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“Encyclopaedia Biomechanica” is published quarterly by Kawartha Total Foot Care Centre chiropodist Sarah Robinson. It features helpful information on different aspects of your body’s biomechanics (how your muscles and joints work together to help you move) and gait (how you walk), the kinds of problems that can occur, and how feet affect your whole body from the ground up.

Are you getting sore feet during your winter sports? Skating and down hill skiing require a snug boot to get the maximum power from your edges. If you have a narrow foot, achieving a good fit can be difficult. In-shoe padding or insoles can help you get a better fit. Even some people with good foot mechanics will need something in their ski boots or skates. For many people, an over-the-counter arch support can make a huge difference. For many others, we need a custom orthotic with correction similar to the correction we need in our walking and running shoes. I personally have a versatile sport orthotic that will fit in both my skates and down hill ski boots, and I also transfer it into my rollerblades in the summer time.

If you are finding that you’re just not enjoying your winter sports as much due to foot pain or fatigue, consider looking into an over-the-counter or custom insole.

Don’t be “sheepish” — wool socks can help protect your feet during winter activities

This winter has been a strange one. The thaws and rain have led to a damper cold than usual. As a result, we have seen a rise in “chill blains”. Chillblains are a cold injury that can happen at much warmer temperatures; for example when feet have gotten wet due to sweat on a warmer day. It looks a bit like blisters, and may itch or burn. It feels tender long after the foot has returned to normal temperature and takes 7-14 days to heal. Sometimes you will need medication to help with the itch if it is severe. To prevent chillblains, make sure your footwear are appropriate. They should be warm, waterproof, and be able to wick moisture away from your feet. Pairing a good winter boot with a wool sock can go a long way to prevent this cold injury. Wool retains its ability to insulate even when it is damp, which can help when you are sweating your way through one of these mid winter or upcoming spring thaws.

Mistle Toes

Christmas is coming which, besides Santa, hearkens the arrival Old Man Winter. Winter can be especially hard on the feet of people with diabetes. So, if you want to stay on the right side of your Chiropodist’s naughty and nice list, here are four tips for people with diabetes to help keep their feet healthy for the winter season.

1. Moisturize. Diabetics are already prone to dry skin, and the low humidity of our northern winter climate makes the problem worse. Dry skin cracks easily, which can lead to skin ulceration or serious infections. Your Chiropodist can provide a proper moisturizer meant for the thick skin of your feet, regular wax bath therapy, and other treatments to combat the problem.
2. Proper winter footwear is essential. It needs to fit correctly, be in good repair, and be suited to your foot type. Poor footwear creates friction points that can lead to skin breakdown and ulcers for people with diabetes. It’s best to shop for your winter boots (or any footwear) later in the afternoon, since your feet swell during the day. If you wear orthotics, be sure to bring them with you for sizing. Your Chiropodist can provide unbiased advice and a prescription to help you shop for what will be best for you.
3. Remember the “wear” part of “winter footwear!” Those fantastic winter boots do you no good if they’re not on your feet. Many people with diabetes suffer from a lack of feeling called neuropathy. This puts them at real danger of frost-bite that can happen without them even knowing it. Also, neuropathy can make people more prone to falling. The warmth and extra traction of winter footwear helps guard against both of these concerns.
4. Just as in any season, regular visits to their Chiropodist are essential for people with diabetes to maintain good foot health and to keep their feet merry all year long.

Web Feet is a quarterly blog posted by Registered Chiropodist David Murphy. Dave has ten years’ experience in his field and works at Kawartha Total Foot Care Centre’s main clinic in Bobcaygeon, Ontario as well as the practice’s sites at Lakefield Physiotherapy & Foot Health Clinic and the Curve Lake First Nation Health Centre.

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The New Shoe Review is published quarterly by Kawartha Total Foot Care Centre chiropodist Nadine Webster. It features helpful unbiased reviews on the latest footwear styles and how they suit different needs for optimal foot health.

