Orthotic Flip Flops

Flip flops are never the best shoes for your feet.  BUT, we have found what we consider to be the healthiest flipflop on the market.  Essentially, this flip flop has the best arch support of any that we have seen.   If you wear flip flops at all, get yourself a pair of these sporty sandals.  Detailed information on the benefits of this sandal is here.      Ordering info is available here.

Rheumatoid Arthritis and Foot Orthotics

A number of studies support the use of foot orthotics to treat foot pain in patients with RA.   We have listed three of them here.    If you have RA, find a podiatrist in your area who specializes in orthotic therapy.

Can you run thorugh achilles tendonitis?

This is a question I recently received from a runner.

I would be extremely cautious about running with Achilles tendonitis. It is one of the few injuries that I tell runners to stop running altogether until it is healed.  The problem is that the Achilles has a horrible blood supply and is very slow to heal in the best of circumstances.   If not treated correctly, achilles tendonITIS (inflammation of the tendon) can quickly become achilles tendonOSIS (degeneration of the tendon) and will be even more difficult to treat.   There has been substantial research on achilles injuries over the past decade and a good sports oriented podiatrist or other sports med specialist can get you on a program to get you back to running ASAP.  But I highly discourage running through the problem.  More detaileld info on achilles tendonitis is here:

Orthotics or night splints for plantar fasciitis treatment?

Here’s the latest research, published in the journal Foot and Ankle,  showing foot orthoses are effective in the treatment of plantar fasciitis. Patients had better outcomes, better compliance and fewer side effects when using foot orthoses than when using night splints.   I’ve treated thousands of patients with plantar fasciitis in our Seattle clinic over the past 18 years and this study correlates well with my findings.

Foot and Ankle International
AUGUST 2006 Number 08

Foot Orthoses for the Treatment of Plantar Fasciitis

Ewa Roos, Ph.D., P.T.; Mikael Engström, B.Sc., C.P.O.; Bengt Söderberg, B.Sc., C.P.O.
Lund, Sweden

ABSTRACT

Background: The literature suggests mechanical interventions such as foot orthoses and night splints are effective in reducing pain from plantar fasciitis. There is, however, a lack of controlled trials. We studied the effects of foot orthoses and night splints, alone or combined, in a prospective, randomized trial with 1-year followup. Methods: Forty-three patients (34 women and nine men with a mean age of 46 years) with plantar fasciitis were randomized to receive foot orthoses (n = 13), foot orthoses and night splints (n = 15), or night splints alone (n = 15). Data were available for 34 (79%) patients after treatment (12 weeks), and for 38 (88%) at 1-year followup. Pain, functional limitations, and quality of life were evaluated with the Foot and Ankle Outcome Score. Results: All groups improved significantly in all outcomes evaluated across all times (p < 0.04). At 12 weeks, pain reduction of 30% to 50% compared to baseline were seen (p < 0.03). At 52 weeks, pain reduction of 62% was seen in the two groups using foot orthoses compared to 48% in the night splint only group (p < 0.01). Better compliance and fewer side effects were reported for orthosis use. At 12 months, 19 of 23 patients reported still using foot orthoses compared to 1 of 28 still using the night splint. Conclusions: Foot orthoses and anterior night splints were effective both short-term and long-term in treating pain from plantar fasciitis. Parallel improvements in function, foot-related quality of life, and a better compliance suggest that a foot orthosis is the best choice for initial treatment plantar fasciitis.

Orthotics for Plantar Fasciitis

Plantar fasciitis is caused by increased tension on the plantar fascia – usually from the arch collapsing. As the arch collapses, the foot gets lengthens and  tension is increased within the fascia.  It can occur in both high and low arched feet (it’s not the flat foot that causes it, it is the FLATTENING of the foot).  So to treat plantar fasciitis, you must reduce tension on the fascia (otc arch supports, custom orthotics, correct shoes), AND get rid of the inflammatory responce (ice, NSAIDS, night splint.  If that is not enough we use a couple weeks of immobilization and sometimes injections).

If you end up needing custom orthotics for this problem, the most recent studies show that the orthotics must be prescribed to conform very, very close to the arch (total contact orthotics) in order to reduce arch collapse and subsequent tension on the plantar fascia.

Orthotics for stress fractures of the foot

There are a number of causes of stress fractures, but if you do not have any decrease in bone mass (osteoporosis) the most likely cause of stress fractures is excessive pressure or force on the bone that is developing the fracture. In the foot, the metatarsals are the most common area for stress fractures. Stress fractures can usually be prevented by reducing the force on the one bone that is injured and redistributing that force to orther portions of the foot. The can usually be accomplised with orthotics, but the orthotics should conform extremely close to the arch of the foot in order to best redistribute force (total contact foot orthotics).          More info on stress fractures is here.     Finally, the orthotics should have a little extra cushion than normal.   Cushion reduces velocity of the foot and thus reduces force.

Troubleshooting Foot Orthotics – the sign of an orthotic master

The ability to troubleshoot and adjust foot orthotics is critical to assure that you receive the best orthoses to treat your particular problem.   If you are considering having orthotics made, always ask the podiatrist whether they can do most orthotic adjustments in their office or do they have to send them back to the lab?  If they are not able to do most adjustemnts in their office, find another practitioner.    In our Seattle clinic, we modify orthotics every hour, every day in order to ensure that our orthotics are offering absolutley best outcomes for our patients.  Denise, our full time orthotic technician,  keeps things running smoothly.

Orthotics for Runners

A 2008 study evaluated the effect of using cushioning on top of orthotics in runners.  They found that the use of specific types of cushion decreased force through the entire lower extremity.    Based on this study we now add an extra 1.5mm of a cushioning material called Poron to all of the orthoses that we make for runners we see in our Seattle Foot and Ankle clinic.

Here is the study: OLeary K, et. al. Effect of Cushioned Insoles on Impact Forces During Running. J Am Podiatr Med Assoc 98(1): 36–41, 2008

How close should your orthotics match your arch?

A number of studies the last few years have demonstrated that for most of the conditions we treat with custom foot orthotics, the orthotics should conform extremely close to the arch of the foot.   For problems including plantar fasciitis, heel pain, bunsions, big toe joint pain and pain under the ball of the foot, orthotics that make perfect contact with the arch simply work better.   If you have orthotics that don’t seem to be working as well as they should, have  a podiatrist who specializes in orthotic therapy check them out.   More information on these “total contact orthotics” is available here.

Foot Pain While Skiing

We’ve had a great snow year at Washington State ski areas and with that we’ve had a rash of patients lately complaining of severe pain in their arches while skiing. Many people complain of debilitating pain, it’s worse after skiing harder (for example on ice or through moguls) and after a run they want to do nothing but get off of their feet. A number of people simply give up skiing altogether.

But don’t give up – there is a cause and a solution for most of you suffering this pain.

It is easiest to ski when your foot is very stable. When a ski turn occurs, your leg places pressure on the top of your boot and, if your foot is stable, the boot pushes the ski to the inside edge and you carve a turn. If your foot is stable, that turn occurs easily. If not, then you start using small muscles in the bottom of your foot to try to make your foot stable. Overuse of these muscles is what causes the pain.

Treating this problem is fairly straightforward. First we take a mold of your foot and make a very controlling foot orthotic for your boots. In addition, we start our patients on a series of strengthening exercises for the small muscles in the arch of the feet. For some patients we also work with a boot fitter to ensure that boots fit properly.

Detailed information on foot orthotics for ski boots is available here.

Don’t let foot pain ruin the fun of skiing. See a sports oriented podiatrist with experience with skiers if you are suffering any foot pain while skiing.