If you characterize yourself as having “weak ankles,” and find your ankle giving way or turning when you are walking, running, playing golf, tennis, basketball, or other sports, you may suffer from chronic ankle instability. At Blue Ridge Foot & Ankle Clinic, we frequently treat patients for this condition. Other symptoms of chronic ankle instability include persistent discomfort and swelling of the ankle, pain or tenderness, and just a general feeling that the ankle is wobbly and unstable.
Causes of Chronic Ankle Instability
Most often, chronic ankle instability is the result of an ankle sprain or sprains that have not healed completely or were not rehabilitated fully after initial injury. When you sprain your ankle, the ligaments (connective tissues around the ankle) are over stretched and sometimes even torn, leaving them like a rubber band that has lost its ability to snap back. Physical therapy and exercises to properly rehabilitate the muscles around the ankle are necessary to strengthen them and retrain the tissues that are responsible for balance. If this rehabilitation does not happen, the likelihood of spraining the ankle again is greatly increased. With each additional sprain, the ligaments get weaker and additional ankle problems can develop.
Surgical and Non-surgical Treatments
After a thorough exam, which may include digital x-rays at one of our central VA locations, Dr. Stewart M. Chang or Dr. Kevin P. Murray will determine the best treatment for your chronic ankle instability based on your test results and level of activity. Common non-surgical treatments include:
- Bracing: An ankle brace can provide support and keep the ankle from turning and thereby prevent another sprain.
- Physical therapy: Exercises and other treatments can strengthen the ankle and retrain your muscles resulting in an improved range of motion and balance.
- Medication: Ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to relieve pain and inflammation.
In severe cases, or if you are not responsive to non-surgical treatments, our board certified podiatrists many recommend surgery. If you are experiencing chronic ankle instability and would like more information about your condition, call our Charlottesville office (434-979-8116) or our Fishersville office (540-949-5150) to schedule an appointment or use our online appointment request form.
After 10 long years on South Magnolia Ave in Waynesboro, we are moving into our new office in Fishersville, VA. Construction starts this month at the end of Parkway Lane near Augusta Health Hospital. Our new facility will offer more space, easier access, and more parking. Dr. Murray and Dr. Chang are excited about our new facility and the conveniences it offers our patients.
Parking and handicap accessibility is a constant issue with our current office. The new location will have it’s own parking lot with handicap accessible sidewalks and entrance way. Inside, our hallways and doors will be wide enough to comfortably accommodate wheelchairs.
For more information about our new office visit us on Facebook.
If you or a loved one are experiencing foot & ankle pain, we hope you will consider our practice. Please CONTACT us to make an appointment. We are accepting new patients and referrals.
Plantar Fasciitis: Treatment Pearls
by Douglas Richie, Jr. D.P.M., President Elect AAPSM (2003 – 2004)
Epidemic Of Heel Pain:
Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age segment in our population.
The orthopedic and podiatric literature have been filled with original scientific investigations and anecdotal reports about the appropriate surgical and non-surgical approach to plantar fascitis. The vast majority of these scientific articles deal with the general patient population presenting with heel pain. There is a growing consensus of opinion that plantar fascitis is best treated non-surgically with the vast majority of patients becoming asymptomatic within twelve months of the onset of symptoms.
While patience, rest and tolerance of pain are virtues recommended to the patient presenting with plantar fascitis, different treatment strategies must be employed when dealing with the athlete.This article will focus on the differences in treating plantar fascitis in athletes vs. the general, sedentary population.
Subcalcaneal pain syndrome in athletes is thought to be brought on by an overload of the plantar fascia.However, the mechanism of this overload is debated.Overload causes micro-tears at the fascia-bone interface of the calcaneus or within the substance of the plantar fascia alone.The central band of the plantar fascia is primarily affected where a hypercellular, inflammatory response occurs within the fibers of the fascia, leading to degenerative changes.
A spur may result from further inflammation but is not implicated as the primary source of heel pain.Many studies have shown the presence of spurs on the heels of asymptomatic patients.One study found that only 10% of all calcaneal spurs visible on x-ray were actually symptomatic.
Other authors have attributed “painful heel syndrome” to an entrapment of either the medial calcaneal nerve or the first branch of the lateral plantar nerve.However, the mechanism of entrapment proposed by these authors is still related to overload of the soft tissue and fascial structures on the plantar and medial aspect of the calcaneus.