Getting ready for back to school includes shopping for nice new shoes for our little ones. We want them to look good of course but they must be comfortable and able to hold up to endless activity. I was very excited to come across the Clark’s Kids line at Bigley Shoes. They are one of only ten stores launching this line into Canada. Watch the sizing as the UK sizes are a half size smaller. There is a wide selection of colours and styles from cute little “first walkers,” boots, dress, casual, and even shoes that have those blinking lights kids love so much. They are made with leather uppers and liners for breathability and firm soles which flex at the toes but are nice and stable overall − not too soft or flimsy. The other wonderful thing is that they are available in half sizes and with up to four different widths. This can help ensure a perfect fit. Clark’s also has a unique measuring system which includes measuring around the foot for girth to help locate size. As with adult shoe fitting you must still check the fit once the shoes are on and look at several things while your child is standing:

• Fit to the bigger foot after measuring both.
• Make sure there is a thumb’s width of room from the longest toe (not always the big toe) to the end of the shoe. With these shoes you can usually feel where their toes are if they “wiggle” them, but another trick that can help is to take the liner out of the shoe (most come out) and see where your child’s foot lands when they stand on the insole. Length/fit should be checked every three months as children can grow a half size or more in that time.
• Check that the width is not too snug. It also helps to shop for shoes later in the day when feet will be a bit wider and to wear the type of foot covering that ordinarily would be used with that particular shoe (ie. a thick vs. thin sock or leotard). Shoes should always be worn with socks.
• Check depth and wiggle room and make sure the little toe doesn’t feel pinched. Look for a nice rounded (not pointy) toe box shape.
• Check that the sides do not rub on or irritate the ankles.
• Check that the shoe grips the heel well and is not slipping and that the shoe is secured on properly (ties/straps). It should not gape at the back or sides and you should not be able to fit a finger down behind the heel.

Make sure you get a professional fitter who is familiar with children’s shoes to help guide you, but listen to what your little end consumer has to say as well since they have to wear them and should be able to walk around comfortably. A shoe should not have to be “broken in” otherwise it is likely not a good fit. Avoid buying them more than a half to full size bigger to allow for “growing room.” They won’t last forever but they are an important investment that needs to fit well. Passing down used shoes is also not ideal for little growing feet.

We usually have our children’s eyes and teeth checked but not their developing feet. We know lots of adults with foot problems but don’t stop to think that these problems start in our youth and may even be preventable. Keeping our children in properly fitting footwear is the first step in helping to protect their feet and preventing problems from developing. Just like flossing and brushing help prevent gum and tooth decay, proper shoes will help prevent foot and nail problems.

Remember our Kawartha Total Foot Care Centre staff and chiropodists (foot specialists) are always here to help your child with any problems, concerns or questions you may have about current pain or gait (walking pattern) or for a general foot health exam and education to make sure your child’s foot health is on the right track.

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Web Feet is a quarterly blog posted by Registered Chiropodist David Murphy. Dave has ten years’ experience in his field and works at Kawartha Total Foot Care Centre’s main clinic in Bobcaygeon, Ontario as well as the practice’s sites at Lakefield Physiotherapy & Foot Health Clinic and the Curve Lake First Nation Health Centre.

There’s a moment of wonder for every chiropodist before reaching into a patient’s shoes at what discoveries might be revealed. From pennies to pins and everything in between, I’ve seen my share of “shoe treasures” over the years. The sheer oddness of some of them may bring a smile to one’s face, but for people with diabetes and diminished sensation caused by peripheral neuropathy, the result can be anything but amusing – skin ulcers, serious infections, even amputations.

Here are a few examples of some shoe finds this year, and they make clear just how important it is for people with reduced sensation to check the insides of their footwear regularly.

1. Tacky Tricks
Shortly into back-to-school season, I removed the insole of one particular teacher’s shoes to reveal a bevy of thumb tacks! Unbeknownst to her, it seems she was the subject of some classroom pranksters. This “joke” could have become decidedly not funny very quickly had the tacks remained undiscovered.

2. Ho, Ho, Hold on a Minute!
The holidays are such a wonderful time full of tradition. Last season, a patient visited me shortly after the family’s annual Christmas tree cutting adventure. Just as he finished telling me that his work boots are the most comfortable boots he has ever owned, I reached in and pulled out a branch with an entire clump of pine needles that would rival any of Charlie Brown’s Christmas trees. Needless to say we went on to further sensation testing.

3. One Piña Colada Please… Hold the Cocktail Umbrella
A patient returned last winter from some fun in the sun with what I thought was a sliver embedded in his sole, perhaps picked up on a long walk on the beach. On closer examination of his deck shoes, I realized that I was right about the sliver but wrong about its origin. It was from an umbrella – a cocktail umbrella to be precise. Perhaps the next time the customs agent asks you to remove your footwear on return from your favorite all-inclusive winter destination you may also want to use this opportunity to check the insides of your shoes for unwanted stowaways!

4. Dog Gone It!
Attention pet owners… knick, knack, paddy whack give a dog a bone? This four legged member of the family used its owner’s shoe as a cozy hiding spot for a favourite bone. Unfortunately for the pet owner who was unaware of what was hiding in his Hush Puppies, the shards of fragmented bone had caused a severe infection by the time I discovered them.

