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.