One of the biggest challenges I have found over the last 25 years with being an extremity-based Chiropractor is the general lack of public knowledge regarding the feet and how they affect the rest of the body. Starting from a very young age, we are not properly taught about our anatomy and how different body parts work with and affect each other. This comes into play when incorporating the use of orthotics into Chiropractic care.
When patients need medical care, the majority of them will begin with allopathic medicine. This is because they believe that pain is the indicator of when to seek treatment. It’s common to only treat the pain of conditions like plantar fasciitis, metatarsalgia, and Achilles tendonitis, rather than identifying and correcting the foot/arch dysfunction and biomechanical problems that are their underlying cause. Interestingly enough, many patients with faulty foot biomechanics live their lives without having any foot pain at all. However, in my experience I have seen that upwards of 87% of all human beings in a standing posture exhibit signs of flat or pronating feet that that can lead to pain and disfunction in the knees, hips, pelvis, neck, and spine. Even common conditions like shin splints and sprained ankles can stem from unhealthy foot function.read more
Flip-flops, also known as thong sandals, are a summer staple for men and women of all ages. Many people who live in warm climates wear them every day. It’s no wonder flip-flops are a favorite – they’re sporty and stylish, light and cool, and quick and easy to take on and off.
The most popular flip-flops are the generic, inexpensive ones sold over the counter (we’ve probably all got a pair – or more, in our closet). These are made of thin, cheap materials and feature a flat sole with no arch support or shock absorption. They provide little to no stability for the foot and ankle. Even in the short-term, wearing generic flip-flops stresses the joints in the ankles, knees, hips and lower back, and can increase your risk for injuries and painful conditions like plantar fasciitis. Here’s how:read more
Your time on digital devices can hurt your health – addressing tech neck with custom orthotics will help
These days, cell phones are used for much more than just making calls. They’re multi-tasking tools used in place of watches, alarm clocks and maps. Are you among the 63% of Americans who keeps their cellphones within arm’s reach at all times, and checks them hourly (or more)?1 Handheld digital devices like cell phones sure make life a lot more convenient. But the way we use them can cause undue stress on our bodies. Over time, that stress can lead to pain and increase your risk for a neck injury.read more
What is a heel spur? A heel spur is a bone growth that develops on the back or bottom of the heel. While anyone could get a spur on the heel, they’re more common in women than men and in people aged 40 or older.1
Heel spur pain can vary from a sharp, stabbing sensation to a mild ache. In many cases, spurs on the heel are present for some time but don’t hurt until they grow to the point that they press on the nerves and soft tissue of the foot.
Dorsal spurs form on the back of the heel, and plantar spurs appear at the bottom. It’s possible to have multiple spurs on one heel.
It is extremely rare for someone’s feet and their stride to be perfectly balanced and equally weighted. Some people have feet that visibly turn inward or outward, while others have a subtler inner or outer weight distribution.
It’s hard to see, unless you look at the bottom of your shoes or have your feet scanned with the Foot Levelers Kiosk or other Foot Levelers scanning technology. (Click here to find a provider near you.)
Pronation vs Supination
When bodyweight is placed on the outside of the foot while walking or running, it is known as supination. When the weight is placed more on the inside of the foot, it’s referred to as pronation. An easy way to differentiate and remember the difference is that supination has “up” in the word. In a proper stride, the foot should move from heel to toe with a person’s bodyweight evenly distributed on their feet, giving them neutral pronation.read more
Baseball pitcher Roy Halladay died in a plane crash in 2017. Toxicology reports showed he had prescription medications in his system. ESPN is releasing a new documentary on Halladay's life. Foot Levelers is urging the public to seek out conservative care treatments prior to taking opioids.
Many people think they are born with flat feet and that some people are simply, flat-footed. While it’s true that some people are flat-footed for most of their life, over time we all become more and more flat-footed since our arches collapse as we age. It’s possible that someone with flat feet feels no pain. However, if your arches collapse over time, causing your feet to become flatter, you will likely experience pain and discomfort.
