Meeting a medical standard of foot care

A medical standard of care is defined as the level at which an ordinary, prudent professional with the same training and experience in good standing in a same or similar community would practice under the same or similar circumstances.

With only between 80 and 90 podiatrists practicing in British Columbia at any time, the majority of foot care is delivered by medical professionals that are not as exclusively trained as podiatrists. Because of this, the patients visiting our office for the first time often come in having seen different medical professionals with varying levels of education and competencies. Despite the best efforts of these professionals, some patients on occasion have some erroneous and misguided ideas about what is going on with their feet. While this misinformation can be frustrating for patients, it does not usually cause any negative consequence. Regrettably, charlatans with no medical training looking to make a buck will target the foot. They will set themselves up at different exhibitions and trade shows that travel through different regions of Canada promising to improve your foot health by selling you what they claim to be custom foot orthotics. Do not be fooled by these individuals. Their orthotics are always mass-made products of usually very poor quality that are not custom to anything and will only make you lighter in the pocketbook. Hopefully you have received only evidence based information about your own feet but if not, our office door is open to help you get the information you need.

Why over the counter orthotics are not custom or functional

The foot aisle at your local pharmacy or your nearest shoe store are often the first stops for patients experiencing foot pain.

Sometimes, these over the counter devices work to relieve painful foot symptoms, or at least for a short time period. But more often than not, they do not provide long lasting pain resolution. One of the biggest reasons for this is that they are usually made of accommodative, flexible material that do not control your unique biomechanics. While accommodative orthotics do have a place for certain patients with specific foot pathologies, they very often fail to improve relatively healthy individuals younger than 75 years old with a normal, functioning gait (how you walk). Another reason for over the counter failures is that patients may have an underlying medical condition affecting their feet that will not be resolved by a mass-made product. And just as your right and left eyes often require a different prescription, your right and left feet are not identical either and are very rarely corrected by over the counter devices.

Minimalist Shoes

What defines a minimalist shoe and does it facilitate a more ‘natural’ way of running?

As with any other category of footwear, there is no strict criteria to define a minimalist shoe. Generally, they have less of everything — less weight, less cushioning and less structure than conventional running shoes. To answer if they are more functional, it is important to distinguish the marketing from the science. Like other marketing campaigns the impression was made that these shoes are new and revolutionary.

On the contrary, it has long been known that humans move differently while shod versus barefoot. A history of minimalist commercial failures in the 1990’s also diminish the revolutionary claim. Manufacturers will often conflate research on barefoot running to make the case for their minimalist shoes, when the two are obviously not the same. Runners wearing conventional foot wear — including minimalist shoes — will usually strike the ground with their heel, while barefoot runners usually do not. Given this, it questions the benefit of wearing a shoe with less cushion and less support.

Still, they may create favourable gait changes for some while increasing the risk for new injuries in others. The impact forces of running do not disappear but are redistributed based on the foot wear you choose.

How Diabetes Affects Your Feet

How exactly can diabetes cause me to have foot problems?

Diabetes that is uncontrolled will affect the organ systems in different ways. Peripheral neuropathy is a term commonly used to indicate an uncomfortable burning or tingling sensation in the feet. While this is correct, the term also encompasses other symptoms
related to nerve damage. The inability to feel a small pebble in your shoe to ominously not feeling a razor blade left in the bathroom is also caused by peripheral neuropathy.

Healthy nerves that regulate perspiration from sweat glands in the feet
and send motor signals telling our foot muscles and tendons when to contract and relax are also compromised in peripheral neuropathy. This can lead to dry, cracked skin, and rigid contractures of our toes leading to dangerous pressure points, respectively. Increased blood sugar circulating in the blood stream will deposit into tendons causing them to be more rigid and lead to further contractures and a less supple leg and foot.

Arteries carrying blood to your feet can also become diseased limiting blood flow needed to help heal any wound or bring antibiotics needed to treat infection. If you have diabetes, it is a good idea to see your podiatrist to be assessed for the above and also for care of your nails and calluses.

Buying Supportive Shoes

How do I know if my shoes are supportive?

Foot wear can be a significant factor associated with painful feet. The problems commonly seen in our office include shoes that are much too flexible and lack midfoot support. If you can bend your shoe so that the heel and toe touch together, your shoe lacks support. Other signs of supportive shoes are ones that have some torsional rigidity — if you can wring it out like a wash cloth, it may be time for an upgrade.

The heel of the shoe should be rigid enough that you can’t easily push it down. Flats are often comfortable but sometimes not supportive enough. A low profile orthotic device can be made to offset this. Lastly, shoes should be alternated daily to allow one pair to properly dry. If you can’t afford a new pair of shoes annually, spraying the inside with Lysol to clean them is a good idea.

The Cause of Bunions

What causes bunions?

Bunions are an angular deformity occurring at the big toe joint. They are the result of faulty
mechanics and joint motion. They are not caused by shoes. We are born with bunion-prone feet or bunion-proof feet. Bunion-proof feet don’t have to worry. Bunion-prone feet can develop bunions over time, and how much the deformity becomes larger can be dependent on the amount of weight-bearing activity you might enjoy.

Despite this fact, it is impossible to predict just how quickly the deformity will progress, if at all. There is no scientic tool to predict how much larger your bunion might be a year from now. It is entirely possible to have a bunion on only one foot. Bunions can sometimes be painful and sometimes not. Bunions that are not painful do not require medical attention but fitting into certain types of shoes can sometimes be a problem.

Bunions that are painful can sometimes be alleviated by custom foot orthotics, however, surgical correction is often required. If you have any questions about bunions or other foot issues, your podiatrist is your best resource. No referral is required to see a podiatrist in BC.

How Orthotics Help Your Knees, Hips, and Back

Can functional foot orthotics reduce the pain in my knees, hips, and lower back?

It all depends on the make up of your lower extremity. Outer or inner knee pain may be caused by increased pressure in that area of the knee joint and functional foot orthotics can help realign you to alleviate that pressure.

The same applies to the hips and lower back. Flat feet and abnormal knee mechanics can cause poor posture when walking and place strain on your lower back. Functional foot orthotics must be made with a rigid or semi-rigid plastic polymer or graphite material to have any impact on your feet and knee mechanics. In other words, even if your feet were casted or molded, if the orthotic you receive can be easily folded or twisted  — that is, not rigid — it will not improve your alignment or mechanics.

Orthotics that are soft and malleable are known as accommodative orthotics and are essentially a soft landing for sufferers of neuropathy from diabetes or those who shuffle from Parkinson’s disease. Seeing your podiatrist will help you solve what is best for you.

Education of Podiatrists in British Columbia

Education of Podiatrists in British Columbia

What are the requirements to become a podiatrist in British Columbia and what level of medical training do podiatrists receive?Podiatry is a branch of medicine devoted to the study of diagnosis, medical and surgical treatment of disorders of the foot, ankle, and lower extremity. It is a four year post-graduate medical degree and graduates are awarded a Doctor of Podiatric Medicine (DPM) degree.

Applicants can choose from nine schools in the United States. There are no accredited DPM degrees available in Canada. Podiatrists entering into practice in BC are now required to have at least two years of post-DPM residency-level training. US residencies are now three years in duration and residents become proficient in performing elective foot surgeries such as bunions and hammertoes, and partial foot amputations for patients with bone infection caused by diabetes.

The ankle is also within the scope of practice in most US states. Podiatry residents rotate through anesthesia, radiology, internal medicine, pathology, and other surgical specialties such as orthopedics and plastics. If you have foot, ankle or knee pain while standing or walking, podiatrists specialize in evaluating the gait cycle and can improve your overall mechanics. No referral is required to see a podiatrist in BC.

Custom versus OTC Orthotics

How are Custom Foot Orthotics (CFOs) different from orthotics purchased Over-The-Counter (OTC)?

CFOs can only be considered custom if your feet were physically casted with plaster, inserted into a foam box, or scanned electronically. CFOs are also known as functional foot orthotics because they aim to improve and correct your unique biomechanics during walking or running. This is accomplished with a rigid plastic polymer or graphite device. They can also be calibrated to your weight and shoe size.

Conversely, OTC orthotics are pre-made devices made with material varying from plastic to cork to foam and designed to be accommodating – minimizing changes to your foot function while providing comfort and protection. They can be a worthwhile, inexpensive investment for those needing less correction.
While CFOs are well known to help pronators with flat feet in need of greater arch support, they have also been proven to treat heel and forefoot pain of various causes. By distributing pressure more evenly through the bottom of your foot they can also decrease the likelihood of calluses, nerve pain, and diabetic foot ulcers. Numerous modifications of different materials can also be added to different areas of CFOs to treat corresponding foot ailments.