Thursday, May 16, 2019

Beware of Flip Flops!

As the weather changes to warmer and sunnier, we are all excited to get out the summer shorts, and yes, the flip flops! As popular as they are, they can cause some serious problems for your feet and your body.

The lack of an arch can cause the plantar fascia to abnormally stretch in the arch, which can lead to plantar fasciitis and heel pain. The lack of a supportive sole doesn't offer proper shock absorption, which can lead to stress fractures.

The thong that separates your toes on flip flops can cause blisters irritation, and wounds, as well as making your toes scrunch at the wrong time as you walk. This can shorten your stride and make you leg muscles work harder, leading to conditions like claw toes, shin splints, and muscle pain. The lack of a backstrap can can also cause the toes to scrunch more to get a grip on the flip flop, leading to the same conditions.

Flip flops can also harbor bacteria and fungi, so it is important to disinfect then regularly. They also get pretty slippery in wet grass or around the pool, and you have to be careful not to run in them and slip out of them and fall! (guilty)

And last but not least, there are many emergency room visits from tripping over your flip flops and stubbing toes. You can tear your toenails, fracture to your toes, and sprain your toes or ankles. Not to mention the people who do yard work in flip flops and injure or amputate their toes 😭. And have you ever gotten your flip flop stuck under the gas or break pedal while driving? You should NEVER drive or do yard work in flip flops - always wear protective shoes when working around equipment.

Flip Flops are best worn around the pool for a short time. If you have to wear them, please limit your time and be step carefully!


Friday, May 10, 2019

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

Thursday, May 2, 2019

Do You Have Questions? WE HAVE ANSWERS!!

We get great questions every day from our patients, and if they are about something we think other patients may be wondering about we add them to our FAQ on our nolaro24.com patient portal.

Here are a few examples:



HOW DO I ORDER OR RE-ORDER?


QUADRASTEP® and littleSTEPS® foot orthotics are sold through Practitioners and clinicians. You may use our FIND A PRACTITIONER Tool to locate someone in your area. If there is not a local practitioner or clinician in your area, you can Email Us and we will try to assist you in finding someone that you can order from online or by phone.

WHAT IS THE BREAK IN PERIOD FOR MY NEW ORTHOTICS?
Most patients should be able to gradually increase their wear time over a 7-10 day period. This begins with normal activity and gradually works towards more strenuous activities, such as sports. It is recommended that all foot orthoses be worn with socks to avoid blisters.

HOW LONG WILL QUADRASTEP® OR littleSTEPS®ORTHOTICS LAST? WHEN SHOULD THEY BE REPLACED?
Depending on usage and body size, a pair of our orthoses should last approximately 1-2 years. You should check you orthotics every few months for signs of wear and tear that might change the way your orthotics are supporting your feet.

For more Q&A, please refer to our FAQ page, and as always, we love to hear from you!

For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Thursday, April 25, 2019

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.

Our QUADRASTEPS Foot Orthotics for adults can address discomfort from many common foot problems, see your practitioner and find out your Foot Type! Each Foot type has it's own unique foot pathologies, and each one treats a different set of symptoms.

Get relief TODAY! Find a practitioner who dispenses QUADRASTEP foot orthotics.
For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS

Thursday, April 18, 2019

Are You Concerned About Your Child's Feet?

You are not alone. It is not uncommon for parents to be concerned about their child's feet!

Ever wonder if foot orthotics would help your child? Does your child have poor balance or coordination, awkward gait, or tend to trip and fall? Do they habitually walk on their toes or walk with their feet turned in (“intoeing”)? Does your child fatigues easily and often want to be carried? Do they have any pain related to walking, or has frequent or severe growing?

If the answer is YES to any of these questions, it's possible that littleSTEPS® foot orthotics will lessen symptoms by providing a straighter, more normal aliment when they walk, run or play.



Consider Genetics! Many adults recognize that they have feet genetically similar to their parents, but many not realize that they might have passed on these same foot traits to their children! Help your children avoid acquiring your foot problems by having their feet screened by a qualified clinician who can help you determine if treatment should be considered.

