Prescription orthotics are custom made inserts worn in your shoes. Orthotics are used to help control symptoms of the feet and lower extremities (in general). Individually constructed from a casted impression of your feet, they are designed to allow the foot to move within its normal range of motion and eliminate unnecessary movement. They can be used in all types of shoes (casual, dress, running, sport cleats).
What do they do?
The purpose of the orthotic is to hold the foot in a more neutral position allowing it to function more efficiently. An ideal orthotic should provide support, shock-absorption and protection. Orthotics are used many times to help control symptoms such as heel pain, persistent pain in the ball of the feet, ankle discomfort, bunions, corns, and calluses. In many situations, orthotics may also avoid the need for surgery.
Custom orthotics are made specifically for an individual's foot. Although others may share a common problem, feet are unique. The physician must take into consideration the foot type, foot conditions/symptoms, types of shoes and type of activity in which the patient participates. After the evaluation, the appropriate materials are chosen from the most shock absorbing, soft and lightweight, to firmer types. Beware of stores that claim to sell "custom orthotics". Most are ready-made inserts taken off the shelf and "fit" to your foot. In addition, over-the-counter (ready made) inserts may at times either not supply enough support or provide improper support resulting in other problems such as knee, back or hip pain.
Examples of Orthotics
Full Length Orthotics
The Diagnostic Ultrasound can usually be done during your scheduled appointment time.
The process is similar to an ultrasound given to a mother during pregnancy. The doctor will place gel on the area that needs to be evaluated and proceed to go over the gel with a probe to examine the tissue. The process of Diagnostic Ultrasound is quick and harmless.
We offer diagnostic and therapeutic injections of the foot and ankle.
What is a Diagnostic injection?
This is an injection typically used to block a particular nerve branch and see if temporarily "shutting it off" relieves symptoms. Knowing whether a particular nerve is contributing to symptoms can help guide treatments.
What is a therapeutic injection?
This is an injection whose purpose is to alleviate symptoms. Examples of such injections include injections to the heel for plantar fasciitis or injections into painful joints.
What do you inject?
Up until very recently the substance injected has typically been a derivative of cortisone (a steroid). This type of medication is a powerful anti-inflammatory. These injections are typically safe and effective. We use these injections only as needed because over time these injections can lead to a break-down of tissue. This property has its pros and cons. The pros being we can use this side effect to break down painful scar tissue. The cons being that repeated injections can sometimes lead to damage to joints or tendons.
Are there alternatives to steroids when it comes to injections?
Yes! At Valley Foot and Ankle we have alternatives to cortisone injections. These include injection of growth factors derived from amniotic tissue. This is an exciting, FDA approved, treatment which leads to recruitment of regenerative cells and promotes healing as opposed to acting as an anti-inflammatory like a steroid. We also offer injections of platelet rich plasma, or "PRP". This is injection takes a patient's own blood, which is spun in a centrifuge to isolate its own growth factors. This is then injected into an area of pain. Both of these therapies are promising in that they can lead to actual healing, not just pain relief. They also do not have potential side-effects of damage to joints, cartilage or tendon ruptures like repeated steroid injections are known to have.
How long do injections last?
This depends on several factors: what was injected, where it was injected and a patient's own unique physiology. Not everyone responds the same way to injection. Some patients do not experience any relief from one injection while another may experience relief ranging from days to months to years. How a particular patient responds is often difficult to predict and some patient's need more than one injection to achieve their treatment goals.
Radial Shockwave Therapy (RSWT)
What does it treat?
Proven to be effective for chronic heel pain, Achilles tendonitis, and Plantar Fasciitis.
How many treatments? How long for each treatment?
It takes 3 treatments, one week apart (maximum 10 days). Treatments last for approximately 8-10 minutes.
Does it hurt?
The treatments are sometimes uncomfortable but tolerated by everyone.
Why use Radial Shockwave Therapy?
Fast and effective
A great option instead of surgery
Shorter recovery time; No lost work time; No lost income.
Surgical success rates are much lower than the RSWT proven results
Eliminate the use of medication
Eliminate the use of cortisone, or repeated injections
Used when all other methods have failed
Athletes who want to return to their sport and suffer from chronic pain
Dr. Mishalanie treats all injuries and/or conditions related to any sports. Please click on a sport below for more information. We treat sports injuries to the following but not limited to:.
Basketball and Your Feet
Peach Baskets to Jams
Ever since physical education instructor James Naismith
Pressed to find a new indoor sport, nailed a peach basket to the wall of a YMCA gymnasium in 1891, Americans of all ages have enjoyed the game of basketball. Naismith's invention caught on like wildfire, and within a year official rules were drawn up and leagues formed.
Today's airborne exploits and backboard-shattering jams of NBA stars like Charles Barkley and Shaquille O'Neal obviously mark significant changes in the game since that first experiment
(When only one basket was scored and the ball retrieved with a step ladder), but basketball's essential elements of running, jumping, cutting, stopping, and shooting on a hard floor remain the same.
In basketball, tremendous pressure is exerted on the foot and ankle.
Without proper equipment and preparation, podiatric physicians say, injuries will invariably occur. Two distinct types of injury to the lower extremity can occur in basketball: acute injury from a sudden and forceful blow, or chronic injury, which develops slowly and becomes aggravated over an extended period of time.
Most acute foot and ankle injuries
Which occur from landing improperly from a jump or twisting while falling, are accidental and difficult to prevent. The most common acute injuries include ankle sprains, torn ligaments, muscle pulls, tendon ruptures, and fractures.
Chronic, or overuse
Injuries can be caused by inadequate warmup, poor conditioning, improper and ill-fitting shoes, worn out shoes, or a biomechanical deformity that causes undue stress on the foot and ankle. Common chronic injuries sustained in basketball include stress fractures, plantar fasciitis, shin splints, achilles heel, tendinitis, patellar tendinitis, sesamoiditis, and blisters.
Similar injuries, especially ankle inversions and stress fractures, are also seen in another indoor court sport, volleyball.
Volleyball is more purely vertical than basketball; there is less running and cutting, but there are more quick-step reactions from a stationary position.
Different playing surfaces can also have an effect on injuries.
Indoor wood courts offer the most shock absorption and are considered the safest courts, while outdoor courts of asphalt are more dangerous. Concrete courts are the hardest and most dangerous courts in relation to lower extremity injuries.
Some acute injuries occur following
Mid-air collisions, erratic lunges for a rebound, or scrambles after a loose ball, and can't be helped, but chronic injuries can be averted with proper conditioning, equipment, and good sense on the court.
Podiatric physicians recommend stretching exercises and gradual warm-up before beginning vigorous play.
A separate weight-lifting regimen of both upper and lower body muscles helps minimize the impact of chronic injuries before they happen.
Another means of preventing injuries while playing basketball is a proper shoe.
Shoes should be basketball-specific, with lots of ankle support and shock absorption.
Some high-topped shoes offer more ankle support than others and are preferred by many doctors of podiatric medicine.
Shoes should fit well and be replaced before the soles become smooth, or before the uppers begin to tear or come apart. A typical basketball shoe should be replaced every two to three months for five days a week worth of play. Acrylic socks should be worn to avoid blistering.
Volleyball-specific shoes should also be worn by devotees to that sport.
They are similar to the basketball shoe, but typically are lighter, have less midsole support, and a "tighter" sole more responsive to quick starts and stops.
When the Game's Over
Acute injuries require immediate medical attention.
After a bad fall or painful twist, the game's over. When an injury occurs, podiatrists advise, get off the court immediately and apply first aid. The best initial treatment for acute injury is ice, rest, compression, and elevation of the injured extremity. See your podiatric or family physician as soon as possible.
