice, is plantar fasciitis. It can be characterized as a pain in the heel or pain along the arch of the foot. Increased pain in this condition may arise from prolonged standing or activity on the feet. People tend to feel it after a period sitting or when waking up in the morning. Stretching out the band does offer some instant, temporary pain relief. Sometimes, the fascia band has been injured for some time that the healthy tissues are no longer working properly and become known as degenerative. What does that mean? It means the tissues no longer lay down healthy tissue in the manner it used to. The injury to the tissue changes the ability to repair and heal.  

My Approach to Treating Plantar Fasciitis – Extracorporeal Shockwave

How I typically treat plantar fasciitis is by the same principles of rest, support, strengthen and treating the tissue. Treating the injured area will have best benefits when one corrects the underlying issue causing the strain on the foot. This means restoring the strength and flexibility to the areas needed so that the strain on the band no longer happens. The problem about this injury is that the bottom of the foot is difficult to rest. That is why the use of an orthotic will help to lessen the strain on the tissue and offer support while standing on it. My preferred method of treatment for this is extracorporeal shockwave therapy.  

Extracorporeal shockwave therapy sends pulses into the degenerative, injured tissue to help speed up recovery. The pulses promote regeneration of healthy cells to heal the tendons and soft tissue. The treatment results in new blood vessel formation, reversal of chronic inflammation, stimulation of collagen production and loosens tissue. The treatments are usually spaced 1 week apart. I do feel the best results are when this is combined with the proper exercises so the underlying mechanism of injury is addressed. This treatment is really what helped me when I had plantar fasciitis in my earlier running years.  

Footwear and Plantar Fasciitis

Footwear can be a tricky one! Some people respond better to a lower heel drop and some respond better to a higher heel drop. I still have yet to find a holy grail which to advise people on this one. The higher heel in a shoe can alleviate the strain on tissues that don’t have flexibility. However, sometimes a higher heel in footwear can cause more focal compression on the injured tissue of the plantar fascia.  It is a bit of trial an error process. It is okay to gradually go into a little lower of a drop for those whose pain scale is quite reduced. I also implement a lot of stretching, mobility and strength work into my rehabilitation program for plantar fasciitis.  

What The Research Says for Pain Relief :

 In the academic journal Comparison of extracorporeal shock wave therapy with custom foot orthotics in plantar fasciitis treatment, it was found that both options were of benefit for those suffering with plantar fasciitis problems.  The results : Both group I and group II achieved significant improvements in our evaluation parameters (morning and evening pain) at 4, 12 and 24 weeks compared with their baseline values (P<0.001), and significant improvement observed in the group II continued at 48 weeks (P<0.05).

The study demonstrates both groups reported improvement in either scenario. Both are found to have benefit for those suffering from plantar fasciitis. I like to combine both in my practice! Orthotics can get mixed views as the person prescribing must have a sound understanding of the foot and lower limb. I am confident in my experience with my sport medicine background, that I understand the interaction of orthotics with the mechanics of the foot. Orthotics can be of great benefit when injured, to help the tissue rest and alleviate strain when recovering from an injury. 

5 Reasons for Top of the Foot Pain

Top of The Foot Pain 

 5 Reasons for Top of Foot Pain 

It is no question that your day to day activities, hobbies and footwear has a direct impact on the aches and pains your feet experience. The changing of seasons usually means a change in footwear. Foot pain located to the top of your foot could be caused by a number of factors and I am here to help you hone in on what it is that may be causing your foot pain. Sometimes, it is not one thing, it is a combination of many factors that result in foot pain. 

