Better Understanding Foot Health Care & Orthotics Services in Ontario

In an effort to clarify the often confusing landscape in this province for foot care and orthotics services, the College of Chiropodists of Ontario published an in-depth article in a supplement to the National Post newspaper called “Bones and Joints”* The following is an excerpt from that publication.

“Foot Health Care in Ontario” by the College of Chiropodists of Ontario

In Ontario, the only regulated foot care professionals are Chiropodists and Podiatrists. Both are regulated by the College of Chiropodists of Ontario pursuant to Ontario statutes, namely the Regulated Health Professions Act, 1991 and the Chiropody Act, 1991. Chiropodists and Podiatrists are regulated by the College within the same legal framework as the 21 other regulated health care professions. There are 476 Chiropodists currently registered by the College to practise in Ontario and 72 Podiatrists. The names of all Chiropodists and Podiatrists who are registered to practise in Ontario and the locations of their practices are listed on the College Web site at www.cocoo.on.ca.

Where Chiropodists and Podiatrists Practise

Ontario’s Chiropodists and Podiatrists can be found in most of the places where health care is delivered. As primary care practitioners, no referral is required to be treated by a Chiropodist or Podiatrist. There are several hundred Chiropody or Podiatry clinics located in communities throughout Ontario. Many hospitals and Community Health Centres operate Chiropody clinics where hospital patients and members of the community can have their foot problems assessed and treated. Long-term care and retirement homes often arrange for regular visits to their residents by Chiropodists or Podiatrists. Family Health Teams and other multidisciplinary health care groups often include a Chiropodist or Podiatrist, or have made arrangements to refer to one.

Foot Orthotics

Foot orthotics, when prescribed and dispensed by qualified practitioners, are clinically proven to help address some of the problems patients experience with their feet. There is a rapidly expanding “industry” in foot orthotics.

The insurance industry is increasingly concerned about fraudulent prescribing and dispensing of foot orthotics. One of the College’s preoccupations is the number of foot orthotics that are prescribed or dispensed by unqualified or unregulated practitioners that have little or no clinical benefit and may in fact make things worse for patients.

Of all the regulated health care practitioners in Ontario, the scope of practice statement for Chiropodists and Podiatrists in the Chiropody Act, 1991 is the only one that specifically refers to orthotics.

As part of its public interest mandate, the College of Chiropodists continually cautions the public to ensure that they obtain their foot orthotics from a regulated practitioner who has requisite experience and training.

Good health for your feet is important to overall health. Don’t forget to properly care for them.

For more information about Chiropody / Podiatry in this province, visit the College of Chiropodists of Ontario’s Web at www.cocoo.on.ca. *”Bones & Joints” material ©Copyright, 2010 Media Planet and The College of Chiropodists of Ontario.

Please visit Kawartha Total Foot Care Centre's website at www.totalfootcare.ca for more information about your good foot health.

Planter's or Plantar?...A Wart by Any Other Name

Plantar warts are caused by the human papilloma virus (HPV) and affect 7-10% of the Canadian population. Yet, this common, contagious, and sometimes painful invader of the foot suffers from an identity crisis, beginning first with its name.

The “plantar” in plantar wart refers to the fact that it appears on the plantar aspect of the foot – your sole. Yet, it’s not uncommon to hear it referred to mistakenly as a “planter’s wart.”

One can’t be sure how “planter’s” came to be. Certainly, there’s no scientific evidence to suggest that farmers or avid gardeners are any more prone to contracting warts on their feet than the rest of us! Actually, most at risk for plantar warts are people who in their bare feet frequent public places like sports locker and change rooms, showers, the deck areas in community swimming pools, and hotel rooms. Frequently- damp footwear like hockey skates or athletic shoes can harbour the virus. Children and diabetics are also particularly susceptible to infection.

Another theory behind the planter’s wart / plantar wart muddle might be the resemblance in people’s minds between the shape of some plantar warts and a certain monocle-wearing shelled man in a top hat you find on the tin of a favourite snack. For our part, we think that’s just nuts since plantar warts most commonly take on a cauliflower appearance. Adding to the confusion, people will sometimes come to us mistaking their plantar wart for a corn or vice versa. Yet, just as any five year old who has ever turned his or her nose up at the dinner table will tell you, there’s a big difference between corn and cauliflower. And, so it is with corns and plantar warts as well – although distinguishing between them often requires the highly trained eye of a chiropodist to make the right diagnosis.