When bothered by a chronic injury, reduce activity level in accordance with the severity of the pain.
If nagging pain gets worse in the course of a game, get off the court and apply ice and a compression bandage, and elevate the foot. Over-the-counter anti-inflammatory medications such as aspirin or ibuprofen can be taken at proper dosage for temporary pain relief.
If pain does not subside within three to five days, see a podiatrist, who will explore possible causes of the injury.
Chronic pain can often be traced to a biomechanical abnormality that is placing undue stress on a particular part of the foot or ankle.
Biomechanical imbalances can be corrected by prescription orthotic devices–specially constructed shoe inserts that redistribute the body's weight evenly on the foot and ankle.
Selective stretching and strengthening programs, shoe modifications, or strapping of the foot and ankle can also correct biomechanical problems.
Lower extremity structural problems that often lead to injury include high arches, flat feet, bow legs, and tight calf muscles.
Getting Back on the Court
Basketball is one of the most demanding sports, physically and mentally, and is especially rough on the foot and ankle.
Understand that competitive basketball puts the entire body under stress and at risk of injury.
When injury to the foot or ankle does occur in basketball, the injured part must be given time to get over the acute inflammatory phase of healing.
Then, adequate support with shoes or splints and/or tape may be necessary.
Finally, and just as important, is the need to strengthen the injured part back to its pre-injury condition.
If not, it will remain weak and predispose the athlete to re-injury.
The article above was published by the American Podiatric Medical Association, Inc. and produced in cooperation with the American Academy of Podiactric Sports Medicine.
Sports and Your Children's Feet
Children and Sports
All parents know that children take to sports like ducks to water.
Almost as soon as they start to walk, they're chasing balls, swinging sticks, and running races against nobody in particular.
Children's sports used to mean baseball, basketball, or football.
That's changed. Soccer has leapt onto the youth sports scene, as have wrestling, tennis, and lacrosse with older children. The starting age for training in individual sports such as swimming, skating, track, and gymnastics grows younger every year.
Parents should encourage their children to participate in sports but never forget that competition should be fun.
Too much emphasis on winning can alienate a child from athletic competition.
Children active in sports programs will improve their cardiovascular and musculoskeletal systems, coordination, and state of mind.
Participation in sports develops a sense of self discipline, teamwork, and recognition of the importance of a healthy body - good habits that last a lifetime.
Every child physically matures at his or her own rate and has a different degree of athletic ability.
No amount of training can improve a child's natural athletic ability, but training helps improve coordination and therefore performance.
Early training should emphasize proper technique and basic movement skills in all sports, especially in children younger than 10.
Podiatric physicians, specialists in treating the lower extremities, say children who concentrate on a single sport at too young an age are more likely to develop injuries of the foot and ankle. Save specialization in sports for the late teens, they advise.
Warming up before participating in sports is more important for adults than children, but it helps loosen the muscles and prevent injuries in athletes of all ages.
Light jogging and smooth stretching exercises (be sure not to bounce when stretching) are all that's necessary for young athletes. Learning to stretch at an early age will set a good pattern for sports activities as the body develops.
Whether parents like it or not, part of a child's image revolves around footwear.
Expensive sneakers have become fashion statements as much as athletic equipment. But for good foot health, the condition of the shoe is more important than the price tag or brand name.
Podiatric physicians agree it's often better to buy a child two $50 pairs of shoes than a single $100 pair, so the shoes can be rotated to avoid rapid wear deterioration.
Excessive wearing of the outsole, loss of shoe counter support, or wearing out in the midsole indicate it's time to replace the shoes.
Because a child's feet are constantly growing, it is important to allow at least one finger's width from the end of the longest toe when buying shoes.
Remember, proper fit is very important. You can have the best shoe in the world, but if it doesn't fit right, it doesn't do its job.
In the shoe store, children should put on both shoes, with their athletic socks and the laces tied tight, for several minutes to properly check the shoes' fit.
Shop for shoes in the afternoon, when the feet are naturally slightly swollen.
In young children, an "all purpose" sports shoe works well for most sports.
A running-specific shoe is not suitable as an all purpose shoe; moving laterally in a running shoe is more difficult and presents greater risk of injury for children. After the age of 10, sport-specific shoes can help improve performance and protect the feet. With the exception of the running shoe, a degree of crossover between sporting shoes is usually not harmful to the feet of a child athlete.
Rubber cleats are not usually necessary for children under 10, though they pose little potential harm for them.
They are most useful on a soft-field sport such as soccer. Podiatric physicians recommend molded shoe rubber cleats rather than the screw-on variety. Metal baseball spikes can be dangerous and should not be used until the teenage years.
Growing Bones and Ligaments
The immature bones of children are different from those of adults.
The "growth plates" in children's bones do not finish closing until age 15-17 in boys and 13-15 in girls. When stressed, these plates are more susceptible to injury than the tendons and ligaments that support the joints. Ligaments tend to "give" before bones in adults.
Podiatric physicians warn repetitive overuse can cause inflammation of the growth plates.
They advise parents to promote diverse physical activities for their children rather than one sport. This is especially important with individual sports such as running, gymnastics, and tennis, which require long hours of practice.
Statistics show children who concentrate on just one sport for long hours at a time are setting themselves up for injuries.
Because of the susceptibility of bones with open growth centers to overuse injuries, sponsors of the Boston Marathon recently increased the minimum participation age from 16 to 18.
A sports medicine podiatrist can offer a thorough examination of the entire lower extremity and identify
a leg length imbalance, weakness, or biomechanical imbalances that may need to be addressed to prevent injuries on the athletic field.
Injuries and Treatments
Many children suffer from mild "torsional" imbalances, commonly known as in-toeing and out-toeing. Most children outgrow these imbalances without medical treatment. However, if a child has obvious torsional imbalances, he or she may be more susceptible to injury. If that is the case, keep a close eye out for foot and ankle injuries associated with sports activity. Foot injuries commonly seen in very active children include:
In older children, stretched or torn ligaments in the ankle, known as sprains, are more common than fractures. A sprain may cause extensive swelling around the ankle just like a fracture. Immediate treatment is crucial to quick healing. A podiatric physician can provide treatment as well as recommend balancing and strengthening exercises to restore coordination quickly.
Fractures from overuse in child athletes are commonly seen in podiatric medical offices. Growth plates are particularly susceptible to injuries, but mid-shaft fractures of the bone also occur. If a fracture is not severe, rest and immobilization may be the best treatment. More complicated injuries may require casting or surgical correction. If swelling and pain persist, see a podiatric physician.
An inflammation of a growth plate, Sever's Disease is often felt as pain behind the heel caused by inflammation of the apophysis, a growth center where a tendon is attached to the bone. Rest, ice, and heel lifts are usually prescribed.
Shin Splints and Stress Fractures
Shin splints are microtears or inflammation of the anterior leg muscles, as are achilles tendon pulls in the posterior region of the leg. Again, rest is most important in healing these injuries. If pain is persistent, see a podiatrist, who can recommend strengthening exercises, certain shoes, or, if indicated, prescribe custom-made shoe inserts known as orthoses.
A Word to Parents
All parents want to see their children do well in sports.
But putting too much pressure on a child to become a star athlete may result in both physical and emotional injury to the child. A child should enjoy playing a sport, but if forced, could be turned away from all sports for a lifetime.
Especially with individual sports such as swimming, figure skating, and gymnastics that require long hours of practice every day, be certain the child's heart is in the endeavor, not just yours.
When it comes to sports, overzealous parents can potentially do their children more harm than good.
