Archive for May, 2010

Do I need orthotics in my running shoes?

May 19th, 2010 by Dr.Chang

The simple answer here is “maybe.” Let’s start by establishing some definitions. The insole that comes in your running shoe is a “sole liner.” It offers minimal support and very little shock absorption. The support and control of a running shoe comes from materials and design features within the shoe itself. A device that you can buy off the shelf at a pharmacy, shoe store, or sporting goods store is an “insole” or “arch support.” It does provide some level of non-specific generic arch support. It is often a good first step in seeking comfort and simple resolution of non-complicated foot issues. It may in fact be adequate for some applications.

Now we examine the functional foot orthotic. These are semi-custom modifiable or full custom insoles made from a mold of your foot. The mold is made from plaster wraps around the foot, a foam impression, laser scanning, or standing/walking on a computer force plate. There are opinions as to what’s the best method … At Blue Ridge Foot and Ankle Clinic we favor the use of plaster casting. Our reasons for that are a topic for another blog post. A functional foot orthotic is specific in design & construction to the needs of the person for whom it is made. We believe it is important to only get a custom orthotic from a doctor, who will also provide an appropriate biomechanical examination.
The evaluation for a custom foot orthotic should involve a full assessment of the static motion and angles of your foot, ankle, knee, and hips during a biomechanical exam. Standing foot X-rays are helpful to examine the bone structure in detail. Lastly, a careful analysis of you walking barefoot is essential to get a complete view of your dynamic lower extremity mechanics. Based on this complete exam, a prescription is made for a set of orthotics to correct for imperfect mechanics. The goal is to make you walk or run as efficiently and stable as possible.
A custom orthotic is always indicated for any sort of foot deformity, such as bunions or hammertoes. A properly made orthotic will help to eliminate or stabilize the forces that caused these deformities and stop the progression. Serious athletes at any level should consider a custom orthotic if they have any pain during the activity. Recreational athletes will likely find adequate support and stabilization from off the shelf insole systems. For mild foot pain or generalized fatigue in your foot and or ankle, start by trying an insole from a specialty running store. An insole of this type should cost about $30-$40. If the problem persists seek professional attention.

The simple answer here is “maybe.” Let’s start by establishing some definitions. The insole that comes in your running shoe is a “sole liner.” It offers minimal support and very little shock absorption. The support and control of a running shoe comes from materials and design features within the shoe itself. A device that you can buy off the shelf at a pharmacy, shoe store, or sporting goods store is an “insole” or “arch support.” It does provide some level of non-specific generic arch support. It is often a good first step in seeking comfort and simple resolution of non-complicated foot issues. It may in fact be adequate for some applications.Now we examine the functional foot orthotic. These are semi-custom modifiable or full custom insoles made from a mold of your foot. The mold is made from plaster wraps around the foot, a foam impression, laser scanning, or standing/walking on a computer force plate. There are opinions as to what’s the best method … At Blue Ridge Foot and Ankle Clinic we favor the use of plaster casting. Our reasons for that are a topic for another blog post. A functional foot orthotic is specific in design & construction to the needs of the person for whom it is made. We believe it is important to only get a custom orthotic from a doctor, who will also provide an appropriate biomechanical examination. The evaluation for a custom foot orthotic should involve a full assessment of the static motion and angles of your foot, ankle, knee, and hips during a biomechanical exam. Standing foot X-rays are helpful to examine the bone structure in detail. Lastly, a careful analysis of you walking barefoot is essential to get a complete view of your dynamic lower extremity mechanics. Based on this complete exam, a prescription is made for a set of orthotics to correct for imperfect mechanics. The goal is to make you walk or run as efficiently and stable as possible.

A custom orthotic is always indicated for any sort of foot deformity, such as bunions or hammertoes. A properly made orthotic will help to eliminate or stabilize the forces that caused these deformities and stop the progression. Serious athletes at any level should consider a custom orthotic if they have any pain during the activity. Recreational athletes will likely find adequate support and stabilization from off the shelf insole systems. For mild foot pain or generalized fatigue in your foot and or ankle, start by trying an insole from a specialty running store. An insole of this type should cost about $30-$40. If the problem persists seek professional attention.

