Tag Archives: foot specialist

Chiropodist Kiran Dave

What Are Orthotics Proper Approach

What Are Orthotics? and What is the Proper Approach to Orthotics?

Our Foot Specialist at Erin Mills Optimum Health in Mississauga gets asked this question often.  Here he discusses what orthotics are and the proper approach towards orthotics.

I find many patients that I encounter in my Foot Clinic at Erin Mills Optimum Health are unaware of what orthotics really are and what they are capable of doing. Patients have all sorts of wrong information. I wanted to share some aspects of orthotic therapy to help you understand a few things about approaching orthotics in a comprehensive manner.

First and foremost, there is always a right way and not so much of a right way to acquire orthotics. I always encourage my patients to ask questions so that they are well aware of what they require and what they get.

I will also say, that there is no replacement for prescription orthosis. I am referring to over the counter and machine insoles. Basically, if they are not from a regulated foot doctor, be aware.

Orthotics devices are prescription medical appliances, like prescription eye glasses, that are an aid to help you restore biomechanical function.

They need to be recommended and evaluated by a regulated foot professional (such as a Chiropodist) that specializes and demonstrates a good depth of biomechanical knowledge and experience.He should address all your questions in the manner that you comprehend.

I customize my orthotics to patient symptoms and specific needs, without compromising function. The materials and design is customized to the specific activities and habits, by balancing shock absorption versus support according to the needs.

Ideal footwear for orthotic function

Orthotics are devices that are fitted into your shoes and can be moved from one shoes to another, thereby benefiting your body biomechanical function. The footwear that you place your orthotics into is important and can help or hinder your function. Good advice on footwear must be considered prior to getting orthotics. It is an important to understand the type of footwear that is normally worn. A deep shoe is ideal with laces, and a deep and rounded toebox. This does not mean that you have to stop wearing other shoe type. I often accommodate for other footwear type, such as dress shoes, if it is important. I like to encourage my patients to bring in some shoe sample so that I can guide them appropriately as well as to help me to customize certain features of their orthotics.

How do I address orthotics for my patients in Mississauga as a Chiropodist?

When consulting with a patient that has biomechanical issues, such as foot, ankle, leg, knee, thigh, hip and back symptoms, I enjoy educating my patients into the” how” and “why” of their issues. I attempt to explain the relationship between various body parts that may carry symptoms. E.g. back pains are often related to foot function, and so by helping to connect the dots, my patients can make a more informed decision as to what may work well for them. I encourage my patients to bring in questions so as to better inform them. In my opinion, a more informed patient is more likely to see success. Once I feel that my patient has a good enough understanding of the reason for their symptomology and what orthotics are as well as what they are capable of doing and not doing, I normally proceed to doing a full biomechanical examination.

Why is a biomechanical examination necessary for orthotics?

This is a very important component of getting prescription orthotics and time is required to undergo this assessment. This needs to be done accurately by an experienced foot practitioner (such as a chiropodist), not their assistant. This assessment needs to be done with every aspect of the body regardless of where the symptoms might be. E.g. a patient complaining of right knee pain and right frequent ankle sprains and right great toe joint pain may well be related to a leg length discrepancy. In this case, I would check the hips, pelvis and alignment of the spine and reflect the finding in the prescription of the foot orthotics. The biomechanical examination is done with the patient in the sitting, standing (with front, side and rear views), during a gait analysis, and in the prone position and supine position. The head, neck, cervical, thoracic, and lumbar spine is examined briefly, along with the gluteal area. Thigh and knee is examined along with muscle range of motion and strength equality from front to back, medial to lateral and compared from left to right limps. Joint alignment and range of motion is checked in the hip, knee, ankle and all joints of the feet.  The biomechanical report that I generate from these tests allows me to create prescription orthotics designed for each foot of the individual patient. The biomechanical reports are also prepared and given to the patients to help them with their submission to the insurance companies as they want to see that the foot specialist that prescribed the orthotics has done the proper examination required to help the patient.