Foot Facts:

  • It is normal for a child's foot to appear flat up until about the age of 2 due to a thick layer of baby fat that fills the arch area. As long as the child is otherwise healthy, and the foot is flexible and free of pain, then no treatment is necessary.
  • A child's arch becomes more apparent around the age of 3 when the fat pad begins to disappear. At this age it is normal to observe a good arch when the child is sitting or lying down. Upon standing however, the arch may look very low. In most cases, this may be completely normal.
  • It is uncommon for children to complain of foot pain. Be aware that “Growing Pains” are not always normal and may be a sign that your child may have an unstable foot. Any child complaining of pain should be seen by their doctor to rule out a potentially serious condition and to determine if they are a candidate for foot orthotics.


What Can Be Done?
There are many things that can be done to manage your Child's condition. Your healthcare provider can help diagnose the condition and recommend appropriate treatment. Intervention may include balance and coordination exercises, in addition to littleSTEPS® foot orthotics for kids.

Need help finding a provider that carries littleSTEPS®? Try our FIND A PRACTITIONER Tool or EMAIL us for a recommendation!


For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS



Friday, April 12, 2019

Do You Know Your All Important Foot Type?

Did you know that the function of your feet, how you walk, and common conditions are all genetic? If your parents had flat feet, or bunions, or shin splits, chances are that you could have these conditions too? You also stand the chance of passing these conditions along to your kids. 


WE CAN HELP! There is something you can do about it before symptoms become worse. Find someone who can tell you your foot type and what symptoms and conditions you are likely to experience throughout your lifetime. There are ways to treat these conditions to help prevent further pain or deterioration. A well-fitting pair of functional orthotics is one of the ways you can stabilize your body, walk correctly, and experience less painful symptoms.

ASK YOUR PRACTITIONER How you can get foot typed and get started on a path to less PAIN. If you don't have a practitioner, we can help you find one. Check our FIND A PRACTITIONER tool on our website.

And don't forget your kids, we have children's models available. For more info check our website.


For more information EMAIL US
Twitter: @LSteps @QuadraSTEPS







Friday, March 22, 2019

The Importance of Treating Feet in Children with Down Syndrome


March 21, 2019 was World Down Syndrome day, and our own Dr. Louis DeCaro, DPM participated in an interview on Mass Appeal, along with cardiologist Meaghan Doherty, MD, on some of the advances made in the treatment of people (particularly children) with Down Syndrome. They brought along superstar Ella, who definitely upped the cuteness factor! Ella has been wearing our littleSTEPS foot orthotics since she was about 2. Check out the interview!


Watch the interview HERE

The Importance of Treating Feet in Children with Down Syndrome


By Dr. Louis J. DeCaro with permission from ACFAP QUARTERLY


The Responsibility of the Pediatric Podiatrist

The goal of any practitioner, no matter what their specialty, should be to better the lives of their patients using every tool available to them without bias. As podiatric physicians we have the unique ability to use all forms of medicine, including surgery, on our patients. It is my belief that a well-rounded podiatrist should be someone who recognizes the implications of foot ailments at the earliest of ages in order to prevent adult problems. That is why I have chosen to specialize in podopediatrics. The feet are the foundation of the body, and from the first step a child takes, deficiencies in the lower extremity begin to create a destructive domino effect on the rest of the human body. It is our job as podiatrists to make sure the feet are taken care of. Whether a child has a simple or complicated medical history, their feet should be screened and treated like those of anyone else. Children with the diagnosis of Down syndrome are no exception.


“Normal” Development of the Pediatric Foot

Let’s talk about what should occur with foot maturation of any child regardless of other medical diagnoses. At the age of 2 years old, the heel bone should sit at about 4 degrees or so everted (means that when you look from the back of someone the heel bone looks like its collapsing down and in.) From 2 years old until 6 years old the “normal foot” should lose about 1 degree of the “eversion” per year and at the age of 6 the heel should stand somewhat “straight up.” This allows an arch to be present. The foot support is on the outside, bringing the center of gravity to a more neutral  stance. Another phenomenon that is “supposed to happen” as we grow older from the age of 0-6/7 is that our lower leg bones start to turn out, and we get a more erect stance. For a majority of those with Down syndrome these two “normal” processes do not occur adequately.