Tips from the APMA
Don't put too much performance pressure on your child.
Don't let children use running shoes for court sports. An ankle sprain could result.
Change shoes often. Check the sizing and wear regularly.
Cycling and Your Feet
More than Fun
In the early 1900s, cycling was one of the more popular ways to get around town.
Ironically, cyclists clamoring for improved roads helped set the stage for the automobile, which relegated the bicycle back to where it started: as a recreational mode of transportation. Today, cycling is more than just fun. It's an extremely efficient way to keep in shape and improve cardiovascular fitness. More than 100 million Americans still ride for pleasure on occasion. In New York City alone, 100, 000 people cycle to work each day.
The bicycle was not invented by one single person but was gradually developed throughout Europe beginning in the late 1700s.
Invention of steering, the wheel crank, and the chain-and-pedal system is attributed to various Europeans.
An important American contribution came in 1889, when John Dunlop developed the first air-filled tires; in 1898, the first coaster brake brought the bicycle into the modern age.
The Feet Link to the Pedals
Besides selecting a bicycle that meets your specific needs, proper shoes are the most important piece of cycling equipment.
Cycling shoes must have a stable shank to efficiently transfer power from your feet to the pedals. The lack of shank support in sneakers allows the foot to collapse through the arch while pedaling, which may cause arch pain, tendon problems, or burning under the bottom of the foot. A rigid shank protects your feet from the stress of pedaling.
Investing in a cycling-specific shoe is a good idea if you have had preexisting problems with your feet or wear orthotic shoe inserts.
Most orthoses control the arch and heel, and for cycling, usually require critical forefoot balancing. Riders with mild bunions or hammertoes should select a wider, deeper shoe that will accommodate the deformity.
Select a shoe that's right for you among models designed for racing and mountain biking.
For the casual rider without known foot problems, cross-training shoes provide the necessary support across the arch and instep in a shoe that can be used for other purposes. They also provide the heel lift that cycling shoes give. Combination cycling-hiking shoes meet the needs of the casual rider well and have recently become popular.
The use of toe clips, and their degree of sophistication, begin to separate the casual rider from the more serious devotee.
Toe clips range from traditional clips to newer shoe-cleat ensembles - "clipless systems" - that resemble ski bindings. Many companies model their units on the French manufacturer Lookª. A Look-compatible unit will offer the most diverse combinations of shoes and clips from which to choose.
Proper shoes and clips or cleats working as a unit are important to achieve maximum efficiency in transferring power generated by the hips to the foot.
For most efficient pedaling, shoes should extend fully under the ball of the foot.
Biomechanics and Cycling
Biomechanics, the study of external forces on the living body, plays a crucial role in efficient, satisfying cycling.
For example, when seated on a bike with hands on the handlebars, the hands, shoulders, and front axle should all be in line.
By enhancing the biomechanics of the foot, podiatric physicians specializing in sports medicine can improve the mechanical functions of related body parts.
If, for example, an experienced cyclist's knees hurt after a 30-mile ride, the problem may be a biomechanical imbalance. A podiatric physician can alleviate the pain by correcting that imbalance through prescription orthotic shoe inserts. Training and conditioning methods should also be evaluated.
To preclude pain before it starts, podiatrists advise stretching the major muscle groups used in cycling - the gluteals, the quadriceps, calves, and hamstrings - before and after getting on the bike.
Riders should start slowly and work up to normal cadence, or rate of pedaling. The seat is at the proper height when knees are slightly flexed and hips are over the knees.
Podiatrists recommend the use of a pulse monitor for a cycling-based training regimen.
Some models strap around the chest, while smaller units wrap around the wrist or the thumb and display the pulse rate as you ride.
Ask your podiatrist about an appropriate pulse rate while you ride.
Usually, the same criteria applies as with running: your pulse should be 60-70 percent of the maximum for efficient training.
Injuries and Treatment
Every day, podiatrists treat cyclists who have sustained overuse injuries by pushing themselves beyond their limitations. Here are some of the most common cycling injuries and their causes. As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.
Irritation and inflammation of the tendon that attaches to the back of the heel bone can be caused by improper pedaling, seat height, lack of a proper warmup, 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.
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 kneecap, can be caused by a biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals. Riding in too high a gear, too far uphill, 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.
Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling that results in numbness, tingling, or burning, or sharp shooting pains into the toes. Wider shoes, or loosening toe straps or shoe laces can alleviate the problem. If the problem persists, try a clipless system. Numbness or tingling with leg pain may represent a serious problem known as "acute compartment syndrome, " which requires immediate medical attention.
Sometimes known as the "ball bearings of the foot, " the sesamoids are two small bones found beneath the first metatarsal bones; the sesamoids can inflame or rupture under the stress of cycling. Sesamoiditis can be relieved with proper shoe selection and orthoses.
Pain to either side of the leg bone, caused by muscle or tendon inflammation. This 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 and corrective orthoses for pronation can help prevent shin splints.
Undertaking a successful cycling regimen frequently results in the desire to match skills with others.
There are four categories of competitive cycling. Category I denotes world-class competition - with conditions and strategies an average cyclist would not be able to navigate. Category II is also advanced, and employs such techniques as drafting and involves certain "courtesies" of cycling etiquette.
Before beginning any exercise program, be sure to check with your physician.
Carefully choose the shoes you will wear in cycling.
Fit your bike appropriately.
Warm up properly. Condition yourself safely in the off season.
Fitness and Your Feet
Striving for physical fitness is not to be taken lightly.
The President's Council on Physical Fitness and Sports cautions that unless you are convinced of the benefits of fitness and the risks of unfitness, you will not succeed. Patience is essential. Don't try to do too much too soon; give yourself a chance to improve.
As you exercise, pay attention to what your body, including your feet, tells you.
If you feel discomfort, you may be trying to do too much too fast. Ease up a bit or take a break and start again at another time. Drink fluids on hot days or during very strenuous activities to avoid heat stroke and heat exhaustion.
First Step - See Your Doctor
Before you start a fitness program, you should consult a physician for a complete physical and a podiatric physician for a foot exam.
This is especially so if you are over 60, haven't had a physical checkup in the last year, have a disease or disability, or are taking medication. It is recommended that if you are 35-60, substantially overweight, easily fatigued, smoke excessively, have been physically inactive, or have a family history of heart disease, you should consult a physician.
Once you have been cleared to begin exercise, your first goal is to make physical activity a habit.
The goals for your activity program, at whatever level of fitness you presently have, are (a) 30 minutes of exercise, (b) four times a week, (c) at a comfortable pace. Stay true to these goals, and you will become fit.
Suiting Up and Shoe Up
For your fitness success, you should wear the right clothes and the proper shoes.
Wear loose-fitting, light-colored and loosely woven clothing in hot weather and several layers of warm clothing in cold weather.
In planning for your equipment needs, don't ignore the part of your body that takes the biggest beating - your feet.
Podiatric physicians recommend sturdy, properly fitted athletic shoes of proper width, with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. They also suggest a well-cushioned sock for reinforcement, preferably one with an acrylic fiber content so that some perspiration moisture is "wicked" away.
Because of the many athletic shoe brands, and styles within those brands, you may want to ask a podiatrist to help you select the shoe you need.
Generally speaking, athletic shoes are available in sport-specific styles or cross-training models.
Foot Care for Fitness
The importance of foot care in exercising is stressed by the American Podiatric Medical Association.
According to the American Academy of Podiatric Sports Medicine, an APMA affiliate, people don't realize the tremendous pressure that is put on their feet while exercising. For example, when a 150-pound jogger runs three miles, the cumulative impact on each foot is more than 150 tons.