In the end, it doesn’t matter so much what you call it we suppose. A plantar wart by any other name is still just as infectious, contagious, and stubborn to treat. Home remedies are seldom effective, and people with diabetes should never use off-the-shelf wart removers since they can cause serious skin ulcers. The name that is indeed important to remember in dealing with your plantar wart or any other foot problem is “Kawartha Total Foot Care Centre.” We have the specialized skills and training to provide the right diagnosis and treatment.

Please visit our website at www.totalfootcare.ca for more information about your good foot health.

Call Us for Callus!

Psychics and fortune tellers often claim the ability to read into people’s past and future by studying the lines in the palms of their hands. Funny enough, Chiropodists can also tell wonders about people’s foot health and predict future pain and problems simply by looking at the calluses on their feet — although there’s nothing magical about it!

The better comparison might be to your automobile mechanic investigating uneven tread wear on your tires. The skin on your feet, like vehicle tires, is where “the rubber meets the road.” In the same way, the bones, ligaments, and muscles underneath are like your body’s suspension, struts, and shock absorbers, cushioning, carrying, and adapting to the ground below.

If your mechanic spots uneven tire wear on your vehicle, step one is likely a new set of tires. While you can’t trade your feet in for a new set, thankfully your Chiropodist is uniquely qualified to reduce and remove the callus effectively.

However, while unpleasant, calluses should be regarded as a symptom of a problem and not the problem itself. Simply replacing a set of unevenly worn tires without fixing the issue causing the uneven wear will quickly result in another unevenly worn set of tires. Calluses are no different. They will return unless what’s causing them is properly addressed.

Calluses form because of undesired friction over pressure points. Often it’s an issue with your foot’s structure that creates this wear problem. Your mechanic would view uneven tire wear as a clue to uncovering underlying problems with your vehicle’s shocks or suspension.

Similarly, Chiropodists will examine the location, thickness, and other properties of calluses and relate their findings to the bones, muscles, and ligaments in your feet, along with other medical factors affecting your foot health. Together, these things help them diagnose and treat the underlying problems that are causing the calluses, at the same time treating conditions such as foot, heel, ankle, and knee pain that often occur with the same kinds of structural foot problems that result in callus formation. This is why calluses can be a predictor of future foot pain and problems.

SOME TREATMENT APPROACHES FOR CALLUSES BY OUR CHIROPODISTS

CALLUS REMOVAL: Chiropodists use a scalpel and specialized instruments to reduce and remove calluses painlessly without the need for undesirable practices such as “foot soaks” which may spread fungus and infection even with sanitization.

PRESCRIPTION CREAMS: Your Chiropodist may provide you with a specially formulated moistening cream to prevent drying of the skin in areas prone to callus buildup.

FOOTWEAR: Chiropodists know your feet best, and will provide advice on the right kind of footwear for your foot type.

CUSTOM ORTHOTICS: Orthotics that are properly prescribed and provided by a Chiropodist for your foot problems, as well as specialized cushioning devices, help normalize problems with your foot structure, eliminating the friction points that cause callus buildup

DIABETES: Pressure points that lead to callus formation can eventually lead to a complete breakdown of the skin in people with diabetes, causing serious wounds called ulcers. Your Chiropodist can help prevent this. People with diabetes should NEVER try cutting or removing calluses themselves, since this can also cause an ulcer or infection.

Visit our website at www.totalfootcare.ca for more information about your good foot health.

Diabetes and Your Feet

Diabetes adversely affects the nerves and small blood vessels in your feet and lower limbs. As a result, people with diabetes are at a much higher risk to develop a number of potentially serious and lifestyle limiting problems, such as:

Infection: People with diabetes are more prone to infection due to weakened immune systems and reduced circulation. Even the smallest cuts, sores, and ingrown nails, can quickly develop into potentially serious blood and bone infections that often result in amputations or worse. In fact, diabetes is the leading cause of lower limb amputations outside of accident or trauma. People with diabetes are also more susceptible to plantar warts and fungal infections of the nails and skin.