Arthritis is another contributing factor to foot pain (as well as pain in other joints throughout the body), and flat feet and arthritis are often co-occurring issues. What many people do not realize when they are experiencing pain is that the source of their pain could be their feet, even if they’re having knee, hip, or neck pain. So, let’s discuss how custom orthotics are one of the best ways to ease pain caused by flat feet and/or arthritis.read more
When you’re seeking out the best orthotics, whether you’re a healthcare provider looking for a reliable orthotics supplier, or a patient looking for pain relief, Foot Levelers is your best option. Let’s explore some of those reasons.
Knee pain is the most common musculoskeletal complaint that brings people to their doctor.
The knee, in addition to bending and straightening hundreds of times each day, carries all of the weight of our body along with our hips and ankles. The knee is also distinctly different from other joints of the body because it also twists and rotates, making it even more susceptible to injury and discomfort. Additionally, the knee is made up of bones, joints, ligaments, and cartilage, so there are a lot of different areas that can be injured and irritated.read more
Chiropractic is a drug-free approach to pain relief and pain management
Currently, more than 2 million Americans are dependent on opioids. For many people, their addiction stems from seeking pain management for an injury or chronic condition, such as back or knee pain. The opioid crisis has become a national emergency causing overdose remedies to be sold over-the-counter for greater availability. Although some opioid abusers turn to hard drugs like heroin, many people develop dangerous addictions to prescription drugs originally provided to them by doctors they trust for treatment. However, opioids are not the only option for treatment and seeking chiropractic care provide patients with pain relief, but also aids in reducing the negative effects of the opioid epidemic on American society.read more
At least 80% of the U.S. population will experience back pain at some point in their lifetime, and more than 3 million reported cases of lower back pain occur each year. Lower back pain is also one of the biggest reasons why people miss work due to the intensity and sometimes sudden onset of discomfort and pain. However, there is a solution that doesn’t include endless trips to the doctor, arguing with insurance agents, prescription medications, and inconvenient physical therapy appointments.
In case you hadn’t heard, the world’s best basketball player, Kevin Durant, recently went down with an Achilles injury. It’s looking like (as we write this) it’s a ruptured Achilles tendon. That’s a devesting injury for anyone, let alone a world-class athlete.
Durant had been dealing with a calf injury, on the same leg, for a few weeks before this Achilles injury. He missed several games because of the calf injury and was in his first game back in action.
In a press conference after the game, the President of the Warriors, Bob Myers commented, “The initial injury was a calf injury. This is not a calf injury,” Myers said. “I’m not a doctor, I don’t know how those are related or not, but it’s a different injury.”read more
Our body is an interdependent system and when one part is not functioning properly, it can negatively impact other parts leading to over or diminished use. Physicals exist because it is necessary to be examined from head to toe, literally, down to each and every toe, and specialists alone cannot effectively treat our entire body. Chiropractic medicine takes a holistic and comprehensive approach to the body to help ensure and optimize functioning so that we can live our daily lives more easily.
Plantar Fasciitis is an inflammation of the tissue in your foot and nearly 2 million Americans suffer from the discomfort of plantar fasciitis. Although many people think that plantar fasciitis affects only the heel of the foot, it can actually affect any part of the bottom of your foot since all of that tissue is at risk for inflammation. Early morning foot pain and/or stiffness is typically a good indication that you’re experiencing plantar fasciitis, as is pain or discomfort after spending long periods of time on your feet. read more
With nearly 2 million American’s dealing with plantar fasciitis, it’s a very common problem that requires attention. Sadly, though, many people ignore their symptoms and discomfort until it becomes debilitating or until they have more time to get treatment. But, treating and alleviating plantar fasciitis can be as simple as seeing a Chiropractor and you can even take steps (no pun intended) to help prevent it from returning.
