Tuesday, June 5, 2018

Why Do Your Child’s Toes Point Inward When They Walk?

By Brandon Macy, DPM, Clark, NJ
Many parents notice that their child’s toes point in when they walk—also known as an “intoe gait”.  At times it is also referred to as being “pigeon toed”. It can look awkward and sometimes a child can not only look clumsy, they may indeed trip and fall more than is usual.
There are several reasons toes point inward and sometimes more than one can be at play.  The key to treating is to identify the source of the problem.  
Most commonly there are biomechanical issues at the root of the problem. Disproportionate hip rotation where they turn inward more than outward is often the problem.  As similar situation can also happen at the level of the knee. There can also be torsional problems of the leg or thigh bones.
Within the foot, if the front part of the foot is tilted towards the outside as compared to the back part of the foot, the forefoot will rotate or flop inwards as the ball of the foot lands in the gait cycle.  Alternatively, due to congenital issues the front part of the foot can turn inward as compared to the back part of the foot. Known as metatarsus adductus, this is treated by serial casting in the very young and may become a surgical problem if older.
How is the intoeing best treated? By utilizing an orthotic—often one of our LittleSteps children’s orthotics which help balance the foot properly.  Very often we’ll use a specialized orthotic called a gait plate for a while and this helps encourage the foot and leg to turn outward and function more normally.
Asymmetrical hip rotation is made worse when a child in the “W” position with their feet outside their hips.  They should be encouraged to sit cross-legged and to participate in activities such as skating or horseback riding to increase external hip rotation. We may also recommend certain exercises and possibly refer for physical therapy to help strengthen and balance the muscles, tendons and ligaments.
The takeaway point is this: don’t let well meaning people tell you to let your child “grow out of” intoe issues!
For more information or an appointment, visit Dr. Macy's website at www.clarkpodiatry.com
"At Clark Podiatry Center and the New Jersey Children’s Foot Heath Institute, we want to keep you and your child walking!"
For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Friday, May 25, 2018

Troubleshooting: Getting Foot Orthotics to Fit Correctly in your Shoes.

By  Kylie Pearce, B.Sc (Podiatry), C.Ped

There’s an old maxim in the Podiatry and Pedorthic world that, an orthotic is only as good as the shoe you put it in. This has proven to be very true and it is worth discussing this in detail when going over orthotic therapy as an option. This is commonly referred to as having the ‘shoe talk’. It doesn’t matter how expensive and customized your foot orthotics may be, they could end up having little functionality and benefit if you decide to wear them in shoes that are worn, fit incorrectly or aren’t well designed to accommodate foot orthotics.

It’s important to educate anyone who is considering foot orthotics that they need to look at what shoes they will wear with them and make sure that the shoes aren’t too small to accommodate the orthotic devices because orthotics do take up some room in your shoes and there needs to be adequate, length, width and depth to ensure that your feet will fit correctly in your shoes with foot orthotics.

It’s really important that the orthotics sit correctly at the back of the shoe, the heel cup should cup around your heel and there shouldn’t be any gap between the orthotic and the back of your shoe (heel counter). If you have shoes that a long enough, wide enough and deep enough, there are a few other factors to consider. Many shoes have a build in foot bed, if you remove this and replace it with your orthotics then usually fit problems are lessened. But in certain shoe styles, like elastic sided boots, the orthotics have a tendency to slip forward, especially if the heel height is greater than an inch. If you are wanting to wear your orthotics in shoes that have heels higher than an inch, you should discuss this with the practitioner who is issuing your orthotics because the orthotics may need to be customized for this.

Unfortunately these days, many athletic shoe models aren’t orthotic friendly. Shoe brands that are notoriously bad for accommodating orthotics are Nike, Adidas and Reebok. Please refer to our shoe recommendations by foot type list that you can download here.

Here’s some tips on troubleshooting these problems:

The orthotic isn’t seating itself back far enough in the shoe, or it has a tendency to slide forward when you put your foot in the shoe. This is commonly because of shoe fit or shoe style problems as discussed above but if you have shoes that fit correctly and are a suitable style then a simple way to prevent this is to use a little bit of double-sided tape or Velcro to ensure that the orthotic doesn’t slip forward. If the orthotics do slide forward when you are putting on your shoes, usually if you tap the back of your heels the orthotics will slide back into place and often your weight is enough to keep them there. If not, try the Velcro or tape trick. Just place double-sided tape under the heel of the orthotic and in the center of the heel area in your shoe if you are using Velcro.