  1. Footwear that is too restrictive or high heels can lead to top of foot pain. It goes without question that we all know high heels are bad for us. Why exactly ? Heels and footwear that does not allow the normal ankle range of motion can lead to imbalances in the foot and ankle. Footwear that drastically changes the angle in which our feet meet the ground, over repetitive steps,day after day, leads to injury. This effect of weakening is  similar to wearing a cast after injury, where foot strength in compromised after a period of time from being immobilized. Over time this can lead to weakness and pain on the top of your foot!
  2. Loose fitting footwear can cause foot pain. Yes, unfortunately,  it is kind of like that Goldilocks Theory. Footwear that is too tight or too loose is never too good for us. The middle ground with that happy medium is always best for our feet. Footwear, like flip flips causes overuse in the tendons in the feet. The flip flops place an overuse demand on the foot in a manner it is not used to. Repetition of this load causes reoccurring tendon strain and pain. This is the same situation when shoe laces are too loose, or footwear of slip on nature is used for longer than our feet are used to. 
  3. A neuroma is a condition where the nerves in our feet become inflamed or irritated . Neuromas are commonly found in those with repetitive strain to the feet or those who wear, yes again, high heels. The nerves in our feet migrate in the toe area and this delicate area can be a vulnerable spot of potential injury. I have been able to help restore function with proper rehabilitation exercises with this condition, but conservative care usually has a poor result. Once conservative measures fail, better success is with anti inflammatory injections and last resort surgical intervention. 
  4. Stress fractures are no joke. For those weekend warriors or those tough athletes who love to push through pain, take warning when this top of foot pain does not improve. Other sings include when one cannot even stand or walk without debilitating pain. These injuries are common in people who overtrain, increase in duration too much too soon, have previous foot injury or stress fracture and those who have nutritional deficiencies.Unfortunately X-rays do not always show a stress fracture. A bone scan will show this injury as well as a CT and MRI will also show this injury. Rest and an air cast followed by a proper rehabilitation program and nutrition is the best protocol in this situation.
  5. Other bone conditions that can results in top of the foot pain include Freiberg’s Disease or various forms of arthritis. Freiburg’s disease is a term used for avascular necrosis. This condition is caused by trauma to the bone that results in lack of blood flow to the bone, causing the bone cells to die. This is a serious condition that needs medical attention and time offloading to properly heal. There are various forms of arthritis that can cause foot pain. Arthritis can be caused  from general wear and tear, while others arise from an auto immune condition. 

All of these foot pain differentials are factors that can result in foot pain. Foot health is so important to your every life and there is no medal to be won for enduring unnecessary foot pain. Before your condition worsens or before you need to take more time off from activity or your lifestyle, please seek professional attention for the best advice on your foot health. 

Podiatry on Yonge at King has a vast amount of experience when it comes to foot health.

I, registered Chiropodist, Laura Desjardins would love to get to the root of your foot pain.

Plantar Fasciitis – our downtown Chiropodist and Podiatrist can help!

Common foot pain pathologies that our downtown Toronto Chiropodist and podiatrist can help with include plantar fasciitis.

Plantar Fasciitis is a very common foot condition that impacts people who are physically active or have occupations requiring them to be on their feet for long hours. Plantar fasciitis can last for months and become very frustrating to those suffering from it.

What is fascia? The fascia is called aponeurosis, which is a white fibrous tissue that is similar to a flattened tendon on the bottom of the foot. It is known to be an extension of the Achilles’ tendon to help propel us forward when we walk. Many factors can combine to create this injury. The onset of this injury is likely to include one or many factors such as overuse, lack of flexibility, lack of strength combined with improper footwear / lack of support. This is a very painful condition that our downtown Toronto chiropodist and podiatrist are experienced in treating.


When we stress our muscles we make micro tears to our tissues and with proper recovery they heal. This is a natural process of training. However, when the demands on the foot tissues are greater than the ability to repair, an injury happens . This is why it is very important to gradually scale up in duration or intensity of activity . Without slowly integrating the demands placed on the foot, the tissues may take on more load than they can tolerate and plantar fasciitis may arise. The same principle applies when returning back to training after injury, it is important to slowly scale back up in duration and intensity. In severe cases chronic plantar fasciitis may lead to a stress reaction in the heel.

How do we prevent overuse ?

By slowly increasing the duration and intensity of your activities. It is also important to include proper rest days and less intense days with a recovery routine to allow for tissues to heal and repair. If you are a runner, our chiropodist is an elite runner and has experience with elite coaches . If you need any advice on training to prevent your running injuries, or how to come back from one, she would love to help!


Flexibility and strength is interrelated. Sometimes a weak muscle may compensate by tightening up to meet the demands placed on it. The problem with this is that sometimes tightness is compensatory and the muscle works in ways it is not supposed to. Muscles  attempt to tighten up to meet the demands placed on them or other muscles start to compensate and tightness is a result of improper function. This can lead to pain and injuries such as plantar fasciitis or tendonitis.


If we always use a muscle group and never stretch it, it can create imbalances in our bodies that contribute to deformity and structural changes . An example of this, is tight calf muscles from always walking or running. The calf muscles ( gastrocnemius and soleus), are always lifting body weight and with time, microtears can weaken or cause an imbalance. This can cause tightness / lack of flexibility to form. Without adequate stretching, flexibility will diminish. Our downtown chiropodist, Laura Desjardins is experienced in assessing which calf muscle is tight and which muscles are imbalanced and prescribe an appropriate rehab program based on your individual findings.

