Shoe inserts vs. Orthotics (short version)

ON THE HEALTHY SIDE

“Shoe inserts and orthotics”      Dr. Ned Ramadan DPM  203-701-0252

What are Shoe Inserts? 

Shoe inserts are found almost anywhere in today’s market from the pre-packaged arch supports with various materials to the “custom-made” foot insoles that could be ordered online or at retail stores. Unless the device has been prescribed by a doctor and crafted for your specific foot, it’s a shoe insert, not a custom orthotic device.

Custom molded foot orthoses is custom made to your foot and made by your doctor. It has a multitude of benefits that vary for each individual foot type and deformity.  They align and correct deformities of the foot such as  high arches, flat arches, ankle deformities, lower leg, hip and low back pain.

Consider your health. Do you have diabetes? Problems with circulation? An over-the-counter insert may increase your risk of foot ulcers and infections. A podiatrist can help you select a solution that won’t cause additional health problems. Think about the purpose. Are you planning to run a marathon, or do you just need a little arch support in your work shoes? Look for a product that fits your planned level of activity.

What are Prescription Custom Orthotics?

Custom orthotics are specially-made devices that are only manufactured after a podiatrist has conducted a complete evaluation of your feet, ankles, and legs. The orthotic can accommodate your unique foot structure and are designed to correct and align, relieve symptoms, prevent other aliments from forming, decreases shock and gives support, and comfort your feet. Prescription orthotics are crafted for you only. They match the contours of your feet precisely and are designed for every step you take. Prescription orthotics are divided into two categories:

Functional “Corrective” orthotics are designed to control abnormal motion that leads to pain. Improper foot function transfers body weight, pressures and forces abnormally through the ankles, legs, knees, hips and spine. Functional/Corrective orthotics are usually crafted of a semi-rigid and rigid materials such as plastic or graphite that vary in thickness/rigidity.

Accommodative orthotics are softer and meant to provide additional cushioning and support. They can be used to treat diabetic foot ulcers, painful calluses on the bottom of the foot, and other uncomfortable conditions. Some are cork and leather, sub ortholen, and several thin plastics with poron and spenco top covers for shock absorption.

Podiatrists use orthotics to treat foot problems such as heel pain, plantar fasciitis, bursitis, tendonitis, diabetic foot ulcers, pediatric and geriatric foot deformities, and lower legs deformities. Clinical research studies have shown that podiatrist-prescribed foot orthotics decrease foot pain and improve overall function.

Orthotics cost more than shoe inserts purchased in a retail store. Unlike shoe inserts, orthotics are molded to fit each individual foot to relief symptoms and correct deformity. Prescription orthotics are also made of top-notch materials and last many years when cared for properly. Insurance coverage vary pending on plan.

When to Visit a Podiatrist

Your podiatrist will examine your feet and how you walk. He or she will listen carefully to your complaints and concerns and assess the movement and function of your lower extremities. Some also use advanced technology to see how your feet function when walking or running.

The information gathered during the exam will help your podiatrist determine if shoe inserts might be helpful or if you need prescription orthotics. If orthotics are needed, then a set of unique foot supports that will improve your foot movement and lead to more comfort and mobility. Your podiatrist might also suggest additional treatments to improve the comfort and function of your feet.

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Amazing feet.

Dr. Ned Ramadan, DPM

Reconstructive Foot Surgeon, LLC

228 New Haven Ave

Milford, CT

06460

(203) 701-0252

 

Foot Anatomy: Your Amazing Feet

 

The foot is a vital organ in our daily life that enables our mobility. It is a well-designed anatomical structure that requires little attention for the normal functioning. Anatomically, a foot is a complex structure; consist of 42 muscles, 26 bones, 33 joints, and at least 50 ligaments and tendons made of strong fibrous tissues to keep all the moving parts together to support the entire body and distributing it to the ground by the curve of the foot or sole … plus 250,000 sweat glands. The foot is an evolutionary marvel, capable of handling hundreds of tons of force — your weight in motion — every day. The foot’s myriad parts, including the toes, heel, and ball, work in harmony to get you from one place to another. But the stress of carrying you around puts your feet at high risk of injury, more so than other parts of your body.