The other possible problem is that the orthotic is too wide.  To test this, stand on the orthotic outside your shoes and look down at your feet. If the orthotic is not wider than the circumference of your foot i.e., you can’t see any of the orthotic when you are looking down then the orthotic is not too wide! If the orthotic is wider than your foot, your practitioner can have this adjusted for you.

So it basically comes down to:
The orthotic is too wide  - this is rare because your orthotics should have been fitted correctly when issued to you. 
Or, the shoe is too small (not wide enough, deep enough or long enough).
Or the shoe style isn’t really suitable for orthotics.

If your orthotics feel good and look like they fit correctly when you are standing on the orthotics when they’re not in the shoe, then it’s most likely a poor fit between the orthotic and the shoe. Have a look to see if the orthotic sits all the way back into the shoe.  Some shoe styles, like dress shoes or even Nikes and Adidas – really cut out the midfoot and the orthotic doesn’t sit properly in the heel counter.  This can be an issue. The answer is to look for a better shoe style, or cut the orthotic down, which reduces correction, so this is only indicated when the orthotic is too wide or if there are restrictions on what styles of shoes can be worn. Sometimes there is a balance between getting the right amount of correction and getting 
orthotics that fit well in your shoes. But in my experience starting off with the right shoe style that accommodates foot orthotics well and fits your feet correctly will get you off on the right foot in regard to getting you the maximum benefit from wearing foot orthotics.

For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Friday, May 18, 2018


Make sure their littleSTEPS® Foot Orthotics or Gait Plates are the right size, because they play such an important role in your child's:

  • Gait
  • Posture
  • Balance
  • Comfort

Do A Quick Check!

Find the Next Size

CALL your practitioner and order the next size up!

If you need help finding a practitioner, try our FIND A PRACTITIONER tool on our website

For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Friday, May 4, 2018

Why Does Your Child Walk On Their Toes?

ReBlogged from Dr. Brandon Macy, Clark Podiatry Center
Link to original blog

“Get up on your toes” is a figure of speech urging you to prepare to start something energetically. But when your child appears to be walking on tiptoe most of the time, you sense that something isn’t quite right.

Many parents fear something dire is going on, whether it might be tightness of the Achilles tendons in need of intensive physical therapy, surgery or some neurological issue which sounds even worse. Fortunately, although those situations do sometimes happen, more commonly the answer is far simpler and easier to deal with.

Feet which overpronate (flatten) too much are unstable—there is a lack of ‘leverage’ during walking and running—which is a very inefficient way of getting around. To combat this, raising up on the toes puts the foot in a more stable position. Also, depending on the balance between the forefoot and the rearfoot and the tightness of the Achilles tendon, the heel may lift off the ground prematurely during the gait cycle.

In these cases, muscles, tendons and ligaments have to work extra hard resulting in early fatigue, achiness and pain, affecting their gait and their athletic activities. Over many years, this can lead to foot deformities and arthritic damage to the feet, knees, hips and back.

Most of the time, if your child can stand with both heels on the ground, there is no major tightening of the Achilles tendon. Fortunately, providing proper support and balancing of the feet with a good set of orthotics such as our LittleSteps pediatric orthotics or our adult versions for those over the age of 10 can help deal with the majority of these situations. Using good orthotics on a daily basis can change things rather quickly, decreasing the toe walking and allowing your child to participate fully in their sports activities with less fatigue and pain—not to mention preventing larger problems into adulthood.

For more information visit our website at www.clarkpodiatry.com.

At Clark Podiatry Center and the New Jersey Children’s Foot Health Institute, we want to keep you and your child walking!

#ToeWalking #ClarkPodiatryCenter #NJCFHI

For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Friday, April 13, 2018

Spring Sports Injuries

It's springtime, and with that our kids are just ending basketball season and starting baseball season. While we love having our kids participate in organized sports, they are more susceptible to injuries than you might think.

Basketball Injuries to the Foot and Ankle

Basketball players put a lot of stress on their feet which can lead to injuries to the foot and/or ankle from jumping, running, quick starts and stops, and contact with other players. Some common problems that can arise from playing basketball are:

  • Ankle sprains that can damage the ankle ligaments, and can be associated with peroneal tendon injuries, fractures, and chronic ankle instability. 
  • Overuse and can lead to heel pain (plantar fasciitis), Achilles tendonitis, sesamoiditis, stress fractures, posterior tibial tendonitis (or PTTD) and calcaneal apophysitis in children and adolescents. 
  • Fracture of the fifth metatarsal base, which can be due to the constant, running and jumping, as well as foot structure.

