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Foot Orthotics – Are They Worth the $?

I’m often asked about orthotics and the questions usually involve two basic issues:

     1.  Do orthotics really work?

     2. Why are orthotics so expensive?

I find it ironic that most people asking these questions own orthotics.  If they are wearing orthotics and they have to ask if they work, it must mean the orthotics are not doing their job.  No one seems to ask such questions about contact lenses or glasses.  If they’re wearing contacts and they question their effectiveness, the contacts probably aren’t the right lenses for that person.

Orthotics are no different.

As for the price, in many cases I think orthotics are grossly over-priced.  Sure there is tons of science and detail installed into a properly fitted pair of orthotics but there is little reason why someone needs to charged $600 for any shoe insert that isn’t covered in gold and diamonds!

I’m a fan of orthotics if fitted properly….for the right reasons and for the right price.  Approximately 40% of my athletes presently wear orthotics.  I owe a great deal of my knowledge about the lower kinetic chain and orthotics to David Tiberio, professor and friend from one of my alma maters, the University of Connecticut.  He’s a brilliant physical therapist and I appreciate him sharing his amazing insight with me over the past 25+ years.

What is an orthotic?

An orthotic is a specifically designed shoe insert which is custom-made to correct a biomechanical abnormality by correcting the poor alignment and enhancing the body’s ability to move.

How Do Orthotics Work?

As I tell my pro football players: “Orthotics bring the ground up to the foot.”  The foot is the base of support of the entire body and it starts the movement pattern when the foot is in contact with the ground during standing, walking or running.

If you were to put a smaller wheel on the front left side of your car, the car will still be driveable and get you to where you want to go.  It will be slower, it will be harder to drive, other parts of the car will be stressed more, the other tires will wear-out faster and the appearance of your car will change.  Poor foot alignment is no different.

To get that car alignment corrected without changing the tire, it can be done two ways.  1.  The car can be driven without the front left tire ever touching the road – not likely to happen or  2. The road can be brought up to the tire as if that tire was now riding on the curb.  This is a simple example of how an orthotic functions.

The Benefits of Orthotics

There are many reasons why orthotics are used.  Those reasons include leg length discrepancy, plantar fasciitis, heel pain, ankle sprains, tendonitis, arch pain, shin splints, foot pain, stress fractures, low back pain, muscle pain/injury, neuromas, bursitis, and sciatica. The influence of an orthotic, as with the base of support of any structure, can reach from the bottom to the top of that structure.

There is much discussion related to the best manner to create the orthotic and it goes well beyond the scope of this sports medicine blog posting.  Weight bearing status, casting, laser, standing, sitting, laying prone, hard orthotics, half-length, orthotic material, where to stabilize the arch,…etc. are just some of the factors related to orthotics.

The Truth About “Perfect Alignment”

The mechanics of the human body are amazing and a big reason why I love doing what I do as an athletic trainer and physical therapist in the NFL.  Every joint in the body has a three-dimensional movement pattern.  Unlike the hinges on your door that moves in only one plane of motion, the human body joints have what is called accessory movements.  These are subtle movements of a joint are necessary for full range of motions to occur.

I like to restore “proper alignment” because there is no such thing as “perfect alignment”.  This normal three-dimensional movement means that an orthotic must bring the ground up to the foot to allow for this normal movement pattern to happen naturally.  In other words, orthotics allow the body to do its job by moving naturally without pain.

I tell my players that the only time they will have bilateral symmetry on the football field is during the National Anthem.  It’s true.  Think about it: the field is never level and they are always changing direction throughout the game.

The A Factor

As for the athletes (A) themselves, one leg is usually longer than the other, injuries change joint motions over the years, flexibilities vary from side to side, the wear pattern of the shoe alters the mechanics of the foot, muscle weakness alters the running sequence and their joint laxity/arthritis changes how that athlete moves.

In other words, the athlete himself isn’t moving the same on both sides of the body.  With this being said, the theory of an orthotic is to help balance the manner in which an athlete moves on both sides of their body.

Back to Orthotics….

Now that we got all the kinesiology and body mechanics out-of-the-way, let’s get back to the orthotics themselves.  I emphasize to my athletes that a properly fitted pair of orthotics should fit like your favorite pair of blue jeans.  They “just fit right”.  No two pair of favorite jeans are the same.  The same is true for orthotics.  A well-fitted orthotic should have no hot spots, no pressure points, no uneasy feeling when they are worn and the athlete should almost forget that they are there.

Think about it this way:  if your orthotics are doing their job properly, the foot and the entire body above it is positioned to do its job.  Those previously noted movements can now happen with ease.  It’s like tucking that napkin under the leg of the wobbly table.  Now the table is both level and stable to do its job of being a table.