The abnormality of feet affects the spine, hip, leg and knee and lead to the muscle spasm, pain, rupture (tear), and joint pathologies head to toe. This occurs due to the unbalanced arrangement of the bones. Consequently, the results of the flatting arch are a twisted ankle, tilting inward freeze or bending tendons in the foot and lower leg. Correct medical management may prevent the deformity from getting worse. The common deformities of the foot include hammertoe, clubfoot, flat feet and pes cavus (high arch foot type).

Many foot problems, including hammertoes, blisters, bunions, corns and calluses, heel spurs, claw and mallet toes, ingrown toenails, toenail fungus, and athlete’s foot, can develop due to neglect, ill-fitting shoes, and simple wear and tear. Your feet also can indicate if your body is under threat from a serious disease. Peripheral vascular disease from the swollen legs and feet with skin pigmentation(discoloration) and tissue scarring to pale, shiny, taut blanched skin with lack of digital hair. Organ disorders and failure manifest in feet, toes and toenails. Gout, for instance, will attack the foot joints first such as big toe, arch, heel, ankle and Achilles tendon. Other arthritis like systemic lupus and rheumatoid arthritis (the autoimmune diseases) and diabetes affect the toes and feet.

In Summary, feet are complex structures with tendons and ligaments acting as pulleys and levers to enable us to perform our daily activities. Proper body weight distribution with or without pathology should be addressed and corrected with various conservative modalities from custom inserts, braces, various shoes and exercises.  When feet hurt, the whole body hurts.  Numerous diseases manifest in the feet and lower leg first.  Unfortunately, our “tires” do not get changed; therefore, do your very best to take care of them.

 

Shoe inserts vs Custom molded foot orthotics.

 

What are Shoe Inserts? 

Shoe inserts are found almost anywhere in today’s market from the pre-packaged arch supports with various materials to the “custom-made” foot insoles that could be ordered online or at retail stores. Unless the device has been prescribed by a doctor and crafted for your specific foot, it’s a shoe insert, not a custom orthotic device.

Custom molded foot orthoses is custom made to your foot and made by your doctor. It has a multitude of benefits that vary for each individual foot type and deformity. They align and correct deformities of the foot such as high arches, flat arches, ankle deformities, lower leg, hip and low back pain.

Shoe inserts are bought over-the-counter pre-packaged or some stores have a machine that you step on. These devices are inserts and can cushion your feet providing shock absorption and comfort, and support your arches. They can’t; however, correct biomechanical foot problems or cure long-standing foot issues.

The most common types of over-the-counter shoe inserts are:

  • Arch supports: “bumped-up” appearance and are designed to support the foot’s natural arch.
  • Insoles: made often of gel, foam or plastic that slip in shoes to provide extra cushioning and support.
  • Heel liners: known as heel pads or heel cups, provide extra cushioning in the heel region. They may be especially useful for patients who have foot pain caused by age-related thinning of the heels’ natural fat pads.
  • Foot cushions: Vary in shapes and sizes that are used as a barrier between your skin and the shoe.
  • Choosing an Over-the-Counter Shoe Insert:
  • Consider your health. Do you have diabetes? Problems with circulation? An over-the-counter insert may increase your risk of foot ulcers and infections. A podiatrist can help you select a solution that won’t cause additional health problems.
  • Think about the purpose. Are you planning to run a marathon, or do you just need a little arch support in your work shoes? Look for a product that fits your planned level of activity.
  • Bring your shoes. Foot inserts are as good as the shoe you’re wearing. Shoe shape, depth, type of material, rigidity, width, and length aid in the correction and proper function of the foot. It’s best to bring your sneakers, dress shoes, or work boots—whatever you plan to wear with your insert.
  • Try them on. Do feel aligned and corrected? Or do they hurt because they’re making matters worse?Custom orthotics are specially-made devices that are only manufactured after a podiatrist has conducted a complete evaluation of your feet, ankles, and legs. The orthotic can accommodate your unique foot structure and are designed to correct and align, relieve symptoms, prevent other aliments from forming, decreases shock and gives support, and comfort your feet. Prescription orthotics are crafted for you only. They match the contours of your feet precisely and are designed for every step you take. Prescription orthotics are divided into two categories:
  • What are Prescription Custom Orthotics?
  • Functional “Corrective” orthotics are designed to control abnormal motion that leads to pain. Improper foot function transfers body weight, pressures and forces abnormally through the ankles, legs, knees, hips and spine. Functional/Corrective orthotics are usually crafted of a semi-rigid and rigid materials such as plastic or graphite that vary in thickness/rigidity.
  • Accommodative orthotics are softer and meant to provide additional cushioning and support. They can be used to treat diabetic foot ulcers, painful calluses on the bottom of the foot, and other uncomfortable conditions. Some are cork and leather, sub ortholen, and several thin plastics with poron and spenco top covers for shock absorption.Orthotics cost more than shoe inserts purchased in a retail store. Unlike shoe inserts, orthotics are molded to fit each individual foot to relief symptoms and correct deformity. Prescription orthotics are also made of top-notch materials and last many years when cared for properly. Insurance coverage vary pending on plan.Over-the-counter shoe inserts are fine for extra cushioning or support. If you have serious pain or discomfort, however, schedule an appointment with a podiatrist. He or she will assess your overall health and look for any other contributing factors. Today’s podiatrists are specially trained to evaluate the biomechanics of the lower extremity.The information gathered during the exam will help your podiatrist determine if shoe inserts might be helpful or if you need prescription orthotics. If orthotics are needed, then a set of unique foot supports that will improve your foot movement and lead to more comfort and mobility. Your podiatrist might also suggest additional treatments to improve the comfort and function of your feet.
  • Your podiatrist will examine your feet and how you walk. He or she will listen carefully to your complaints and concerns and assess the movement and function of your lower extremities. Some also use advanced technology to see how your feet function when walking or running.
  • When to Visit a Podiatrist?
  • Podiatrists use orthotics to treat foot problems such as heel pain, plantar fasciitis, bursitis, tendinitis, diabetic foot ulcers, pediatric and geriatric foot deformities, and lower legs deformities. Clinical research studies have shown that podiatrist-prescribed foot orthotics decrease foot pain and improve overall function.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic systemic inflammatory disease. The condition results in persistent symmetric polyarthritis “many joint involvement” (synovitis, aka inflamed joint) that primarily affects the hands and feet, although any joint lined by a synovial membrane “joint covering” can be involved. Approximately 40% of patients become disabled after 10 years. Because early treatment is key, do you know the signs, workup, and best treatment practices for rheumatoid arthritis? Test your knowledge with this brief article.

Joint involvement is the characteristic feature of rheumatoid arthritis. In general, the small joints of the hands and feet are affected in a relatively symmetric distribution. In decreasing frequency, the metacarpophalangeal joints (knuckles affected by 50%), wrist, proximal interphalangeal joints (fingers and toes by 34%), knee, metatarsophalangeal joints (sole/ball of foot by 18%), shoulder, ankle, cervical spine, hip, elbow, and temporomandibular joints (jaw by 1%) are most commonly affected.

Predicting the course of an individual case of rheumatoid arthritis at the outset remains difficult, although the following all correlate with an unfavorable prognosis in terms of joint damage and disability:

• Blood tests such as HLA-DRB1*04/04 genotype and high serum titer of autoantibodies (eg, rheumatoid factor, anti–citrullinated protein antibodies).

•Extra-articular manifestations common 24% of the time (non joint involvement such as inflammatory nodes “pannus” on skin).

•Large number of involved joints (usually symmetrical common on left and right side)

•Age younger than 30 years with a 34% above age 30

•Female sex by 27% of the time

•Systemic symptoms (heart, kidney, lungs, circulation, etc.)

•Insidious onset

Cardiovascular morbidity and mortality are increased in patients with rheumatoid arthritis by 50%. Nontraditional risk factors appear to play an important role. Myocardial infarction, myocardial dysfunction, and asymptomatic pericardial effusions are common; symptomatic pericarditis and constrictive pericarditis are rare. Myocarditis, coronary vasculitis, valvular disease, and conduction defects are occasionally observed. Other organs include the gastrointestinal system by 10%, urinary by 7%, lymphatic system by 32%.

