November Articles 2013

Biomechanics in Podiatry

Biomechanics and its related study deal with forces that act against the body and effect things like our movement. In podiatry, biomechanics are studied to determine the movement of the ankle, toes, and the foot itself, as well as the forces that impact them. Podiatrists who train in this specialty are able to effectively diagnose and treat conditions that affect people’s everyday movement.

Regardless of your lifestyle, age, or any other factors, many people experience foot problems throughout their lives. Twists and turns, improper balance, and added weight are just a few of the things that can add stress to the feet and limit the mobility everyone takes for granted. Pain in the feet and ankles can also trickle up towards the lower legs, knees, hip, and even back area, all effecting the way you move around on a daily basis.

The history of studying biomechanics dates back to ancient Egypt at around 3000 B.C., where evidence of professional foot care has been recorded. Throughout the centuries, advances in technology, science, and an understanding of the human body led to more accurate diagnosis of conditions such as corns for example. In 1974, biomechanics garnered a large audience when Merton Root claimed that changing or controlling the forces between the ankle and the foot, corrections of certain conditions could be implemented to gain strength and coordination in the area. Due to his research, we still use his basic principle of thermoplastic foot orthotics to this day.

As technology has improved, so have the therapeutic processes that allow us to correct deficiencies in our natural biomechanics. Computers can now provide accurate readings of the forces, movements, and patterns of the foot and lower leg. Critical treatment options can be provided to patients now who suffer from problems that cause their biomechanics to not function naturally. The best results are now possible thanks to 3D modeling and computing technologies that can not only take readings, but also map out what treatment will do to the affected areas.

These advanced corrective methods were able to come to light thanks to an increase in both the technologies surrounding biomechanics and also the knowledge of how they work naturally. For example, shoe orthotics is able to treat walking inabilities by realigning the posture deviations in patients caused by hip or back problems. Understanding foot biomechanics can help improve movement and eliminate pain, stopping further stress to the foot, so speaking with your podiatrist if you have any of these problems is highly recommended.



Systemic Diseases of the Foot

There are several systemic diseases, or diseases that affect the whole body, that either display symptoms in the feet or affect the health of the feet. Common systemic diseases that affect the overall health of the feet, and the patient’s ability to walk comfortably, include gout, diabetes mellitus, neurological disorders, and arthritis.

In gout, which is caused by an excessive buildup of uric acid in the body, the most common symptoms of pain, inflammation, and redness occur at the metatarsal/phalangeal joint at the base of the big toe. Any excess levels of uric acid, crystallize and are deposited in tendons, joints, and surrounding bone and muscle tissue. Gout is commonly treated with NSAIDs to relieve pain and inflammation and other drugs to lower uric acid levels in the body. Gout most commonly affects those who are overweight, have low protein diets and lead a more sedentary lifestyle.

Diabetes mellitus is an increase in the level of blood sugar in which the body cannot counteract with naturally occurring insulin in the body. The three types of diabetes, Type I, Type II and Gestational Diabetes, are all signs the body is either not producing enough insulin or is not efficiently using the insulin that is produced. Gestational diabetes only affects women who are pregnant and have never, prior to pregnancy, exhibited symptoms of the disease.

There are two main issues that affect the feet that are commonly caused by diabetes. They include diabetic neuropathy and peripheral vascular disease. Diabetic neuropathy can lead to damaged nerves and affect the feet through numbness and loss of sensation. Peripheral vascular disease restricts the flow of blood to the foot and can, in extreme cases, lead to the necessity of amputating the foot. Peripheral issues that are caused by diabetes and can affect the foot include athlete’s foot, nail infections, corns, blisters, bunions, severe dry skin, plantar warts and ingrown toenails. These can all be attributed to the decrease of blood flow to the foot.

Neurological disorders and rheumatoid arthritis can also have severe impact on the health of the feet. Neurological disorders can affect the nerves in the main structure of the foot and cause loss of sensation and possible decreased muscle response. Rheumatoid arthritis can affect the bones and joint structures of the foot, making it impossible to walk normally without serious pain.