The Down Syndrome Patient

In a patient diagnosed with Down syndrome, there are a multitude of concerns which may be present involving the heart, digestive system, spine, eyes, intellect, joints and mobility. Individuals with Down syndrome typically have problems with collagen, which is the major protein that makes up ligaments, tendons, cartilage, bone and the support structure of the skin. This creates significant laxity from the feet up, thus beginning at a young age the life long destruction of the kinetic chain. “Almost all of the conditions that affect the bones and joints of people with Down syndrome arise from the abnormal collagen found in Down syndrome.”1 The resulting effect in 88% of the Down syndrome population is hypotonia, ligamentous laxity and/ or hyper-mobility of the joints.2 The combination of this ligamentous laxity and low muscle tone contribute to orthopedic problems in people with Down syndrome.

Within the feet, the most common foot problems which can be found in the Down Syndrome patient are “digital deformities, hallux abducto valgus, pes plano valgus, metatarsus primus adductus, hyper mobile 1st ray, brachymetatarsia, haglunds’ deformity, syndactaly and Tailors bunion.”2 Genu valgus and subluxation and/or dislocation of the patella are another concern due to this condition. Hip and spinal issues are often seen as well.1 Overall laxity of the feet has been reported in 88% of children with Down syndrome.3 This percentage is far higher than those without, yet what I see is that often their feet are ignored. The primary medical diagnosis seems to trump the importance of good foot health. I’m here to say it should not. All medical issues should be addressed.


Specifically the Feet

Many patients with Down syndrome have flat feet due to laxity, which we know will not cure itself. We need to screen for this early. This troubling flexible flat foot can be spotted at  a very young age. Unlike many children though, this flat presentation does not go away by the age of 3 but continues causing foundational destruction to the rest of the body as the years go on.

What I have seen with my young Down syndrome patients is an inability of the heel bone to come out of eversion. When that happens the arch, the ankle, and inevitably the rest of the body stay flat and become “dragged down” toward the midline. This causes many kids with DS to have trouble sustaining good strength when they stand and building good core musculature. This “collapse” will impair normal external rotation of some long bones of the body, which leads to multiple postural changes. As well, when physical therapy is called upon to strengthen the child, failure or delay of achieving a strong kinetic chain is inevitable. You can’t build on a poor foundation! Not only will the structure not support it, but due to poor foot alignment the muscles during the exercises may not even fire.


Quality of Life Factors for Down Syndrome Patients

According to Benoit, “when a person has limited ability for movement, there is bound to be some restriction in exposure to learning opportunities and social stimulation, and this privation tends to be reflected in depressed intellectual ability.”4 In other words, by allowing the patient to be more mobile, the patient’s overall well being will be increased. This is critical since those with Down syndrome are living twice as long as they were 25 years ago.5 In fact, studies have shown that those with Down syndrome live longer when they have developed good self-help skills.6 What better way to encourage self-help than to enable a patient to walk, run and be physically active over the course of a lifetime? It is a known fact that with Down syndrome comes an increased incidence of Alzheimer’s disease. With that typically comes an increase in proteins called Amyloids. Researchers at Washington University in St. Louis found that there was a correlation between a sedentary lifestyle and a higher level of amyloid deposition.7 Thus, the science is once again telling us that inactivity can lead to an early demise. Obesity is also common in Down syndrome patients, partially due to inactivity. By correcting the biomechanics, inactivity may be lessened and quality of life may be increased.


Treating the Pediatric Foot

As a pediatric specialist, now with 11 years of experience, what I find troubling is that identifying problem feet at an early age is non-existent in the medical community. This is especially true in those with Down syndrome. Not only are the feet typically last to be looked at but also being that there can be a plethora of other ailments, the feet get little notice. I try to base my practice on the simple fact that “feet are feet!” A person’s foot type is their foot type no matter what medical condition they may or may not have. Unbeknownst to them, many practitioners fall guilty of not recognizing and treating important issues like flat feet when they become focused on what they deem “larger problems.” I have made it a personal mission of mine to get out to groups across the country, such as parental Down syndrome support groups, pediatricians, fellow podiatrists, Early Intervention specialists, PT’s and OT’s and various other specialists, and lecture on the importance of recognizing the feet and its association of their improvement with improved quality of life.