Radiography remains the first choice for imaging in rheumatoid arthritis; it is inexpensive, readily available, and easily reproducible, and it allows easy serial comparison for assessment of disease progression. MRI provides a more accurate assessment and earlier detection of lesions than radiography does; however, the cost of the examination and the small size of the joints involved militate against its widespread use. Ultrasonography of joints is gaining increased widespread acceptance in clinical practice, but its use in rheumatoid arthritis is not yet the standard of care.

Guidelines from the European League Against Rheumatism (EULAR) are designed to prevent the overtreatment of 20% to 30% of patients with rheumatoid arthritis. The new guidelines focus on early diagnosis and treating to target on the basis of EULAR criteria. Highlights include the following:

•Patients with active disease should be monitored every 3 months, and treatment should be adjusted if no improvement is seen at 6 months.

•Methotrexate is recommended as first-line therapy; sulfasalazine (SSZ) or leflunomide can be substituted if contraindications to methotrexate are present.

•Anti-tumor necrosis factor agents are no longer the only biologics recommended for patients with an insufficient response to methotrexate; all biologics are considered to be similarly effective.

•Biologics should be combined with disease-modifying antirheumatic drugs.

 

 

 

The 4 C’s about Ulcerations: Causes, Concerns, Conditions, and Care.

Dr. Ned M. Ramadan, DPM

228 New Haven Avenue

Milford, CT 06460

Ph: (203)701-0252

Fax: (203)876-0937

Lower extremity ulcerations overview.

Foot and lower leg open sores known as ulcerations.

The 4 C’s you need to know: Causes, concerns, conditions and care.

Prevention and various treatments.

Open sores known  as ulcerations on the foot and lower leg are limb and life threatening conditions requiring immediate medical attention and care.

Ulcerations vary in dimensions and locations along the entire body including the buttocks, lower leg and foot.

Ulcerations require immediate medical attention and avoiding self diagnosing and treatment due to its limb and life threatening condition.

Recognition followed by a thorough understanding and immediate care is crucial to a successful outcome.  Furthermore, it is essential that a medical team approach is adopted to optimize the care.

It is important to recognize and acknowledge the ulceration by either self observation and or others followed by immediate medical care.  The medical professional will then educate you regarding the cause, short and long term treatment goals, and prevention options.

The relevance of advanced studies of the lower extremity circulatory status are vast and important regarding the outcome of the ulceration.

The benefits of various prescription medications, over all healthy living through sound diet, exercise and stress free life style, early detection followed by multi medical professional care is essential to the outcome and prevention.

In depth discussion regarding the various synthetic to biological dressing changes to skin and soft tissue debridement, skin grafting and local tissue flap closures.

Importance of proper local wound care, home nursing, offloading, medication, and diet in lower extremity ulcerations on either foot and or leg.

Please join us for an educational presentation regarding ulcerations of the foot and lower leg.

ULCERATION IS THE MEDICAL TERM FOR OPEN WOUND.

ULCERATIONS ARE BREAK DOWN IN THE PROTECTIVE LAYER OF EITHER SKIN AND OR INTERNAL LINING SUCH AS THE GASTRO-INTESTINAL TRACT.

CAUSES:

  • HEREDITARY,
  • IRRITATION DUE TO REPETITIVE FORCE AND PRESSURE,
  • MECHANICAL INSTABILITY (DIRECTLY AND OR INDIRECTLY),
  • POOR CIRCULATION (ARTERIAL AND VENOUS),
  • MEDICAL CONDITIONS SUCH AS CONGESTIVE HEART FAILURE, RENAL (KIDNEY) DISORDERES, DIABETES AND OTHERS.
  • AGE DUE TO FAT ATROPHY (DIMINISHMENT) AND ARTHRITIS SETTING CAUSING DEFORMITY AND ENLARGEMENT OF JOINTS AND BONES INTURN CAUSING PRESSURE AND ABNORMAL FORCE,
  • MEDICATIONS AND METABOLISM
  • ALLERGIC REACTIONS
  • DIET
  • NEOPLASMS (BENIGN AND MALIGNANT).

