Running

What To Do About Your Flat Feet

March 9, 2020 by Target Therapeutics Leave a Comment

What are Flat Feet?

Pes planus or flat feet is a postural deformity relating to the collapse or flattening of the medial longitudinal arch. It can also be referred to as hyperpronation or overpronation. Although there are varying degrees of collapse, people are still able to live completely pain-free with flat feet.

What Causes Flat Feet?

This condition can be congenital (e.g. from birth) or acquired (e.g. adults, increased exposure to weight-bearing).

Congenital flat feet occur when someone is born with or predisposed to having a more flexible midfoot region resulting in pronation or collapsing of the arch. Ethnicity is an important factor surrounding flat feet, with the condition being more likely in certain indigenous cultures.

Acquired flat feet are caused by a loss of active (e.g. intrinsic foot and ankle stabilizers) or passive support (ligamentous laxity, hypermobile joints) during dynamic weight-bearing activities. Muscular insufficiency in the ankle and arch stabilizers are the most common etiological factor for flat feet.

How Do Flat Feet Progress?

Flat feet progress slowly as you increase your feet’s exposure to weight-bearing activities. The two most common progressions from flat feet are foot deformities and bony stress injuries.

In the active person, hyperpronation alters the load transference up through the leg and can cause stress responses such as shin splints and in the worst case, stress fractures.

At the opposite end, the bones through your foot are also exposed to altered loads potentially causing a bunion. As seen in the image, the midfoot pronation and collapse of the arch change the line of force to the outside of the first metatarsal (from green to red), creating the bony protrusion. As the head of the metatarsal is forced out, the rest of the big toe is forced inwards further accentuating the bunion.

How are Flat Feet Diagnosed?

Your Certified Pedorthist will observe you conducting numerous single leg tasks in order to investigate your overall dynamic control, from your foot and ankle to your hips. This will include activities that challenge your strength, endurance, proprioception, and balance. Integrated into the entire kinetic chain, the main focus will be identifying any active insufficiencies through your arch and its’ respective stabilizers.

In some cases, a weight-bearing Xray may be ordered in order to investigate the integrity and dynamic control of the specific joints of the arch under stress and load.

Flat Feet Treatment

Treatment can vary largely considering the broad etiological factors. Below is a range of treatment directions focussing primarily on improving the active stabilization of the foot and ankle to endeavour to correct the flat feet deformity.

Restore Intrinsic Muscle Control and Foot Arch Biomechanics

Your foot arch is dynamically controlled via important intrinsic plantar muscles, which may be weak or have poor endurance. These foot muscles have a vital role in dynamically stabilizing the base of your foot plus preventing overpronation of the midfoot and loading through your plantar fascia.

Dynamic Foot Posture Exercises

Any deficiencies will be an important component of your rehabilitation. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control. They will be able to help you to restore your normal foot biomechanics and provide you with foot stabilization exercises to alleviate any deficiencies.

Custom Orthotics

After your biomechanical assessment, you may be recommended a soft temporary orthotic to help provide protection and relief through over-loaded structures. If your physiotherapist deems an orthotic will be of benefit for long-term use, a referral to your local podiatrist for a specialized orthotic may be recommended. The good news is that most flat feet sufferers will not need permanent passive arch support such as an orthotic.

At Target Therapeutics, our Certified Pedorthist can make sure you get the best possible custom orthotics.

Restore Normal Calf & Leg Muscle Control

You may find it difficult to comprehend, but all of your leg (calf, thigh and hip) muscles play an important role in controlling your ankle position and foot arch mechanics. Your physiotherapist will assess your leg muscle function and provide you with the necessary treatment or exercises to correct any ankle, knee or hip stabilizer insufficiency. Ask your physiotherapist for more specific advice.

Footwear Analysis

Sometimes it is poorly designed footwear that can predispose you to acquire flat feet or an associated injury. If you do suffer pain or discomfort that is impacting your active lifestyle, you should seek the professional advice of your healthcare practitioner to assist your ability to determine the best footwear for your feet.

Do you suffer from flat feet? You’re not alone. There are many possible solutions that can help you immensely.

Custom Orthotics vs. Store Bought Orthotics

January 16, 2020 by Target Therapeutics Leave a Comment

When weighing the options between a pair of custom orthotics vs. a pair of store-bought orthotics there are a number of things to consider.

The Pedorthic Association of Canada defines store-bought orthotics or over the counter foot orthotics as “mass-produced devices that are not unique to any person”.

Custom orthotics are defined as “an internal foot appliance which is manufactured from a three-dimensional image of the foot, and made from raw materials. Custom orthotics can accommodate bony deformities, and/or modify the movement pattern of the foot and lower limb”.

Store-Bought Orthotics

Store-bought orthotics are made with lower quality materials and are not very supportive through the arch.

Advantage: for a person with a lack of padding on their feet (i.e. fat pad dystropohy) or a person with normal feet who spends a lot of time standing or walking on hard surfaces, may find that a cushion may be all that is necessary.

Disadvantage: Materials break down faster than the higher quality materials used in custom orthotics.

Store-bought orthotics are made for an “average” foot shape and may not be ideal for all people.

Advantage: these orthotics provide a small amount of support for the average shaped foot.
Disadvantage: If the patient’s foot is not the same or similar to the shape of the store-bought orthotic then the level of comfort and support will be minimal if any is achieved at all.

Store-bought orthotics tend to be less expensive.

Advantage: They are less expensive which can be a good thing.

Disadvantage: Insurance companies will NOT cover the costs associated with store-bought orthotics and due to the wear and tear to the materials used, replacement is usually required every 3 to 6 months which is much more often than custom orthotics.

