March Articles 2015

Barefoot Running

Barefoot running is becoming a popular running trend that has been permeating through the running and jogging communities. The act of running without shoes changes more about the motions of your stride than you may think, and choosing to run without shoes is not the only adjustment you will have to make.

Whenever you run normally, with shoes, your heel strikes the ground first as you land while you roll over the ball of your foot and push off with the front part and toes. Barefoot runners actually land on the front part of their feet and not their heels, shifting the impact from the back to the front of the foot. In order to do this safely and without much injury, runners need to reduce their stride to create softer landings.

One of barefoot running’s biggest advantages is the reduced risk of injury. Landing on the front of your foot with a reduced stride lessens the stress placed on the back of the foot, heels, and ankles. It also works out many muscles in the feet, ankles, and lower legs that you do not normally get to strengthen because of the different motion.  Your posture and balance are also improved with barefoot running, as is your sensory input from your feet to the rest of your body. Studies have shown that ironically, countries that have large populations of people who do not wear shoes every day are at lower risk for foot and ankle injuries and complications.

However, there is still some skepticism behind barefoot running because of some disadvantages it brings. One of these is the complete lack of protection for your feet while running. Bruises, scrapes, cuts, and even blisters can easily form when you have no protection from sharp or rough objects on the ground. Landing on the front of your feet can also cause Achilles tendonitis because of the overuse of the Achilles tendon.

Despite this, barefoot running can be made safe and enjoyable if you make a slow transition from your normal running routine into barefoot running. You cannot simply start the activity out of the blue one day, but instead gradually work your way from walking to jogging to running, increasing the distance each time. It is also recommended to start off on flat, even surfaces that do not contain sharp or dangerous objects because your feet are now unprotected. Minimalist running shoes are a great middle ground to start with because they combine the protection of shoes with the fit and feel of barefoot running.

What Are Ankle/Foot Orthotics?

Orthotics is a medical field concerned with the design, manufacture and use of aids used to support weak limbs or direct the proper function of limbs, in this case the foot and ankle. Ankle-foot orthotics, or AFOs, are braces worn at the ankle that encompass some or all of the foot. Diseases that affect the musculature or weaken the affected area require AFOs to strengthen the muscles or train in the proper direction. Tight muscles that need to be lengthened and loosened also benefit from AFOs.

When we think of diseases that affect the musculature we think of the big boys: muscular dystrophy, cerebral palsy, polio and multiple sclerosis. We rarely think that arthritis and stroke can affect the musculature or that there are some who "toe in". But whatever trauma affects that musculature, there is a way to correct it. The orthosis helps to control range of motion, provide support by stabilizing walk, correct deformities and manage pain load. A podiatrist would be consulted for those who "toe in", for instance, or an arthritis sufferer whose ankles suffer through walking on the job or perhaps a victim of stroke whose musculature is wasting away and requires strength.

Before the advent of modern orthotic devices, it wasn’t uncommon to see polio victims wearing metal braces from mid thigh to the bottom of the foot, or children who "toed in" wearing metal braces around their ankle and foot. However, both designs and materials have improved dramatically, allowing for new levels of comfort, functionality, and appearance. Many orthotics are now made from plastics in the shape of an L and designed to fit inside a corrective shoe. These can be rigid, buckling at the calf and extending the length of the foot to support the ankle. This same design except with a hinged ankle provides support while walking by normalizing the gait. In the past boots lined with leather and fiberboard provided the rigidity needed for correction and support. Now corrective shoes are available with built up soles to correct the gait or manage pain by sharing it with another area when the foot spreads during walking.

The podiatrist would prescribe this orthosis in the rigid L shape because the foot moves on a hinge. If the hinge isn't functioning as intended due to an injury or malformation, the muscles tighten up, thus making it difficult to flex the foot. When we walk, the foot flexes and muscles stretch. This brace or AFO would support the ankle and musculature during flexion of the foot, in much the same way a knee brace works. Corrective shoes are for people whose feet hit the ground backward, causing tight muscles and arch problems. Wedges and rocker bars on the heels correct the step to heel first and rock onto the ball of the foot, resulting in relaxed musculature and strengthened ankles.

Appearance also counts when we consider a particular support device, especially if the item is intended for regular, daily wear. The L shaped orthotic is contoured to the calf and flesh-colored, fitting into a sneaker or dress shoe. As present, corrective shoes are more attractive than past models, enabling patients wear such devices with greater comfort and confidence.

Choosing the Right Running Shoe for Your Foot Type

While running seems like a simple activity, it is actually a complicated movement that puts a lot of stress on the joints, bones and ligaments of the body. Consequently, choosing the right shoe is an important step in increasing performance and decreasing injury risk. You should select running shoes based on your foot type. While other considerations are important, such as trail versus road shoes, your foot type dictates the amount of cushioning, stability and motion control you need. The best way to determine your foot type is to visit a local specialty running shop. Professionals there can measure your arch type, stride and gait and summarize your shoe needs for future reference.