All systemic diseases that affect the foot can effectively be treated to minimize joint and muscle damage if they are diagnosed early and treated with medication and lifestyle therapy. Diabetes patients must monitor their blood sugar levels and work with their physician to keep their levels as close to normal as possible. Rheumatoid arthritis patients should work with their physician to ensure the proper medications are being taken to reduce the amount of damage to the joints of the body.


Flat Feet

Flat feet is a foot condition in which the arch of the foot either drops or is never developed. About 20-30% of the population generally has flat feet because their arch never formed during growth. While it is common in babies and small children, it can become a problem if the arch never develops. For adults, the development of flat feet can be brought upon by injury, or may even be a result of pregnancy due to the increased elasticity; however, in adults the flat footedness is usually permanent.

Having flat feet can sometimes make it difficult to walk due to the stress it places on the ankles. The general alignment of your legs is thrown off because the ankles move more inward which can cause some major discomfort. This also has a big effect on the knees as many people that have flat feet often have arthritis in that area. However, in many cases, flat feet does not cause any pain and it should not be a cause for concern in that case.

For those that run, there are specific shoes to help realign the ankles with a lot more support and less pronation. The weight shifting in this activity is very quick, so that's why it's important to know if you have flat feet early on in your life, in case of injury down the road. 

The wet footprint test can be an indicator to diagnosing flat feet. In this test, the individual would place a flat foot on a surface in order to show a footprint. If there is no indentation or indication of an arch, that person may have flat feet. In all cases, it is best to consult a podiatrist if flat feet is suspected or noticed.

Once flat feet has been diagnosed, it can be treated by walking barefoot in beach-like terrain, or wearing insoles. There are two types of flat feet; one being rigid, where the feet appear to have no arch even when the person is not standing, and the other being flexible where the person appears to have an arch while not standing, but once standing the arch goes away. In the case of flexible flat feet, unless there is pain caused by the condition, there is no need for treatment. However, if it causes pain or in the case of rigid flat feet, exercises and orthotic insoles may be prescribed in order to help the arches develop.

In some cases when the condition is severe and all other methods have been exhausted surgery may be required but this is normally avoided due to a lengthy recovery time and high cost.


Ankle Sprains

Ankle sprains, while not as severe as a broken ankle, are still a serious injury that needs immediate attention. They can lead to limited mobility and a significant amount of pain, and are often characterized by swelling and sometimes discoloration of the skin. An ankle sprain occurs when the ligaments are stretched beyond their limits, and even though this can happen in other places, such as the wrist, the ankles are the most common place for a sprain.

Ankle sprains can occur in many different ways, even just by simply walking. They happen when the ankle rolls over itself or twists under the foot, causing the ankle and tendon to snap or pop. Athletes who continually push their bodies to the limits are often at risk, as are people who have previously suffered accidents involving the lower extremities.

In most cases, ankle sprains are not severe enough to warrant medical help, such as going to a hospital. There are many self-care remedies you can use to treat your ankle, including applying ice packs to reduce swelling, remaining off your feet to reduce pressure, and elevating your feet above your head to reduce blood flow and inflammation. Often times an ACE bandage and over the counter pain relievers are enough, but it is still important to remember to stay off the ankle for some time to avoid re-aggravating it.

Even though most of these cases are mild, a severe ankle sprain can occur which will require professional, medical care. A sprain that causes a tear in the ligament or damage to the muscles is severe enough to warrant surgery and keep you off your feet for a prolonged period of time. Post-surgery physical therapy is often required in order to completely rehab the ankle back to health, and this will be administered and monitored by your podiatrist.

Even though ankle sprains may seem harmless and only mildly painful, if you are experiencing non-stop pain over a long period of time, if walking is becoming too painful for you, if the swelling is much more severe than initially anticipated, or if numbness and tingling is present, this may be signs that your sprain is a much more severe broken ankle. It is highly recommended to seek treatment right away for these symptoms.

Often times, preventative care is one of the best ways to avoid ankle sprains. Wearing appropriate fitting shoes that provide both ankle and arch support will help, as well as stretching before any kind of physical activity, including sports, weight training, or even simply jogging.


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