Even without exercising, foot problems contribute to pain in knees, hips, and lower back, and also diminish work efficiency and leisure enjoyment.
It is clear, however, that healthy feet are critical to a successful fitness program.
Further evidence for the necessity of proper foot care is the fact that there are more than 300 foot ailments.
Although some are hereditary, many stem from the cumulative impact of a lifetime of abuse and neglect and, if left untreated, these foot ailments can prevent the successful establishment of fitness programs.
The Human Foot - A Biological Masterpiece
The human foot is a biological masterpiece. Like a finely tuned race car or a space shuttle, it is complex, containing within its relatively small size 26 bones (the two feet contain a quarter of all the bones in the body), 33 joints and a network of more than 100 tendons, muscles and ligaments, to say nothing of blood vessels and nerves. Foot problems are among the most common health ills. Studies show that at least three-quarters of the American populace experiences foot problems of some degree of seriousness at some time in their lives; only a small percentage of them seek medical treatment, apparently because most mistakenly believe that discomfort and pain are normal. To keep your feet healthy for daily pursuits or for fitness, you should be familiar with the most common ills that affect them. Remember, though, that self treatment can often turn a minor problem into a major one, and is generally not advisable. If the conditions persist, you should see a podiatrist. These conditions may also occur because of the impact of exercise on your feet:
A skin disease, frequently starts between the toes, and can spread to other parts of the foot and body. It is caused by a fungus that commonly attacks the feet because the warm, dark, climate of shoes and such places as public locker rooms foster fungus growth. You can prevent infection by washing your feet daily in soap and water; drying carefully, especially between the toes; changing shoes and hose regularly to decrease moisture; and using foot powder on your feet and in your shoes on a daily basis.
Caused by skin friction and moisture, often from active exercising in poorly fitting shoes. There are different schools of thought about whether to pop them. If the blister isn't large, apply an antiseptic and cover with a bandage, and leave it on until it falls off naturally in the bath or shower. If it is large, it may be appropriate to pop the blister with a sterile needle, by piercing it several times at its roof, then to drain the fluid as thoroughly as possible before applying an antiseptic, and bandaging. If the area appears infected or excessively inflamed, see your podiatrist. Keep your feet dry and wear a layer of socks as a cushion.
Corns and Calluses
Protective layers of compacted, dead skin cells. They are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe (another reason to have your shoes properly fitted). Corns ordinarily form on the toes and calluses on the soles of the feet, but both can occur on either surface. Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist's instructions.
Generally traced to faulty biomechanics which place too much stress on the heel bone. Stress also can result from a bruise incurred while walking or jumping on hard surfaces or from poorly made or excessively worn footwear. Inserts designed to take the pressure off the heel are generally successful. Heel spurs are bony growths on the underside, forepart of the heel bone. Pain may result when inflammation develops at the point where the spur forms. Spurs can also occur without pain. Both heel pain and heel spurs are often associated with plantar fasciitis, an inflammation of the long band of supportive connective tissue running from the heel to the ball of the foot. There are many excellent treatments for heel pain and heel spurs. However, some general health conditions - arthritis and gout, for example - also cause heel pain.
Fitness and Your Podiatrist
A doctor of podiatric medicine can make an important contribution to your total health and to the success of your fitness program.
While podiatrists focus on foot care, they are aware of total health needs and should be seen as part of your annual medical checkup. If your foot ailments are related to a more generalized health problem, your podiatrist will consult with your primary physician or refer you to an appropriate specialist.
Golf and Your Feet
Leading the Way
First, your weight is placed lightly on the balls of your feet, balanced between your front and rear foot.
Then there is a slight shift to the back foot, then another shift back to the front. Sound like dance steps? These intricate movements actually describe what goes on below the knees during an ordinary golf swing.
Good foot action is the mark of an accomplished golfer.
"All timing, distance, and direction comes out of the lower body with the feet leading the way, " golf legend Jack Nicklaus has said. Nicklaus or any professional will tell you that problems with the feet, even a painful corn or callus, can impede timing and balance to the point where it's reflected on the scorecard at the end of the day.
Close to 45 million Americans enjoy golf on an amateur level.
Above and beyond the satisfaction of competition, a full round of golf affords the opportunity for a 4-5 mile workout that can reduce stress and improve cardiovascular health.
Before taking to the links, your body needs to be prepared for the workout involved in walking the whole course.
(If the pros can walk, so can you!) Anyone older than 40, or having any problems with weight, respiration, blood pressure, pulse rate, or cholesterol, should check with a doctor before playing. The same goes for smokers, diabetics, and people with preexisting injuries or a history of heart trouble.
Your podiatric physician, a foot and ankle specialist, knows the importance of wearing proper golf shoes.
Once, driven by fashion, golf shoes were wing-tip oxfords with spikes. Today, shoes are constructed using basic principles of athletic footwear. Some even incorporate advanced technological innovations such as graphite shank reinforcements, which keep them light and add strength.
Don't wear anything on your feet that wouldn't be comfortable if you were taking a good long walk.
Make sure shoes fit well in the store before purchasing them. It's best to shop for them in the afternoon when the feet are slightly swollen. Try on shoes with the same socks you'll wear on the course. Tie both left and right shoes tightly and walk around your store or pro shop a few minutes before deciding on a make and model.
Some simple stretching exercises are important before taking to the first tee and after leaving the last.
Consult a podiatric physician who specializes in sports medicine for a light stretching regimen that will help alleviate stiffness after a day of golf.
The Ideal Swing
Biomechanics, the application of mechanical laws to living structures such as the feet, play a crucial part in developing the ideal golf swing.
The lateral motion and the pivoting intrinsic to the golf swing can be functionally impeded by certain biomechanical conditions. Faulty biomechanics can inhibit proper foot function, and your game will suffer.
The anatomy of a biomechanically sound swing goes like this
During set-up, your weight should be evenly distributed on both feet with slightly more weight on the forefoot as you lean over, and slightly more weight on the insides of both feet.
Maintenance of proper foot alignment on the backswing is critical for control of the downswing and contact position.
During the backswing, weight should be shifted to the back foot. It should be evenly distributed on the back foot or maintained slightly on the inside. Shifting weight to the outside leaves you susceptible to the dreaded "sway, " a common error in swing. Without an exact reversal of the sway in the downswing, swaying will result in improper contact with the ball.
As the back foot remains in a solid position on the back swing without any rolling to the outside, the front foot is in turn rolling to the inside.
The front heel occasionally comes off the ground to promote a full shoulder turn. Completion of the backswing places the weight on the back foot, evenly distributed between forefoot and rearfoot, with the weight left on the front foot rolling to the inside.
The downswing involves a rapid shift of weight from back to front foot
Momentum brings the heel of the front foot down, and follow-though naturally causes a rolling of the back foot to the inside and the front foot to the outside. Golf should always be played from the insides of the feet.
Like the great Nicklaus said, "lively feet" are critical to a successful golf game.
Having healthy, biomechanically stable feet is the first prerequisite for achieving that goal.
Orthoses: Preventing Pain, Improving Game
For the foot that is not able to function normally due to biomechanical conditions such as excessive pronation (rolling in) or supination (rolling out)
A state of optimal biomechanics can be achieved through the use of orthoses, custom shoe inserts that can be prescribed by a podiatrist. Orthoses not only allow the feet to function as they ought to but can alleviate the predisposition to injury brought on by biomechanical imbalances.
If you already wear orthoses in your street shoes, by all means transfer them to your golf shoes.