Support and footwear

Certain foot types can benefit from extra support, especially when battling a foot injury.A flatter foot type is one where the ankles may buckle in and the toes splay outward. This is called a pronated foot type. A certain amount of pronation in regular gait is required, but excessive amounts can lead to a torsion / twisting strain placed on the fascia band and cause plantar fasciitis. At our downtown Toronto chiropody and podiatry practice we encouraged strengthening the lower leg and foot and will help educate on a supportive shoe or orthotic to help control these forces.

If you would like to seek a well rounded approach to plantar fasciitis, our chiropodist Laura Desjardins will help guide you through a thorough rehabilitation plan. She is also experienced with soft tissue release and a well structured return to exercise plan. Orthotics are also an excellent tool utilized in the prevention and treatment of plantar fasciitis.

In summary, plantar fasciitis is a very frustrating injury one does not have to live with. In our practice, for severe chronic cases, we may refer you out to Platelet Rich Protein Injections or Cortisone Injections. These severe cases may require offloading with an air cast. This injury is not merely just a foot injury and structures above and below the site of injury should always be strengthened, rehabilitated and stretched . Here at Podiatry on Yonge at King, Laura Desjardins is on your team and will help you get through this !

A Few Words on Toronto Orthotics

We always like to suggest that Toronto orthotics that are professionally fitted are the best for foot pain. If you find you are suffering from foot pain constantly, this is usually the right way to go. There are generally two different ways to go for foot pain.


As we’ve already touched on, these are prescribed medical devices that are worn inside your shoes. They are specifically designed to correct different types of foot issues and help you with the way you run, stand and walk.

These are also helpful with different kinds of foot pain that can be caused by conditions like arthritis, bursitis and even diabetes. You might even be able to avoid the type of surgery that fixes flat feet with the right orthotics.


If you’re looking for simple cushioning and support, you might be able to get away with the kind of inserts that you can buy in a store. Remember that although these are made with plastic or foam and innovative types of gel, they are not custom-made for your individual foot.

Even though they might be able to help you by making your shoes more comfortable, they aren’t designed to correct any kind of these issues you might have with your feet. They also do not provide the quality or durability of custom devices. Our clinic uses a high quality orthotic lab that also provides a guarantee on your orthotics for 6 months!

Toronto Orthotics and What We’ll Look For

As your Toronto podiatrist and chiropodist of choice, we will do a thorough examination to find any foot issues requiring these Toronto orthotics. One of the things that we can do in our office is take a look at the way you walk. That’s the best way to get an accurate appraisal of how your legs, ankles, and feet and hips all move together.
If we find that you need these types of specialized devices, we will be able to take a mold of your feet to get the process started. This mold is then turned into either a rigid or flexible orthotic, depending on your activities or foot type..

The flexible orthotics are generally made from semi flexible carbons or semi compressible materials. Generally, these take the pressure off specific sore spots on your feet and help with other issues like diabetic foot ulcers. The soft orthotics can be somewhat bulky so it’s often the case you’ll need prescription footwear to go with them. Te more flexible soft orthotics do not take up as much bulk.

Like the name suggests, rigid Toronto orthotics are made from more sturdy stuff. These are specifically designed to help you with pain in your lower back and legs and to compensate when your foot doesn’t act properly. As Chris Hastings will say, orthotics typically need to be rigid to have any real biomechanical effect on your foot!

Toronto orthotics are all designed to help you with a variety of issues.

Let’s Talk About Orthotics

Our downtown Toronto Podiatry on Yonge and King practitioners want to educate people how orthotics help foot pain. Mixed views and theories exist on the role orthotics. We would like to clarify why this may be. First of all, an orthotic needs to be moulded the by the gold standard method. Additionally, it should be prescribed by a practitioner who greatly understands foot mechanics.

The gold standard for making orthotics is by plaster cast or by a 3D laser with the foot held in neutral. Other methods may not have as great of an outcome, as they may not correct the foot during the moulding procedure. Specific skills in prescription writing also plays a key role in the outcome of an orthotic. Chiropodist and Podiatrist have special training in this area.  In specific conditions a podiatrist or chiropodist may further correct to the foot while casting.