Baseball Injuries to the Foot and Ankle

Every year, approximately three million children play baseball in the USA. Many of these kids play from elementary school throughout their middle and high school years. Common problems that can arise are:
  • Ankle sprains that may occur while running, fielding balls, stepping on or sliding into bases. Sprains should be evaluated by a qualified clinician to determine the extent of injury. Untreated they can lead to chronic ankle instability and recurrent sprains.
  • Overuse by focusing on only one sport can cause Achilles tendinopathy or heel pain such as plantar fasciitis, or calcaneal apophysitis in children and adolescents. 
  • Stress fracture
  • Catchers are prone to plantar fasciitis from squatting constantly
  • Peroneal tendonitis
  • Anterior Ankle impingement (especially in catchers)
  • Bruising can occur from impact with the ball or contact with other players
  • Cleats can cause aggravation of neuromassesamoidsbunions and hammertoes. It is important to make sure that cleats are fitted properly by someone trained to do so.
  • A common injury seen in pitchers and catchers is ingrown toenails. If ignored, they can lead to a nail infection and cellulitis.

 Some Common Signs of Foot Problems:

  • Your child has poor balance or coordination, awkward gait, or tends to trip and fall.
  • Your child habitually walks on their toes or walks with their feet turned in (“intoeing”) for no known medical reason.
  • Your child fatigues easily and often wants to be carried.
  • And Yes, If you child has any pain related to walking, or has frequent or severe growing pains.

Preventing Foot and Ankle Injuries in Kids

The growth plates in children’s bones are not mature until their later teen years, and these immature bones, as well as the surrounding tendons and ligaments, are more susceptible to both traumatic and stress injuries. 

Proper footwear, including shoes specifically designed and constructed for one specific sport, is also an important part of preventing sports injuries in kids.
Foot orthotics can be a part of your injury prevention scenario, and if you see any signs of difficulty or pain when your child is playing sports, they should be evaluated by a certified clinician immediately.

It’s important to choose the correct foot orthotic for your child. Consider littleSTEPS® foot orthotics for kids up to teens, and QUADRASTEP® foot orthotics for older teens. They are the closet to prescription foot orthotics that you can get in a prefab and they are more affordable than custom orthotics!

Friday, April 6, 2018

Looking for a Practitioner in Western CT?

Stride Pedorthic Center is located in Middlebury CT. Stride is a full service location where you can not only see a certified practitioner, you can also pick up shoes, orthotics, and accessories.

"Nolaro’s Quadrastep Orthotics are the closest thing to Stride Custom Orthotics that you can get without casting a patient’s foot. They’re more functional than many of the custom orthotics I’ve seen, thanks to the differing rigidity of each model and quad-specific rearfoot and forefoot posting. Quadrastep Orthotics can also be customized with additional posting, met pads and top covers! Nolaro co-founder Roberta Nole has invented a cost-effective bridge for the wide gap between over-the-counter insoles and custom foot orthotics."

Clinicians at Stride Pedorthic Center use a patented, proprietary method of gait evaluation that helps them to identify and relieve injuries that you may have sustained in weight bearing and gait. Stride’s system is so effective that it has helped clinicians to identify patients’ susceptibilities to injury which, consequently, has led to the prevention of foot, ankle, knee, hip and back pain.
Stride has a comprehensive Diabetic Shoe Program where you will be evaluated and fitted by our clinicians, who have years of diabetic shoe fitting experience and are eager to find the right fit for you. Stride provides diabetic approved shoe styles by New Balance, Anodyne, Orthofeet, and other premium manufacturers.

Stride Pedorthic Center has many different shoe styles to choose from, including running, casual, diabetic and sandals from premium manufacturers such as New Balance, Vionic, Aetrex, Revere and more! We also carry a full range of accessories such as socks, foot care products, and shoe products.

Stride clinicians successfully treat hundreds of patients per year by communicating with their primary care physicians, pediatricians, physiatrists, physical therapists, surgeons, orthopedists, chiropractors, custom shoe fabricators and any other professional that can lend to a multidisciplinary enhancement of patients’ biomechanical wellness. 

