Take a walk through an athletic shoe store and you will see a shoe for almost every sport…running shoes, walking shoes, aerobic shoes, cross trainers, tennis shoes, court shoes and the list goes on. The specific demands of each sport require specific features in shoes that will enhance performance and reduce the risk of injury. In this article we will zero in on the difference between running shoes and walking shoes.

Running shoes are designed for a single direction sport(running or walking). The focus of running shoe design is to create a lightweight shoe with heel stability and proper shock absorption. They have a higher pitched heel that helps with forward propulsion.  The upper of the shoe is a combination of nylon mesh, to allow breathability, and leather and suede, to provide support and durability. The outsole of the running shoe is designed to be highly durable. This type of shoe is appropriate for either running or walking. Due to the higher pitched heel, it is not appropriate for multi-directional sports such as tennis, basketball, or volleyball.  The extra heel pitch increases the risk of ankle sprain when an athlete needs to make a quick turn.

Walking shoes are similar in design to running shoes. And while running shoes are appropriate in design for walking , there is a need for a shoe that is focused on the needs of recreational athletes’ who may not be accustomed  to wearing athletic shoes and who does not like the flashy appearance of running shoes.  The heel pitch is slightly lower than running shoes and the upper is primarily one coloured leather, which is more durable , water resistant and pleasing to the eye than the nylon mesh of a running shoe.  This shoe is appropriate for walking or as a supportive shoe to be worn at work for someone who is on their feet most of the day(ie nurses, hair dressers etc.) Walking shoe are not recommended for running as they do not have the same heel pitch for the forward momentum of running.

Many models of running and walking shoes exist. Most athletic shoes stores that stock a variety of athletic shoe types can help you choose the appropriate shoe for your activity.

Filed under: Articles About Active Sports by ABLE Orthotics

Many people simply don’t know the options that are available for foot and lower limb care, or how problems there can impact the rest of their body. A primary goal at ABLE Orthotics’ is educating patients, potential patients and physicians about the benefits of orthotics. We believe we can solve many biomechanical problems for the foot and lower leg.

Use the links on the left to navigate to the article of your choice. If you have a suggestion for an article, email us. We’d love to hear it.

Filed under: Site Navigation by ABLE Orthotics

For each of our patients we provide an assessment report for the referring physician(s). This is simply a quick reference to clarify terms we use frequently while some or all of the terminology may be familiar to you we wanted to be through.  As always if you have any questions please give us a call.

Clinical Observation Terminology

Excessive Pronation – triplanar motion of abduction, eversion and dorsiflexion

Excessive Supination – triplanar motion of adduction, inversion and plantarflexion

adduction – movement or deformity in the transverse plane toward the median

abduction – movement or deformity in the transverse plane away from median

eversion – movement in the frontal plane towards the midline

inversion – movement in the frontal plane away from the midline

Forefoot Valgus

valgus – position of eversion, deformity in the frontal plane

Forefoot Varus

Varus – position of inversion, deformity in the frontal plane

Plantarflexed First Ra

plantarflexed / plantarflexion – downward position / movement in the sagittal plane

dorsiflexed / dorsiflexion – upward position / movement in the sagittal plane

internal rotation – movement around the vertical axis so anterior aspect faces towards median

external rotation – movement around vertical axis so anterior aspect faces away from median

circumduction – movement in circular pattern combining flexion, extension, abduction and adduction

Orthotic Terminology:

Metatarsal Pad: placed proximal to the metatarsal heads to support the transverse arch and unload the central metatarsal heads

Metatarsal Bar – placed proximal to the metatarsal heads to

support the transverse arch and unload 1-5 or 2-5 metatarsal heads

Casting

Casting is the process of capturing the 3D shape of the foot in the corrected position. At ABLE, we choose the method that will allow the best results for each patient’s individual needs.  Our casting methods include:

• direct mold – the material that will become the shell of the orthotic is heated and wrapped around the foot directly; semi-weight-bearing or full weight-bearing
• foam box – patients foot is pressed into a box of compressible foam by the pedorthist; semi-weight-bearing
• plaster bandage – strips of plaster of Paris are wrapped around the foot; non-weight-bearing
• laser scanner – electronic imaging matched with AutoCAD software and milling machine

Materials

At ABLE, we have more than 40 different material combinations to choose from when we design each orthotic device and we select the appropriate materials based on the patient’s needs. Options include:

• Accommodative
• corrective
• cushion
• semi-rigid
• rigid

Filed under: Articles for Healthcare Professionals by ABLE Orthotics

At ABLE Orthotics, our focus is our patients, and we use our assessments to find the best solutions for each patient.  Our breadth of treatment extends beyond “just orthotics”, including:  education on footwear or foot care, simple stretching exercises, specialty footwear, footwear modifications, night splints, turf toe plates, custom toe spacers, compression stockings, etc.  We work hard to gain your trust,and you can be confident that our focus is to do what is best for your patients.

Here are some general guidelines on when to refer to ABLE Orthotics, including some examples:

1. Pain of the foot, ankle, or lower limb due to abnormal biomechanics

• Common conditions: plantar fasciitis, metatarsalgia, patellofemoral knee pain
• Common abnormal mechanics: flat feet, high arches, abnormal pronation, excessive supination, dropped metatarsal arch, excessive or limited ranges of motion

2.  Activity limitation or aversion secondary to mechanical issues

3. Deformity

• Bunion or hallux valgus, clawed toes, hammer toes
• Club foot

4. Post Trauma or Post Surgery

• Amputation of toes, or part of foot
• New pains due to change in foot or limb structure/function

5. Leg Length Discrepancy

• Structural limb length difference
• How much of a difference is significant to treat?  We look at it case by case.  In some cases 5 mm can be significant

6. Footwear fitting issues

• Extra depth, extra wide, extra narrow
• Seamless or stretchable uppers
• Deep toe box

7. Poor balance/unsteady gait patterns

• Elderly, stroke, cerebral palsy, neuropathic

8. High Risk Feet

• Insensitive feet – neuropathy, Raynaud’s
• Circulatory compromise

If you have questions as to when a referral is appropriate, please don’t hesitate to call and speak with us.

Filed under: Articles for Healthcare Professionals by ABLE Orthotics

Our treatment approach is to work as a part of a team of health-care professionals.  We work hard to ensure effective and timely communication, and rigorously guard our reputation.  If at any time you have any questions or concerns, please don’t hesitate to contact us.

Our focus is to improve the quality of our patients’ lives by eliminating or reducing pain and improving function and activity level. We know that it is challenging for you to keep up with the constant barrage of new developments in your own field, let alone someone else’s.  So we work hard to be a resource for you.  We constantly update our skills and knowledge of the different treatment options so that we can provide the best patient solutions.

Why a Pedorthist:

Pedorthists’ are specialists and one of a few medical professionals trained in the assessment of lower limb anatomy and biomechanics. A Canadian Certified Pedorthist has a minimum of 3500 hours of training in clinical evaluation, footwear (fit and modification), and fabrication of custom orthotics.

How we solve problems:

At ABLE Orthotics, all patients are assessed by a Certified Pedorthist (Canada).  The initial appointment is usually one hour long, and we assess the function of the foot and lower limb through static and dynamic assessment.  From our assessment findings, we are able to develop a treatment plan specific to the patients’ needs that will help alleviate pain or problems caused by their specific foot and lower limb function.  When appropriate, we design and manufacture custom made prescription foot orthotics, educate on proper footwear choice and fit, and fit therapeutic footwear.