Podiatrists who specialize in sports medicine say there are cases when orthotic devices optimally designed for golf shoes will be different than those designed for street shoes.
If biomechanical problems are present in your swing, they will invariably cause symptoms when walking the links as well.
Addressing biomechanical problems in walking may therefore result in the secondary benefit of an improved swing through proper foot function.
If a round of golf is painful on the feet, first assess the quality of your shoes.
Any time pain is not adequately resolved with good, stable golf shoes and is present for more than two or three consecutive rounds, it's time to visit a podiatric sports physician. He or she can diagnose and treat any problems and help make your feet an asset, not a liability, to your golf game.
Other Injuries and Treatment
The torque of a golf swing can strain muscles in the legs, abdomen, and back.
The fact that the game is usually played on hilly terrain increases these forces, which in turn predispose to injury. Proper warm-up and stretching exercises specific to golf can help in injury prevention. A sports podiatrist can recommend a suitable warm-up regimen.
If biomechanical imbalances are present, these existing stresses will overload certain structures, and predispose the golfer to overuse of muscles and strain on ligaments and tendons.
Orthoses will equalize the weight load on the lower extremity and in essence rest the overused muscle.
Other problems, such as tendinitis, capsulitis, and ligament sprains and pulls, can also keep a golf enthusiast back at the clubhouse.
Improper shoes can bring on blisters, neuromas (inflamed nerve endings), and other pains in the feet. Podiatrists see these problems daily and can treat them conservatively to allow for a quick return to the sport.
When injured, participation is no substitute for rehabilitation.
Injured body parts must be thoroughly treated and rehabilitated to meet the full demands of golf or any other sport. If you are injured, your return should be gradual. As much as you may want to get back to your game, take it slowly. A healthy body makes for a more enjoyable game and possibly a better scorecard at the end of the day.
Tips from the APMA
Start easy and build up your playing time carefully
Don't forget to stretch regularly
Fit your shoes with the socks that you plan to wear.
Running and Your Feet
Running Advice From The APMA
Nowhere is the miracle of the foot more clear than watching the human body in motion.
The combination of 26 bones, 33 joints, 112 ligaments, and a network of tendons, nerves, and blood vessels all work together to establish the graceful synergy involved in running. The balance, support, and propulsion of a jogger's body all depend on the foot. But before entering a fitness regimen that includes jogging, don't forget to make certain your body's connection with the ground is in proper working order.
See Your Podiatrist
It is a good idea for a beginning jogger to visit a podiatric physician before starting an exercise program.
Your podiatrist will examine your feet and identify potential problems, discuss conditioning, prescribe an orthotic device that fits into a running shoe (if needed), and recommend the best style of footwear for your feet.
Frequent joggers ought to see a podiatrist regularly to check for any potential stress on the lower extremities.
During a 10-mile run, the feet make 15,000 strikes, at a force of three to four times the body's weight.
If you are more than 40 years old, see a family doctor before starting any exercise regimen.
The doctor will perform an electrocardiogram, check for any breathing problems, high cholesterol levels, and high blood pressure before giving the go-ahead for a vigorous exercise program.
Anyone, regardless of age, should check with a doctor if a cardiac condition, weight problem, or other medical complication already exists.
The Importance of Stretching
Before beginning an exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced. Stretching exercises should take 5-10 minutes, and ought to be conducted in a stretch/hold/relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior) and not forget the anterior muscles. Some effective stretching exercises include:
The wall push-up.
Face a wall from three feet away, with feet flat on the floor, and knees locked. Lean into the wall, keeping feet on the floor and hold for 10 seconds as the calf muscle stretches, then relax. Do not bounce. Repeat five times.
The hamstring stretch.
Put your foot, with knee straight, locked, on a chair or table. Keep the other leg straight with knee locked. Lower your head toward the knee until the muscles are tight. Hold to a count of 10 then relax. Repeat five times, then switch to the other leg.
Lower back stretch.
In a standing position, keep both legs straight, feet spread slightly. Bend over at the waist and attempt to touch the palms of your hands to the floor. Hold the stretch for 10 seconds and repeat 10 times.
Shoe choice should be determined by weight, foot structure, and running regimen.
Keep in mind that all shoes have a different shape, and sizes and widths are not uniform from shoe to shoe.
Consider whether an orthotic device will be placed in your shoe and whether your running style is flat-footed or on the balls of the feet.
Shoes should provide cushioning for shock absorption and ought to be able to fully bend at the ball of the foot area. Visit the shoe store in the afternoon, when the feet are slightly swollen, and wear thick running socks when trying shoes on.
Systematic exercises must progress slowly from easy to rigorous to prevent debilitating muscle strain or more serious injury.
The best and safest way to start a running program is with a four-day-per-week conditioning program for 12-16 weeks.
Begin with two sets of two-minute jogs interspersed with five minutes of fast walking.
If muscles are stiff, walk only; have an "easy day" if you're in pain. As the weeks progress, gradually increase the number of minutes jogged per set to 20 minutes. Spend at least five workouts at each new level attained.
By the 16th week, you should be able to run two sets of 20 minutes each, with a five-minute walk before, between, and after.
Make adjustments for heat and altitude, and don't be frustrated if you think your pace is too slow. Remember, a disciplined regimen will decrease your chances of injury.
Proper foot hygiene can also prevent injuries.
Keeping feet powdered and dry is important, especially to the jogger suffering from blisters. Blisters can be prevented by application of petroleum jelly or creams to the places where they tend to occur.
Aches and Pains of Running
Even with the best preparation, aches and pains are an inevitable result of a new jogging regimen.
If the pain subsides with slow easy exercise, you may continue, but if it gets worse, stop the activity and rest. If it persists, see your podiatrist.
The most common pain associated with jogging is known as runner's knee, a catch-all for jogging-related knee pain.
One of the most common causes of runner's knee is excessive pronation, or rolling in and down, of the foot. Orthoses (arch supports - shoe inserts) prescribed by your podiatrist are the best way to alleviate the problem. Occasionally, rubber pads in the arch of the shoe will help.
Shin splints, which are painful and appear at the front and inside of the leg, are caused by running on hard surfaces, overstriding, muscle imbalance, or overuse.
Treatment includes changing running technique or insertion of an orthotic device in the shoe.
Start easy and build up your distances slowly
Don't forget to stretch regularly
Use sport specific shoes
Fit your shoes with the socks that you plan to wear during your running.
Tennis and Your Feet
A Game for Everyone
For centuries, people of all ages have enjoyed tennis in one form or another.
As far back the 1300s, European royalty batted balls across nets on elaborately constructed indoor courts. One court built in 1529 by Henry VIII at Hampton Court Palace outside London is still in use today.
Modern tennis can also be traced to the United Kingdom
Where British Army officer Walter C. Wingfield introduced a new, smaller court and simpler set of rules at an 1873 garden party on his Welsh estate. The new game was played outside on a grass court, which eventually made the sport accessible to everyone.
Tennis provides a total aerobic body workout, and regular play is a relatively safe and enjoyable way to stay fit.
Children need only be old enough to swing a racquet to play, and seniors need only be mobile enough to get from one side of the court to the other.
It doesn't take a superior athlete to have fun playing tennis, but care must always be taken to avoid injuries to muscles not exercised vigorously off the tennis court.
This is especially true of the foot and ankle, which are put under considerable stress by the continuous side-to-side motion and quick stopping and starting the sport requires.
Different court surfaces also stress the foot and ankle in different ways.
Similar racquet sports, such as racquetball, squash, badminton, and paddle tennis, also leave the foot and ankle susceptible to injury.