Although heel pain is common, there is no commonality of opinion of the biomechanical etiology of this syndrome.Contributing factors reported in the literature include leg length inequality, pronation of the subtalar joint, restricted ankle joint dorsiflexion, weakness of plantar flexion, high arched feet, low arched feet and heel strike shock.Studies have shown that decreased arch height has shown no correlation to the development of plantar fascitis in runners.In fact, it is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.
Scherer and coworkers have given the best insight into the pathomechanics of plantar fascitis.Their study proposed that supination around the longitudinal axis of the midtarsal joint is a common feature in over 100 feet presenting with heel pain.Supination about the longitudinal axis of the midtarsal joint can occur in two primary situations:when the heel everts past perpendicular (heel valgus) or when a forefoot valgus deformity is present (sometimes accompanied by rearfoot varus).
TREATMENT STRATEGIES FOR THE ATHLETE
In most cases, the goal of the athlete is to quickly return to activities to minimize loss of fitness and performance.This will put pressure on the treating practitioner to be more aggressive than treating cases of more sedentary patients.
A survey was conducted by this author of the board members of the American Academy of Podiatric Sports Medicine two years ago to compare treatment protocols for athletes vs. standard population.The following treatment pearls were elicited:
1) Assignment to alternative activity
The athlete must be encouraged to maintain cardiovascular fitness during rest from damaging activities that may delay healing.For the runner, dancer or volleyball player, this means a complete cessation from running and jumping activities until acute symptoms subside.On the other hand, the athlete should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, upper body weight machines, and low resistance flat-footed stair master machines.
2) Change and modulation of footwear
Footwear analysis is critical for evaluating athletes with subcalcaneal pain.The footwear may be a contributory factor and can be utilized as a powerful treatment modality.Athletesshould be placed into shoes that have a minimal 1″ heel height with a strong stable midfoot shank and relative uninhibited forefoot flexibility.The American Academy of Podiatric Sports Medicine has a list of recommended footwear for the athlete that can be obtained on their web site:www.aapsm.org.It is well recognized that recent trends in athletic footwear have actually predisposed to greater frequency of plantar fascitis due to the fact that athletic shoes have weaker midsoles with newer designs.The popular “two-piece” outsoles with an exposed midsole cause a hinge effect across the midfoot placing excessive strain on the plantar fascia in the running and jumping athlete.These shoes must be eliminated if the injured athlete is wearing them.Careful attention must be paid to having the athlete keep shoes on in the house and during all standing and walking activities.Barefoot and sandal-wearing activities are prohibited.
3) Home therapy
Athletes are accustomed to designing and participating in their own training programs.They are willing participants in their own treatment programs. Heel cord stretching is central to the rehabilitation process to decrease load on the plantar fascia and encourage healing.The use of plantar fascia night splints has been well proven to be a treatment adjunct for plantar fascitis by placing the heel cord and the plantar fascia on a sustained static stretch during sleeping hours while preventing the normal contractures that occur in the relaxed foot position during sleep.Having the athlete roll or massage their foot on a golf ball or tennis ball is helpful to improve blood flow and break down adhesions in the injury site.
4) Custom foot orthoses
Intervention with semi-rigid custom foot orthoses has been well proven in many prospective and retrospective studies showing successful outcomes in patients with plantar fascitis.In the athlete, the use of foot orthoses should be considered earlier than in the average sedentary patient because of the fact that the athlete will be subjecting their feet to greater stresses during treatment and certainly after return to activity.Athletic footwear is more amenable to semi-rigid and rigid orthotic therapy than are casual shoes worn by sedentary patients.Sports podiatrists are more likely to employ arch taping procedures as a precursor to or adjunct to orthotic therapy.Athletes respond very favorably to the immediate intervention and relief obtained by expertly applied arch taping procedures.
5) Physical therapy
Athletes are amenable to referral for physical therapy because they are willing to invest the extra time to expedite recovery.Many athletes are used to going to the training room for hands on rehabilitation.Athletes appreciate a partnership between the sports podiatrist and the physical rehabilitation specialist.
