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.

.

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.

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.

How Often Should You Replace Your Shoes? Chiropodist, Explains to Canadian Running Magazine!

How often should you replace your shoes?

Podiatric medicine practitioner Laura Desjardins explains how to prolong the life of your shoes, and when it’s time to throw them out

Your shoes are arguably the most important part of your running wardrobe, which is why runners spend so much time and money looking for just the right pair. Once you have found the perfect shoe, you should do your best to take care of them so they continue to provide the support you need throughout your training. This includes replacing them when they’re no longer in good condition. But how do you know when it’s time to replace your shoes, and why is it so important? We spoke with avid runner and podiatric medicine practitioner Laura Desjardins to find out.

 

RELATED: Tips for buying running shoes online

Desjardins says on average, you should replace your shoes after about 800 kilometres. That being said, how long your shoes last depends on their structure and durability. Lightweight shoes with soft soles, such as a racing flat, will wear much faster than a sturdier shoe with firmer soles.

For this reason, it is important to examine your shoes regularly to look for signs that they may need to be replaced. Desjardins told us that the soles of the shoe are the best indicator of wear. She explained that if the treads on the bottom are worn or if the foam is compressed unevenly on either side of the shoe, you should look into getting a new pair. According to Desjardins, most shoe soles are made of ethylene-vinyl acetate (EVA), which contains tiny, circular air bubbles. Over time EVA will get thinner, causing those air bubbles to flatten or burst. Multiple wrinkles on the sole of your shoe are a sign that this is happening and your shoes need to be replaced.

ADVERTISEMENT

Aches and pains may also indicate that it’s time for a new pair of shoes. This is because the compressed soles are no longer providing the same level of shock absorption, which increases the stress on your muscles, bones and joints while you run.

RELATED: 5 signs you need new running shoes

Why is it so important to replace your shoes?

According to Desjardins, worn-out footwear is often a contributing factor in almost all overuse injuries. This is because poor biomechanics can mold into your shoe, which then promotes that movement when you run. For example, Desjardins explained that people who have weaknesses resulting in overpronation can actually mold collapsed forces into their shoes. If your footwear is contoured due to collapsing, it can encourage that form when running which can lead to injuries.

If you are trying to manage an injury or correct your running form, replacing your shoes is necessary for this reason. Even if you fall into neither of those categories, you should still avoid running in worn-out shoes to avoid injuries.

How can you prolong the life of your shoes?

If you’re running 50 kilometres per week, just as an example, replacing your shoes every 800K means you’re making a trip to your nearest shoe store every four months. This, of course, can get pretty expensive, so Desjardins offered some advice on how to make your shoes last longer. The secret? Buy more than one pair at a time.

When you keep using the same pair of shoes every day, the foam in the soles doesn’t have enough time to bounce back, causing them to compress faster. Alternating between pairs every other day gives the soles a chance to rest and rebound. While buying two pairs is initially more expensive, you actually save money in the long run because each pair will last longer than they would have otherwise. For those who are able, Desjardins suggested having three pairs: a designated pair for easy mileage runs, a pair for workouts and a pair for long runs.

Of course, if you’re not running every day, having multiple pairs of shoes may not be necessary. This is why the most important thing you can do is regularly check your shoes for signs of wear, and replace them as soon as your wallet will allow. Having a proper pair of shoes that are in good condition will help prevent injuries, so you can continue running and stay healthy.

RELATED: 5 simple tips to make your running shoes last longer

Ingrown Toenail Treatment 

Ingrown Toenail Treatment 

 

 

Ingrown toenails are commonly seen in our practice. They can be painful, debilitating and can even keep you up at night! 

What Causes an Ingrown Toenail? 

Your anatomical makeup 

Some people have nails that grow with a curvature on the sides, opposed to flat. What can happen is when the nail grows down and into the sulcus. These nails can be called pincer nails. What also happens is skin and callus buildup and develop in the corners, leading to more pain. When the nails are trimmed, people with curved nails cannot see the nail going down on the sides. They end up leaving a piece of the nail in the corner of the nail sulcus. 

 

Trimming Nails 

How one trims and maintains their nails can lead to ingrown nails. Some people tear their nails instead of cutting them. This is not a good idea because the nail can be torn off extremely far back and left jagged. The further back the nail spicule is, the more likely one is to undergo a surgery to remove that spicule. 

Another issue is that people tend to chase the corners when trimming their nails. It is always best to trim the nails straight across and file the corners with a nail file. I suggest filing with a nail file so the corners are not sharp and do not cut the adjacent toe. Another tip is to make sure the nails are not cut too short. Having some length to the nail ensures that you are going to cut across the entire length of the nail. 

 

Trauma 

Dropping something on your toe nail or stubbing your toe is never fun! What makes this situation a bit tricky is that the nail can break or chip leaving sharp corners. These jagged edges or sharp corners can dig into your skin, leading to a wound that can become infected. 

Improper footwear 

Some people wear tight dress shoes or pointy shoes and are unaware how that impacts their nails. This is more problematic in people who already have nail troubles. The constant pressure on the nails can lead to an ingrown toenail. If shoes are too small, that is also a predisposing factor for ingrown toenails. 

Biomechanical issues 

People who have flat feet or pronate a lot can drive their big toe into the shoe leading to trauma. This can be corrected with strengthening, toe aligners, toe spacers, gait retraining, wider footwear, stability footwear or orthotics. 

Medical Conditions 

Underlying medical conditions can make some people more susceptible to this condition. Fungal nails can become thickened and hard to or break off leaving jagged edges. Some people who have excessive swelling in their feet such as lupus, kidney disease, venous insufficiency to name a few, can be prone to ingrown toenails. The soft tissue around the nail can become swollen, making trimming the nail more difficult to accurately see, thus resulting in an ingrown. 

Why Ingrown Toenails Become Painful 

Ingrown toenails hurt due to the nail creating a wound in the skin. Once there is a wound that becomes a portal of entry for bacteria and infection. Your feet have exposure to bacteria and can become easily infected, especially in immunocompromised people.  The pain is due to the nail but also compounded by the soft tissue infection. 

Treatment 

It is best to seek a foot specialist to take care of your ingrown toenail . While you wait for your appointment here are some tips. Soak your feet in Epsom salts for 10 -15 min one to two times a day. Apply antibiotic ointment around the area. I also suggest Betadine prior to the antibiotic ointment. Some literature advised cotton under the nail to lift the nail. That may be tricky and I just advise seeing a medical professional if it is that bad. Use a Band-Aid to adhere on the affected side to pull the skin away from the nail. Toe spacers can help avoid pressure if the nail is close to a digit. Use Tylenol or Advil for pain relief. 

What It Mean When The Balls of Your Feet Hurt and What to Do!

Foot Pain On the Ball of the Foot (Metatarsalgia).

Covid 19 has lead to people walking around barefoot more often. Underlying foot injuries when walking barefooted can worsen the severity of the condition. 

Metatarsalgia 

What is it?  Now there are different types of of conditions categorized as metatarsalgia. 

The main sign and symptom pain at the end of one or more of the metatarsal bones. Those are the bones located near or on the balls of your feet!

  • The pain is typically worse  when you walk or run.
  • You may feel tingling or numbness in your toes. 
  • Athletes who take part in high-impact activities and also have an inflammatory condition like bursitis often have more widespread pain in the ball and middle of the foot.
  • The pain can be sharp, a dull ache, or a burning feeling.
  • You may feel like you’re stepping on a pebble.

Most often, the pain comes on gradually, opposed to all of the sudden. 

Metatarsalgia Causes

This is an overuse problem where, for some reason, there is a lot of load on one focal point on the forefoot. Such activities that pound the metatarsals  like, running, sprinting, plyometrics, jumping , skipping or dancing, result in impact forces leading to pain in the forefoot. Or you may have a predisposition to this injury due to your current anatomy such as:

  • Weak foot intrinsic (muscles)
  • Hammertoes
  • Hypermobile first foot bone
  • Tight calf muscles 
  • A short first metatarsal bone or a long second metatarsal bone 
  • Tight muscles that extend your toes, placing more downward pressure on the balls of the feet. 

Other things that can cause metatarsalgia include:

  • Pronation issues
  • Being overweight
  • Stress fractures in your toes or metatarsals
  • Bunions 
  • Torn ligaments in your feet
  • Tight calf muscles

Morton’s Neuroma is also a condition that is under the metatarsalgia term. This is when the nerve has extra tissue growth around it. It is usually located in the area between third and fourth toes, but can also happen in other web spaces of the feet. People with webbed toes also experience an increased likelihood of this issue. People may say it feels like they are stepping on a pebble or a stone. 

Medical Treatment

To relieve metatarsalgia pain, your downtown Toronto Foot Chiropodist or Foot Doctor may have you

  • Rest the foot. 
  • Orthotics with metatarsal support. Orthotics help control abnormal movement of the foot, as over pronation was mentioned as one the causes of the injury,  and also help with protecting those painful areas of the feet. 
  • Icing the foot 
  • Use compression bandaging
  • Wear cushioned pads, arch supports or other orthotics in your shoes.
  • Do gentle stretching and strengthening exercises.
  • Sometimes callusing can cause pain the foot, so having the callous removed, that can help
  • Sometimes surgery may be required or steroid injections to the area. 

Recovery 

I, Chiropodist Laura Desjardins, suggests If you are an athlete you may want to cross train or do activities that does not require pounding on the feet. 

Gradual return to activity is also recommended. One way to prevent this injury is to wear proper footwear, or orthotics if needed during high impact activity, stretch and strengthen your feet as well as keeping the hips strong. 

If you have any other questions or concerns with your foot pain, our Chiropodist, Laura Desjardins, would be happy to help you!

Running in the Heat

Hydration and Exercising on Hot days 

It is hot these days and that means we need to make sure we stay hydrated. Simply drinking water is not enough. When we sweat we lose a lot of electrolytes (minerals). If you don’t ever get cramps and then all the sudden on a hot day, you find yourself experiencing one, be careful, it could be the early signs of heat illness. I was on a run and felt a stitch coming on. I did not care, I had to stop and get water and since then I have been more mindful of my fluid intake and ways to prevent heat illness on hot days. 

Dehydration increases fatigue and impacts your form, thus making you susceptible to injury. Being dehydrated also increases DOMS (muscle soreness), so hydrating after helps facilitate in a speedier recovery.

Why Hydrating is important. 

Lack of proper hydration can lead to serious problems that can cause heat stroke or heat exhaustion.  This happens when the body’s cooling system shuts down and body temperatures rise above normal . Here is a table that breaks down the difference between the two. 

 

Heat exhaustion symptoms Heat stroke symptoms
general weakness elevated body temperature above 103F (39.4C)
increased heavy sweating rapid and strong pulse or heart rate
a weak but faster pulse or heart rate loss or change of consciousness
nausea or vomiting hot, red, dry, or moist skin
possible fainting
pale, cold, clammy skin

How much water should you drink ?

Everyone sweats at a different rate. Weighing yourself before and after exercise can help indicate how much water you have lost. According to Burke., L.M. et al and Sawka et al it is recommended to drink 1.5 L of water for each Kg of fluid lost. 

It is recommended to drink ½ your body weight in ounces of water. So a 100 lb person would drink 50 oz. 

The main electrolytes lost are sodium and chloride. These minerals are important for the regulation of nerve function, muscle contraction (hence why you camp up when dehydrated), absorption of nutrients, blood pressure regulation and the balance of fluids in our body. 

Dehydration also results in fatigue in workouts. So if you train in the morning and went all night without fluids, hydrating in the morning is important. If you slurp down water in a short period of time, that invokes diuretic response ( you excrete it). Simply adding electrolytes to that water will help you retain your fluids.

Other Tips That I Practice

Running during the coolest times of the day are best, but life demands may not always allows for this and sometimes it is still hot even when you wait. 

Wear a white hat training that is thin and made of a synthetic material that allows for evaporation of heat. Bring water on your workouts and drop bottles and go out and back on intervals so you can ingest water. Even having two so one you can pour on your head can really help.

Try to stick to the shade, and adjusting for paces can help. Jack Daniel’s table for pace adjustment is beneficial so you are not too hard on yourself for running a bit slower in heat!

Running Injuries – A Well Rounded Strength Program Can Ward off Injuries

Pain in the Foot is not fun. Especially when you are trying hard to stay fit during the COVID-19 outbreak. No access to gyms has forced people to be creative and move their exercise routines outdoors. It may even mean taking up new exercise. That may mean new aches and pains, because our body is not used to the form of exercise.

Here are some tips to help keep our body well rounded when taking up running.

First of all. My philosophy has always been that the foot is part of the kinetic chain of the entire leg. Forces acting on the foot can contribute or exacerbate foot pain.

A lot of the time we do not spend enough time focusing on staying strong in a well rounded approach. Weakness is why we get hurt. So lets try our best to avoid weaknesses.

Please note this is me sharing what I do. I have worked together with a physio to ensure I have my proper form so I do not hurt myself.

Exercises to do to help up stay injury free!

Strength training we should aim to do 2-3 times per week.

Lunges or Split Squats

The main point here is that how you position your body can impact where you feel the strengthening. Your back should be straight . Hinging at the hip and sinking backwards when you lower can target the glutes more. While hinging slightly forward can target the quads more. I specifically like to target the glutes. Running and walking already makes you quite quad dominant.

Lunges are also a great warm up to do prior to runs. Simple walking lunges helps to wake those muscles up!

Step Ups

This is where there is a step or a stool in front of you. You place one foot on the step and then press up . You straighten the leg and drive the other leg up. You pause at the top for a couple of seconds and then slowly go back to the ground.

Calf Raises

This is a big one for runners. The calf muscles work hard during runs. Over working can lead to wear and tear and actually weakness. The calf helps to absorb the impact of running as well as drive you forward in toe off phase of gait. Keeping this area strong can help reduce foot and ankle related injuries

To do this exercises you can do on two feet or one. You simply go up on the balls of your feet while attempting to not roll your ankle in or outwards. You want to think of maintaining the even weight distribution on all balls of the feet.

If you suffer from Plantar Fasciitis, I can help guide you to build up to this exercise. As doing this when injured can hurt the fascia band more, depending on the severity of the injury.

Hip Abduction

This can be done lying down or standing up . Lying down is a good place to stat initially. To do Stand with band around your shins and then raise the leg outwards. Keep the foot in line with your hip, try to not have it migrate in front of you your behind you . Keep your toes pointed forwards.

Hip Extension

Place a band around your shins and keep both feet facing forwards. Lift one leg back behind you and then return to normal. This works the hamstrings and the glutes.

Hip Flexors

This helps with running and form. You place a loop band around both feet and drive the bent knee up towards your chest.

Core Exercises

I am a big fan of planks for the core. This is done on the floor with your elbows bent. You can squeeze your glutes and ensure your back does not sag . To make this more difficult you can lift one leg up and hold. This is a hip extension variation. The other exercise you can do is side planks. This helps to work the hip abductors. A more difficult variation is to extend your arm and then raise one leg up in the air and hold.

 

Do not forget to also stretch!

 

Running Shoes – Footwear Advice !

Foot Pain Running? How and Why Footwear Matters. 

Lets face it, we are trying to make the most of this time of isolation. We want to be healthy and maybe take the opportunity to reach our fitness and health goals.  Without access to the gym or our fitness groups we are forced to get outside and get moving! Running is easy, right? We put on a pair of shoes on, put one foot in front of the other and get our heart rate up. An unexpected pain in your foot has put a road block into your plans. 

What to do if you get foot pain.

The first thing people should do, who experience foot pain, is rest and also take a look at what they have on their feet. I am offering some suggestions for what types of shoes to look for when you are experiencing pain in certain areas of your feet. 

Simple Terminology You Should Know When Buying Shoes 

Heel Drop – this is the difference of the heel height in relation to the forefoot height. A heel drop from 8 mm up to  12mm is seen as a higher heel drop. A lower heel drop is from 6mm down to 0 mm. 

Neutral shoe does not offer any gait correction. Stability offers gait correction for people that have flat feet or their knees and feet collapse inwards. Support is defined as non corrective gait movement guidance, this is seen in Brooks footwear as guiderails.

Foot Pain Symptoms and Shoes to Look For 

A key note – With any foot pain issues, a stiffer sole of some substance is better for foot pain. A soft sole may feel nice, but a stiffer sole adds stability to the foot. Brooks tends to have their shoes on a firmer sole across the board. Other lines may have firmer options. 

Achilles pain. Achilles issues can arise from lack of flexibility, calf weakness and pronation issues. Depending on if your issue is a result of pronation or not you should shop for a shoe at least a 10mm drop. 10 -12 mm heel drop brings the ground up to the foot and helps to alleviate strain off the achilles.

Tibialis Posterior Pain. Pain on the inside of your shins or inside of your arch. A 10 – 12 mm drop.Stability or support shoe will help with this. This problem usually arises from weak hips, calf and feet.

Plantar Fasciitis – 8-10 mm heel drop.  A firmer soled shoe with pronation control and a wide toe box. This problem usually is a complex one! I like a more supportive shoe with pronation control and a wider toe box. Intrinsic weakness is common with this condition. Having a wider toe box allows one to use toe spacers to help work their intrinsics when exercises. I also like a higher drop as calf tightness and weakness is also common with this condition. Bringing the ground up to the foot helps to take off some tension from the foot. 

Pain bending the toes upwards or a toe sprain – Any of the carbon plate shoes will to go well with this . These fancy shoes include the zoomfly, TC New Balance, Saucony Endorphin Pro and Hoka Carbon X shoe. 

Metatarsalgia or pain in the ball of their feet- Now these people would respond well to a lower drop 4-8 mm. I also recommend more cushion in the forefoot and wearin a met pad. Certain met bads are better than others for running. Materials that absorb sweat can lead to hot spots and friction/ blisters. That is no fun!

There you have it ! A few common foot conditions with footwear choices. 

A key note, when going down into a lower drop be careful. It takes time to adapt to that drop to avoid any achilles or ankle issues. 

Happy Running !

 

 

Best Footwear for Foot Pain

How Footwear Is Changing

I have noticed a recent trend in footwear companies across the board.  Specifically, in their stability and support lines. Support used to have medial posting, which is a foam made of a higher density on the inside of the sole. Sometimes these shoes also have a raised heel on the inside relative to the outside. This makes a wedging effect to prevent the foot from rolling inwards. A lot of foot problems are related to problems in the mechanics along the kinetic chain of the leg. However, not all foot types can tolerate a wedging effect. For instance, a Pes Cavus foot type or a supinating foot should not be forced into excessive supination. This can result in other foot problems.

How Footwear is Using Podiatry Concepts

The latest footwear technology is something similar to what we use in Podiatric Medicine. The new trend attempts to guide the foot to remain straight by having support above the sole of the shoe on either side of the foot. This concept is similar to what is used in Podiatric Medicine, which are “flanges” on medial and lateral sides of the foot. Flanges are designed to prevent the foot from rolling in or rolling out. However, in an actual orthotic this modification can be difficult to tolerate as it may not be the most comfortable. With a  shoe having this design, that makes a flange more tolerable.

This new design does not mean the foot is posted in either direction, it just guides the foot from rolling inwards or outwards. Brooks has changed a lot of their shoes to this new technique called Guide Rails. Similarly, Nike has so called replaced their Structure with the Nike Infinity React Shoe. he footwear companies have claimed that this new design has the potential to help reduce the occurrence of running injuries. Nike compared the Structure to the Infinity React and apparently found the athletes in the study had missed fewer training sessions in the new React Infinity shoe.

A Foot Specialist’s Opinion of the Stability Concept 

I have personally tried the Brooks Adrenaline and do really like this philosophy for foot health. The shoes are lighter without the heavier density of foam from the posting on the medial aspect of the shoe. I do like this new concept because it is shifting to a more neutral trend of support across the board.The other reason I do like a more neutral shoe is that it also does accommodate an orthotic well for those who need it. Orthotics should be in neutral shoes to avoid the effect of “ over-correction”. The shoe provides those “flanges “ for support and works well to help an orthotic do its job. The amount of “correction” can be done in an individualized manner in an orthotic based on individual biomechanic numbers, opposed to having a shoe with posting that is one size fits all among a population.

Additionally, in a study of Runrepeat, it was found that neutral shoes in combination with custom foot orthotics had a better impact on foot and lower limb injuries opposed to just stability shoes themselves. https://runrepeat.com/arch-support-study

I do really like this new trend in footwear and have tried it. I approve !