The feet are the foundation of the body. Problems with your feet are akin to having a sinking or cracking foundation in your home. It’s a chain reaction that influences how the rest of the body operates, but discomfort can also cloud your mind and negatively impact your mood and productivity, too. So how can you tell whether you have plantar fasciitis?read more
Over-the-counter (OTC) orthotic insoles are foot supports made from various materials including foam, leather, and plastic. OTC insoles are designed to go inside your shoe and provide some type of relief. OTC insoles are popularized by clever branding and packaging techniques and can be bought at local pharmacies and grocery stores. Some are marketed as providing additional comfort. Others promise to relieve pain from common conditions like bunions, plantar fasciitis, and arch support issues. Additionally, you can buy OTC insoles for a variety of shoes like high heels, athletic shoes, and boots, so as to seemingly work with every consumer’s lifestyle.read more
Nearly 2 million Americans suffer from plantar fasciitis.
Heel and foot pain, spurs, tight tendons, and stiffness
could be signs that you had a long day, you wore the wrong shoes, or that you
have a common condition known as plantar fasciitis, along with nearly 2 million
other Americans. For many of us living busy lives, we often brush off our own
health unless or until we experience excruciating pain or some form of
debilitation. But, foot pain, even a mild amount, is nothing to put on your
to-do list for when you have time. The feet are the foundation of the body and
when your feet aren’t operating at 100%, neither are you. Identifying,
diagnosing, and treating plantar fasciitis can be fast and easy, leading you to
have more comfort as you handle everything else in your life. read more
Our feet are perhaps the most overused and under-appreciated parts of the human body. We use them relentlessly, depending on them daily to bear our body weight, transport us places and allow us to stand, walk and run. Only in cases where they are painful do we bother to have them looked at. Even then, proper and complete knowledge of the feet, their movement patterns and their effects on the rest of the body are rarely adequately taught.
In the world of foot pain, heel pain and plantar fasciitis are among the most common ailments people consult a medical provider for. Up to ten percent of the population will present with heel pain over the course of their lives, and it can affect everyone who engages in weight-bearing physical activity. (1) It is important for the healthcare consumer to understand the various treatment options available.
Aside from physiotherapy modalities (i.e., cold laser, ultrasound, muscle stim, etc.), stretching/strengthening exercises and braces, foot orthotics are very often prescribed. The belief is the bottom of the feet are supported by an external device to “shore up the arch”.
British Journal of Sports Medicine
On March 19, 2018, an article was published by the British Journal of Sports Medicine (BJSM). The article was titled Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. It reviewed “current” literature and analyzed how effective orthotics were for plantar heel pain. In conclusion, the article found that there was no difference in improvement in pain or function between prefabricated, custom-made and sham orthoses in the treatment of patients with plantar heel pain.
Since the article’s release, some media outlets have released news reports discussing the article, but they have interchanged plantar heel pain with plantar fasciitis. Although the areas of involvement are close to each other, clinically speaking they are not the same and not synonymous. It is essential for patients and the public to know the difference so let’s make sure we define these terms as separate ailments.
Plantar Heel Pain and Plantar Fasciitis
Plantar heel pain is soreness or tenderness of the heel that has a location restricted to the underside or pad of the heel. It often radiates from the central part of the heel pad or the medial tubercle to the back of the heel itself.
Plantar Fasciitis involves inflammation or irritation of a thick band of tissue (the plantar fascia) that runs across the bottom of your foot from the heel bone to your toes. In this instance, pain is located anywhere on or radiate from the medial tubercle across the plantar fascia up to the toes. Here the plantar fascia gets excessively stretched and irritated.
Because of their location, plantar heel pain and plantar fasciitis are not the same thing. It may seem like splitting hairs, but in the study, we mentioned above, their findings made conclusions only for plantar heel pain, not plantar fasciitis.
The argument of which treatment(s) are helpful for plantar surface foot pain has been made for years by different health care providers and patients. Some believe there is no effective treatment for plantar surface foot pain while others vehemently disagree. It comes down to the patient and their specific situation. There is not a one size fits all treatment for Plantar Heel Pain and Plantar Fasciitis.