Injuries common to tennis and other racquet sports include ankle sprains, stress fractures, plantar fasciitis, and tennis toe, among others. If they're minor, some of these injuries are self-treatable. But if pain persists, a doctor of podiatric medicine, especially a sports medicine specialist, is well equipped to help you get back on the court as quickly as possible.
Don't Forget the Feet
In modern times, maintenance-intensive grass courts have given way to harder, more durable courts.
Clay courts, and new crushed stone "fast-dry" courts, which duplicate the softness of clay but require less upkeep, are becoming more popular because players can slide on the soft surface. Clay and fast-dry courts are undoubtedly safest to the foot and ankle.
Outdoor courts are often surfaced with asphalt or concrete, and indoor courts with carpet, none of which allow for sliding.
It's becoming more popular to coat the harder outdoor courts with a cushioning surface containing rubber granules. While this coating softens the court and slows down the game, it's no more forgiving to the feet than the concrete or asphalt beneath it.
Popularity of the different court surfaces varies geographically
Based on rainfall, humidity, and the age of most of the players (older players tend to prefer the slower, gentler clay or fast-dry court). Regardless of court surface, proper shoes are crucial to injury prevention.
Shoes should be specifically designed for tennis.
Unlike running shoes, proper tennis shoes "give" enough to allow for side-to side sliding. Running shoes have too much traction and may cause injury to the foot and ankle. In addition, running shoes don't have padded toe boxes, which leads to toe injuries for tennis players.
Heels should be snug-fitting to prevent slipping from side to side, and both heel and toe areas should have adequate cushioning.
The arch should provide both soft support, and the toe box should have adequate depth to prevent toenail injuries. Your podiatrist can recommend a shoe that is best for your foot.
Shop for tennis shoes in the afternoon, when the feet swell slightly.
Try on several pairs with tennis socks. Put on and lace both shoes and walk around for a minute or two. Make sure your ankles don't roll in the shoes.
If you have bunions or other special considerations, do not buy shoes without consulting a podiatric physician.
If you already wear prescription orthotic inserts, make sure that any potential new shoe feels comfortable with it in place.
An Ounce of Prevention
It's a good idea to have your feet and ankles evaluated by a professional foot care specialist before taking to the court.
Your podiatrist can check for excessive pronation or supination (turning inward or outward of the ankles), and if necessary prescribe a custom orthotic device for insertion in the shoe to correct the imbalance.
Because of the stress on calf and hamstring muscles, thorough stretching before a match can prevent common injuries to the leg.
Stretching out after a match alleviates stiff muscles.
Basic stretches such as the hurdler's stretch, the wall push-up, and standing hamstring stretch will loosen up the muscles enough to prevent pulls and other injuries.
Your podiatric physician can explain how to do these exercises.
Your podiatric physician may advise you as to proper nail care and warning signs of nail problems.
Feet should always be kept clean and dry. Socks should always be worn - tennis socks made of either acrylic or a blend of acrylic and natural fibers are preferable.
Injuries and Treatment
Injuries on the tennis court range from simple to serious. Some are self-treatable, while others will require professional consultation with a physician. The most common injuries in all racquet sports include:
Ankle sprains are the most common of all tennis injuries. They usually occur when the foot turns inward, causing swelling and pain on the outside of the ankle. To self-treat a mild ankle sprain, get weight off the ankle, apply ice to reduce swelling, wrap the ankle in a compression bandage, and elevate the ankle. If the sprain does not improve within 3-5 days, consult a podiatric physician.
Corns, Calluses, and Blisters
Such friction injuries are readily self-treatable, yet care should be taken to ensure that self-treatment does not aggravate the problem. When treating corns and calluses, do not try to trim with sharp objects. Instead, buff problem areas with a pumice stone after bathing. For blisters, pierce the side with a sterilized needle and drain, then apply an antibiotic cream. Do not remove the roof of the blister. Application of a frictionless pad provides relief from blisters.
Stress on the bottom of the foot sometimes causes arch pain. The plantar fascia, a supportive, fibrous band of tissue running the length of the foot, becomes inflamed and painful. If arch pain persists, consider investing in better shoes, an over-the-counter support, or see a doctor of podiatric medicine for a custom-made orthotic device to insert into the shoe.
Stress Fractures and Shin Splints
Sometimes the long metatarsal bones behind the toes fracture and swell under the stress, causing severe pain when walking. Shin splints, which are microtears of the anterior calf muscles, and achilles tendon pulls of the posterior calf muscles, are all treatable with rest, ice, and elevation. These injuries tend to occur on harder court surfaces and should be healed fully before resuming play. Persistent pain signals the need to visit to a podiatrist for consultation.
A subungual hematoma, or tennis toe, occurs when blood accumulates under the nail. Tennis toe can usually be traced to improper shoes and should be drained by a podiatrist for quicker recovery. For slight buildup, cool compresses and ice will provide relief.
This Above All
All racquet sports require quick acceleration, twisting, and pivoting, putting the whole body under stress.
If you are more than 40 years old, see a general physician before beginning to play tennis or other racquet sports.
Even if you consider yourself generally healthy, ease into a regular schedule of playing time.
Whenever you change courts, be sure to get a "feel" for the new surface before serving up a match. Even professional tennis players arrive at tournaments up to a week early to acclimate themselves to the court surface.
Above all, listen to your body.
Persistent minor aches and pains are not normal and will become aggravated if ignored or neglected. Proper care of the whole body, and especially the foot and ankle, will make tennis and other racquet sports a healthy part of life for people of all ages.
Start easy and build up your playing time carefully.
Don't forget to stretch regularly.
Use tennis shoes to play tennis.
Fit your shoes with the socks that you plan to wear.
Walking and Your Feet
Benefits of Exercise Walking
The fundamental health benefits of exercise walking are many.
Metabolically, it helps control weight, blood sugar, and cholesterol levels. A brisk walk can burn up to 100 calories per mile or 300 calories per hour. Walking is the perfect compliment to a sensible diet to lose weight and keep it off.
Walking improves cardiovascular fitness.
As an aerobic exercise, walking gets the heart beating faster to transport oxygen-rich blood from the lungs to the muscles. The heart and lungs grow more efficient with a regular walking regimen, reducing blood pressure and the resting heart rate. Walking is even a central element of medical rehabilitation. Recovery from many ailments, including heart attack, is facilitated by a regular walking regimen.
For people with poor circulation to the arms and legs, walking can increase the size and improve the efficiency of the tiny vessels that supply blood for cellular respiration.
Anyone diagnosed with poor circulation should see a doctor before beginning exercise walking.
Psychologically, walking generates an overall feeling of well-being, and can relieve depression, anxiety, and stress by producing endorphins, the body's natural tranquilizer.
A brisk walk will relax you and stimulate your thinking.
If you are more than 40 years old and have any problems with weight, respiration, blood pressure, pulse rate, or cholesterol, check with your doctor before walking.
The same goes for diabetics, smokers, or people with preexisting injuries or a family history of heart problems.
On Your Feet
The ideal walking shoe should be stable from side to side, well-cushioned, and it should enable you to walk smoothly.
Many running shoes fit all of these criteria well, and for most people are acceptable for a walking program.
However, there are specialty walking shoes that may work well for you.
These tend to be slightly less cushioned, yet not as bulky, and lighter than running shoes.
Most important, whether you are wearing a walking or running shoe, is that it must feel stable to you.
Either type of shoe is acceptable if it works well with your foot mechanics, providing cushioning and stability.
Shoes should always feel comfortable and fit well in the store.