Our solutions:

Not Just Orthotics – in the course of treating patients, we draw from a wide variety of treatment possibilities to find the right solution for each patient.  The treatments options include:

1. Education: including footwear, exercises or other recommended treatments
2. Orthotics: both custom made and off the shelf options may be used
3. Shoe modifications: ranging from the relatively simple to complex
4. Footwear: primarily for specialty cases
5. Specialty needs: work or sport specific footwear: boots, skates, dance shoes
6. Other foot products:

• custom toe spacers
• forefoot stiffening plates
• dorsiflexion night splints
• compression stockings

Filed under: Articles for Healthcare Professionals by ABLE Orthotics

Today, there are an estimated 2 million Canadians living with Diabetes and 60,000 new cases of diagnosed Diabetes every year. Many more people display undiagnosed symptoms that can lead to this terrible disease. The incidence of diabetes is on the rise! Our focus at ABLE is to help you stay active and healthy; so you can enjoy life. For the Diabetic, applied knowledge and diligence towards foot care can have a dramatic impact on your quality of life.

Medical studies show that Diabetes has a debilitating effect on the extremities, most often the feet. In simple terms, this debilitation is due to a combination of impaired nerve and circulatory function.

1. Reduced blood circulation occurs as the arteries, both small and large, become blocked. The result is decreased healing power, which is the main reason why diabetic patients take so long to heal once a problem has begun. As a result a simple blister can develop into an ulcerated lesion that will be difficult to treat and very slow to heal.
2. Impaired nerve function or neuropathy involves the loss of sensation in the nerves that supply the lower leg and foot due to altered blood glucose levels. In fact, research has demonstrated that 60-70% of the people with diabetes have mild to severe forms of nerve damage to their feet.  With the loss of sensation, the danger is that the diabetic patient can have a simple scratch or irritation that goes unnoticed and develops into a foot ulcer.

The combined effect of impaired nerve and circulatory function can put diabetics at risk of developing a foot ulcer which can escalate and result in the amputation of a foot or leg.  Of  all the diabetics admitted to hospitals, over 20% of them are there because of foot problems. The American Diabetes Association reports that 15% of all people with diabetes will eventually develop foot ulcers and that these ulcers frequently become infected and lead to amputation. In addition 50% to 70% of all non-traumatic amputations occur in patients with Diabetes. Thankfully, many of the potential problems can be prevented with proper foot care.

Prevention is the Key:

Aggressive care of the diabetic foot can often offset or alleviate potentially painful and irreversible damage that can decrease the quality of your life forever.

Footcare:

• Check your feet daily by visually inspecting them. Be alert for: redness, swelling, broken skin, sores or bleeding. See your doctor immediately if any of these problems arise
• Wear shoes around the home, indoors as well as outdoors, to protect your feet from injury
• Wash your feet with soap and warm water every day, but do not soak them
• Avoid heat pads or hot water bottles even though your feet might get cold easily. With a lack of sensation it is easy to burn the feet without noticing if the water is too hot
• Avoid socks with heavy seams, as they can cause irritation of the skin and lead to breakdown or ulceration
• Avoid tight constrictive socks and clothing that can limit blood flow to the extremities
• If you have a problem with lower limb swelling, graduated compression stockings can help control swelling and improve the fit of shoes over the course of a day

Shoe Selection: Get good shoes! Key features for diabetic footwear include:

• soft uppers with minimal seams. Particularly avoid seams over the toe area of your shoes. Seams resist stretching and create bumps that can rub against the skin and cause it to break down or ulcerate
• deep and wide toe boxes to reduce abnormal pressure
• firm but cushioned soles
• removable insoles
• a strong heel counter
• rockered sole
• Lace up shoes offer a versatile fit and should be used, if possible. Alternatively, use Velcro closures if tying laces is difficult.
• Avoid slip-on and restrictive footwear, such as high heels with pointed toes or shoes that are narrow in style,  as they depend on a tight fit to stay on the foot

When Fitting shoes:

• Have your shoes fitted properly by a trained specialist such as a Canadian Certified Pedorthist
• Remove the insole from the shoe and stand on it to see if your foot overlaps the insole, indicating that the shoe is too narrow or short for your foot
• There should be a full finger width between the end of the longest toe and the end of the shoe

Filed under: Articles On Health and Wellness by Jonathan Robinson

What is it?