How to Treat Plantar Heel Pain and Plantar Fasciitis
To better understand what can be done to help these conditions, let’s take a look at the anatomy of the feet. The twenty-six bones of each foot are supported on the underside by three arches: the medial, lateral, and transverse. Most people only think we have one arch.
These three arches are fully formed by age seven, and together they are vital for supporting not only the feet but the ankles, knees, hips, pelvis and the entire spine above.
Now back to the BJSM Study. Recall, that the study evaluated existing research that had previously been published. The article found that there was no difference in improvement in pain or function between prefabricated, custom-made and sham orthoses in the treatment of patients with plantar heel pain.
If one analyzes the information in the study carefully, the type of orthotics that had been studied were custom made or prefabricated, hard, rigid, single arch support inserts. The orthotics in those studies were not custom molded, flexible and three arch support. There is a big difference between these types of orthotics and those classically made which are rigid.
The types of orthotics discussed in the study did not provide adequate support for all three arches of the feet. So, to be very specific, the study itself came to conclusions that are aimed explicitly at classic hard, rigid orthotic with one arch support.
When a custom molded, flexible, three arch orthotic is worn by the patient, it gives the appropriate amount of support for the feet. The three-arch support takes the stretch or elongating force caused by the overpronation or supination to the plantar fascia and reduces it significantly minimizing or eliminating the pain.
Pat McKee, a retired University of Toronto professor of occupational science and therapy, used to teach students how to make custom foot orthotics out of thermal plastics. She had this to say about custom orthotics and Plantar Fasciitis to CTV News: “Some (custom orthotics) are created better than others. I think it is better if they are shock absorbing and not a hard plastic.”
Custom molded, flexible and three arch support orthotics do the following:
1. Absorb 30% more ground shock with each step thereby reducing the stress on the ankle, knee, hips, pelvis and the spine. 2. Provide individual support for all three arches under each foot in all weight-bearing positions. 3. Help enhance the nerve sensation, circulation and muscle balance in the feet. 4. The reduction of stress in the joints above the feet will allow the muscles to fire in a healthier pattern, reduce nerve involvement and reduce pain. 5. Help prevent injuries in the joints of the body that arises from the repetitive stress created by over-pronation and excessive supination.
Ultimately, treatment for Plantar Heel Pain and Plantar Fasciitis comes down to the patient and their specific situation. Custom orthotics can be an effective treatment for Plantar Fasciitis. The types of orthotics discussed in the study were hard, rigid orthotics with one arch support and did not provide adequate support for all three arches of the feet. Custom molded, flexible, three arch orthotics give the appropriate amount of support and take the stretch or elongating force, caused by the overpronation or supination to the plantar fascia, and reduces it significantly minimizing or eliminating the pain.
The competitive and the recreational athlete can each be affected by injuries to the muscles and ligaments around the hip. These injuries can significantly interfere with sports enjoyment and performance levels, and they occasionally will end participation completely. Poor shock absorption and excessive pronation have been found to be underlying causes or contributing factors for many leg/hip injuries. (1) Orthotics, which have been custom made to improve the biomechanics of the feet and reduce the extent of pronation, can help to prevent many sport-related leg injuries.
Excessive Foot Pronation a Factor
Busseuil et al. looked at the foot biomechanics of athletes who reported a recent foot or leg injury and compared them to an uninjured control group. (2) The researchers determined that those athletes with more foot pronation had a much greater statistical probability of sustaining one of five leg injuries, including iliotibial band syndrome (which is due to excessive tightness of the hip abductor muscles). This study helps us understand how providing appropriate orthotic support to patients who are involved in sport or recreational activities lowers their likelihood of developing both traumatic and overuse hip injuries.
In the Busseuil et al. paper, sixty-six injured athletes who ran at least once a week, and who had no history of traumatic or metabolic factors, were the study group. Another (control) group of 216 athletes were matched who had no symptoms of lower extremity injuries. The amount of pronation during standing and while running at “regular speed” was determined by measuring the angles of their footprints. This quick and inexpensive method of determining the amount of pronation during functional activities (plantar prints) had been previously investigated. (3)
The investigators concluded that those athletes with more pronation had a much greater likelihood of having sustained one of the overuse athletic injuries. While both the standing (static) and running (dynamic) prints showed some correlation, the amount of pronation seen in the static weightbearing footprint was the most predictive of developing an overuse injury. This study helps remind us that it is very important to athletic performance and for injury prevention to check the alignment of patients’ feet in the standing position.