6) Anti-inflammatory medication
Sports podiatrists should be cautioned against over-aggressive use of anti-inflammatories in treating the athlete.While it is tempting to utilize corticosteroid injections to expedite healing, athletes are often skeptical of receiving this treatment and are certainly at greater risk for sequela of over-ambitious use of steroid injections.There are reports in the literature of athletes undergoing spontaneous rupture of the plantar fascia after even single injections of their plantar fascia with corticosteroid.The conservative, biomechanical interventions outlined above should be implemented before considering injection therapy.
Athletes presenting with plantar fascitis must be treated aggressively because they have immediate needs and long-range goals that are different than those seen in the average sedentary patient with heel pain.It is important to be aggressive and employ a variety of modalities and treatments when formulating a treatment plan for the athlete.At the same time, caution should be made about the overzealous use of quick fixes, including corticosteroid injections because of the potential deleterious effect on athlete.
The cornerstone of plantar fascitis treatment for the athlete is biomechanical.Podiatric practitioners possess the greatest skill set and knowledge available in medicine today to adequately address the pathomechanics of plantar fascia overload.The use of properly casted and designed custom foot orthoses should be the cornerstone of non-surgical treatment of subcalcaneal pain in the athlete.
Resistant Plantar Fasciitis Treatment Program (Initial)
Contributed by Richard Bouche D.P.M. , William Olson, D.P.M., Stephen Pribut, D.P.M., Douglas Richie, Jr,. D.P.M.
PHASE 1- Acute Phase:
- Goal decrease acute pain and inflammation:
- absolute or relative rest- Decrease sports activity to avoid rebound pain
- ICE: 2 appliations of 20 minutes per day
PHASE 2- Rehabilitation Phase:
- Further decrease pain and inflammation:
- contrast baths
- Maintain/increase flexibility of injured (and surrounding) tissue:
- gentle stretching exercises: calf, hamstring, posterior muscle groups
PHASE 3- Functional Phase:
- Functionally strengthen intrinsic muscles of the foot
- closed chain therapeutic exercise
- Doming of Arch (towel toe curl)
- closed chain therapeutic exercise
- Protect injured area during functional activity
- stability running or other appropriate athletic shoes
- orthoses as needed
Note: this is probably the most important phase because it prepares the patient for their return to activity. Care needs to be taken at this stage not to allow the patient to overdo these exercises and stay within their limits as re-injury can easily occur.
PHASE 4- Return To Activity
Return to desired sport activity: gradual, systematic, “to tolerance”
Initiate preventive strategies:
appropriate athletic shoewear
functional exercises (i.e., pilates, plyometrics)
revise training program
Note: Be careful in the first months return to exercise to avoid recurrence of pain.
Consider shock wave therapy if there is a 6 month failure and a failure after repeated modification and remaking of orthotics.
- Posted in Athletic Injury, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, EPAT, Extracorpeal Pulse Activation Treatment, Foot Doctor, Foot Pain, Heel Pain, Orthotics, Plantar Fasciitis, Podiatrist, Podiatry, Running, Shockwave Therapy, Shoes, Shoes and Socks, Uncategorized
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- Tags: Athletics, charlottesville podiatrist, Custom Orthotics, Exercise Related Pain, foot inflammation, Overuse Injury, Plantar Fasciitis, Sports Related Injuries
Common cycling injuries are often due to trying to do, “too much, too soon”, but may also be due to improper equipment, biomechanics, technique, or bike fit. As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.
1. “Hot foot” (numbness and burning in the ball of the foot)
Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling which results in numbness, tingling, or burning, or sharp shooting pains into the toes. Loosening shoe toe straps, wearing wider shoes with a stiffer sole and using anatomical footbed with a metarsal pad will help alleviate the problem.
Besides tight shoes, another risk factor is small pedals, especially if you have large feet. Small pedal surfaces concentrate pressure on the ball of the foot. Switching to larger pedals may be the cure. Re-focus the pressure on the ball of the foot by moving the cleats towards the rear of the shoe. If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.
Physician-designed custom orthotics provide biomechanical benefits and can be made with built-in “neuroma pads”. Cycling orthotics are different than those for runners, as cycling is a forefoot activity, not a heel-strike activity.
Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.
