Know Thy Foot - Ailments and Treatments
A Short History of Podiatry
Podiatry, or the treatment of feet and their ailments, is a relatively new specialty in medicine. In the early 1900's, there were medical professionals who took care of patient's feet, but they were not "Doctors of Podiatric Medicine" as they are today. This certification would not come around until the mid 1900's, along with the development of Root Biomechanics and Orthotic Technology. Today, because of the hard work of Podiatrists, we know more about the foot and ankle than we ever have. Noninvasive treatments like orthotic therapy have been developed extensively and treat a variety of conditions. Also, surgery, while often not required due to improvements in orthotic therapy, can be more accurate with a faster recovery than any previous time in history. It is truly a great time for patients and doctors of the foot and ankle, as there are more resources for treatment than ever before.
Common Ailments of the Feet
Overpronation and Oversupination
When the foot is functioning normally, there is a certain degree of pronation and supination in the gait cycle. Pronation is a combination of dorsiflexion, abduction, and eversion, where supination is a combination of plantarflexion, adduction, and inversion. In general, pronation is the part of gait where the foot is landing on the ground, and the weight of the body is moving over it, where supination is when the foot is lifting off the ground, and the weight is transferring to the other foot. These motions have their happy medium, as well as their extreme versions, which can lead to an unbalanced transfer of forces and damage and even deformity over time. The most common extreme is overpronation. This is when the medial arch of the foot collapses and the major joints in the foot can subluxate, or hyperextend. Over time, repetitive subluxation can lead to pain, damage, and in extreme cases, diagnoses like Posterior Tibial Tendon Disorder and Adult Acquired Flat Foot. Correctly sized foot orthotics stabilize the foot during gait, reducing overpronation, oversupination, and the chance of developing ailments.
Bunions are a very common ailment that is equally associated with genetic inheritance as it is a result of poor gait. The medical term for a bunion is "Halux Abducto Valgus" which refers to the motion of the big toe as its tip begins to point inward, and the first metatarsal appears to bulge outward. Bunions can be painful and unsightly when they become extreme. Surgery is a possible solution; however, often orthotic therapy is attempted before surgery is considered an option. Because orthotics help to stabilize the foot and forces acting on its bones and ligaments during gait, they can reduce the discomfort of a bunion, as well as prevent the condition from becoming more exaggerated.
Heel Spurs are another very common ailment. A heel spur is a small calcium build up on the plantar surface of the calcaneus, or heel bone. Often they are caused by overpronation, which causes the plantar fascia, or tissues running underneath the foot, to stretch too much where they connect to the calcaneus. This overstretching at the tissues' insertion point can lead to a buildup of calcium which can eventually cause great discomfort upon heel strike. Again, surgery is a potential solution; however, recovery times, and other complications can lead to attempting less invasive treatments first. Foot orthotics are one of the common less invasive treatments, because they not only relieve tension on the plantar fascia, but can also add padding beneath the heel and reduce the direct force to the heel upon impact.
Plantar Fasciitis is the most common ailment of the feet that leads to orthotic therapy. Almost everyone experiences plantar fasciitis at some point during their life. When overpronation continues, it eventually leads to the overstretching of the plantar fascia. At some point the plantar fascia cannot stretch further, and small tears can occur, leading to discomfort or even severe pain. Plantar Fasciitis is characterized by a sharp pain upon standing, especially in the morning when getting out of bed. However, it doesn't always stop there. The arches of the feet can become very sore due to overuse and fatigue. Orthotics are a perfect solution for this ailment because they prevent the plantar fascia from overstretching, therefore stopping pain at it's cause. Why go through the hassle of surgery, when all that's needed is a simple orthotic insole? Click here to see KLM's products that can help with plantar fasciitis.
Posterior Tibial Tendon Disorder
Posterior Tibial Tendon Disorder (PTTD) is a more extreme ailment that often leads to Ankle Foot Orthotic (AFO) Therapy. When PTTD becomes severe, the posterior tibial tendon, which reaches from behind the gastrocnemius down to the navicular bone in the arch of the foot, is so weak that not only is the arch of the foot collapsed, but the ankle is beginning to look misshapen as well. In these cases, more than a simple foot orthotic is necessary, hence the development of Ankle Foot Orthotics. These devices have an orthotic foot plate as well as upright extensions, which secure to the leg below the calf. These uprights further support the ankle, and encourage proper alignment in the lower extremity. KLM Laboratories also makes Ankle Foot Orthotics. Click here to see KLM's products that can help with PTTD.