Getting the proper orthotic to meet your needs is the key.  The most important factor related to the orthotic is what YOU, the athlete, feel and think.  Speak up and give your medical team the necessary feedback to adjust your orthotics so they “just fit right”.  Don’t forget that it’s your feet and your money!

 

How to Recover from the Unavoidable Ankle Sprain [coreperformance.com]

Dreaded Ankle Sprain (Photo: Thinkstock Photos)

There’s on injury which is painful and and can happen at moments notice.  It’s the dreaded sprained ankle.

Sprained ankle’s can happen while your running, playing a sport or walking into a store.  Why is this injury so limiting that it can put the best of athletes on the sideline?

It’s usually the result of damage to the ligaments of the ankle and/or foot.  The  most common symptoms are swelling, pain and limited mobility.

What’s the best way to recover from an ankle sprain? Are there quick solutions to accelerate the healing?

Sprained ankles are one of the most common injuries in the sports.  With so many people being active within their lives, the need for a solution is high.

These key recovery tips can get you off the sidelines and back in the game.

From coreperformance.com

Reoccurring ankle sprains often have less to do with a lack of strength around the ankle as much as a loss of balance and proprioception—the ability to know where your joint is in space. Proprioception is a fancy word, but the concept is relatively simple. Here’s how it works:

Close your eyes and make a fist. Place one finger up, then two. You can sense where your fingers are, right? That’s not because you’re looking at them, but because you can feel them due to proprioceptors in your ligaments.

When you first sprain your ankle, you damage the ligaments, which in turn damage the proprioceptors in that area. When you suffer another sprain, it isn’t necessarily a lack of strength that’s at fault, but since you weren’t looking at your ankle, you had less of a sense of where it was in space, so you turned it.

Re-establishing balance and proprioception will help you avoid future ankle sprains. Try balance activities that challenge your vision, like the 5-level progression below.

Directions:

Perform this progression as part of your training program or at home when you have a few minutes. Progress from one level to the next to continue challenging yourself and improving proprioception. Do this someplace where you can easily touch to regain your balance if needed, such as a doorway.

  • Level 1: Stand on one leg for 30 seconds. Repeat on your other leg.
  • Level 2: Same as level one, but with your eyes closed.
  • Level 3: Same as level one, but stand on an unstable surface like a pillow or “stability trainer.”
  • Level 4: Same as level three, but with your eyes closed.
  • Level 5: Standing on one leg, turn your head to the left, right, up, and down. This is one repetition. Repeat 5 times.

Article Source: http://www.coreperformance.com/daily/recovery/how-to-avoid-ankle-sprains.html

Author: Sue Falsone

Sprained Ankle Management

Lateral Ankle Sprain

Ankle sprains remain the most common lower extremity injury in all of sports.  From the minor “tweak” of the ankle to the high ankle sprain, the range of symptoms and the limitations vary greatly.  The challenging factor with ankle sprains remains the ongoing vulnerability of the ankle joint for years after a sprain because of the resulting ligament instability so common after a significant injury.

The term “sprain” refers to an injury that involves damaging a ligament.  Ligaments connect bones to bones while tendons connect muscles to bones.  Ligaments are common stabilizers of joints, often embedded within a capsules surrounding most of the joints in the body.  The ligaments in a normal ankle provide static stability to the bones of the lower legs and hindfoot.

A ligament sprain can be as simple as a minor stretch or as complex as a complete disruption or tearing of the ligament fibers that give stability to a joint.

Lateral Ankle Sprain

With a lateral ankle sprain, commonly called an inversion sprain, occurs, a majority of the ligament damage takes place along the lateral or outside of the ankle joint.  These ligaments include the following ligaments:

1.  Anterior Talofibular Ligament (ATF) – located in front of the outer distal Fibula (shin) bone.

2.  Calcaneofibular Ligament – Connects the fibula (shin) to the heel bone

3.  Posterior Talofibular Ligament (PTF) – located behind the outer distal Fibula (shin) bone.

High Ankle Sprain

Often we read about elite athletes with an ankle sprain that forces the athlete to be out of competition for 2-6 weeks.  Immediately, questions arise as to why anyone would miss so much time with “just an ankle sprain”?  In most cases, the reason is that the athlete has suffered a high ankle sprain.  The high ankle sprain is one of the most frustrating and difficult injuries for an athlete to recover from during a season.  This injury is even more difficult to overcome when the athlete is involved in what I refer to as a “stop and go sport” where rapid changing of direction is required.

With a high ankle sprain or interosseous ankle sprain, most of the damage is found in the anterior ankle and distal shin area.  These structures include the following:

  1. Interosseous Membrane – located between the two bones of the distal shin.
  2. Anterior Distal Tibiofibula Ligament – located at the front of the distal two bones of the shin just above the ankle joint.