The sesamoids are two small “seed-like” bones found beneath the big toe joint. Injury to these tiny bones can result in inflammation or even fracture, leading to debilitating pain and inactivity. Sesamoiditis can be relieved with proper shoe selection, accommodative padding, and foot orthoses.
1. Achilles tendonitis
Irritation and inflammation of the tendon that attaches to the back of the heel done can be caused by improper pedaling, seat height, lack of a proper warm-up, or overtraining. This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin, or other anti-inflammatory medications. Chronic pain or any swelling should be professionally evaluated. Floating pedals which allow excessive foot pronation may also worsen this condition.
2. Shin splints
Pain to either side of the leg bone, caused by muscle or tendon inflammation, which may be related to a muscle imbalance between opposing muscle groups in the leg. It is commonly related to excessive foot pronation (collapsing arch). Proper stretching, changing pedals, and corrective orthoses that limit pronation can help.
Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist. Cartilage irritation or deterioration, usually under the knee-cap, can be caused by biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals. Riding in too high a gear “mashing”, excessive uphill climbing, or standing on the pedals all may aggravate the problem. Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet, and pedals are misaligned.
Pain under the kneecap. Most chondromalacia sufferers can ride at some level no matter how sever the degeneration.
2. Patellar Tendonitis
Strain of the tendon which attaches the kneecap to the leg, this injury often occurs in the novice cyclist or early in the cycling season. The first sign of a problem may be an ominous twinge after cycling in too hard a gear.
Bike fit is key; have a professional check your fit and make bike modifications as needed.
Carefully choose the shoes you will wear in cycling.
Train properly using adequate warm-up and cool-down. If you are doing “too much, too soon” and start having pain, reduce training frequency, intensity, and time.
Pain is not normal and may indicate a medical condition. Seek medical attention from a sports medicine specialist.
Before beginning any exercise program, be sure to check with your physician.
-The American Academy of Podiatric Sports Medicine (AAPSM)
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro, VA 22980 540-949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
you to our practice.
- Posted in Achilles Tendon, Athletic Injury, Blisters, Bunions, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, EPAT, Foot Doctor, Foot Pain, Heel Pain, Ingrown Toenails, Leg pain, Neuroma, Orthotics, Our Community, Plantar Fasciitis, Podiatrist, Podiatry, Shockwave Therapy, Shoes, Shoes and Socks, Triathlons
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- Tags: Athletics, charlottesville cycling, charlottesville podiatrist, Custom Orthotics, Exercise Related Pain, foot inflammation, foot surgery, mortons neuroma, Overuse Injury, Plantar Fasciitis, Sports Related Injuries, Tendonitis
Blue Ridge Foot and Ankle Clinic enjoys promoting physical activity in our community. We believe physical exercise is the best medicine available. Charlottesville and the Shenandoah Valley are fantastic areas to enjoy the outdoors. Our clinic sponsors the 2013 Virginia Off-Road Series mountain bike races and some of the Devils Playground fun runs at Devils Backbone Brewery in Roseland, VA. We want to encourage you to find local events this summer to participate in. Your participation is a healthy choice and helps promote physical activity to others by being a role model.
Our staff participates in many physical activities year round. Dr. Murray and Dr. Chang enjoy activities such as cycling, hiking, skiing, and ice hockey. Kindra Jones, medical assistant, hits the gym regularly. She’s expecting an addition to her family this fall and now exercising for two. Congratulations Kindra! Mary Mead, billing specialist, and her husband walk all over the streets and trails of Charlottesville. Our jack of all trades, Amy Flevarakis, participates with her family in events such as the March of Dimes Walk. Newbie, Teresa Thompson, enjoys hiking and running the trails in and around Staunton and wants to run her first 5k race this year. Welcome to our practice Teresa. Mallory Snow, Charlottesville receptionist, stays fit by running while her kid participates in dance class. Mallory and Amy are running the Color Me Rad 5K in Virginia Beach this fall. Mark Smith, Waynesboro receptionist, rides his bike daily and competes in local mountain bike and running races. Aside from keeping our offices running smoothly, Mary Ishee – office manager, walks with her daughter and has participated in the Charlottesville Women’s Four Miler for the last two years.
We hope you join us this summer in some of the fun activities and events our communities have to offer. Let us know if there is anything we can do for your feet or ankles to help you be a role model to you family and friends.