Running shoe design is based on the idea of pronation. Pronation is the natural rolling of your ankle from outside to inside during foot strike. In other words, proper running mechanics involve striking the ground on the outside of your heel and rolling toward your big toe before pushing off again. Pronation is a good thing: it helps your lower extremities absorb shock and store energy. Neutral runners who pronate correctly do not depend on their shoes to correct their form. Neutral runners can select from a large variety of shoes, even minimal or barefoot models. However, runners with problematic foot arches or incorrect form may pronate too much or too little and require specific qualities from their running shoes.

Overpronators run with excessive ankle rolling. Even when standing, severe overpronators exhibit ankles that angle inward. They also tend to have flat feet or bowed legs. Overpronation can cause a plethora of injuries, especially in the knees, ankles and Achilles tendons. If you overpronate, you should select a shoe with extra stability and motion-control. Motion-control shoes are firm and straight; they do not curve at the tip. The lack of flexibility along the midsole prevents the foot from rolling too far inward during your foot strike.

Underpronation, also called supination, is less common than overpronation. Unlike overpronators, underpronators have inflexible feet and high arches. When they land, their feet are unable to roll inward. While this places less rotational stress on the ankles and knees, it prevents any kind of shock absorptions. This additional force can result in fractures, ligament tears and muscle strains as the legs compensate for the impact. Underpronators require shoes with increased cushioning and flexibility. If you underpronate, stability or motion-control shoes may compound the problem by further preventing pronation.

New Treatment Helps Relieve Heel Pain Caused by Plantar Fasciitis
Recently, a groundbreaking study concluded that their treatment combining ultrasound with steroid injections was 95% effective in the treatment of plantar fasciitis.

Plantar fasciitis is a foot problem affecting the plantar fascia, a connective tissue in the heel. This condition is treatable, but in many cases can take up to a year to be effective.

Conventional treatments have included exercises, rest, arch supports, and night splints. If this proves to be ineffective, many patients undergo shockwave therapy. In shockwave therapy, sound waves are directed to the area where pain is experienced. This therapy can be affective, but is somewhat painful, and calls for several sessions. Even still, shockwave therapy does not always alleviate the pain caused by plantar fasciitis.

Luca M. Sconfienza, M.D., from the University of Genoa in Italy, conducted the study. The new treatment involves an ultrasound-guided technique with a steroid injection to the plantar fascia. It is a one-time outpatient procedure involving a small amount of anesthesia. This technique, known as dry-needling, causes small amounts of bleeding that aid in healing the fascia.

It was discovered that 42 of the 44 patients involved in the study had their symptoms disappear entirely within three weeks. “This therapy is quicker, easier, less painful, and less expensive than shockwave therapy” Dr. Sconfienza stated. “In cases of mild plantar fasciitis, patients should first try non-invasive solutions before any other treatments. But when pain becomes annoying and affects the activities of daily living, dry-needling with steroid injection is a viable option," she added.

Stretching Your Feet

Debilitating foot pain is a problem for many people. But just as stretching the torso can help alleviate back pain, stretching the feet can also mend existing problems and prevent future ones.

The feet carry the entire weight of the human body all day and can get easily strained from overexertion. Persistent sharp pain and cramping in the feet are common problems. Foot pain and problems can be due to any number of causes, and in many cases pain may be eased without medication or doctor visits; however, it is always a good idea to rule out any serious medical issues first with a physician.

Stretching may help relax the feet and alleviate pain at any time, but it is especially important before    heavy aerobic exercise to avoid painful cramps or straining muscles in the feet. Stretches should be performed slowly and deliberately without forceful pulling. The stretch should be held for several seconds, and then relaxed.

A great way to stretch out and loosen up the foot muscles while sitting is to cross one leg over the other and pull the toes carefully back without overextending. Start by resting the left ankle on the right knee. With the left hand, gently flex the left foot by pulling back on the toes. Do not pull too hard, just hard enough to feel the stretch in the arch of the foot. Then point the toes of the left foot as far as you can. Rotate the motion of pointing with pulling back on the toes. This should relax and stretch the muscles on the bottom and the top of the foot. Doing this stretch ten to twenty times should bring relief. Repeat the whole process for the other foot by resting the right ankle on the left knee.

A stretch that focuses on the often injured Achilles tendon involves standing, facing a wall, with your arms out and hands flat against the wall. Step back with one foot, keeping it flat against the floor. Move the other leg forward and lean toward the wall. You should feel a stretch through the back of your leg and your Achilles tendon, but do not push yourself too much. Stop when you feel the stretching sensation and hold for 30 seconds. Ten repetitions may be done for each foot.

Stretching the feet is important for athletes or those performing aerobic exercise, but it can also help anyone with foot pain caused by poor footwear, plantar fasciitis, or long hours standing and walking. Individuals who tend to their feet by regular stretching every day should be able to minimize foot pain and prevent new problems from arising.

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