Discuss Foot Problems

What kinds of problems do you see in the weekend athlete?
They are not prepared to play, absolutely. They don’t stretch, they just go out and play. They have three beers and then fracture an ankle or tear a tendon. For those people it’s just sheer trauma.

What advice about shoes would you give them?
Most people, and most doctors, don’t know what shoes are good. The best way to pick a shoe? The counter of the shoe, that’s the back of the shoe, has to be rigid. Feel that shoe, see how hard it is. People will buy some of these shoes and say boy it’s so soft. Well, the counter of the shoe has to be hard for anybody with any foot problems. And when you’re buying a running shoe or a walking shoe you want the insole to be removable. If you reach down and the insole is stuck in there you know it’s a cheaper shoe. If you reach down and the insole comes out so you can put an orthotic in you know it’s a good shoe. And if you get those things you’ll go a long way towards preventing foot problems, even without orthotics.

When looking for shoes we need to look for a rigid counter and removable insole. Is there anything else we need to look for?
Well they have to fit well, but most of these shoe places know how to fit shoes. The American companies are doing a wonderful job compared to what they used to do. There are really good shoes out there. But again, rigid counter and removable insoles and they’re going to do very well.

For someone not familiar with sports shoes who wants to take up running or some other sporting event are they well advised to visit a store that specializes in running shoes, and to find someone who knows how to fit shoes?
Absolutely, all of these places, Athletic Avenue, Just for Feet and Track Shack, all of them are very good. Find somebody and say “Please help me to choose a shoe. I want to start running and I want a rigid counter and removable insoles.” As soon as you say that they’ll give you a good shoe because they’ll know you have the information.

Do you have some tips for weekend athletes in terms of foot care and avoiding injury?
Yes, start slow, stay slow and gradually increase your activity. Stretch before and stretch after. Stretch more than you exercise. Spend as much time stretching and make sure you stretch out. To avoid injuries when you’re a weekend athlete, always put a heel pad in the back of your shoes. It will put you on your toes a little bit and elevate your heel. Your Achilles tendon won’t be stretched so much and it will limit your injuries. If you sprain your ankle you won’t sprain it as bad. You won’t get a serious injury like a knee injury because your foot will be up a little bit. Your heel will be up so you won’t get a serious knee injury. So heel pads, a felt heel pad, about a quarter of an inch in the back of your shoe will help everyone.

And stretching after exercise?
Stretching after will help you significantly. Stretching before will prevent a lot of injuries. Stretching after calms you down, cools you down, makes you feel better. And that will keep you stretched so that next time it won’t be as hard on your musculature. Stretching and flexing. As you get older you get heavier and you get less flexible.

Are there any specific stretching exercises people should do?
Well touch your toes, and stand on a step and stretch you Achilles tendon. Put your feet on the step and your heel with the weight of your body down so it stretches the Achilles tendon. Or reach to the wall, or pick your knee up and back and stretch your quadriceps by holding your knee in back of your thigh, holding it up for thirty seconds. Twenty to thirty seconds. Stretch your arms up and around and bend your torso down and touch your toes. Not hard just soft. And everybody should do bent knee sit ups to strengthen their abdominals. That’s important, bent knee sit ups.

Do men and women suffer different types of foot injuries?
I don’t think gender does it. I mean women may be a little lighter than men, the bigger you are the more severe the injury.

When does a person know they need to go see their podiatrist, not just to see the doctor?
If you want to run regularly, or if you want to play basketball regularly and you’re starting to have some symptoms: pain in the arch after sitting for twenty minutes or when you get up after a nights sleep, your feet hurt, your heels hurt, you’ve got to take ten minutes for it to start to warm up, or after long periods of sitting or sleeping when you get up your feet hurt, that will tell you have a problem. Then you need to see a podiatrist. If when you’re playing, after playing you get shin splints that hang on for a day or two, if you’re having foot pain during an activity, pain tells you to hold up and get some help.

What part of the foot do orthotics affect?
The whole foot. The orthotic itself is from the heel to the metatarsal heads. It’s cushioned for the full length of the toes for shock absorption. You get an arch support, which is a mold of your foot, and then a covering which is shock absorbing and then on the back of the orthotic there’s a post. So you have three things, the post prevents the pronation.(note: Pronation is movement of the bones of the foot in such a manner as to cause the foot to come down in its inside edge.) The arch support molds the foot, and then the shock absorbing material.

How do the orthotics work?
In order to get a good orthotic you have to get an impression. It’s like teeth, if you don’t get a good impression you can’t get inlays or caps or a whole set of teeth. It won’t work. You have to take a cast. You have to put that joint that opens up into the neutral position, non-weight bearing. So that when you step on this orthotic the foot can’t flatten out. If you make a cast while weight bearing, the arch would be down and you would never get a correction, it would never work. If you stood on your head and spit nickels you could never get it to work.

You mentioned a post in the orthotic, what does the post do?
The thing that makes the orthotic work is the little post. We take an x-ray and sometimes it’s one and a half, two degrees and you put that post there. I told you about the rigid counter with the shoe. Now if you put that post there that foot cannot turn so you prevent pronation. If you have a soft shoe the body can push the shoe over. So if you have a rigid counter, the counter and the orthotic work together so the foot can’t pronate. Once you stop the foot from doing that you will run efficiently and you get better. So all the orthotic does is prevent abnormal motion during walking and running. Most of the orthotics we make are for mailmen or for heavy guys with heel problems.