Neuropathy: Diabetes can result in damage to the nerves of the lower limbs resulting in a condition called neuropathy. Symptoms include tingling, burning, pain and cramping, reduced sensation, or even complete loss of feeling. Neuropathy greatly affects people’s mobility and painful cramping and “pins and needles” tends to reduce the quality of sleep. Neuropathy is also a problem because the reduced sensation can lead to secondary problems like burns because sufferers can’t sense that the bath water is too hot, and infections because they can’t feel blisters or cuts.

Wounds / Ulcers: Cuts, scrapes, bruises, blisters, and pressure points can deteriorate into a stubborn wound in the diabetic foot known as an ulcer. Ulcers are extremely difficult to treat and they can spread in size and depth. Not only are they painful, the open flesh is a portal for all kinds of nasty germs, viruses, and fungus to enter the foot and cause serious infections such as gangrene.

Prevention is the key to helping avoid complications from diabetes, and prevention begins at home. Here are some ways to help avoid problems:

• Inspect your feet daily, including the soles, for cuts, cracks, redness, blisters, bruising, or any other unusual marks or blemishes. See your Chiropodist right away if you find any of these things.
• Wash feet daily in warm water using mild soap or antibacterial cleanser.
• Do not soak feet in water for more than five to ten minutes, and never use hot water since excessive soaking and heat can damage or dry out the skin.
• Always test the temperature of bathwater with your hand or elbow first to make sure it isn’t too hot. Or, use a temperature gauge.
• A soft nail brush may be used to clean toe nails. Pat them dry with a clean towel. Pay particular attention to dry between your toes where moisture can cause damp skin to break down or macerate. You can use a swab of isopropyl alcohol to help dry skin.
• Use pumice or a file to lightly exfoliate or rub off any rough areas on your skin.
• Never use scissors or sharp objects to remove callus or rough spots on the skin. Excessive callus buildup may be a sign of other problems. See your Chiropodist.
• Use a moisturizer on your skin, but never between your toes.
• Even though it is commonly done, do not use powder between the toes, unless prescribed by your Chiropodist for a specific condition. Powder can cause your skin to break down since it absorbs and traps moisture.
• Never use over-the-counter wart or corn remedies. They contain a chemical that burns the skin and creates an opening that may cause serious wounds or infections. See your Chiropodist.
• Always wear a pair of indoor shoes or slippers. This will help avoid potentially serious cuts, punctures, bumps, and bruises to your feet.
• Footwear should be in good repair and fit properly. Your Chiropodist can provide proper footwear advice.
• If you have been prescribed orthotics, use them in all of your footwear!

Beyond home prevention, it is important to see a foot health specialist for maximum benefit. In Ontario, the only legally regulated specialists exclusively trained and licensed in complete foot health and orthotics are Chiropodists / Podiatrists. You should make a visit to your Chiropodist / Podiatrist at least once each year for a complete foot health check up the same way you would to have your eyes checked or for your annual physical. Even better, seeing your Chiropodist / Podiatrist for regular nail and foot care will help ensure that problems can be prevented or detected early for treatment.

For more helpful foot health information, visit our Web site at www.totalfootcare.ca.

There's No "Fun" in Fungus

What does that delectable, garlic and butter fried accompaniment of mushrooms next to your steak have in common with thick, brown-discoloured, and flaking toenails? Well, nothing palatable for sure!

However, they’re indeed cousins at a scientific level – the phylum known as fungi to be precise.

Nail fungus (also called onychomycosis) is an extremely common problem. It’s contagious and thrives in moist conditions such as persistently wet or sweaty footwear, pool decks, bathrooms, hotel carpets, and public change rooms.

The symptoms of fungal nails can be shared by other problems such as psoriasis or nail trauma, and so your chiropodist may sometimes take a nail sample for microscopic analysis to determine whether fungus is present and what type it is.