Don't cut corners on your shoe budget; buying shoes is the only real expenditure necessary for the sport, so treat your feet well. Visit the shoe store late in the afternoon, when your feet are slightly swollen (this is when you'll likely be walking, anyway).
Wear the same socks to the store that you will wear while walking.
Try on at least four or five pairs of shoes. Put on and lace both shoes of each pair and walk around for a minute or two.
Remember that every shoe manufacturer uses a different basic shoe shape, or "last."
Some lasts are shorter or longer than others of the same size; some fit a wide foot perfectly, while others are cut for a slimmer foot.
When the shoes are on your feet, the heel should be snug.
If it slides in the store, it will slide while you are walking. You should be able to wiggle your toes in the shoe, and there should be one half to a full thumb's width between the end of the longest toe on your longer foot and the end of the shoe's toe box. Make sure your ankles don't roll in the shoes.
If you have bunions or other special considerations, consult your podiatrist about the best shoe for you.
If you have prescription inserts, substitute your insert for the existing one (most shoes have a removable insole) to make sure it will fit properly, if possible.
Foot Care for Walking
Good general foot care must be maintained if you plan to subject your feet to a walking regimen.
Wear thick, absorbent socks (acrylic is preferable to cotton); dry feet well after bathing, paying special attention to the toes, and use powder before putting on shoes. Nails should be cut regularly, straight across the toe.
Podiatrists warn that self-treatment of corns and calluses with over-the-counter remedies before starting to walk can do more harm than good.
Serious maladies like bunions and hammertoes absolutely should be evaluated by a podiatric physician before you begin to walk for aerobic exercise.
If blisters develop, self-treatment by opening the blister with a sterilized needle and draining the fluid is acceptable.
Do not remove the "roof" of the blister. Cover the treated blister with antibiotic ointment to guard against infection.
Hitting the Road
Before you get going, a series of loosening-up exercises will help alleviate any muscle stiffness or pulled muscles that may be ahead of you.
Consult your podiatrist for some specific ways to loosen up the heel cords (achilles and calf) and thigh muscles (quadriceps in front and hamstrings in back).
Take five deep breaths for each slow stretch and hold the stretched muscle firm without bouncing.
After every walk, stretch again to improve circulation and decrease buildup of lactic acid, the chemical byproduct that causes muscles to ache.
Setting appropriate goals is vital to a successful walking program.
First, make walking a habit. Start slowly, with five or 10-minute walks three to five times a week. As walks get longer, their frequency can be adjusted.
Before you know it, you'll be making time for weekly walks wherever you are.
But don't overdo it. Starting too quickly and getting injured or uncomfortably sore can sour you on the whole idea before it's had a chance to work its magic on your mind and body.
Start your walks slowly, and gradually work up to a brisk speed that will cover a mile in 15 minutes (that's four miles per hour).
Measure a one-mile stretch, record your time, and see how you improve as the weeks go by.
To get significant benefits from walking, you must eventually be able to walk 20 minutes at a brisk pace without stopping.
Walks shouldn't last more than an hour. Calculate your week's total walking time in minutes, then try to increase it by 10 percent each week. A starting regimen should involve walking at least three times per week, but never exceeding five times a week. Walking every day denies the body the rest time it needs to repair minor injuries and could lead to more serious ones.
Exercise Walking Tips
Start easy and build up your distances slowly.
Don't forget to stretch regularly.
Fit your shoes with the socks that you plan to wear during your walking.
Winter Sports and Your Feet
Winter's Own Sports
Under the pastoral beauty of a blanket of fresh-fallen snow, the outdoors beckons.
For a while, winter doesn't feel quite so cold, and people of all ages feel a sense of youthful excitement about bundling up and getting outside.
From the downhill rush of snow skiing or sledding, to rough-and-tumble ice hockey or placid casual skating, winter provides a fast track for fun and cardiovascular health.
In the absence of long, sunny days, winter sports provide the exercise active Americans otherwise couldn't get without being cooped up in a gym.
High speeds attained on skis and skates make for exhilarating sports but expose the body to injuries.
Healthy feet and ankles
Which act together as accelerators, steering, brakes, and shock absorbers in winter sports, are not only crucial to success in competition but also help keep the body upright and out of the emergency room. Any problems with the foot or ankle could have serious repercussions for winter sports participants.
Preventing Cold Feet
Without warm, dry clothes, any wintertime outdoor activity is a potential health risk.
Proper footwear–insulated, waterproof boots or shoes–is as important as coats, hats, or gloves in the outdoors during the winter.
Socks are also important.
Podiatric physicians recommend a single pair of thick socks made of acrylic fibers, or a blend including them, that "wick" away moisture caused by perspiration in the boot.
Feet soaked in snow should get back indoors quickly.
In sub-freezing temperatures, soaked feet are in immediate danger of frostbite, a serious, painful condition that can result in loss of toes.
In skiing, particularly at an intermediate or advanced level, high speeds and force of gravity place tremendous levels of impact trauma on the lower extremity, especially on steep and bumpy runs.
Skating also puts tremendous stress on the ankle.
Hockey players change direction at speeds near 30 miles per hour, and even casual figure skating requires quick turns and stops negotiated by the lower extremity.
If any preexisting foot conditions
Such as corns, calluses, bunions, or hammertoes are present, see a podiatric physician, a specialist of the foot and ankle, for evaluation before buckling or lacing up. A medical examination is also important if you have any preexisting circulatory problems, such as Raynaud's Disease or diabetes.
Before taking to the ice or slopes in cold weather, it's important to loosen up the muscles by stretching.
Stretching helps to prevent muscle pulls and tears and prepares the muscles for the flexing required by the constant "forward lean" stress of skiing and skating.
Ski Boots and Skates: A Perfect Fit, Please
Podiatric physicians specializing in sports medicine say properly fitted ski boots and skates are the single most important factor in safe and successful skiing and skating.
Without a snug (but not too tight) and accurate fit, the pressure exerted by the constant forward motion and lateral movement of skiing and quick turns of skating will surely result in discomfort or injury.
If boots and skates are too loose, toes quickly get irritated in the toe box.
If they are too tight, pressure leads to blisters and abrasions that result in a host of painful problems and keep you indoors or, worse, compromise control and lead to an accident.
Tight footwear also may inhibit circulation of the blood vessels of the lower extremity and cause cold feet, which both compromises performance and presents danger in the cold.
Ski boots are available in a forward-entry variety, a rear-entry style for easier entry and more comfort, or "hybrids" which incorporate both designs.
Modern systems of cables and buckles make it possible to alter the boots to a near-perfect fit.
With ice skates, proper fit is equally important.
Do not put children in hand-me-downs; skates that are too large or too small will cause blisters, inflammation of the foot, or nail irritation. The lack of proper ankle support in a too-large skate will leave the ankle susceptible to sprains, strains, or fractures. Whatever the style, skates should be laced snugly, using all the eyelets.
If you are not sure your ski boots or skates fit properly, or if an apparently proper-fitting pair still hurts
Take them to a podiatric physician, who can evaluate the fit and make recommendations to improve both comfort and performance on the ice or slopes.
Cross-Country Skiing and Winter Running
Cross-country skiing is quite distinct from downhill.
An excellent way to maintain cardiovascular fitness in the winter, cross-country involves the entire body and requires different equipment.
Cross-country footwear is more like a bicycle shoe than a downhill boot.
Bound to the ski only at the ball of the foot, cross-country boots should not irritate the balls of the feet.
As with running in winter, proper stretching is vital before cross-country skiing.
In cross-country, the heel goes up and down constantly. Without proper loosening up first, the motion can result in painful achilles tendinitis and plantar fasciitis, among other problems. A podiatric physician can recommend proper stretching exercises.