Custom Orthotics

Custom orthotics provide a large number of design options with respect to materials used so that the orthotic can be designed exactly to your needs.

This allows for a customized fit, feel and design for each individual and for the types of shoes that they wear. We can take into account the person’s foot, biomechanical control needs, the type of shoe the custom orthotic will need to fit into, the persons’ activities and any material allergies or discomfort the patient may have.

Custom orthotics tend to be more expensive.

Disadvantage: It is recognized that custom orthotics do have a rather large upfront cost

Advantage: When custom orthotics are made by a properly licensed professional, insurance companies will cover a portion, if not the entire cost, of the custom orthotics.

Key Factors to Consider:

Durability: The “lifespan” of store-bought orthotics are shorter than custom orthotics due to wear and tear on the materials used.

Cost: Custom orthotics are much more expensive however some or all of the costs are covered by most extended insurance policies and custom orthotics last much longer.

Time Sensitive: Custom orthotics require time to be manufactured and there is a 2-3 week time period from the examination to dispensation. In moments of urgency, store-bought orthotics can help with immediate relief.

Biomechanical / Motion Control: custom orthotics can be designed with exact specificity to suit your needs. These features are not available in off the shelf orthotics.

For further questions give us a call and we would be happy to answer any questions that you may have.

The 7 Most Common Running Injuries

January 16, 2020 by Target Therapeutics Leave a Comment

How physiotherapy can help prevent the most common running injuries

As a runner, you know how to push through. From bad weather to blisters to stitches on your side, you’ve trained to let the little things slide in order to cross that finish line—even when that comes to pain.

Though the joy of running is unlike anything else, the repeated movements involved can be hard on the body. We’ve all heard the stories or maybe even experienced some of them firsthand—the full-blown injuries that keep a runner’s shoes in the closet for weeks or months.

Whether you’re running for pleasure or training for a race, you’re bound to have aches and twinges along the way. Injury prevention isn’t about the absence of pain; it’s about having the right reaction when that pain comes along. A timely response will help you avoid acute injuries that could pull you from the pavement for an indeterminate hiatus.

A physiotherapy appointment is a great way to get answers to the questions you have about your running pain:

Is it safe to run through the pain?
What are the signs it’s getting more serious?
How can I treat the pain at home?
What exercises will help me keep running?

Your physiotherapist can help you with information, advice, and treatment
to keep you running, injury-free.

Here are the 7 Most Common Running Injuries and When to Book a Physio Appointment.

1. Runner’s knee

While it can affect other athletes, runners are the most commonly afflicted with this pain or tenderness in and/or around the kneecap. According to a University of Calgary study, this type of pain accounts for 57% of all knee problems in Canadian runners— if you’re having pain in this area, it’s most likely runner’s knee.

Book a physio appointment when: You’re having twinges on the outside or inside of the knee when you begin your run, but then seem fine throughout, only to flare up afterward or during prolonged sitting—this is a sign that things could get worse without physio treatment.

2. Achilles tendinitis

Up to 20% of runners are affected by this injury, which appears when the Achilles tendon (connecting the two major calf muscles to the back of the heel) comes under too much stress. The tendon tightens and gets irritated, leading to the pain in the back of the foot.

Book a physio appointment when: You’ve got a dull pain in your heel during and after a run, but at home remedies like ice usually take care of it—book a physio appointment before this pain shows up even when you’re not running

3. Hamstring issues

Your hamstrings make up the majority of the muscles in the back of the thighs, propelling you forward during your run; injuries involving this group can be an issue of flexibility or strength. Hamstring strains are common and take a lot of time to heal—re-injuries often occur without the proper physiotherapy and if the re-introduction of training is rushed.

Book a physio appointment when: You have a constant ache or tightness in the back of your legs when you run, which you try to ease with a slower pace or a shorter stride—you’ll want to get physio before there’s a pop, snap or bruise.

4. Plantar fasciitis

Foot pain accounts for 15% of all running injuries, with plantar fasciitis mat the top of that list. This injury involves small tears and inflammation of the tendons and ligaments of the foot, resulting in pain that might feel like a dull ache or bruise along your arch or heel.

Book a physio appointment when: You’re having foot pain when you first get out of bed, walking around after sitting or the first few strides of a run. It may disappear after that, but you’ll want to avoid having that constant pain by consulting with a physiotherapist as soon as possible

5. Shin splints

Also known as medial tibial stress syndrome, this achy pain down your shins makes up about 15% of all running injuries. It may seem small, but these are actually tears happening around your shinbone and can develop into something more serious.

Book a physio appointment when: You can walk and even jump without pain, but there’s a tightness and ache around your shin when you run. Before it becomes too tender to touch (or walk), see a physiotherapist for simple ways to correct the issue.

6. Iliotibial (IT) band syndrome

When the band that runs along the outside of your thigh—connecting hip to knee and shin—gets irritated, runners experience a pain down the outer area of the knee joint. At 12% of all running injuries, it’s often mistaken for a knee injury.

Book a physio appointment when: Two to three kilometres into your run, you start experiencing pain and tightness on the outside of your knee. If you walk it out, the pain disappears, but this means it’s time for physio—before you hear the clicking or popping sensation of the IT band snapping against the joint.

7. Stress fracture

For runners, the constant impact of activity can cause too much strain on the shins, feet or heel bones and lead to a stress fracture—the most serious of all running injuries. Different than an acute fracture that happens in one brief moment, stress fractures happen gradually, which means they can be prevented.

Book a physio appointment when: You’ve got pain when you run, but also sometimes when you’re on your feet for too long. Like any progressive injury, it’s key to listen to your pain and respond early—a physiotherapist can help make sure you’re on track to prevent or recover from stress fractures caused by running.