Nail fungus is extremely stubborn, and treatment may last several months (even years in severe cases). In addition to the in-office procedures performed by your chiropodist, he or she may provide medication and a home treatment plan to achieve maximum benefit. It’s very important to sanitize shoes, socks, and places around the house that harbour the fungal spores. Your chiropodist can also perform a cosmetic procedure that effectively restores the appearance of the toenails while treatment is ongoing.

As the old saying goes, however, prevention is the best medicine. Nail fungus can usually be avoided with a few common sense precautions such as:

·        Ensuring that footwear is kept dry and clean

·        Wearing slippers, sandals or water shoes in the kinds of public places where the spores are prevalent

·        Use only breathable, antifungal toenail polish. Most nail polishes form an air-tight seal that causes fungus to flourish

·        Trying to avoid injury to the nails

·        Never sharing footwear

Without treatment by your chiropodist fungal nails will become increasingly thick and unsightly, eventually damaging the nail bed so that the disfigurement becomes permanent. They may become painful and cause secondary bacterial infections. The fungus can also spread to the surrounding skin, fingernails, and other parts of the body. 

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.

Heal Cracked Heels

The tires on your car provide the traction and support to take you from A to B. And, if the rubber becomes cracked and dry, the problem needs to be addressed as it can pose a risk to one’s safety and well-being.

Well, your feet take you from A to B as well. And, at this time of year in particular, they can become excessively dry and cracked in the heels and other high-pressure areas.

Cracked heels before treatment at
Kawartha Total Foot Care Centre

Cracked heels are also known as fissures, and the cold and dry of winter makes for conditions when they can be especially problematic. Cracked heels can develop to the point that they bleed and become very painful. For people with diabetes, circulatory, or other conditions that result in weakened immunity, cracked heels provide an open doorway to potentially serious bacterial, viral, and fungal infections and should always be addressed promptly by your chiropodist. 



After only one treatment at
Kawartha Total Foot Care Centre

There are some things people can do at home to help prevent and treat cracked heels. Don’t go barefoot around the house. Use a pair of indoor shoes or slippers. Make sure to wear well-fitting, high-quality winter footwear outdoors. Avoid excessively hot baths, since these will dry the skin. People with diabetes or other conditions that can result in reduced nerve sensation should avoid hot baths anyway, due to the risk of burns.

However, for many people these tips will not be enough on their own, and they will still experience cracked heels. Our chiropodists can help, and patients are often surprised when they arrive with even a severe case of cracked heels how they can leave with feet that are “baby’s bottom” smooth. Beyond treatment of the cracked areas themselves, your chiropodist may employ intensive in-clinic moisturizing therapies as a preventative means to address the dryness and cracking. He or she may also provide or recommend a proper moisturizer for home use, since most off-the-shelf moisturizers are not strong enough for the extra thick skin of your feet. Structural foot problems that create friction and cause the build-up of callus and dry skin in the cracked areas are another area that your chiropodist may identify and treat.  

William Shakespeare wrote, ““Blow, winds, and crack your cheeks! Rage! Blow!” With your chiropodist’s help, at least your feet can be crack-free despite winter’s cold, dry winds.

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.

Negative SEO… Is it the Business Equivalent of Internet Bullying?

“Bullies are cowards.” It’s the sort of thing those of us who are parents might tell our children.

As adults, we realize that bullies are basically insecure people. Their dread of being scrutinized by others leads them to redirect focus onto the people they’re bullying to achieve a sense of empowerment. However, knowing this – whether you’re an adult or child – doesn’t make it any more pleasant if you happen to fall victim to a bully. Unfortunately, the Internet allows would-be bullies to hide behind that most cowardly of masks called anonymity. Worse, the Internet feeds bullies’ sense of empowerment because they have a forum to broadcast freely and en masse.

In this sense, “negative search engine optimization (SEO)“ is in many ways the business equivalent of Internet bullying. At a high level (and from this semi-novice standpoint), negative SEO is when someone tries to undermine a business’ online reputation and high search engine rankings through different means including by flooding the web with “backlinks” to that business’ website from “low quality” sites unrelated to the business -- especially things like adult, gambling, spam, and other sites in that vein. It came as a surprise to me, but a Google search of “negative SEO” will quickly reveal the extent to which businesses have had to deal with the actions of unscrupulous competitors and others who try to sabotage their brand and search engine rankings. Put in bullying terms, it’s cowardly, faceless, and, in the case of business competitors, it seems a de facto admission that the competitor isn’t able to compete on a footing like quality of service or value.