5. Automatic Toe-nition
My last recollection is one that was quite remarkable and humorous to everyone involved… initially. This particular patient could not understand why on earth he could still start his car (push button ignition) when his keys had been missing for days, even leaving him to wonder perhaps about artificial intelligence or some sort of electromagnetic disturbance. He had even involved his mechanic who was also very puzzled. It was only when his wife noticed the bleeding in his socks that she checked his shoes and the mystery was solved. There they were – his full set of keys pushed into the end of his shoe. The patient was completely unaware, felt nothing, not even the bottle opener also attached to his key collection. The sad ending to this story is that complications developed and progressed to the point that his great toe required amputation.

These examples illustrate the severity and potentially life-changing impact of neuropathy. It’s something we see and treat regularly at Kawartha Total Foot Care Centre.

Know the Warning Signs and Your Risks for Neuropathy

Neuropathy can range from a mild tingling or a “pins and needles sensation,” to sharp stabbing pain, and complete numbness. This occurs when the nerves in the feet that supply the brain with sensory information are damaged. Neuropathy can result from a variety of factors such as chemical toxicity, alcoholism, and chemotherapy. However, the most common cause by far of neuropathy and neuropathic changes in feet is diabetes.

In diabetics, the neuropathic changes are caused by the fluctuating blood sugar levels. The inconsistent blood sugar levels, over time, erode the insulating layers that cover the nerves, leading to altered or complete loss of sensation.

Prevention is the Best Medicine

Don’t let a nail in your shoe be the wake-up call to give your neuropathy proper consideration.

1. If you have been previously diagnosed with neuropathy, are diabetic, or have a family history of diabetes, it’s critical to have your feet examined and cared for regularly by a Registered Chiropodist. This assessment should include a full clinical vascular and neurological exam, dermatological exam, biomechanical evaluation, and a footwear assessment, along with ongoing foot medical care.

2. If you are a diabetic, controlling your blood sugar is crucial, having a healthy balanced diet and active lifestyle is a necessity, and getting enough restful sleep is essential in preventing or delaying neuropathic changes.

3. Self Examinations – use your hand and a mirror to check your feet as well as the inside of your footwear daily. This will become habitual and will likely prevent any close calls from becoming a more serious matter later on.

4. For those individuals who have diabetes and/or neuropathy and find their symptoms progressing or find they are having a big impact on daily life, then certain medications may provide benefit. Be sure to measure your blood sugar regularly – you can’t manage what you don’t measure! Bring these results to your family doctors and/or endocrinologist regularly and work with them to manage your condition.

5. At Kawartha Total Foot Care Centre, we have had success with weekly infrared light therapy sessions. This form of treatment helps treat the symptoms of neuropathy and although results are very specific to the individual, it may be the difference between keeping up with your normal daily activities or not.

My earlier stories might be a dose of lighthearted humour, but I know first-hand that neuropathy is no laughing matter. Remember that while we may not be able to reverse nerve damage, chiropodists can certainly help patients to better manage symptoms, prevent impacts from neuropathic foot changes, and improve quality of life.

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“Encyclopaedia Biomechanica” is published quarterly by Kawartha Total Foot Care Centre chiropodist Sarah Robinson. It features helpful information on different aspects of your body’s biomechanics (how your muscles and joints work together to help you move) and gait (how you walk), the kinds of problems that can occur, and how feet affect your whole body from the ground up.

There are a lot of people out there claiming to offer “custom” orthotics. There is that guy who visits the gym with his pressure mat, people at an information booth in the mall, a very professional looking set-up and compelling sales pitch at a trade show, the woman who visits your work place and “does everyone’s insoles,” and the health professionals whose primary focus is not feet but offer “orthotics” as a sideline business to generate additional income.

Unfortunately, orthotics are poorly regulated right now. There is no legal definition of what a custom orthotic is, how it should be made, and anyone can lawfully dispense one. This is not the case for most biomedical devices. Hearing aids, glasses, even compression stockings have tighter restrictions than orthotics.

Who should you choose as your orthotics provider?

Orthotics may be poorly regulated, but Chiropodists / Podiatrists have a regulatory body; the College of Chiropodists of Ontario. This regulatory body has defined what a true custom orthotic is, how it must be made, and what examinations are done to determine the design of the device. Members of the College of Chiropodists of Ontario are the ONLY regulated health professionals whose legal scope of practice includes treatment with orthotic devices.

Our regulations are your protection, and insurance companies have caught on. Most companies have limited their coverage to restrict reimbursements for only true custom orthotics from a member of the College of Chiropodists.