Additional damage to the surrounding bone, tendon, capsule and joint surfaces can result from any ankle sprain.  A serious ankle sprain can result in complete ruptures of the lateral and anterior ankle ligamentous structures including the capsule.  Ankle joint dislocations and fracture often occur.  I suffered such an injury while in college resulting in two surgeries and four months of rehabilitation.

Signs and Symptoms of a Lateral Ankle Sprain

The signs and symptoms for a lateral ankle sprain will vary based upon the grade or significance of the ligament damage.  Sprained ankles are graded from 1 to 3 based upon their laxity or the ligament looseness.

Grade 1 Lateral Ankle Sprain:

  • Minor stretching of the lateral ankle ligaments.
  • Minimal joint instability with a firm end-feel or tautness of the ligaments when stressed.
  • Mild pain.
  • Minimal swelling around the bone on the outside of the ankle.
  • Mild joint stiffness with walking or running.

Grade 2 Lateral Ankle Sprain:

  • Moderate stretching and tearing of the lateral ankle ligaments.
  • Moderate joint instability with a firm end-feel or tautness of the ligaments when stressed.
  • Moderate to severe pain and difficulty walking.
  • Moderate swelling on the outside, front and back of the ankle.
  • Significant stiffness of the ankle and mid-foot.
  • Moderate bruising of the lateral ankle and mid-foot.

Grade 3 Lateral Ankle Sprain:

  • Complete tearing of the lateral ankle ligaments.
  • Significant joint instability with a soft end-feel or tautness of the ligaments when stressed.
  • Significant pain.
  • Significant swelling throughout the outside, front and back of the ankle and mid-foot.
  • Significant bruising of the lateral ankle and mid-foot.

Treating a Lateral Ankle Sprain

  • Rest the distal leg with Ice, Compression and Elevation (RICE).
  • Ice is a valuable tool for a fast recovery.  Ice bags on the outside and inside of the ankle joint for 15 minutes is a good way to reduce the swelling and pain.  The best way to aggressively ice the entire ankle/foot/distal shin area is to place the ankle into an ice bucket for 10 minutes.  A rubber glove or insulated sock covering only the toes will significantly help make the ice bucket more tolerable.
  • Depending upon the grade of the sprain, limitations in the weight bearing status may be necessary.  The use of a walking boot and/or crutches will prove to be helpful to allow for a daily reduction of the symptoms while still performing normal activities of daily living. (ADL’s)
  • Easy range of motion (ROM) with elevation can be started in a painfree range.  This motion should only be in the upward (dorsi flexion) and downward (plantar flexion) directions to avoid stretching any damaged ligaments located on the outer ankle joint.
  • Compression when weight bearing and with activities is very helpful to control swelling and pain in the ankle joint and surrounding tissue.  Compression with rest will be helpful for acute sprains.
  • Massage to the arch, ankle joint, Achilles and calf will help reduce the swelling and enhance blood flow the injured tissue.
  • Bike riding with compression can be started early.
  • Manually resisted strengthening exercises can be started when the swelling is reduced by 50%.  Starting with resisted upward (dorsi flexion) and outward (eversion) movements while avoiding inward (inversion) stretches.  Typically this inversion motion was the mechanism of injury resulting in ligament damage to the outside of the ankle.
  • Slant board can be initiated when stretching of the calf and posterior ankle joint is comfortable.  Include calf strengthening heel raises when tolerable.
  • Balance activities are great drills for the final stages of treatment to prepare you to return to your sport.
  • Sports specific activities can be started when strength is at least 75% and the swelling is not significantly increasing with activities.
  • Having your ankle joint taped by a certified athletic trainer is the smart way to minimize your chances of re-injuring your ankle.

Questions a Pro Athlete Would Ask

A smart professional athlete with an ankle sprain who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:

  1. What grade is my ankle sprain?
  2. Do I need an x-ray to rule-out a fracture?
  3. What do I need to accomplish with my rehab to be able to safely return to my sport?
  4. Do you recommend that I have my ankle joints taped or braced when I return to my sport?

Sports Medicine Tips for a Sprained Ankle

Avoid the Bum Ankle – Trust me: a chronically loose ankle can ruin your confidence and your game.  So many have a “bum ankle” that rolls over just walking across the yard or stepping off a curb.  Treat your ankle sprain right now will keep your ligaments tight and keep you from becoming a “bum” down the road.

Flexible Calves and Achilles Are Key – If your calves and Achilles remain loose, your ankle will have great range of motion and function normally.

Compression is Your Friend – Wearing compression on the ankle joint and distal calves will help maintain the congruity of the lower leg long after the sprain has healed.

Back to Basics – Other then Michael Jordon, none of us where born with sneakers on our feet.  Get out of those hard shoes and spend more time barefoot.  It will strengthen your arches, foot muscles and ankle ligaments.