LOCATIONS:

ENITRE BODY PARTS; MOST COMMONLY THE BUTTOCKS, LEGS AND FEET.

TYPES OF WOUNDS:

DRY, MOIST AND WEEPING (DRAIN A LOT) WOUNDS, NECROTIC AND GANGRENOUS.

DIMENSIONS:

  • IRRITATION WITH REDNESS NO BLISTERING EFFECT
  • PARTIAL THICKNESS OF THE SKIN INVOLVING THE EPIDERMIS  (OUTER PROTECTIVE LAYER OF THE SKIN);
  • FULL THICKNESS OF THE SKIN INVOLVING THE EPIDERMIS AND DERMIS (LAYER BENEATH THE EPIDERMIS);
  • SUB CUTANEOUS (FAT LAYER);
  • FASCIAL LAYER (FIBEROUS LAYER OVER THE MUSCLES TYPICALLY AND UNDERNEATH THE FAT LAYER);
  • MUSCLE LAYER,
  • IN THE PODIATRIC MEDICAL FIELD, WE TYPICALLY FOLLOW WAGNER’S CLASSIFICATION:

Grade 0 – skin with prior healed ulcer scars, areas of pressure which are sometimes called pre-ulcerative lesion or the presence of bony deformity which puts pressure on an unguarded point.

Grade I – A the wound is superficial in nature, with partial or full thickness skin involvement but does not include tendon, capsule or bone.

Grade I – B as above, the wound I superficial in nature, with partial or full thickness skin involvement but does not include tendon, capsule nor bone; however, the wound is infected. The definition of this wound implies superficial infection without involvement of underlying structures. If the wound shows signs of significant purulence or fluctuance, further exploration to expose a higher grade classification of infection is in order.

Grade I – C as above but with vascular compromise

Grade I – D as above but with ischemia. Because ischemia is a type of vascular compromise, the distinction between these two grades is often difficult to make.

Grade 2-A penetration through the subcutaneous tissue exposing tendon or ligament, but not bone.

Grade 2-B penetration through the deep tissues including tendon or ligament and even joint capsule but not bone.

Grade 2-C as above 2B, but including ischemia.

Grade 2-D as above 2C, but including infection.

Grade 3-A a wound which probes to bone but shows no signs of local infection nor systemic infection.

Grade 3-B a wound which probes to bone is infected.

Grade 3-C a wound which probes to bone is infected and is ischemic.

Grade 3-D a wound which probes to bone characterized by active infection, ischemic tissues and exposed bone.

Grade 4 gangrene of the forefoot

Grade 5 gangrene of the entire foot. 

CONCERNS:

OPEN WOUNDS REQUIRE IMMEDIATE MEDICAL ATTENTION AFTER PATIENT RECOGNITION.

OPEN WOUNDS COULD LEAD TO LIMB AND LIFE THREATENING CONDITIONS IF NOT PROPERLY TREATED.

OPEN WOUNDS OFTEN GET INFECTED REQUIRING ORAL VS INTRA VENOUS ANTIBIOTICS.

OPEN WOUNDS CAN LEAD TO AMPUTATIONS.

CHECK YOUR FEET AND LEGS DAILY; OTHERWISE, HAVE YOUR SPOUSE AND OR FRIEND CHECK.

DO NOT SELF DIAGNOSE AND TREAT YOURSELF.

DO NOT ASK YOUR NEIGHBOR OR FRIEND WHAT THEY HAD AND HOW IT HEALED.

EACH INDIVIDUAL CASE IS DIFFERENT.

TREATMENTS:

MULTI SPECIALITY / TEAM APPROACH.

ADDRESSING THE ETIOLOGY (CAUSE), RESOLUTION FOLLOWED BY PREVENTION.

For example, an ulceration on the bottom of the foot requires offloading with proper shoe devices and modifications, x-rays, cultures, possible MRI to rule out abscess formation and or bone infection requiring surgery and hospital admission.

BENEFITS OF WOUND CARE CENTERS AND VISITING HOME CARE NURSES.

WHY IS MY CARE IMPORTANT?