For those who aren’t familiar with negative SEO, you’re not alone. We had no idea what it was at our business either until it became clear that someone was engaging in it against us. Suddenly we were thrust into this strange and seedy world of “black hat,” “grey hat,” and “white hat” websites as well as being forced to look at things like the “quality of backlinks affecting search engine ranking.” Believe me, it’s not something that I ever imagined having to contend with when I graduated as a Chiropodist back in 1997!

So, what do you do if your business falls victim to negative SEO?

Another one of those parental idioms is to “just stand up” to the bully, but the shady, faceless nature of Internet business bullying makes it difficult to do directly. I’m certainly no expert on the subject, so the first answer was to research information and engage people who are the experts. There is an abundance of information, tools, and expertise out there, including through Google, to help deal with the issue. Also, slowly, it seems that civil and criminal law is catching up, too. One has to think that the more Sony’s and other big businesses (not to mention governments) that fall victim, the greater the legislative pressure and case law precedent there will be.

Certainly, I can’t bring myself to think that the answer here is to fight fire with fire. Instead, I prefer to fight fire with water. Don’t be distracted from your core focus and the things that make your business a success. Focus on positive SEO, a strong value proposition, and delivering a great product or service. Remember, even though we’re living in this "new" information age, the truth about positive word-of-mouth stands the test of time. Embrace this, and understand that in an era of Internet social media, you have an opportunity to generate positive word of mouth referrals to the world at large just by being good at what your business does and taking the time to incorporate this into your social marketing repertoire.

You’ll be better off and so will your business for not settling to the level of reprisal negative SEO bullydom. Call me old fashioned. Call me naive. But, it seems one of the best ways to “just stand up” is to be street smart but still choose to be one of the good guys.  

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.

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.

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.

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.

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.

Alien Invaders - Treating Plantar Warts

One day you’re taking your socks off and quite accidentally you notice a raised, hard, and rough area on the sole of your left foot. You wonder if you might be developing a corn or a callus. A few days after that you check again and ask yourself, “Is it getting bigger?” Several days later you swear that you see black dots forming under the skin. You begin to wonder. A little more time passes, and with some trepidation you inspect your foot once more only to find that the area is definitely getting larger, and it’s even beginning to take on the appearance of… cauliflower! To make matters worse, there appears to be another one beginning to form on your heel that’s really beginning to hurt. And wait! What’s this on the ball of your right foot?

Fearing that your feet have become the stuff of a science fiction-like alien invasion, you fumble nervously through the phone book to find the number of your nearest Chiropodist to book an appointment to either solve this mystery or send a sample off to NASA for further investigation.

On inspection of your feet, your Chiropodist reassures you that there’s no need to call in NASA, but that you’re not far off the mark suggesting an alien invasion. The unwelcome invader’s name is the papilloma virus. Diagnosis? A case of plantar warts.
Papilloma thrives in warm, moist places (like shoes and socks, swimming pools, locker rooms, public showers, and hotel bathrooms and carpets). People with diabetes or diseases that compromise their immune systems are particularly susceptible to developing warts. Once established, plantar warts can be very stubborn invaders, and, yes, if left untreated they are liable to spread on one or both feet, to other parts of the body, or to other people.

Ways to Prevent Plantar Warts

As with most health problems, prevention is the best medicine. Thorough washing with soap and drying of feet along with good cleaning and sanitization practices on surfaces prone to hold the virus will help prevent infection and re-infection. Never share someone else’s footwear. Even more importantly, always wear protective shoes, sandals, or slippers in public areas such as public swimming pools, locker rooms, and hotel rooms that are at high risk of holding the virus.

Treating Plantar Warts

Although many people try off-the-shelf remedies first, it’s best to see your chiropodist for a proper diagnosis. Warts, corns, and other skin lesions are often confused, and we recently saw a patient at the clinic who had been treating a foreign body lodged in the foot for years with an off-the-shelf wart treatment. Your chiropodist is better equipped to diagnose and treat plantar warts most effectively using a range of approaches that will vary depending on the location, severity, and duration of infection.  Importantly, people with diabetes should never use off-the-shelf wart remedies since the caustic chemical damages tissues and can lead to serious complications like ulcers and bacterial infections. Some plantar warts can be painful, and so your Chiropodist may also provide temporary cushioning devices to “offload” pressure areas of your foot until treatment is complete.