What kind of training is needed to properly provide an orthotic?

Some providers you meet will have been trained briefly by their employer. Others will have taken a “course” as short as an hour — or no course at all! Chiropodists undertake an exhaustive nine semester post-undergraduate podiatric medical program that includes extensive training on biomechanics and orthotics, and how they play a role in treating foot pain, corns and calluses, sports injuries, arthritis changes, and progressive deformities like bunions and hammer toes. We don’t just learn how to “cast” for an orthotic, we learn how to design that orthotic to address your individual problem, and we have the overall knowledge of your foot health to ensure optimal results.

How do I know if I have a truly custom orthotic?

A custom orthotic is made using a three dimensional model of your own foot in a special position called suspended subtalar joint neutral. To achieve this, your foot must be cast using a laser imaging unit or plaster (not a foam box) by a practitioner with the requisite knowledge and skills. If there was no three dimensional capture of your arch, your orthotic is not custom. This includes “walk-on” computerized pressure pads, which by virtue of the technology, may seem impressive but provide only a two dimensional image of your foot and use a “library” or standard sizing system to create the closest match to your foot profile.

Why shouldn’t I shop around for the best price?

Orthotics are “Buyer Beware.” Most of the time, you get exactly what you pay for. If your orthotic wasn’t made properly, it will likely not fully address your problem. It might make things a bit better, and it can make things worse. If you are in pain, it may not allow your injury to heal. If it is not properly designed, it may cause injury. Some just don’t last long, break or bottom out quickly. If they can discount the cost, they are likely purchasing a ‘cheaper’ device. If you have diabetes and your provider doesn’t have the comprehensive foot knowledge of your chiropodist / podistrist, it might even cause an ulceration!

Until the orthotics industry is cleaned up and legally restricted to properly qualified practitioners only, consumers will continue to have to research their orthotics providers. In the end, it’s up to you to make the right step. After all, you wouldn’t see a dentist for a problem with your eyes. Your good foot health is tremendously important, and you can rest assured that when you put your feet in the hands of a chiropodist you’re seeing a skilled, highly trained, and legally regulated foot specialist. Your good foot health is our “sole” interest.

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This is one example of the Sandalista which comes in many attractive styles. Tip: visit a high-quality shoe store for the best variety and a wide selection of sizes.

The New Shoe Review is published quarterly by Kawartha Total Foot Care Centre chiropodist Nadine Webster. It features helpful unbiased reviews on the latest footwear styles and how they suit different needs for optimal foot health.

Hello. Welcome to my first blog! Being a foot specialist I need to work with and know a lot about shoes. There are many different feet out there and many varieties of shoes from which to choose. I often describe the proper features to look for in a shoe and what type of shoe is best suited for a particular foot or foot problem. This is important, but so is trying it on. A lot of shoes may be great, but they may not be great for you. You are the one wearing them, so you will need to try them on to help you decide. A professional fitting can also help.

Since summer is around the corner, I decided to check out a new line of sandals for women from Aetrex called “Sandalistas.” I was pleased to find many positive features in these sandals which make them both fashionable and functional. These sandals come in a great variety of styles and colours and they all have a cushion memory foam footbed with a mild arch support for extra comfort. The material also has antimicrobial properties which is especially helpful for people with odour concerns.

A lot of the styles have a removable footbed as well. Underneath the footbed are extra cushion pads below the heel and metatarsal heads. These can also be removed to help offload pressure from a metatarsal head that has a corn or extra pressure. This helps customize them for individual foot problems. The other nice thing about the removable footbed is that you can replace it with a custom orthotic. Our patients will often bring sandals in to have us properly fit custom support into it for them. Just because it’s summer doesn’t mean that you have to interrupt your orthotic therapy. These sandals also offer a good option to use in the house instead of bare feet or slippers. Yes, despite all the press lately, bare feet are not the best option. Take it from someone who knows feet best!

These sandals also have a great fastener system meaning that they have several points of adjustment, mostly with hidden Velcro. So, they look more simple and streamlined but you can really adjust them to fit you best if you need more room in one area or if you need it to be more snug. Another nice surprise is that these sandals are available in different widths and half sizes. This is not usually the case and can be frustrating for a lot of people who need that “in-between” size.

For sandals, I think that these new Aetrex are a thumbs up. They may not be what you see Lady Gaga wearing in public, but I bet she might be wearing them after a concert. Don’t forget that feet are your foundation so treat them well. What happens at the base helps give proper support to the rest of your body as well. Here’s to happy feet!

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