Fascia is a tough tissue (connective tissue) found throughout our body, offering support to our body’s structure. The plantar fascia is the band of fascia that spans the bottom of the foot. It originates at the heel, extends through the arch and attaches at the toes. Plantar fasciitis is the painful condition that results when the plantar fascia becomes torn, inflamed, or irritated due to sudden trauma or repeated stress.

Plantar fasciitis is particularly common in:

• runners
• people who are overweight
• pregnant women
• people who wear shoes with inadequate support

Symptoms:

Symptoms can vary from one person to another, but most often, plantar fasciitis begins as a dull ache under the heel, and possibly in the arch. It can become a sharp pain with the first steps out of bed in the morning, or after any period of sitting or rest. The pain often lessens after a period of walking, but can recur throughout the day with prolonged or vigorous activity.

Treatment:

Numerous treatment options exist, and a thorough assessment can help determine what treatment, or series of treatments, may be necessary to reduce the aggravating stress and allow the injured fascia to heal.

Here are a few things that you can do on your own that may provide relief:

• If you have stiffness or pain first thing in the morning, a few simple stretching exercises to “wake up” your feet before you get out of bed may be helpful (see below for description). Other exercises may be helpful, but an assessment by a Pedorthist or Physiotherapist would be required to know if they are appropriate for you.
• Wear appropriate, supportive footwear. Ask your Pedorthist if you are not sure what is appropriate for your foot type.
• Replace old and worn out footwear – if shoes that you wear 80% of the time are more than one year old, replace them
• Avoid barefoot walking completely until condition resolves – wear a pair of supportive shoes around the house, and keep them by your bed to wear when you first get up
• Daily contrast foot baths (total 20 minutes), alternating warm and cold water.
• Apply ice for 10 minutes after activity or at the end of the day to relieve pain and reduce inflammation

If your symptoms are not improving, please book a follow up appointment with your family doctor to see if a referral to a Pedorthist is appropriate. If you are already under the care of a Pedorthist, set up an appointment to see how they can maximize results.

Not all individuals will achieve complete pain relief with the treatment described above. In some cases, dealing with plantar fasciitis may require other treatment to reduce pain and/or control foot mechanics. These treatment options may include:

• Foot orthoses
• Physiotherapy
• Acupuncture
• Massage therapy
• Dorsiflexion night splint
• Anti-inflammatory medication (as prescribed by your physician)
• Cortisone injections, in extreme cases only (as prescribed by your physician)

Stretching Exercises

Perform the following stretches in a pain-free range of movement. This means stretch only to the point of tension, never into pain. Try to do these stretches before getting out of bed and before standing after periods of sitting or rest.

Ankle Rotations:

• Lie (or sit) with leg outstretched
• Make slow controlled circles with your foot / heel – 10 clockwise and 10 counter-clockwise.
• Draw the alphabet with the foot

Calf Stretches:

• While seated or lying down, have leg outstretched and knee straight



• Alternate between gently pointing your toes away from you and then flexing your ankle to pull your toes toward your shins.

Filed under: Articles On Health and Wellness by ABLE Orthotics

Wow, selecting new shoes can be such an overwhelming task! Choosing shoes based on price, or even simply on looks, can get you in a lot of trouble. Ask me — I’ve seen lots of examples over the years!

Over the course of your lifetime, you will walk over 150,000 miles, so it’s important that your feet are well set up to accommodate you. Shoe choice is an essential part of that. Your choice of shoes will make a big difference as to how active you are able to be and will have a big impact on your quality of life. It can mean the difference of running and or walking in comfort or in pain, how active you are able to be and, most importantly, your ability to stay healthy and injury free.

Often we don’t accurately connect the symptoms or problems we experience with the pain that we feel. You probably remember the children’s chant “the ankle bone connected to the knee bone, knee bone connected to the hip bone, hip bone connected to the back bone..” and so on.  While not immediately apparent when you are running, walking or standing, everything rests on your shoes.  If your shoes don’t support you properly, that can translate into problems all over the rest of your body.

According to the Canadian Pedorthic Association,  “Approximately 20-30 per cent of people experiencing pain or discomfort during an activity, such as a walking or even running program, are unaware that this is caused by improper footwear and can be easily be rectified by finding the right type of shoe. Buying the wrong type of footwear can cause problems ranging from minor discomfort such as blisters, corns and calluses to more serious conditions including repetitive stress injuries to the joints and muscles.” So do yourself a favour and take good care of your feet!

Here at ABLE Orthotics, shoe sales are not a big part of our business, but we care about your feet! So if you come and see us we probably won’t sell you shoes. The shoes we do sell are primarily for specialty cases, or when shoes need to be modified to accommodate a patient’s particular needs.

However, we are experts at ensuring that you know the right type of footwear for your specific lifestyle needs (work and play), for your biomechanical needs, and for any specific problems you may be presenting with. We can help ensure the proper fit and correct support for your foot type. In addition, we would be happy to recommend shoe stores where we know you will be properly fitted.

So remember, while choosing shoes can be an overwhelming task given all the high-tech shoes available today and all the special features each shoe claims to have, keep these things in mind:

• Proper footwear choice and fit is essential in reducing symptoms and may help prevent problems. Every year more than 1.2 million Canadians have a sports related injury that could have been prevented through proper fitting footwear and shoe selection.
• A Pedorthist is trained to evaluate your foot needs and provide you with footwear education that is specific to your foot type and lifestyle needs.
• If you require foot orthoses in your shoes, the footwear must compliment the orthoses to improve the outcome of wearing the orthoses.

When Should You Retire Your Old Shoes?

• A general rule: a shoe worn 80% of the time, should be replaced within 8-12 months.
• Running shoes need to be replaced every 500 miles

Shoes are worn out if:

• the tread has worn off/ become smooth on the bottom of the shoe
• the wear pattern on the bottom of the shoe is excessive/severe
• there are a lot of creases/wrinkles in the sides of the sole

Remember, do yourself a favour and take care of your feet. Not everyone needs to consult with a Pedorthist, but if you are experiencing pain and you think you may have a lower limb or foot problem, talk with your Doctor and they can recommend that you see a Pedorthist. Canadian Certified Pedorthists (C Ped (C)) are one of the few healthcare professionals trained in the assessment of lower limb anatomy and biomechanics, with specialized education and training in the design, manufacture, fit and modification of foot orthotics and footwear.

Filed under: Articles On Health and Wellness by ABLE Orthotics

As a buyer, you need to be aware that when looking for a medical foot-care professional it pays to do some research and be well informed.

Footwear and orthotic experts, Canadian Certified Pedorthists, are one of the few health-care professionals educated and tested in how to assess, modify, design and fit both footwear and foot orthotics.  Many individuals with a variety of backgrounds dispense “custom foot orthoses”, but not all orthotics or providers are created equal.

As part of your due diligence here are some information to check out:

1. Reputation: A lot of problems can be avoided simply by inquiring about the company or individual’s reputation in the community and with other health-care professionals.
2. Assessment: Inquire about their assessment approach.  How thorough is their assessment? Do they take a comprehensive history?  Do they observe your feet in action?  Do your research and don’t be fooled by complicated terms, techno speak or computerized gadgets.
3. Fabrication: In fabricating orthotics, do they use a “one material suits every situation” or can they tailor their approach and use different materials based on your specific needs?
4. Qualifications: Are they specifically trained in biomechanics and fabricating orthotics? In some cases individuals selling custom orthotics, while well qualified in their own field, are unqualified or have very limited training in providing foot orthoses. As an example while I like my dentist I won’t go to him to have my arm set if it is broken. In the same way if you need orthotics Canadian Certified Pedorthists are orthotic and footwear experts.
5. Results: Will they follow up with you to ensure they get results? Sometimes, with more complex situations, it takes some adjusting and fine-tuning to get it right.  Is your health care professional going to follow up to ensure results? For how long?

Like many things in life, it pays to invest time upfront to ensure you get the best solution for you. In your lifetime you will spend a lot of time on your feet, make sure you get the best care and solution so that you are as comfortable as possible.