WHY DO DOCTORS “DEBRIDE” CUT OFF TISSUE EVERY TIME I SEE HIM OR HER? IS THAT MAKING MY WOUND WORTH OR BETTER?

VARIOUS OINTMENTS, HYDRO GEL, SILVADENE CREAM, WET TO DRY DRESSING (SALINE WATER DAMPED ON THE GUAZE) AND OTHER SYNTHETIC LOCAL WOUND CARE DRESSINGS SUCH AS AQUACEL AG SILVER DRESSING, MEDIHONEY, HYDROFERA BLUE, etc.

OTHER DRESSING SUCH AS THE BIOLOGICALS SUCH AS Oasis matrix dressing extra cellular matrix derived from porcine intestine which comes in 3.0cmx3.5cm sheets.

WOUND VACCUM (NEGATIVE PRESSURE).

SKIN GRAFTING AND OTHER SOFT TISSUE FLAP CLOSURE SUCH AS ROTATIONAL, TRANSITIONAL AND ADVANCEMENT FLAP CLOSURES.

LASTLY, COMPRESSION WITH EITHER MECHANICAL PNEUMATIC DEVICES AND OR KNEE HIGHS AND OR ABOVE KNEE SOCKS.  WHAT’S THE DIFFERENCE?

GRADIENT OF PRESSURE REQUIRED?

HOW DO I PUT THEM ON? THEY ARE VERY TIGHT?

I HAVE ARTHRITIS IN MY HANDS, IS THERE AN EASIER WAY TO PUT THEM ON?

I APPRECIATE YOUR TIME AND PLEASE REMEMBER TO LOOK DAILY AT YOUR FEET.

Loose weight the logical way

This article is intended to all healthy individuals who choose to loose weight the logical and sensible way.
We ought to learn from nature which has a pot of valuable goodies for our daily lives. One of which is the restricted diet where the coyotes as an example do not eat daily and therefore lean, energetic and healthy.
In the medical field the liver acts as the gateway pathway for all ingested and inhaled things. Furthermore, the liver acts as a “snickers bar” which provides immediate energy required over a 24 hour period. In other words, your piggy bank of energy through out the day.
In the case of over consumption, the liver then stores its energy into fat.
Basically I devised a plan of loosing weight without exercise. I lost 70lbs over 6 months with out breaking a sweat. If those of you choose to exercise, be cautious of over consuming due to the “demand” and “supply” method. I encourage exercise without a doubt but a thorough understanding is required.
The more you exercise, the more you break down tissue, the more external sources of energy, vitamins and electrolytes, building blocks, and hydration becomes required, aka more eating and drinking. It’s the healthier way to loose weight but will require a lot of dedication, self will, and persistence.
Another topic we all need to know is blood type.
Blood type is like an engine which requires certain type of fuel, aka not every engine runs on gas.

Another relavent subject in weight lose is counting calories.

Staying within 2000 calories daily intake after reaching your ideal weight to height and gender rule.

For those that are healthy and willing to loose weight without exercise, I suggest Monday and Thursday’s to eat normally without restrictions with the exception to stay within the 2000 calories daily rule.
Here’s how it gets tricky where Tuesday and Wednesday I recommend half of your daily intact aka 1000 calories. The first two to three months include Saturday and Sunday as well. Yes, it’s another form of starvation diet if the term fits.
Eventually, only Tuesday and Wednesday would be sufficient after the third month until the six month. Be patient do not give up. It is tough initially but you will find out to be more energetic with an uplifted mood.
Take any person without food as an example, that person becomes hyper and active. Obviously, in moderation and persistence your body will learn to consume its stored energy from the liver and now you’re on your way to lean hood.

Lastly but certainly not least is Stress and its ramifications on weight fluctuation.

The fight or flight mechanism and cortisol production from the adrenal gland have an impact on weight fluctuation.

In summary, weight lose can be achieved without breaking a sweat through what I call “starvation diet”. Eat sensably and in moderation with occasional restricted intake throughout the week until you reach the weight you desire or what your height, weight and gender ratio requires.
This “starvation diet” is not for everyone.
Please consult with your physician prior to commencing any type of diet.

Foot doctor (podiatrist)