We recently upgraded our 3D foot scanner, which we use to take impression for custom-made foot orthoses. The scanner allows us to capture an accurate 3D image of the foot, which we then use to design a specific orthotic prescription based on the patients foot type, injury, activity and footwear.
Talking all things ‘Bunions’ with Sophie Jennings
As Podiatrists we play an important role in the early diagnosis and management of patients who may be at risk of developing bunions, or those who have already developed a bunion (also known as Hallux Valgus, Hallux Abducto Valgus or HAV). We are also equipped with the knowledge to identify those who are less likely respond to conservative management, and therefore require referral.
A stress fracture is a partial or complete bone fracture, resulting from repeated low grade stress. There has normally been an increase in the amount or intensity of activity just before the foot gets sore. The pain is worse with activity, and is usually in a specific area of the foot where the fracture is present. It may settle with rest, or continue at a low level.
The most common areas of the foot that present with stress fractures are the metatarsal shafts (2nd, 3rd and 4th), the navicular bone, and the sesamoid bones (little bones that sit under the big toe joint).
Diagnosis is usually made by feeling the sore area, description of pain and description of the amount of training and the surfaces that this training has been on. Sometimes an X-ray, MRI or CT scan are needed if the diagnosis is uncertain, or if an athlete wants to continue training and needs specific details of their injury.
Stress fractures can be caused by a number of factors:
A rapid increase in training loads or intensity (too much too soon)
Type of activity:
Navicular stress fractures are more common in sprinting and jumping sports
Hard surfaces such as concrete can increase the risk of stress fracture when combined with other factors
Depending on the location of the stress fracture, feet may either be over-pronated (rolled inwards, flattening of arch) or supinated (high arch, stiff foot type). Pronated feet often cause increased loading through the metatarsals and midfoot joints. Stiff ankles and high arched feet can have reduced shock absorption which can be a contributing factor.
Wearing the incorrect style of shoe for the activity, or footwear that does not have adequate support, can be a major contributing factor to the development of a stress fracture. The drop or gradient of the shoe (height at the back compared to the front) should be at 10mm for most activities.
Can be a factor in female athletes (‘the female triad’ – disordered eating, amenorrhea and osteoporosis).
Most stress fractures settle with rest.
Sometimes a cam walker needs to be worn for up to 8 weeks. Cross training is recommended, as long as there is no pain (swimming, pool running, cycling) to maintain fitness levels. Some stress fractures (particularly of the navicular and 5th metatarsal) need surgery.
A full biomechanical assessment will need to be undertaken by a Podiatrist.
This can detect a limb length discrepancy, over-pronation (rolling in of the ankle and flattening of the arch), muscle imbalance or weakness, and joint stiffness. Orthotics may need to be issued or the foot taped, to improve foot function. A footwear assessment also needs to be undertaken, and shoes updated if necessary. Sometimes, the patient may need to undertake gait retraining, which involves changing running technique through strengthening and repetition of improved technique.
Return to activity involves a graduated loading program.
This usually starts with a jog/walk program, which slowly increases the amount of jogging time. This progresses up to a 15 minute jog pain-free before any increases in intensity can be added or any agility, depending on the sport. The overall training program will then need to be reviewed, to monitor loads long term.
Diversity of training is the key to prevention of a stress fracture.
A training program should always include different surfaces, different intensities, and even different footwear. Cross-training is vital to any training program (swimming, pool running, cycling, rowing).
If you need any advice regarding treatment or prevention of a foot stress fracture, see Podiatrist Nicki Quigley at Bayside Sports Podiatry - 9589 3777.
If you are having pain in your feet, legs, hips or back, you may require orthotics to improve your foot position and function during activity.
What are orthotics?
Orthotics are insoles that are issued by Podiatrist’s, and are worn in shoes to redistribute pressure, and reduce stress on certain structures in the foot and lower leg. They are used for both the treatment and prevention of injuries. They should only be issued after a full biomechanical assessment has been conducted, which looks at a person walking, running, the movement of their joints, strength in their muscles, and checking the wear pattern on their footwear. Orthotics are used in a variety of foot types (flat or high arched feet) and are worn by participants in a variety of sports. They can be fairly rigid, or very flexible/soft, depending on foot type, activities and footwear.
When designing and manufacturing an orthotic, the Podiatrist takes into account:
A higher arched foot needs a more flexible orthotic(a rigid orthotic under a high arched foot is very uncomfortable). A lower arched foot needs a slightly stiffer orthotic so it doesn’t compress too much when they walk on it, to ensure good support.
Heavier people need a stiffer material, or it just squashes underneath them and doesn’t give enough support.
Sports that require directional changes will need a more flexible orthotic. Some sports also require light-weight orthotics, or low bulk orthotics to fit into football boots and running spikes.
Harder training surfaces will need a more flexible orthotic to improve shock absorption.
Football / soccer boots, racing spikes and racing flats may require lower bulk orthotics for shoe fit. Most of the time, a full length cover is added to the top of the orthotic for comfort, but sometimes a smaller cover works better in spikes and flats. Ballet shoes are difficult to fit orthotics into, but sometimes a very low bulk pair can fit, although often dancers are just better off strapping their feet (a Podiatrist can show you how to do this).
Do I need a custom-made orthotic or an off-the-shelf orthotic?
Custom-made orthotics are generally more durable, and can be made specifically for a foot type. Off-the-shelf orthotics don’t fit every foot type. Some feet need increased tilt at the heel or more specific support, and others just don’t suit a generic device because their arches are too high or too low. Custom-made orthotics are more expensive, but they last longer. For short term injuries, where you may not be required to wear orthotics long term, off-the-shelf orthotics (if they are suitable for your foot) are perfect. They can be issued on the day of consultation, and once your injury has settled, they no longer need to be worn. I normally try to issue off-the-shelf orthotics for children with injuries or biomechanical concerns if appropriate, as their feet are growing rapidly and changing shape. Sometimes, athletes might prefer an off-the-shelf orthotic for their sports shoes, and a custom-made orthotic for their everyday shoes or vice-versa.
How long do they take to get used to?
It will take you 1-2 weeks to adjust to wearing orthotics, although I normally give people 4 weeks to fully get used to wearing them, so they can run in them for a few weeks before I review them. They should be comfortable within one week of wearing them for daily activities, and you should be comfortably playing sport in them 2 weeks later. If this is not the case, then you should see your Podiatrist, as they may need a minor adjustment. Often stretching and strengthening exercises are given when orthotics are issued, and you should make sure you adhere to these, as orthotics are usually only part of your treatment plan.
How often should I wear them?
Your Podiatrist will advise you how much you need to wear your orthotics. Some people just need to wear them for activity, others need to wear them for about 80% of the day or more. This will depend on the reason you were given orthotics (to settle an injury, to prevent the progression of a foot deformity such as a bunion, or to improve walking and running style).
How long do they last?
Custom-made orthotics normally last an average of 5 years. During this time, the cover often needs replacement once or twice (depending on the amount and type of activity – some AFL players need several recovers in a season). Off-the-shelf orthotics usually last about 12 months.
How often should I have them checked?
You should have your orthotics reviewed by a Podiatrist every 1-2 years, to ensure they are still supporting your feet adequately. If you start to have any pain in your feet or legs or feel like the orthotics are not supporting you as well as they were, then have them checked earlier.