Here are some sites to help you find local activities:
Bike rides and racing:
Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!
Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years.
Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and
diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
you to our practice.
- Posted in Athletic Injury, Children, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, Our Community, Our Team, Podiatrist, Podiatry, Running, Seasonal Foot Care, Uncategorized
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- Tags: Augusta Health, charlottesville cycling, charlottesville podiatrist, charlottesville shoe stores, Custom Orthotics, Exercise Related Pain, mark lorenzoni, mortons neuroma, Overuse Injury, Plantar Fasciitis, running shoes charlottesville va, Sports Related Injuries, Winter Foot Care, Winter Running
A runner with a Stress Fracture, often times have a burning desire to return to running. Some think a stress fracture really in not a “real” fracture, so return to activity should take less time. Right? I say maybe ……A fracture of any type is a challenge as is significantly alters ones lifestyle. Particularly runners. They may end up forgoing a race, a goal they have set for achievement, or just miss the “runner’s high” they get from getting out on the road. In find that runners often get in a hurry to get back into the activity and can cause additional injury from not waiting until the appropriate time to return.
While it is true stress fractures are not “true” and complete fractures … the condition does require similar protocols for fracture healing. However, in my experience, the traditional fracture healing times may by truncated.
Generally speaking an osseous injury requires 6-8 weeks of protection and relative inactivity to heal adequately. This is a “rule of thumb” benchmark which has been made over time by medical professionals based on experience, x-ray evidence and patient feedback in the healing process. It is individual dependent, fluid, but very close to accurate in my experience.
What are the biggest factors that influence my determination of healing? !) X-Ray evidence. 2) Resolution of pain.
So, how do I transition back to running?
– What is the most accurate indication of healing? Bone healing, as with fractures, is usually confirmed on x-ray. If the x-ray shows sufficient callus formation around the fracture and “filling” fracture by reduction of fracture line lucency, the area is healed. This means the bone is sufficiently stable for return to activity and re-injury risks are reduced. It is best to wait until this has occurred to return to any running type of exercise…. If your goal is to get back to running pain free, hastening your return to running is not advised.
– Pain is improved can I run? Depending on the type and degree of the fracture, pain can improve and sometimes resolve by 2-3 weeks. I often see most fractures being pain free at week 4. Absence of pain is a good sign, but not a guarantee that healing is complete. If you were to run too soon, I could create a situation requiring a return to cast or boot and possibly even surgery.
– How do I get back to running? The best way to get back to running is to do it progressively and gradually. . Expect recovery to normal to be 3 times that (at least) to what your recovery time was observed at. This means a recovery time of 6-8 weeks is a 18-24 gradual return to activity. . Start slow, preferably on a surface that will protect you from re-injury. As you transition back running, try up to 1 mile only for the first 3-5 days, and then start adding mileage to your normal running routine. Pain is always a good guide to prevent re-injury. Too much too soon, and your body will tell you. Don’t ignore these signs.
Anything worth doing, is worth doing right. This is especially true in an orthopedic injury. There will always be another race. There will be another time to set fitness goals. Take time to respect your body and appreciate the remarkable ability you have to affect healing to an injury. Your body thanks you!
Back to school : Youth sports injuries and prevention.
As our children return to school many are involved with extra-curricular athletics. In our experience, this return to school sports is sometimes plagued by injury and/or onset of foot and ankle pain. This past week our office has seen several middle and high school teens with an assortment of foot and ankle problems related to athletics. Here are the common ones we see:
Many of these conditions are a result of engagement in activity without adequate preparation and conditioning. Our active young children are involved in sports that are becoming increasingly competitive and demanding. I’d like to offer some TIPS for pre-conditioning and injury prevention.
- Warm up before exercise. Pre-activity stretching
- “Fuel up” – EAT before exercise
- Hydrate your body before exercise.
- Gradually increase: Time & Intensity of your exercise activity
- Cross Train
- Wear proper equipment
- Consider supporting the feet. Orthotics or Off shelf arch supports
- Consult a personal/athletic trainer
- Have a pre-participation athletics physical
- Take time to rest and recover from exercise activity. Post activity stretching.
- LISTEN to your body…
Here is one of my favorite articles on this topic by a Sports Podiatrist.
Stewart M Chang, DPM
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.
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.