During and after treatment for plantar warts it is important to always wear clean, dry shoes, socks, panty hose, and the like. Also remember that old footwear items must either be thoroughly sanitized or discarded or else re-infection is likely to occur.

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.

A "SOFT" Approach to Foot Pain

For anyone suffering from foot, heel, or ankle pain, the there’s nothing “soft” about it. In fact, the “hard” truth is that the pain can be so severe as to become debilitating.
However, the acronym “SOFT” (Structure, Over-use, Footwear, Trauma) is a helpful way for patients to understand foot-related pain and some of the things we look at as chiropodists when first diagnosing and treating it.
 
1. Structure – Just as no two snowflakes are alike, the same holds true for feet. The reality is that few of us are born with an “ideal” foot, but there is a range of normal in which your feet function most effectively. Structural issues like flat feet, high arches, or other concerns can be increasingly problematic the further they are from this normal range. The result can be pain in the feet, heels, and ankles, and may even affect joints and soft tissue right up to the back, since all of these are connected in what’s known as the gait cycle.
 
2. Over-use –The sudden onset of new activities or exercise, heavy physical training, or intensive work-related activity may cause tissues to become inflamed and tender. Over-use injuries are a sign that your body is trying to repair itself and that you need to give it a break. However, ignoring them can result in the pain becoming a more stubborn chronic (long-term) problem, and may even cause structural foot issues such as heel or bone spurs to happen over time.

3. Footwear – Okay, so most of us understand (but may choose to ignore it!) that footwear like high heels or flip flops are less than ideal. However, fewer of us recognize how important it is to match the kind of footwear you choose to your foot type. Not every shoe is suitable to every foot, and your chiropodist can provide unbiased, expert advice on the kind of footwear best suited to your foot either as part of your treatment for pain or to prevent it.

4. Trauma – Traumatic injuries like those experienced in car accidents and other less severe mishaps can have long-term impacts that result in chronic pain. The foot can be structurally disfigured or tissues can be damaged in ways that cause functional impairment – preventing your foot from working as it should. Your chiropodist’s treatment strategy will help to normalize foot function while addressing the pain.

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.

What's the Difference When You See Kawartha Total Foot Care Centre for Orthotics?

Would you see your optometrist for a cavity? It would be like seeing your dentist for a broken arm or your chiropodist/podiatrist for a spinal chiropractic manipulation. It makes no sense. The expertise and training is completely mismatched.

Yet, when it comes to treating foot pain, particularly in the case of prescription custom orthotics, people often see providers who claim to treat feet but are not regulated foot specialists. To be clear, the only legally regulated foot specialists in Ontario are members of the College of Chiropodists of Ontario – chiropodists/podiatrists. All other providers’ primary areas of expertise may be things like spine and joint manipulations, physical therapy, massage therapy, or unregulated retailers, all for whom orthotics are only a sideline business.

Orthotics are (or at least they should be) precision medical devices that have a profound and lasting impact on your feet and body. Does it make sense, then, to see anyone except your foot specialist… a chiropodist/podiatrist?

Here are four areas that set chiropodists/podiatrists apart:

1. Training: Chiropodists receive four years of comprehensive education in diagnosing and treating all foot pain and problems, which includes exhaustive study in biomechanics, gait analysis, and prescription custom orthotics. Other providers typically receive from ½ day to two weeks of training in orthotics. Frighteningly, some receive no training at all.

2. Breadth of practice: Chiropodists/podiatrists are not an orthotics “one trick pony.” They prescribe a set of orthotics only after taking into consideration your complete foot health and determining which approach or combination of podiatric medical approaches will relieve your pain and problems most quickly, effectively, and inexpensively over the long term.