Hip Injuries and Hamstring Control
Many hip injuries develop from poor biomechanics and gait asymmetry, especially when running. Smooth coordination of the muscles that provide balance and support for the pelvis is needed for optimum bipedal sports performance. This includes the hamstring muscles and the hip abductor muscles, especially the tensor fascia lata (the iliotibial band). When there is a biomechanical deficit from the feet and ankles, abnormal motions (such as excessive internal rotation of the entire leg) will predispose to pulls and strains of these important support muscles. The hamstrings (comprised of the biceps femoris, semimembranosus, and semitendinosus muscles) are a good example.
During running, the hamstrings are most active during the last 25% of the swing phase, and the first 50% of the stance phase. (4) This initial 50% of stance phase consists of heel strike and maximum pronation. The hamstring muscles function to control the knee and ankle at heel strike and to help absorb some of the impact. A recent study has shown a significant decrease in electromyographic activity in the hamstrings when wearing orthotics. (5) In fact, these investigators found that the biceps femoris — which is the most frequently injured of the three hamstring muscles (6) — had the greatest decrease in activity of all muscles tested, including the tibialis anterior, the medial gastrocnemius, and the medial and lateral vastus muscles. The authors of this study theorized that the additional support from the orthotics helped the hamstrings to control the position of the calcaneus and knee, so there was much less stress into the hip joint and pelvis.
Hip Injuries and Excessive Pronation
Using orthotics to correct excessive pronation and to treat hip problems requires an awareness of the various problems that can develop. The following is a list of the pathologies that are seen in the hip and pelvis secondary to pronation and foot hypermobility: (7)
Anterior pelvic tilt
Hip adductor muscle strain
Hip flexor muscle strain
Hip joint capsulitis
Iliotibial band syndrome
Piriformis muscle strain
Tensor fascia lata strain
These conditions will develop much more easily in athletes who push their musculoskeletal systems, in order to achieve greater functional performances.
Excessive pronation and/or poor shock absorption have been shown to be an associated or causative factor in many leg injuries — from the foot itself, up the lower leg to the knee, thigh, and into the hip joint. The good news is that many of these conditions can be prevented with custom-made orthotics. Evaluation of foot biomechanics is a good idea in all patients but is especially necessary for those who are recreationally active, or for anyone who has experienced hip problems. To avoid potentially disabling hip injuries, competitive athletes must have regular evaluations of the alignment and function of their feet. Additional preventive measures include wearing well-designed and solidly-constructed shoes. When athletes are provided with custom-made orthotics, we chiropractors can prevent arch breakdown and biomechanical foot problems, and we can also treat numerous injuries to the lower extremities, including the hip joints.
Dahle LK et al. Visual assessment of foot type and relationship of foot type to lower extremity injury. J Orthop Sports Phys Ther 1991; 14:70-74.
Busseuil C et al. Rearfoot-forefoot orientation and traumatic risk for runners. Foot Ankle Intl 1998; 19:32-37.
Freychat P et al. Relationship between rearfoot and forefoot orientation and ground reaction forces during running. Med Sci Sports Exerc 1996; 28:225-232.
Mack RP. AAOS Symposium on the Foot and Leg in Running Sports. St. Louis: Mosby; 1982.
Nawoczenski DA, Ludewig PM. Electromyographic effects of foot orthotics on selected lower extremity muscles during running. Arch Phys Med Rehabil 1999; 80:540-544.
Garrett WE. Muscle strain injuries. Am J Sports Med 1996; 24:S2-8.
Hartley A. Practical Joint Assessment: A Sports Medicine Manual. St. Louis: Mosby YearBook; 1991:571.
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