A proper Foot Impression is important for prescription orthotics.

Casting of the foot with the patient in the prone position is what is highly recommended and preferred, in order to get the best impression of the foot in the aligned (sub-talar neutral) position. This is your prescription position of the foot and is another very important aspect of orthotics therapy that the patient should not compromise. I discourage foam box, computer mat and laser foot impressions, as my opinion is that they are not as accurate in placing the foot in the proper alignment required.

Fitting of the Orthotics

A short time after, once the orthotics are sent out by the licensed orthotic laboratory, quality control checks are done on each orthotic, prior to approving. Once approval is given, the patient is contacted for a fitting appointment.At this appointment, the features of the orthotic are explained and what function it plays to aid the patient. Many technologies are incorporated into my orthotics to not only resolve symptoms, but also to help prevent other potential problems.Advice is administered to the patient on how best to adapt to the orthosis as well as more footwear advice.

Ongoing Monitoring for orthotics is important

I am very interested in following the progress of my patient, once orthotics are administered. The progress of the patient and their orthotics is monitored for its success and its prevention elements over the year. In closing, I would always encourage everyone to think prevention and consider early intervention with prescription orthosis. I like to believe that we can control the problems before they break, rather than wait to fix it after it breaks, which does not always work well. Preventative care is the chief concern that I look to address in my patients in Mississauga. I find, by empowering my patients via this education and preventative care, I see much more success in their treatment plans with the prescription orthosis.

Hope to be of service to you and your family, Kiran Dave D.Ch. Chiropodist in Mississauga at Erin Mills Optimum Health Chiropodist Foot Care Specialist

 

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Foot Specialist

Patient Presented With A Painful Ingrown Toenail

Patient presented with a painful ingrown toenail – By Kiran Dave, D.Ch, Chiropodist / Foot Specialist

There are many unnecessary and painful conditions related to the great toe or lesser toes, which can be avoided with some simple sound advice, professional examination and early treatment. I would like to demonstrate with a case of a painful ingrown toenail that I saw in my Mississauga clinic recently.

A patient in the early 20’s presented with an acute, painful, inflamed right toenail, with a purulent discharge. The patient complained that she could not wear a closed shoe or sleep at night as the bed sheets caused her discomfort on the right toe. On examination, the patient had a typical ingrown toenail on the medial sulci of the right toe, with an infection.

What was the cause of the ingrown toenail?

In this situation, there was a number of reasons. However these are common causes for the condition.

  1. Improper toenail cutting. Toenails were cut too short and down the sides.
  2. The right great toe was in an abnormal triggered configuration, creating pressure on the sides of the nail.
  3. The footwear was too narrow and shallow, which further aggravated the pressure on the toenail.
  4. The quality of the nail plate was thin and very flexible, thereby more prone to be directed under pressure into the side of the toe space.
  5. There was as added structural problem, with the medial toe pressure from the patient pronating.
  6.  Patient was uninformed and did not know what to do so she kept digging into the sides, further perpetrating the problem.

What was the solution to the ingrown toenail?

The solution; Patient was seen for professional advice and treatment of the toenail and foot.

What was the treatment for the ingrown toenail?

  1. As the condition was too far developed, a partial nail avulsion surgery was scheduled.
  2. The surgical procedure involved the administration of local anesthesia with a safe freezing agent. The offending nail was surgically removed partially.
  3. The nail matrix (roots) was phenolized to prevent further growth and prevent reoccurrence.
  4. Post-surgical dressing and advice was given.
  5. Patient returned to work the next day.
  6. Patient was monitored until complete healing, over several weeks.
  7. Education regarding proper nail cut.
  8. Footwear advise

If you encounter any challenges to your toenail or toes, please schedule an appointment earlier rather than later.

Also, check out Kiran’s blog on why cutting your nails too short is NOT a good idea and can lead to other painful toenail problems.