3. Technique: Chiropodists/podiatrists use an approach that is considered to be the medical gold standard called “suspended sub-talar joint neutral.” This is accomplished using a plaster cast or highly-precise three-dimensional computer imaging along with the chiropodist’s/podiatrist’s calculations and specifications to manufacture the orthotics in a certified laboratory to rigorous industry-recognized standards for excellence and durability. Remember, three-dimensional imaging is VERY different from the step on computer pads, foam boxes, or other gimmicks and shortcuts to create orthotics. Think about it. A computer pad, for example, takes an image of your foot to create an orthotic in precisely the unhealthy weight-bearing position that is causing your pain or problem. Also, the image taken by the computer pad is extremely limited in that it’s only two dimensional – measuring just length and width – while your feet are most certainly three dimensional! Also, common sense applies here. If this approach used by the chiropodists/podiatrists takes four years to learn and perfect, it only stands to reason that there must be a substantial difference over the approach that was learned in a matter of days or hours. 
   Apart from the “flashy” marketing value, the benefit to users of gimmicks and shortcuts is that they require very little training to learn or use and are far more profitable. However, what the unsuspecting public may be purchasing is no more than an expensive arch support or a faulty device that is not suited to correcting their particular foot condition.

4. Regulation: Orthotics in Canada are not regulated. This means that anyone – despite their lack of qualifications – can post a sign and begin providing orthotics. This said, Chiropodists/podiatrists are legally regulated through the Chiropody Act by the College of Chiropodists of Ontario. Theirs is the only regulated body to specify standards for quality, care, and technique when it comes to orthotics.

In the end, it is a case of “buyer beware.” Before investing your hard earned money on a new or replacement set of orthotics, it is well worth seeking the advice of a chiropodist, even if for a second opinion. It’s a “step” your feet may thank you for taking.

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.

The Funniest Things I've Found in Patients' Shoes... that Demonstrate why Neuropathy is No Laughing Matter

By Fellow Kawartha Total Foot Care Centre Chiropodist David Murphy, M.T., D.Ch.

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.

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.

New Life for "Old Soles"

Kawartha Total Foot Care Centre has been collecting gently used shoes for the past few months so that these “old soles” can be reincarnated to help others. For young and old, footwear is an essential part of everyday life, whether for work, recreation, or basic mobility.

Kawartha Total Foot Care Centre
Chiropodists Nadine Webster
& David Murphy pose with
a sample of the shoes collected.

Yet, it’s something easily taken for granted. Socio-economic barriers, natural disasters or catastrophic events, and other issues can make access to footwear a challenge. A pair of high-quality, good- condition footwear can make a real difference in a person’s ability to work or find work, for a senior to maintain his or her mobility, for the family who has lost everything in a house fire, or for a child to participate in sport and play. Sadly, there are children even here in Canada who go to school with shoes that are full of holes and too small. Worse, now imagine it in the cold of winter.

It’s also a health issue. Good footwear supports physical activity, especially in Western society where we’re becoming increasingly sedentary. In colder climates like Canada, winter footwear is needed to protect feet from damage. There are also those with issues like diabetes, injuries or deformities, and other health concerns where proper footwear is vital to preventing pain and potentially serious complications.

Tremendous Community Support

“I’ve been incredibly impressed and touched by the generosity of those who’ve donated,” remarks Kawartha Total Foot Care Centre owner and chief chiropodist Nadine Webster, noting that the quantity and excellent condition of the shoes donated was well beyond expectations. “I remember one person, in particular, whose spouse had just passed away. She donated several pairs of his shoes, all in beautiful condition. It made her feel good for something of his to carry on and make a difference. It was so heartwarming.”

Initially, the shoe collection was something that Kawartha Total Foot Care Centre was taking on for a limited period of time, but with the level of support and the positive impact it makes they’re now going to make the collection permanent and year round. The clinic plans to direct the collected footwear to local agencies like “Women’s Resources” and “A Place Called Home” as well as internationally through “Soles4Soles Canada,” a charitable organization that distributes footwear free of charge to those in need in North America and around the globe.

Anyone wishing to make a donation of gently-used shoes or boots can drop them off to the clinic at 100 East St. S. in Bobcaygeon.

For more information on your good foot health, you can always visit the Kawartha Total Foot Care Centre web site.