Orthotics prevent ninety percent of the heel surgery in the country. In other words in the old days we used to operate on ninety percent of the heel spurs. Now probably ninety five percent are corrected with orthotics. They don’t correct the heel spur but it doesn’t make any difference, it can’t kill them, it can’t give them any bad problems. They take the pain out. They wear an orthotic and the pain stops hurting forever.

Can you sum up for us what orthotics do?
Orthotics do three things. Number one they prevent surgery. Two, after surgery they prevent an inherited problem from coming back because it makes you walk correctly. And third, with an athlete it makes them more efficient, prevents the build up of waste products and prevents pain because of pronation and of their biomechanical problem. So they are very, very effective when they are used properly. If you don’t know biomechanics and you think that an arch support and orthotic are the same you really don’t know what you’re doing.

What are some of the most common foot injuries or ailments that you see in professional or top ranking athletes?
The most common I would think is a sprain. The interesting thing about ankle sprains is that all of the ankle sprains occur in twenty five percent of the population. So there’s a predisposition in certain foot types for ankle sprain.. If you’re born with a short Achilles tendon, those are the ankle sprains. Or a caveous foot. Those are ankle sprains, those are foot types, high arched foot.

Caveous foot?
Caveous means a high arch foot. Very little flexibility. They’ll be playing basketball and come down on the side of a foot and seriously sprain the ankle. And, if you have a short Achilles tendon that means the foot can’t bend up very well and you will sprain that ankle because of a lack of flexibility.

Do women tend to have a higher arch in their foot?
I think it depends, it’s familial, the foot type is completely inherited. We see ingrown toenails in athletes because the shoes are sometimes very tight. They are crammed into the front of the shoe on athletic endeavors, high jumping, pole vaulting, biking, you know. So sometimes you see a dramatic ingrown toenail. You see a lot of stress fractures because when you see an athlete, and especially if you look today, people are very compulsive.

I get runners in here who have to run, they are hurting. Take my wife, take my kids, take my house but I have run. So stress fractures, strains, sprains, over use syndrome, heel pain, shin splints, runners knee, where the knee hurts, and there’s a condition called iliotibial band syndrome. That’s when the muscles of the thigh hurt while running on uneven surfaces or when they pronate too much. Kim was an inherited pronater. But all of these things are correctable. You can’t cure the foot type but you can stop all symptoms. You can make them run efficiently.

Is a lot of that correction a result of training them to run differently or the use of devices?
You see there are twenty six bones in the foot and then two little bones under the ball of the foot, that’s twenty eight. And in order to be efficient in walking or running all those bones have to work together as a unit. And when you pronate past four degrees, the body allows for four degrees pronation. That means the arch comes down and the toes go up and out, that’s pronation. And that allows four degrees and then four degrees supination, that’s exactly the opposite of pronation. When you’re born with a foot that pronates excessively which is very common, the twenty six bones don’t work together. A large joint opens up in the foot and seven bones in the back of the foot and the remainder in the front of the foot work in two units. So the muscles and tendons that are used to being used for running and walking and propelling the body are now used to splint that joint closed.

If you don’t do anything, this is exactly what happened to Kim, when you don’t do anything to stop that abnormal motion, after a while, sometimes six months to ten years depending on the over usage of what you’re doing, the body says to hell with it and collapses. It says I can’t do it anymore. So Kim was twenty seven years old when her body gave out just before the Olympic trials. And she went to Europe, to France, Sweden, England, Alabama, Los Angeles and they were looking for a specific injury. But it wasn’t an injury it was a pronation problem.

So you made an orthotic for her?
Yes, and what orthotics do is they prevent the foot from pronating. Well, if you prevent the pronating you prevent that joint from opening up. If you prevent that joint from opening up, all twenty six bones work together. If all twenty six bones work together the fatigued muscles heal because now they’re not being used to splint that joint closed. They are being used to propel the foot. So I knew she would get better, I knew she would get better fast. Her coach didn’t know she was going to get better. And I knew if she finally was able to run one race every, other race would be better. Her coach thought that she would fatigue out and not be able to make the finals in the Olympics. I assured him she would run faster the fourth time than the first time and I believe sincerely she will break a world record in the Olympics.

So this wasn’t something you looked at and then told her that she had to sit out a while to let it recover. Once you made that adjustment did it take care of itself?
If you sit and you start running with no adjustment you’re going to hurt. See that’s what she was doing, She would rest, she rested for a month and a half. Every doctor said we’ll put you in a cast, you rest. But if you are pronating and the foot is opening up abnormally those tendons they can’t be used to run, they’re used to close that joint, and splint it closed. And so what happens you build up waste products called lactic acid and the body says to hell with it, I can’t do it anymore. And she couldn’t even run, she couldn’t walk. Because she couldn’t run and walk she would get tendinitis, Achilles tendinitis, back pain, shin splints. But if you correct the major problem and you know what you’re doing you can get this healed quickly.

Kim’s was a hereditary problem?
It’s a familial problem. The biomechanics in her foot were there at birth. Now when you’re young and you’re flexible you don’t feel anything. As you get older, you get to be twenty seven years old, she gains a little weight, she loses a little flexibility you get the injury, or the so called injury which is really a biomechanical problem that was coming all the way along although nobody could see it or relate to.

Dr. Burton Bornstein is a podiatrist in Winter Park, Florida, where he has been practicing since 1957. His work is well known by athletes, trainers and coaches around the world.

Source: Ivanhoe reproted in 1999

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