Roberta Nole, PT, MA, Cped and Scott LaBianco, BOCPD dispense custom and non-custom foot orthotics & ankle-foot orthotics, as well as footwear that effectively Improve How You Move.

Contact us today to learn more and to schedule a fitting at (203) 758-8307 or email info@strideorthotics.com

For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Thursday, March 29, 2018

Common Foot and Ankle Problems

Here are some of the most common reasons for foot and ankle problems:
  • Injuries
  • Congenital foot deformities that occur at birth and can be hereditary
  • Infections (bacterial, fungal, or viral)
  • Arthritis affecting one or multiple joints
  • Tumors, abnormal growths, and neoplasms
  • Issues that arise from ill-fitting or improper footwear, stress, or mechanical changes
Here is a list of some common foot and ankle problems people experience:
Bunions: A bunion is a deformity of the big toe joint that results from bone misalignment or repositioning at the joint. Although bunions occur most frequently at the base of the big toe, they can also arise on the outside of the foot at the base of the small toe.
Fractures: Bones are susceptible to two kinds of fractures: stress and general. Stress fractures are small fissures or cracks in the surface of the bone and usually occur in the forefoot, or the area from the mid-foot extending to the toes. General fractures travel into the bone beyond its surface and can be stable or displaced, as well as closed or open. Stress fractures can become general fractures if not properly treated.
Hammertoe: Hammertoe occurs when the second, third, or fourth toe bends at the middle joint, often as a result of wearing ill-fitting shoes. Genetics, arthritis, and muscle imbalance can also cause hammertoe. With hammertoe, the toe bends downward, rather than pointing straight forward.
Plantar fasciitis: Plantar fasciitis is inflammation of the plantar fascia, the fibrous tissue that runs along the arch of the foot to connect the heel bone and ball of the forefoot. Heel spurs are not the same as plantar fasciitis; however, the two are often associated. Since the plantar fascia is subjected to great amounts of impact and pressure while supporting the foot’s arch, it can become inflamed and irritated. In some cases, it begins to deteriorate.
Heel spurs: Spurs are outgrowths of bone. In the feet, they most commonly occur in the heel. The spurs usually develop in areas subjected to constant pressure. Heel spurs, or bone spurs in the heel, occur on the bottom of the heel bone as a result of calcium deposits forming over time. They frequently accompany the condition plantar fasciitis.
Ingrown toenails: Ingrown toenails, known as onychocryptosis, most commonly occur on the big toe and are caused by pressure that drives the edge of the nail into the surrounding skin. This results in pain, redness, inflammation, swelling, and sometimes, infection. Clipping the toenails too short or exercising poor foot hygiene can also lead to ingrown toenails. Runners and those with toe deformities can also be prone to ingrown toenails.
Neuromas: Neuromas are benign growths of nerve tissue, or nerve tumors, that form when the nerves are irritated by surrounding tissue rubbing against them. Symptoms of a neuroma include intense pain, swelling, tingling, numbness, and/ or a burning sensation in the toes and forefoot area. Neuromas most frequently develop between the third and fourth toes.
Sesamoiditis: In the foot, there are two sesamoids underneath the top of the foot and near the big toe that allow the big toe to move up and down freely. These help with push-off activities such as walking, running, and climbing. Since the sesamoids are exposed to excessive force and pressure during weight-bearing activities, sports, and exercises, they are often prone to injury and trauma, as well as stress from overuse or from standing on hard surfaces for prolonged periods. Sesamoids can fracture or become inflamed.
Ankle Sprain: When the ankle bones twist or receive too much force, the ligaments surrounding the outside of the bones may suffer from over-stretching or tearing, resulting in a painful ankle sprain. There are different levels of severity when it comes to ankle sprains, and if the sprain is not properly diagnosed and treated, it can cause permanent, lasting ankle trouble.
Shin splints: Shin splints, a common condition, happen when the muscles or tendons surrounding the leg bone become inflamed, irritated, and painful, which can result from overuse, a collapsing arch, stress fractures in the lower leg bones, or imbalance between opposite leg muscle groups. Shin splints can be prevented by properly stretching prior to and after exercise, sports, or activity. Corrective shoes or corrective orthotics can also be used to prevent shin splints.
It is important for a patient to seek medical care as soon as possible, as immediate, proper diagnoses, treatments, and care can prevent problems from worsening or resulting in permanent damage.
For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS