Tag Archives: custom orthotics

Foot Facts – Tips for Healthy Feet

tips for healthy feetYour feet are your foundation. They function to support body weight during stance and to propel the body forward during gait. There are 26 bones in each foot and 206 total bones in the human body. Thus, your feet account for 25% of the bones in your body! An average person takes between 5000 and 7000 steps per day and this increases for people who are more active.

overpronation causing posture changeYou don’t need to have foot pain to have a foot problem. Typically, unaddressed mechanical problems of the feet exist for a period of time before causing symptoms. Sometimes mechanical issues only become apparent after a change or increase in one’s activity level or an increase in body weight (due to added stress and resulting pain). In addition, a mechanical or alignment problem at the feet can alter mechanics and position of joints higher up in the kinetic chain including ankles, knees, hips, the back and even the neck! Thus, foot posture is related to one’s whole body posture and a mechanical foot issue can cause or contribute to pain in other areas of the body. Uncorrected, postural imbalance and uneven joint wear can accelerate joint degeneration (arthritis).

1) Choose appropriate footwear:

The unfortunate trend is people choosing fashion over function, however, footwear with poor support and fit is frequently the cause or contributor of musculoskeletal foot disorders. Womens’ high heeled shoes are the worst culprit forcing excessive weight distribution at the ball of the foot and inward deviation of the toes. When choosing footwear…

a) choose flats or a slight heal over high heeled shoes

b) ensure correct fit

The toe box should not put excessive pressure on the sides, top or front of feet. A good tip when buying shoes is to take the insole out and place your foot on it – your footprint shouldn’t go over the edges of the insole for correct fit. Another tip is to shop for shoes at the end of the day as your footprint will be slightly larger from the day’s stresses.

c) for adequate motion control and support, shoes should pass 4 tests (shown below)

Dish Rag Test: if the shoe twists easily, it fails the test

dish rag test for torsional rigidityPinch Test:if the heel counter is soft, it fails the test

pinch test for heel counter rigidityFold Test: the shoe should bend easily where the toes naturally bend only

fold test for flexion stabilityShelf Test: there shouldn’t be any drifting of the shelf relative to the heel when viewing shoes end on; there shouldn’t be excess ‘give’ when you push the shelf side to side.

shelf test2) Replace shoes every year:

Running shoes should be replaced at a minimum of yearly but even sooner (every 3-6 months) for runners or the overweight as shoe structure breaks down faster.

3) Weight loss if overweight:

Being overweight will result in more load on all joints of the body but especially the feet because they support the whole body. As a result, obese people tend to have flattened arches more often than the general public. Muscles must also work harder to support excessive weight. The added force of weight also exacerbates any mechanical or alignment problems.

4) Do exercises for feet and calves:

Appropriate stretching and strengthening of the lower extremity muscles can be greatly beneficial. Tight, shortened muscles should to stretched and weaker, lengthened muscles should be strengthened. By doing so, muscles become more balanced which adds mechanical balance to related joints. A chiropractor can give you more specifics related to your particular case. For example, stretching the the calves is particularly helpful for those with plantar fasciitis (a painful inflammation and scarring of the plantar fasciia which results in heel and arch pain that is worst with the first morning steps). Rolling your foot forward and back over a tennis ball is also great, massaging and improving circulation. There are also specific exercises for those with flat feet which help to strengthen and support the longitudinal arch of the foot.

5) Have a gait scan:

gaitscan by The Orthotic GroupHaving a gait scan involves walking barefoot across a pressure sensitive mat. A computer records data and generates an image of where you put pressure on your feet when you walk. This is compared to the normal foot. A gait scan (along with a chiropractic analysis) helps to determine need for orthotics. Data from the scan can be used to create custom-made orthotics which will reduce abnormal foot function while walking and realign your feet to a more normal position. As many as 60-70% of people have some sort of abnormal foot function and can benefit from a custom orthotics prescription. The cost of foot orthotics is covered by most extended healthcare and insurance plans.  Some insurance plans require a referral from your medical doctor first.  Check with your policy for the specifics of your coverage.

6) Have a chiropractic analysis:

Chiropractors are skilled at assessing posture, alignment and function of the neuromusculoskeletal system. As mentioned earlier, foot position relates to whole body posture. Thus if you have a foot problem, a full spinal analysis is beneficial as well. Chiropractic adjustments to the spine help normalize overall mechanics and also reinforce response to orthotic prescription. Chiropractic can assess bones in feet and determine if a particular joint is restricted. If a joint is restricted then it means that other joints must compensate – this can lead to pain. Adjustments help correct this.

7) Other:

Other tips for healthy feet include regular cardiovascular exercise and a healthy, balanced diet as these are beneficial for overall health and healing. It is also important to maintain good foot hygiene including keeping toenails neatly trimmed. Inspect feet for any unusual changes in appearance.

Dr. Elisabeth Miron

Looking for custom foot orthotics in Aurora? Visit Dr. Miron’s chiropractic website.

Scoliosis Treatment Options – Chiropractic Care & Medical Model

scoliosis treatmentScoliosis is a condition in which there is an abnormal lateral deviation of the spine. In layman’s translation: if you look at a person from the back side, the spine has a C-shape or S-shape curve instead of the normal, vertically upright orientation.

There are two categories of scoliosis: postural scoliosis and structural scoliosis. The purpose of this article is to differentiate these two types of scoliosis, to describe the chiropractic approach to scoliosis care and lastly, to differentiate this from the medical approach. This is so that you may better understand some of the various available options for scoliosis care.

Functional / Postural Scoliosis:

overpronation causing posture changeA postural scoliosis is essentially an postural adaptation to an imbalance in your base of support. For example, a leg length inequality or a low arch on one side compared to the other. This will cause the pelvis to dip down on one side. Then your spine will curve as an adaptive response because all of the joints are functionally connected. This type of scoliosis is generally flexible and can be diagnosed from physical examination findings (evidence of short leg and a flexible spinal curve that unwinds with side bending of the torso). This type of scoliosis is also usually fairly straightforward to correct. Custom foot orthotics are used to correct the alignment of the feet or a heel rise is used if there is a structurally short leg. Chiropractic care may also be recommended to the postural scoliosis patient to address any muscle or joint findings and any resulting pain from years of abnormal force distribution.

Structural Scoliosis:

A structural scoliosis is a bit more complicated to deal with. There are many types of structural scoliosis. One such type is adolescent idiopathic scoliosis. This is a rigid, inflexible spinal curve and for unknown reasons, the spine just grows that way. While the spine continues to grow, there is a risk that it will continue to get worse. Chiropractic management includes manual adjustments and/or mobilizations to the spine to improve flexibility, function, alignment and mechanical balance. Chiropractic care is also helpful for naturally managing pain. Exercises are also prescribed.

Proprioceptive exercises are particularly beneficial for scoliosis patients (of either type). Proprioceptive exercises are exercises that improve body position awareness. Examples include exercises on an exercise ball, rocker board, wobble board or vibration platform. Yoga and Tai Chi are also great balancing exercises. Chiropractic care combined with proprioceptive exercises help to retrain the central nervous system. Beyond this, specific corrective exercises may be prescribed which are designed to stretch the relatively tighter muscles and strengthen the relatively weaker ones. Preferably, these should be done daily. Deep breathing exercises and sleep posture awareness are also beneficial.

Risks of Scoliosis:

Just because you have scoliosis does not guarantee that you will have problems later in life. Many people carry on with their lives with no idea and a scoliosis is incidentally found later. That being said, there are some risks with scoliosis. Statistically, with greater curves there tends to be more pain and also earlier onset of arthritis due to uneven wear and tear to the joints. There is also a risk that the scoliosis may continue to progress (especially during adolescence, when the spine is still growing). With structural scoliosis, there is concern about compression of the internal organs when curves progress beyond a certain point.

Scoliosis Diagnosis:

Scoliosis is diagnosed through physical examination and/or x-ray imaging. The physical examination entails an assessment of posture, flexibility of spinal ranges of motion and orthopedic testing. Chiropractors have trained eyes for detecting posture abnormalities such as unleveling of the shoulders, pelvis, hips, knees and feet which may indicate an underlying scoliosis. If a scoliosis is detected, the second step is to determine if it is postural or structural. A postural scoliosis will unwind upon side bending of the torso. A structural scoliosis will not unwind fully upon side bending and will have a positive Adam’s test (forward flexing the spine will have evidence of rib protrusion on one side). An x-ray may be ordered to evaluate the severity and objectively measure the curve. Other potential causes for scoliosis also need to be ruled out.

Conventional Medical Management of Structural Scoliosis:

The conventional medical management of structural scoliosis involves monitoring, bracing, medication and/or surgery. Medication is suggested only as a means for symptomatic relief and does nothing to solve the underlying cause (which is unknown). If the patient is still growing, progression is monitored by first a baseline x-ray and then follow-up x-rays every few months. If the curve progresses, a spinal brace is typically recommended. A brace is intended to prevent further progression but patient compliance is a challenge because spinal braces tend to be uncomfortable and awkward (especially for the self-conscious adolescent). If the scoliosis progresses beyond a certain point, the patient may be recommended spinal surgery in which a metal rod is surgically fused to the spine to straighten it out. This procedure is invasive and has many inherent risks.

Why Chiropractic Makes Sense:

In light of the other available options, chiropractic care is a logical approach for scoliosis management. Chiropractic care is hands on, non-invasive and drug-free. It attempts to correct the underlying mechanical problems in scoliosis, relieve pain naturally and empower the patient to continue appropriate home care corrective and postural awareness exercises. While there is no guarantee that chiropractic will correct a structural scoliosis, there is evidence in the literature that it can slow the progression and improve the curve in some cases. For these reasons, chiropractic care makes sense. If unsuccessful, the conventional medical management is still an option. While chiropractic care is a logical approach, it is not a quick fix. Typically a lengthy course of care is recommended, with regular progress examinations to objectively evaluate changes.

  1. Chen, Kao-Chang & Chiu, Elley. (2008). Adolescent Idiopathic Scoliosis Treated by Spinal Manipulation: A Case Study. The Journal of Alternative and Complementary Medicine: 14(6); 749-751.

  2. Sanna, Mark. (2009). A New Look at Adolescent Idiopathic Scoliosis. The American Chiropractor: April 2009; 18-19.

  3. Woggon, Dennis. (2005). Scoliosis Correction – CEAR Solutions; Chiropractic Leadership, Educational Advancement & Research. The American Chiropractor. February 2005; 54-56.

  4. Hyland, John. (2008). Functional Scoliosis. The American Chiropractor. April 2008; 30-31

  5. Payne, Mark. (2008). Scoliosis: A Postural Approach. The American Chiropractor. April 2008; 26-28.

  6. Yochum, Terry & Maola, Chad. (2008). Scoliosis. The American Chiropractor. April 2008; 14-16.

  7. Lamantia, Marc. (2009). Review of the Literature: Non-operative Scoliosis Treatment. The American Chiropractor. April 2009; 20-23.

  8. Woggon, Dennis. (2006). Can Chiropractic Care Help Scoliosis? The American Chiropractor: May 2006; 24-25.

  9. Morningstar, Mark, Woggan, Dennis & Lawrence, Gary. (2004). Scoliosis treatment using a combination of manipulative and rehabilitative therapy: a retrospective case series. BMC Musculoskeletal Disorders.

Dr. Elisabeth Miron

Conservative Treatments for Knee Pain

conservative treatments for knee painWhen it comes to knees, it is probably best to explore conservative options prior to undergoing surgery, according to some of the latest research (1, 2, 3). Certainly, it is important to be informed as to the potential benefits and risks of any treatment prior to making any decision about your health.

There are many different pain generating structures in the knee (including the cruciate ligaments, collateral ligaments, menisci, muscle tendons, bursae, etc). The first step before entering any treatment program is to establish a diagnosis as depending on the type of injury, the recommended treatment may differ. Seek a chiropractor or other musculoskeletal professional in your area.

Conservative Options:

Chiropractic care: Chiropractors are biomechanical experts who can not only establish the diagnosis but can deliver conservative forms of care. The goals are to restore mechanical balance / alignment in your body such that no one area is being overworked, to relieve pain without medication, to improve function and to accelerate your body’s natural ability to heal.

Pain relieving modalities: Electrical stimulation and acupuncture are both great choices for relieving knee pain without the use of drugs. These are especially helpful during the acute phase of recovery when there is usually considerable pain and inflammation. Depending on the condition, ice or heat can also work well.

Targeted rehabilitation: Following the acute phase, rehabilitation becomes important. Optimal knee function requires muscular balance and both flexibility as well as stability. Rehabilitation involves strengthening the muscles that are relatively long/weak and stretching muscles that are relatively tight/strong.

Soft tissue therapy: Soft tissue therapy can help break down scarring and adhesions from injuries that may otherwise compromise normal range of motion and function. It also temporarily increases circulation in the area to enhance healing.

Activity modification: Sometimes too much activity, or not enough, or poor form during an activity can result in aggravation of symptoms. In addition certain types of activities are not as safe for your knees (such as high impact sports or activities on an uneven terrain). That being said, some amount of activity is necessary as it flushes fluids through the joints, carrying nutrients and removing metabolic wastes. One of the best things for osteoarthritis, for example, is low impact range of motion exercise (such as swimming).

Orthotic for pronationCustom orthotics: Orthotics are special insoles for your shoes. Custom made orthotics are specially constructed to correct the alignment of your feet and to improve shock absorption so there is less impact through your joints. Because the knees are functionally connected to the feet, poor alignment of the feet can cause or contribute to knee pain (or pain higher up in the kinetic chain). A common contributing factor to knee injury is overpronation. Overponation causes the longitudinal arch to drop which results in an inward torsion of the knee (creating more tension on the MCL and medial meniscus and compression of the lateral knee joint space). Over time, this suboptimal loading can result in pain or injury.custom orthotics and knee pain

Appropriate footwear: Choose shoes that are appropriate for the activity with good support, stability and shock absorption.

Ideal body weight: Reaching your optimal body weight if you are overweight, will help lessen the compression though your knees as well as other joints in your body and reduce the risk for osteoarthritis (4).

Knee brace or athletic tape: Using a knee brace or athletic tape while performing activities can help provide passive support to the knee and proprioceptive feedback. For injuries involving ligament damage, there is often a loss of joint position sense (proprioception) due to damage to nerve endings. This can set one up for future injury. Athletic tape provides more stimulation to the skin receptors to enhance your joint position awareness.

Glucosamine supplementation: Glucosamine is a natural substance the body makes that supports the health of joint cartilage.

Anti-inflammatory diet: Different foods are metabolized differently, some promoting inflammation and others reducing it. Having an anti-inflammatory diet will help rid your body of excessive inflammation and help to reduce pain naturally.

Have patience: Depending on the nature and severity of the problem, it may take several weeks or even up to a year to reach maximal recovery.

  1. Moseley JB, O’Malley K & Petersen NJ, et al (2002). A controlled trail of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. Jul11;347(2):81-8.

  2. Katz JN, Brophy RH & Chaisson CE, et al (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Eng J Med; Mar18.

  3. Kettunen JA, Harilainen A & Sandelin J, et al. (2007). Knee arthrooscipy ad exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trail. BMC Medicine. 5:38

  4. Felson DT, Zhang Y & Anthony JM et al. (1992). Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1;116(7):535-9.

Dr. Elisabeth Miron