Dedicated runners hate to give up their passion during the winter months.
Remember, however, that muscles take longer to warm up in the cold, and the body is much more susceptible to muscle pulls and tear injuries. Again, proper stretching is essential.
Whether consciously or unconsciously, runners may change their foot-strike pattern to protect themselves, which can lead to muscle strain or other overuse injuries.
To increase traction, runners may land on slippery surfaces with the whole foot instead of the natural rolling action of the heel-to-toe strike. Lateral slippage could result in a painful groin pull.
It's best to avoid running on icy areas, but if that's impossible, podiatric physicians give a qualified endorsement to use of spikes slipped over running shoes.
Spikes, however, have their own problems, so don't use them in winter if you're not familiar with their use on a running track.
Even though your feet are in motion while running, they're still susceptible to frostbite in thin nylon running shoes.
Feet will sweat while running, and cold will permeate the thin material, inviting the condition. If shoes are too tight, there is an even greater chance of frostbite.
Biomechanics of Winter Sports
Keeping the ankle perpendicular to the ground and straight up and down while skiing brings out the best performance.
Users of custom orthoses (shoe inserts) should transfer them to skis and skates to help maintain the best possible position.
Skiers with minor biomechanical imbalances may encounter a frustrating phenomenon known as "edging, " in which the ski rolls to the inside or outside edge, inhibiting control going down the slopes.
Ski boots and skates can be "canted" internally to adjust the relationship between the boot and leg.
For cases of rolling-in of the foot, or pronation, or rolling-out (supination), caused by flat feet or high arches, cants may be applied directly to the skis or within the boot. This improves edging and enhances performance and control, making the sport safer and more enjoyable.
Ski shop technicians can work in conjunction with podiatric physicians on specific biomechanical adjustments to improve performance and safety.
Ice skates do not come in as many shapes and sizes as ski boots.
Common side-to-side wobbling in the heel area can be remedied with "shims, " or pads, in the heel. Shims can also be added to the counter area, or middle of the skate, for a more snug fit.
In recent years, skiers have shared the slopes with more snowboards–wide single skis that zigzag down the slopes.
The feet are loosely bound perpendicular to the board.
No special footwear is required for snow boarding
But podiatric physicians say large, sturdy, insulated boots flexible enough to accommodate the twisting of the lower body are best to safely control the board. Most popular with young people, snowboarding has become a bona fide alpine sport, and more snowboarders will share the slopes with skiers in the future.
Problems to Watch For
Friction in winter sports footwear often causes blisters. Do not pop a small blister, but if it breaks on its own, apply an antiseptic and cover with a sterile bandage.
Bunions and tailor's bunions, bony prominences at the joints on the inside or outside of the foot, often become irritated in ski boots or skates. Pain at these joints may indicate a need for a wider or better-fitting boot. Other preexisting conditions, such as hammertoes, and Haglund's Deformity (a bump on the back of the heel) can be irritated by an active winter sports regimen. If pain persists, consult a podiatric physician. Fractures caused by trauma require immediate medical attention.
It's impossible to overstate the importance of understanding symptoms of frostbite. Skin-color changes, from blue to whitish, can't be seen under a boot, but if toes are extremely cold for a prolonged period or feel burning or numb, there is a danger of frostbite. People with a history of frostbite often get it again in the same place. New battery-powered heated ski boots are effective in preventing its occurrence. New exothermic packs are also effective in keeping the extremities warm and preventing frostbite.
Enlarged benign growths of nerves between the toes, called neuromas, are caused by friction in tight footwear and can result in pain, burning, tingling, or numbness. Neuromas require professional treatment, including an evaluation of skates and boots.
Sprains and Strains
The stress of skiing and skating can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression, and elevation (RICE). If pain persists, seek medical attention.
Pressure in the toe box of a ski or skate can cause bleeding under the toenail known as a subungal hematoma. Such a condition should be treated by a podiatric physician to prevent the loss of a toenail.
Tips from the APMA
Start easy and build up your distances slowly.
Don't forget to stretch regularly.
Use sport specific shoes.
Fit your shoes with the socks that you plan to wear during your running.
Children's Foot Problems
The Child's Foot
The human foot is a very complicated part of the body and the feet of young children are soft and pliable, so abnormal pressures can easily cause the foot to deform. The foot of a child grows rapidly during the first year, reaching almost half their adult foot size. That first year can be very important in the development of the feet.
Foot Pain in the Child
Foot pain and symptoms in children are not as common as they are in adults due to the flexibility and resilience of the tissue. Ingrown toenails can occur and will probably need treatment. Non-specific growing pains in the leg are a common complaint of children, often causing a deep ache-like leg pain during the night. There are some specific causes of growing pains, especially in the heel, called Sever's Disease or Calcaneal Apophysitis and at the knee, where it is called Osgood-Schlatters disease. Clubfoot is a relatively rare deformity at birth that may still cause problems in later life after correction. Feet that sweat profusely or have a smelly odor can also be a problem in the older child.
Flat Foot in the Child
Flexible flatfoot or a pronated foot in children is usually painless in young children, but may cause an ache, especially if the child is overweight or older. In the very young child, there is often a 'fat pad' in the arch area of the foot which gives an appearance of a flat foot, when it is not. If the foot also rolls inward at the ankle (pronates), then this may be cause for concern. In the majority of cases, most will grow out of it, but some do not. Treatment with foot orthotics are indicated if it's severe, causing symptoms, and if both parents have flat feet, as this indicates that they may be less likely to grow out of it.
In-Toe and Out-Toe Walking in Children
In-toeing means that the foot or feet point inwards instead of pointing straight ahead when walking. A common problem with children with in-toeing is that they can trip more often than other children. Most will probably outgrow the condition naturally. If in-toeing does persist or is causing problems, special shoes, stretching exercises or other treatments could be needed. By about age two, most children walk with their feet pointing straight ahead or slightly outward. Often just reassurance is needed if a child is out-toeing or in-toeing, with treatment reserved for the persistent and severe cases. Sometimes the in-toeing and out-toeing does put abnormal pressures on the foot structure and function, so special shoes or foot supports may be required to protect the foot.
Some infants are born with feet that can bend inwards from the middle of the foot to the toes – called metatarsus adductus. It usually improves on its own without treatment. If the child reaches about 6 to 9 months and the condition is not improving, special corrective shoes or casts are often recommended.
Toe Walking in Children
Toe-walking (walking on their tip toes) is usually normal in children, especially if they are just beginning to learn how to walk and everything else is normal. However, it can be a sign of a condition that needs further investigation (especially if the ankle joint range of motion is limited). Most cases of toe-walking are just a habit and the child will grow out it. Toe-walking can be caused by neuromuscular conditions, such as cerebral palsy or muscular dystrophy, leg length differences, spinal cord abnormalities and achilles tendon shortness. If it is a mild shortness, stretching exercises and/or physical therapy may be necessary. If the toe-walking is more severe or persistent, then consideration needs to be given to casting, botox injections or surgery. All cases of toe-walking should be evaluated to rule out the causes.
Radiofrequency Ablation (RFA)
Uses energy to create heat which is used to destroy painful nerve signals. This treatment is often used on sensory nerves such as the ones that cause pain in the heel or in the ball of the foot (neuromas). This procedure is done in our office, does not require cutting, stitches or general anesthesia. Patients are able to walk the same day after the procedure in a regular shoe.
We also offer treatment for the following:
Custom Molded Inserts
Achilles Tendon Disorders
Arthritic Foot & Ankle Care
Back-Hip-Knee Pain (as related to biomechanical problems)