The Overall Plan

Figure 1: A functional UCB type orthotic, with a high medial and lateral sidewall flanges, such as littleSTEPS, combined with supportive footwear, can be highly effective for the typically flexible foot of a young child with Down Syndrome.
Orthoses need to be specifically designed to improve coordination, balance, pain, posture, and strength, and to aid in the development of a more stable and functional gait. These orthoses should be comprised of a deep heel cup, a medial heel skive, and high medial and lateral sidewall flanges. (FIGURE 1) Control of the subtalar joint is paramount. Often kids are over-braced with AFO’s due to lack of foot control. By providing adequate foot control, SMO’s and AFO’s are often times not necessary. I find many children who are “over-braced” lack necessary joint movements and muscle development vital for normal growth and maturity.


Complementary solutions to Early Biomechanical Support

Physical Therapy progress typically associated with Down syndrome motor development is slow; and instead of walking by 12 to 14 months as other children do, children with Down syndrome usually learn to walk between 15 to 36 months. Specific physical therapy recommendations to consider, along with inserts/ orthotics/SMO’s, include: “Strengthening of lower extremity musculature (hips, knees, ankles, and feet) aimed at improving push off and augmenting support of the knee joint. Heel cord stretching with the heel in neutral alignment when limited passive range of motion exists. Lastly, Dynamic balance activities, such as running or descending stairs, which encourage the child to shift their weight during late swing phase rather than waiting until heel contact.” 8 These are very good  recommendations. I, along with many therapists in my area of practice, am seeing that when orthotic inserts are prescribed along with physical therapy, the improvement really sticks and builds. I see children in therapy all the time that have these everted/flat feet who just either never or too slowly build on strength absent there orthotics. Building better foundation helps those muscles move along faster.


Getting the Down Syndrome Patient to Make an Appointment

But to treat a Down syndrome patient, you have to see them. That is where the education piece is so critical. In many of our communities, we have Early Intervention services for babies born prematurely or with medical concerns. This can be the place where an initial referral can originate. When an EI therapist understands the importance of the feet and biomechanics in the development of any child, she/he can screen for this. With early intervention, Down syndrome patients can have a better outcome in meeting their  developmental milestones and lessening their risks of Alzheimer’s and obesity.


In Summary

So what can you do to help? As podiatrists, we are in the unique position of being trusted medical professionals of the lower extremity and its effects on the kinetic chain. This gives us the ability to get out and educate, educate, educate. Preparing the community of people who work with the Down syndrome patients is the key to getting these clients proper foot care early in life in order to allow them a better chance at a long, healthy, active existence. “Treatment of painful feet in patients with Down syndrome is imperative because foot pain leads to relative immobilization and immobile retarded adults do not remain long in the community.”9 My goal as a practitioner and someone who recognizes the progression of foot types is preventing pain by knowing how to deal with it before it happens, coupled with improving overall biomechanical strength and structure. No matter a child’s medical diagnosis, it is important to educate parents and their children what their “foot type” is, and what that may bring them during their adult years. Please feel free to reference my websites www.nolaro24.com and http://www.decaropodiatry.com for additional
information regarding my practice and its methodologies.


References
1. Leshin, L. (2003). DS Musculoskeletal Conditions in Down Syndrome.
In Musculoskeletal Disorders in Down Syndrome. Retrieved
May 25, 2012, from www.ds-health.com/ortho.htm.
2 Rogers, C.: Carers Knowledge of common foot problems associated
with people with Down’s Syndrome. University College
Northampton, 2002.
3 Aprin H, Zink WP, Hall JE: Management of dislocation of the hip
in Down syndrome. J Pediatr Orthop 5: 428, 1985.
4 Benoit, E.: Podiatry and mental retardation: The podiatrist’s
role. J.A.P.A., 55: 434, 1965.
5 Young, E. (March 22, 2002). New Scientist. Down’s syndrome
lifespan doubles. Retrieved June 5, 2012, from www.newscientist.
com/article/dn2073-downs -syndrome-lifespan-doubles.html.
6 Eyman RK, Amer J Mental Retard, 95(6): 603-612, 1991.
7 Head, D., Exercise Engagement as a Moderator of the Effects of
APOE Genotype on Amyloid Deposition, January 9, 2012.
8 Selby-Silverstein, L.: The effect of foot orthoses on standing foot
posture and gait of young children with Down Syndrome. NeuroRehabilitation
16 (2001) 183-193.
9 Diamond, L.S. and Lynne, D. et al., Orthopedic disorders in
patients with Down’s syndrome, The Orthopedic Clinics of North
America 12(1) (1981), 57-71.