Doctor, my shins are killing me!

May 15th, 2010 by Dr.Murray

“Shin Splints” is a common term for any exercise-related leg pain. The most common cause of exercise related leg pain is Medial Tibial Stress Syndrome (MTSS). Other frequent causes of exercise related leg pain in athletes are stress fracture or posterior compartment syndrome.
MTSS, a specific overuse injury, causes pain along the posterior inside & outside aspects of the lower leg. Athletes most commonly afflicted with this condition compete in track, cross-country, basketball, and volleyball. The incidence of MTSS in long-distance runners is reported as high as 16.8%. It affects females more than males. In our experiences it occurs frequently from training error and running on uneven surfaces.
There is no consensus on the cause. Some believe it is inflammation of deep fascia or strain of deep muscles of the leg. Others believe it is tearing of the leg bone-muscle interface. Yet, another theory is a stress reaction of the bone that has become painful.
The diagnosis is made by history, clinical exam and full consideration of the symptoms. Commonly, athletes will complain of pain at the beginning of a run that seems to subside during the middle but recurs at the end of the run. Some risk factors for MTSS are: excessive foot pronation (flat feet), tight calf muscles, foot/leg geometry and alignment, body mass, sex and age. Diagnostic exams can be utilized if other conditions are suspected and initial treatment program does not result in improvement.
As for most overuse injuries treatment involves cessation of the activity. Assumption of alternative forms of exercise should be utilized if competitive athletes want to remain in condition. Stabilization of the foot is essential if excessive pronation is found. Support of the foot will involve evaluation of shoes for wear. Replace if necessary. Foot orthotics should also be considered and made to specifications based of appropriate biomechanical foot exam and gait analysis. Anti-inflammatory medications are also helpful for pain control. Finally, a well directed range of motion, stretching and muscle recovery-rehabilitation-strengthening program should be started (see articles below).
If you suffer from shin splints or know someone who does make and appointment at Blue Ridge Foot and Ankle Clinic. We can help keep you “in the game.”
Further readings:

How can I stop the blister blues?

May 3rd, 2010 by Dr.Chang

What is a Blister? A blister is a swelling of the skin, from an intradermal body fluid collection and is caused by burning or repetitive friction irritation. It is also caused by excessive moisture or sweat remaining on skin during athletic activity.  Blistering is very common among springtime athletes and hikers as they get back in the “groove” and their skin has not had time to adjust to the demands of the sporting activity. Today, sports have become very demanding. A well designed pair of socks can help with foot injury prevention. No athlete, competitive or recreational, can perform at 100% when they have burning and/or swelling in their feet. Although certain socks may help you limit your blisters, not all of them will.
There are plenty of ways to prevent blister formation. Here are some helpful tips to keep you “in the game” this spring.
1. Wear Properly Fitted Shoes. Replace worn shoes.
2. Keeping feet dry during a race or game is key !
3. Wear polyester or acrylic blended socks. Blended material fabrics are best as opposed to 100% cotton or wool. Special blister-proof running socks are worth experimenting with.
4. Use bandage strips, moleskin, or blister block adhesive tape on prominent and friction prone areas.
5. You may experiment with petroleum jelly or skin lubricants. These often help prevent blistering.
6. Try antiperspirant powders or sprays if you have excessive sweating. Products with Aluminum Chloride are a good choice. We like Breeze Mist (Pedinol) and Bromi-talc and Bromi-lotion (Gordon’s Lab)
7. Try a foot soak after activity to help prevent blisters. Astringent soaks such as Domboro can dry out excessively moist skin.

For socks, we would suggest Thorlo Socks. They are a specialty sock manufacturer for athletic applications. They have quality socks for specific activites and use. Also check out our online store at Blue Ridge Foot and Ankle, we have many solutions for blister care and prevention.

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