Filed under: Articles On Health and Wellness by ABLE Orthotics

If you live long enough, you can count on developing at least some form of arthritis; a touch of osteoarthritis, at the very least. Arthritis affects an estimated 4.2 million Canadians of all ages, with numbers expected to increase by 50% by 2020. And while arthritis is often considered a disease of older people, babies in diapers can get it too, and many people are affected in the prime of their lives. Here at ABLE Orthotics, our focus when dealing with patients with arthritis is to alleviate pain and help people stay as active as possible.

Arthritis: a group of conditions involving damage to the joints of the body. Arthritis is the most common cause of disability in the USA. More than 20 million individuals with arthritis suffer from severe limitations in function on a daily basis. Absenteeism and frequent visits to the physician are common in individuals who have arthritis. Arthritis makes it very difficult for individuals to be physically active and they soon become home bound. Wikipedia

There are eight forms of arthritic type conditions that typically affect the joints of the feet and the lower legs. All of them cause pain, inflammation and limited movement of the joints. In this article, we will focus on two types of conditions: Osteoarthritis, which is by far the most common, and rheumatoid arthritis, the second most common.

Osteoarthritis

Osteoarthritis (degenerative joint disease) is a result of trauma or infection to the joint, or simply due to aging. Most experts do not consider osteoarthritis to be a disease. Rather, over time, it is a result of  the wear-and-tear process in a body joint that can precipitate an inflammation , when there is a breakdown of the cartilage tissue that normally keeps bone from rubbing against bone.

What makes the problems worse is when the cartilage tissue is unduly stressed and broken down by the following two common ways:

• abnormal forces on the joint; forces that often result from a biomechanical fault in the lower limbs. As an example excessive pronation leads to overloading of the first metatarsal joint which can in turn result in breaking down of the cartilage and eventually osteoarthritis in the joint.
• athletes may also place excessive stress on lower limbs while performing or exercising, and as a result the joints in the lower extremities will be subject to more wear-and-tear than those people who do not participate in strenuous activity.

It is important to note that it is not disease itself that is destroying the stressed joint, but rather excessive biomechanical forces. As a result, this degeneration can accelerate if you allow a biomechanical fault to continue, untreated. You are essentially accelerating the wear-and tear process in your feet, legs, hips and lower back, because you are regularly  placing undue stress on those joints in order to walk or run.

The good news is that abnormal biomechanical forces cause most of the common foot pain, including osteoarthritis. However, with proper mechanical adjustments, for example the wearing of orthotics and/or proper shoe fitting and selection, further wear and tear can be prevented. As a result pain can be drastically reduced, or even eliminated altogether.

Rheumatoid Arthritis

Rheumatoid arthritis is a disease that has yet to be tamed. Although rarely life threatening, it can be tormenting because of the relentless pain. It is not a result of wear-and-tear but rather an auto-immune condition in which the body’s own immune system attacks the joints thinking they are foreign matter; attempting to destroy them. Usually relief for painful joints in the feet or ankles will require custom made shoes and soft inserts to take much of the weight off the diseased metatarsal heads. It is important that a rheumatologist, a specialist well versed in the various diagnostic methods of treatments, treat this disease.

Choosing Footwear:

To alleviate the pain caused by arthritis, Canadian Certified Pedorthists recommend selecting footwear featuring:

• Rigid rocker soles (the curve at the toe area of a shoe) to decrease stress on the ball of the foot and provide a more efficient push-off
• Soft leather uppers or materials that will mold around deformities or sensitive areas
• Wide, deep, square toe-boxes with no seams over hammer toes or other sensitive areas to avoid pressure on painful joints
• Velcro closures or elastic laces to eliminate the need to lace up a shoe, if fine dexterity in the fingers is difficult
• Avoid high heels. Stick with a heel that is lower than 1″ or 2.5 cm

Talk to your Doctor who can refer you to a Pedorthist. Your pedorthist can help you make good footwear choices and provide custom orthotics, if appropriate.

Filed under: Articles On Health and Wellness by Jonathan Robinson