Drop Foot is a condition characterized by the patient's lack of ability to dorsiflex the foot. Dorsiflexion is pulling your toes up toward your knee, as opposed to plantarflexion which is extending the toes away from the knee. When dorsiflexion is disabled, the gait cycle can be greatly effected, because the patient is unable to lift the foot up and forward to make the next step. Sometimes in this case the issue is neurological, and surgery is not a viable solution. Fortunately, there is a type of Ankle Foot Orthotic which is designed to assist with dorsiflexion. These "Dynamic Assist" AFOs have special hinges that engage during the swing phase of gait, dorsiflexing the foot so it may land in a more correct position for the next step. Click here to see KLM's products that can help with Drop Foot.
Intoeing and Outtoeing
Foot orthotics can have a positive affect on intoeing and outtoeing if the cause is foot related. However, often times these conditions can be caused by knee or hip issues. If you experience intoeing or outtoeing, or have a child who experiences the same, a correctly sized foot orthotic can help to reduce the development of further symptoms to this condition. When the foot is not striking or pushing off in the correct position, it can cause an inefficient transfer of forces, which can lead to compensation and discomfort, or other conditions like plantar fasciitis and heel spurs. Finding the correct orthotic insole for you can be beneficial in these cases, even if it does not prevent the cause of the
Corns and Calluses
Corns and Calluses are also very common foot ailments. One would be hard pressed to find an adult who has never had a callus on their foot. Sometimes, corns and calluses exist without causing any noticeable symptoms. However, there are also situations in which these buildups of tissues and dead skin can become quite painful, and a solution is required. As always, a properly sized foot orthotic can help to improve the transfer of forces during gait, therefore reducing pressure on the painful area. At times a more custom accommodation might be needed to relieve the pressure on such a specific location, in which case KLM recommends you see your foot care provider. However, in any case of corns or painful calluses, orthotics help to relieve excess pressure and the symptoms of overuse. Click here to see KLM's products that can help with corns and calluses.
Hammer toes, often known as claw toes or mallet toes, are another common foot ailment. Though often benign, these curled up toes can be uncomfortable and unsightly. There is a common addition to custom foot orthotics known as a "toe crest" that gives the hammer toes something inside the shoe to reach over and grip. However, the toe crest is not a common addition to over-the-counter orthotics. Even without the toe crest, a correctly sized over-the-counter foot orthotic will help to alleviate the discomfort of hammer toes by more evenly distributing the forces of ambulation. This is an excellent example of how incorrect alignment in the foot can lead to a deformity that adversely affects the shape and function of the feet. By correctly supporting the arch of the foot and relieving undue pressure on its structures, the extremities, the toes in this case, also experience a relief of pressure and are encouraged to function normally.
The Structure and Function of Foot Orthotics
In the early 1900's, foot orthotics were originally developed using leather and lasts. A "last" is a positive model of a foot and leather was the best moldable material of the times. Today orthotics are more commonly made from a combination of rigid materials like polypropylene and graphite, and soft materials like EVAs, plastizotes, and other foams. The rigid materials more commonly form the "shell" or supportive part of the orthotic, where the soft materials create a comfortable cover and allow for easy application. The orthotic shell is typically the more functional aspect of the device. This is the "brace" that supports the arches of the feet during gait, relieving undue pressure elsewhere. When injury or overuse causes the arches of the feet to loose their strength and flexibility, the weight of the body and other forces are transferred incorrectly and can lead to developing a variety of ailments. Having a corrective functional orthotic shell is the first step to engaging orthotic therapy. However, the soft covers also have their purpose: not only for providing comfort, but in certain cases, especially for diabetics, pregnant women, and other situations in which the patient is extra sensitive, having that accommodative cover material on the orthotic can make all the difference. KLM Laboratories manufactures a variety of custom foot orthoses for foot care professionals around the world. Often times the experience and understanding of a doctor is necessary to build a successful orthotic to treat a particular case. However, in many situations, over-the-counter orthotics can provide equal relief. And, over-the-counter orthotics are typically much less expensive. The important thing as a consumer is to understand the principles behind orthotic therapy so you can choose an over-the-counter orthotic with the materials and sizing that best suits you. Here at KLM Labs, we encourage you to engage orthotic therapy whenever it can be of use to you and your family. We also encourage you to seek a foot care professional whenever necessary. Click here to see all of KLM's over-the-counter products available to you online, and get the treatment you need shipped directly to you!