Podiatry on Yonge and King has experience and expertise in prescribing orthotics for foot pain and treatment in foot rehabilitation. We understand the mechanics of the foot and know certain orthotic modifictions cannot be done for certain foot conditions. Why? That can result in iatrogenic conditions. This means some conditions should avoid particular orthotic modifications as this can lead to foot and lower limb problems down the road.

A practitioner with an extensive understanding of foot mechanics will know when to include or exclude modifications in an orthotic. Our Chiropodist Laura Desjardins has a sound understanding of how to apply orthotics to active patients. She runs in orthotics and understands the interaction of footwear and the orthotic. Chiropodist Desjardins not only has clinical experience, but first hand personal experience of lower limb injuries and orthotic management. 

In academic literature of sports medicine, rehabilitation and physiotherapy, orthotics are known as a helpful tool in the treatment of foot injuries. Orthotics offer support to injuries and weakness of the foot, offload painful areas and control abnormal forces placed on the foot. They can help prevent and treat conditions such as bunions, hammertoes, plantar fasciitis and shin splints to name a few.

In addition to offering orthotics at our downtown Toronto Podiatry and Chiropody clinic,  our approach to care is to address the underlying foot problem. This is done by a thorough history,  biomechanical and gait assessment. Depending on the nature of your pain, we may advise you to see your family Doctor for an X-ray, MRI or Ultrasound. Unless in obvious or foot emergency circumstances, it is suggested to try conservative measures first to limit the amount of radiation exposure.

At Podiatry on Yonge at King we take pride in offering a quality orthotic to our patients. We try our best to prescribe an orthotic suitable for your style of footwear. However, we may advise changes to your footwear for best management outcomes. Chiropodist Laura Desjardins has great experience with orthotics for athletes and runners. She can also help ladies find the correct orthotic for their business attire. Our downtown Toronto Podiatrist Chris Hastings and Chiropodist Laura Desjardins are her to help guide you through you foot pain! 

Toronto Foot Treatment Tips on Orthotics

If you’re looking for professional Toronto foot treatment, Chris Hastings and Laura Desjardins has the experience you need. Chris Hastings has worked as a practicing doctor of podiatric medicine in Muskoka, Barrie and Toronto. He has several different specializations including orthotics. Laura has worked in Saskatchewan, Barrie, Toronto, and with Olympic level athletes.

Here’s a few tips that they’ve been able to put together that should help you with this type of
Toronto foot treatment.

We all know that our feet need support. Without the right kind of support, your feet can be the source of serious problems related to your hips and knees. In academic literature, extra support is to be found with foot orthotics. First off, we like to tell our patients that orthotics have break in period. That means you wear them for a short period of time at first and build up gradually over time.

Our Toronto foot treatment clinic wants to make sure that each and every one of our patients receive the best care possible. That’s why we recommend that you take out any insoles that you already have in your shoes before inserting your orthotics. You should also be looking at shoes with extra depth and not necessarily ones that are wider or longer. It is more difficult to fit orthotics to flats, however with medical padding available at our clinic, those supportive devices can even fit into flats!

Adjustability is another factor that will help you. That means we suggest you choose shoes that have laces or adjustable hooks as well as buckles or straps. Keep in mind that our Toronto foot treatment clinic offers a variety of other services including diabetic foot care supervision.

We are always happy to answer any and all of your questions. If you take just a few minutes to look at our website you’ll see what you can expect on an initial visit. After an initial diagnosis, we will discuss what we find with you and the best way forward. Our chiropodist will also help manage your foot pain with one on one rehabilitation exercise guidance.

Toronto Foot Treatment, Orthotics and Exercise

Your feet will need time to adjust to these new treatments. That’s why we like to suggest that our patients stay away from strenuous physical activity during this period. If you are an athlete we recommend 20 minute of running to be the cap of trying out the orthotic, preferably on a treadmill. . We also suggest wearing orthotics with non- cotton/ synthetic socks to avoid friction. If you find there’s any discomfort, you should come in and talk to us right away. Chris Hastings and Laura Desjardins have great experience with orthotics . Laura is an elite runner and excellent at fitting orthotics to active and the running population. Chris Hasting has years of experience correcting foot problems with orthotics.

Our priority is making sure that you get the proper treatment. Naturally, we understand how important it is to keep your feet in the best possible shape. Remember, you only get one set to last a lifetime and our Toronto for treatment procedures are here to help .