September Articles 2013

Pregnancy and Foot Health
Many pregnant women complain about foot pain while they are expecting, primarily caused by weight gain and hormonal changes taking place in the body. By understanding how pregnancy impacts the health of a woman's feet, a pregnant woman can take action to keep her feet as healthy and comfortable as possible.

Because a woman's weight changes during pregnancy, more pressure is brought to bear on both the legs and the feet. This weight shift can cause two major foot problems: over-pronation, also known as flat feet, as well as edema, which is swelling of the feet. Over-pronation occurs when the arch of the foot flattens, causing the foot to roll inwards when the individual is walking, and can aggravate the plantar fascia tissues located along the bottom of the feet. If these tissues become inflamed, a pregnant woman can experience pain in the heel of the foot as well as severe foot pain while walking or standing. Swelling of the feet, or edema, often occurs in the later stages of pregnancy, caused by slow circulation and water retention, and may turn the feet a light purple color.

To keep feet in good health and prevent over-pronation, pregnant women should avoid walking barefoot and be sure they are wearing shoes that offer good arch support. Often a device known as an orthotic can be added to regular footwear in order to provide additional support for the feet during pregnancy. Any expectant mother whose feet hurt should first check to see if the shoes she is wearing are old, worn out and not offering the arch of the foot the proper support necessary to support and distribute the weight of her body during pregnancy.

To treat edema of the feet, a good start is to wear quality footwear which offers support and good circulation. Keep feet elevated whenever possible by using a foot stool while seated. Stay well hydrated by drinking plenty of water to prevent water retention in the feet. Any swelling that occurs in only one foot should be examined as soon as possible by a doctor.

Good foot health during pregnancy can help expectant mothers avoid foot pain that leads to other health problems. Massaging the feet and doing regular gentle exercise like walking aids in foot health by contributing to good circulation. Supportive shoes are also a good investment that will support foot health during pregnancy.


Foot Surgery and Related Techniques
Normally, foot surgery is reserved for cases, which other treatments have failed to succeed. Surgery may be necessary for many reasons. Surgery may be necessary in the following cases, but are not limited to: removing foot deformities (such as bone spurs or bunions), arthritis problems, reconstruction due to injury, and congenital malformations (such as club foot and flat feet). Among all ages and races, foot surgery may be necessary.

Depending on what is wrong with your foot, this will dictate what type of surgery is necessary. A bunionectomy is necessary if you have a growth, such as a bunion. Surgical fusion of the foot is recommended if your bones need to be realigned, or fused together. If you are enduring nerve issues or pain, you may need surgery in which the tissues surrounding the painful nerve are removed. Normally, less invasive treatments are tried first, but surgery is considered if all else fails.

Though surgery is seen as a last resort in many cases, there are benefits of surgery to fix your problem, if you and your doctor choose that route. The first benefit is that the pain associated with your problem is normally relieved; therefore meaning you can resume your daily activities normally. The second benefit is once you have surgery the problem is generally eliminated.

Podiatry history has shown that foot techniques continue to grow every year. In the field of foot surgery, endoscopic surgery is just one of the many advancements. Foot techniques will continue to improve, as technology does. Many procedures require small incisions, and use better, more efficient tools. Because of this, surgery is no longer as invasive as it used to be, and recovery has become easier and faster. Therefore, you will be back on your feet in no time.


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.


How to Prevent Running Injuries
Many common running injuries are caused by overuse and overtraining. Several common injuries can occur due to running. When the back of the kneecap starts wearing away and starts causing pain in the knee, this is commonly referred to as runner’s knee. Runner’s knee can occur because of decreased strength in the quadricep muscles or shoes that do not offer proper support to the inside of the forefoot. Runner’s knee usually is treated with strengthening exercises focusing on the quad muscle and sports orthotic. To prevent runner’s knee, efforts should be focused on hip strengthening. Physical therapy is also beneficial in helping to learn the best exercises to heal runner’s knee. To prevent runner’s knee, strengthen the quad muscles to keep the kneecap aligned.

Overtraining is one cause of a common running injury called iliotibial band syndrome, which occurs when the iliotibial band gets irritated, causing pain and discomfort to the outside knee area. Another common running injury is known as plantar fasciitis, which occurs when the bone in the foot becomes inflamed and irritated. This injury primarily causes pain in the foot. Causes can include a high arch, incorrect footwear, tight muscles and flat feet. The best way to avoid plantar fasciitis is stretching and proper footwear.

Stress fractures are a common injury for runners. These fractures can occur because of overtraining, lack of calcium or running style. In runners, it is common for stress fractures to occur in several locations including the inner bone of the leg, the thighbone, the bone at the base of the spine and the toe bones in the foot. The best approach to preventing stress fractures are proper footwear maintenance and running on a surface with enough “give” to absorb some of the shock produced during running.

Besides overtraining, other causes of these common running injuries are poorly fitting footwear, irregular biomechanics, and lack of flexibility and strength. The best way to avoid running injuries is to prevent them. Fortunately, each of these common running injuries can be prevented. To avoid running injuries it is highly recommended to wear only footwear that fits properly and that suits your needs. Running shoes are the only protective gear that runners have to safeguard them from injury; therefore, choosing the correct footwear for running is important. It is important, too, to think about other aspects of your running routine like training schedules, flexibility and strengthening, and tailor them to your needs in order to minimize the possibility of injury. Regular stretching before and after running should be considered also when trying to avoid running injuries. Stretching keeps muscles limber resulting in greater flexibility.


Barefoot Running
Barefoot running is a popular and growing trend that is taking over the running and jogging community by storm. Barefoot running is exactly what it sounds like, running without shoes. However, this doesn’t just affect whether or not you need to buy new shoes, but it also affects the motion of your feet and requires an entirely different workout.

When you run with shoes on, most of the time you land on your heels, roll over the ball of your foot, and then push off with your toes. However, in barefoot running, you actually land on the front part of your feet and not your heels. The impact shifts from the heels to the front of the feet, and barefoot runners shorten their strides to create softer landings.

Barefoot running has a lot of advantages. Landing on the front of your foot with a reduced stride lessens the stress and pressure placed on the ankles and feet, which lessens the chance of injury. It also strengthens the muscles in your feet and muscles in the ankles and lower legs that are not usually worked out. Your balance is also improved and there is a greater sensory input from your feet to the rest of the body, making your motions and posture less stressful on the body. Ironically enough, studies have shown that countries with large populations of people who do not wear shoes actually have a much lower number of those suffering from foot and ankle injuries.

Despite this, many people are still skeptical about barefoot running, and for good reason. There are some drawbacks to the unique exercise, one of the most obvious being the complete lack of protection of your feet from objects while running. Bruises, scrapes, cuts, and sometimes blisters can form on runners’ feet.  Landing on the front of the feet can also cause Achilles tendonitis, or worse yet, a rip or rupture of the Achilles tendon.

But there are a lot of ways to make barefoot running safe and enjoyable. First off, make a slow transition from your normal running routine to barefoot running, do not just dive right into it one day. Once your feet begin to adjust, slowly move from jogging to running and gradually increase the distance. It is also recommended to start out on a surface that does not contain many sharp or dangerous objects, as your feet are now unprotected. Minimalist running shoes are also another great option to get you into barefoot running and provide the perfect middle ground for those looking to get into the sport.

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