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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.

 

Playing Sports With Foot Injuries

There are many types of foot injuries common among athletes such as plantar fasciitis, overpronation, strains, turf toe, heel spurs, and stress fractures of the foot. Plantar fasciitis is when the thick ligament in the base of the foot becomes swollen, and causes pain. Overpronation is excessive movement of the foot during gait. Pronation would be normal movement of the gait, but when movements become excessive, it leads to a variety of areas becoming painful due to the overpronation. The most common complaint is a burning sensation or inflammation under the arch of the foot, often called strain or arch pain. Heel spurs are growths of the bone in the heel where soft tissues and tendons connect. Turf toe comes from upward bending of the big toe outside of the normal range of motion. It most commonly occurs in athletes that play on artificial surfaces because a shoe grips the surface and forces and athletes weight forward causing the upward bending of the large toe. This causes damage by stretching the ligaments under the toe. Stress fractures could be caused by overuse due to muscle fatigue in the foot, preventing the muscles and ligaments from absorbing the shock and trauma.

Many athletes continue to play with mild foot injuries. You should remember to properly stretch  before any activities, focusing on their calves to prevent injuries and reduce reoccurring pain. It is also common to wear braces to protect the areas that commonly become overstretched and use shoe inserts such as heel pads. It is important to remember to wear proper footwear and replace shoes when needed.

There are many kinds of treatments required to keep the injury from becoming serious. Most commonly an athlete should immediately ice the injury to take down swelling and inflammation. Applying a compression bandage and resting will also reduce pain and stress on the foot. Rest could include using crutches to keep weight off of the injury to allow proper healing for instance. For plantar fasciitis, make sure calves are properly stretched and refrain from hills or speed work. One should try wearing an arch strap to add support. Those with heel spurs should also try arch straps to reduce strain and ice often. The best remedy would be heel pads. Aside from that, one would need a podiatrist or orthopedic specialist. It may require surgery. Those who are suffering from overpronation or turf toe should invest in a quality shoe to reduce motion. There are special insert and braces for the big toe, as well as shoes with firm soles to prevent bending. Stress fractures usually require rest, so an athlete may participate in lower impact activities to allow rest and healing. Most importantly, one should seek medical advice if pain does not go away or recurs frequently.



Stretching Your Feet

Debilitating foot pain is a problem for many people. But just as stretching the torso can help alleviate back pain, stretching the feet can also mend existing problems and prevent future ones.

The feet carry the entire weight of the human body all day and can get easily strained from overexertion. Persistent sharp pain and cramping in the feet are common problems. Foot pain and problems can be due to any number of causes, and in many cases pain may be eased without medication or doctor visits; however, it is always a good idea to rule out any serious medical issues first with a physician.

Stretching may help relax the feet and alleviate pain at any time, but it is especially important before heavy aerobic exercise to avoid painful cramps or straining muscles in the feet. Stretches should be performed slowly and deliberately without forceful pulling. The stretch should be held for several seconds, and then relaxed.

A great way to stretch out and loosen up the foot muscles while sitting is to cross one leg over the other and pull the toes carefully back without overextending. Start by resting the left ankle on the right knee. With the left hand, gently flex the left foot by pulling back on the toes. Do not pull too hard, just hard enough to feel the stretch in the arch of the foot. Then point the toes of the left foot as far as you can. Rotate the motion of pointing with pulling back on the toes. This should relax and stretch the muscles on the bottom and the top of the foot. Doing this stretch ten to twenty times should bring relief. Repeat the whole process for the other foot by resting the right ankle on the left knee.

A stretch that focuses on the often injured Achilles tendon involves standing, facing a wall, with your arms out and hands flat against the wall. Step back with one foot, keeping it flat against the floor. Move the other leg forward and lean toward the wall. You should feel a stretch through the back of your leg and your Achilles tendon, but do not push yourself too much. Stop when you feel the stretching sensation and hold for 30 seconds. Ten repetitions may be done for each foot.

Stretching the feet is important for athletes or those performing aerobic exercise, but it can also help anyone with foot pain caused by poor footwear, plantar fasciitis, or long hours standing and walking. Individuals who tend to their feet by regular stretching every day should be able to minimize foot pain and prevent new problems from arising.



Effect of High-Heels on the Feet

Women have been wearing various kinds of high-heels for hundreds of years, mostly for aesthetic reasons. Shoes with heels make their wearer appear to be taller and to have longer and thinner legs, and change the wearer’s gait and posture. High-heels’ association with femininity have kept them popular over the years, but there are definite health problems caused by wearing high-heels too frequently.

High heels also limit the motion of the ankle joints as well when they are worn. The ankle is a very important joint in the body when it comes to walking. These joints have a great deal of weight put on them because of their location. This is why it is so important to keep them as healthy as possible. The main tendon in the ankle is the Achilles tendon. Studies have shown that wearing high heels often causes the calf muscle and Achilles tendon to shorten, and stiffens the Achilles tendon as well, which can cause problems when shoes without heels are worn.

By forcing the toes into a small toe box, and putting a great deal of pressure on the ball of the foot, high-heels can cause or worsen many foot problems, such as corns, hammertoe, bunions, Morton’s neuroma and plantar fasciitis. 

Wearing high-heels regularly, especially very high ones, can have long term negative effects on many other parts of the body, as well as the feet. One of the most important joints in the entire body, the knees, can be affected by wearing high heels. Wearing high heels causes the knees to stay bent at all times. It also causes them to bend slightly inward as well. Many doctors believe that constantly walking like this is the reason that women are so much more likely to suffer from osteoarthritis later in life. High-heels also cause increased stress on the knees by limiting the natural motion of the foot during walking.

The back may also be negatively affected by high heels because this shoe style causes the back to go out of alignment. This affects the spine’s ability to absorb shock, and can cause continued pain in the back if high heels are worn constantly. High-heels also compress the vertebrae of the lower back, and can cause overuse of the muscles in the lower back.

This is not to say that high heels should never be worn. They will not cause serious problems if they are worn only occasionally. However, they should not be worn every day in order to avoid long term physical health problems to the feet, knees, ankles and back.


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Dr. Mayer Salama and Dr. Daniel Salama
3408 West Rd (In Grange Plaza)
Trenton, MI 48183 -(734) 676-4664

2200 Monroe
Dearborn, MI 48124 - (313) 274-0990

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