Kiran Dave, D.Ch, Chiropodist / Foot Specialist in Mississauga at Erin Mills Optimum Health

Chiropodist Foot Care Specialist

 


Ingrown Toenail Pain – Do you need Chiropody Treatment?

 

There is no greater pain than an ingrown toenail.
Some will describe the pain as being comparable to a bad tooth ache and it is usually unbearable.

Our chiropodist is ready to meet your ingrown toenail and help eliminate the pain and resolve the situation as quickly as possible.

Through careful examination of potential problems that may have given rise to this problem, he will help educate and allow you to make an informed decision on what may be the most appropriate course of action for you.

How are ingrown toenails diagnosed?

Ingrown toenails are technically diagnosed when a sharp piece of toenail is penetrating the flesh of the skin and causing an infection or/and an inflammatory response. It will appear very red, hot to the touch and painful, even without touching it sometimes. Commonly, patients will describe the bed sheets at night time being bothersome.

Most of the patients will attempt to cut the offending piece of nail, and sometimes find temporary relief. Some will visit their family doctor who may attempt to do the same. However, our chiropodist advises against these practices, as it will usually worsen the condition and set up a scenario where the underlying problem is allowed to create more progressive problems. This can make further treatment more complicated, delaying adequate resolution.
Besides, it is better to have a specialist such as our chiropodist to have a better look and administer proper and safe treatment, after considering all factors, such as medical conditions, drugs history, usual activity involved and occupational stress.

We see more unnecessary ingrown nail infections after a home treatment than any other nail condition. Some are not even ingrown toenails, but another condition called involuted nails.

What will our chiropodist do for you?

This question depends on what stage of the condition is reached and what the proper diagnosis is.

  • Is it infected or just inflamed?
  • How long has the patient experienced pain and what has been done previously?
  • Are there other aggravating factors that can be simply eliminated for more comfort?
  • Are there biomechanical factors that are contributing to the condition such as a hyperextended hallux?
  • Footwear history is considered as is the medical and drugs history.

Once a clear pictured is formed, the chiropodist will do what is required to resolve the pain as quickly as is possible. This could be simple conservative treatment or it could require surgical removal of the offending nail for good.

Our goal is to get you back to your naturally healthy self from the feet up!  Contact us for help.

Kiran Dave. D.Ch.
Chiropodist / Foot Specialist in Mississauga at Erin Mills Optimum Health

Kiran Dave Chiropodist Foot Specialist Education Treatment Foot Related Functions

 


 

Want to learn more from our foot guy Kiran? Read his blog on the common foot issue of Bunions here or connect with him in person in Mississauga.

Foot Specialist

Risk Factors For Foot Pain By Chiropodist/ Foot Specialist

The Foot Clinic at the Erin Mills Optimum Health, prevention is high on the list.

As the chiropodist at the foot clinic, it is important for me to explain to my patients, the need to explore to find and understand the underlying cause of their symptoms. Treatment is based on controlling the cause of the problem, rather than the symptoms.  This treatment approach may naturally resolve the symptoms and prevent other pathologies from developing.

So, to that point, it is important to consider risk factors which can give rise to foot and foot related problems. A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop foot pain with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing foot pain. If you have a number of risk factors, pop in and have me check you to reduce your chances of developing preventable conditions.

Risk factors for foot pain include the following:

Age

Nearly everyone who wears shoes has foot problems at some point in their lives. Those who are at a slightly greater risk, include children, women and men wearing dress shoes inadequately fitted for their feet. The group most vulnerable is the elderly.

Children Foot pain is fairly common in children. Heel pain is common in very active children between the ages of 8-13, when high-impact exercise can irritate growth centers of the heel. This is also a great age to start prevention intervention, or to control conditions that already exist. E.g., flat feet.

The Elderly These groups of people are at very high risk for foot problems. With age, feet becomes wider (forefoot flare) and flatten, and the fat padding on the sole of the foot wears down. Older people’s skin is also drier and thinner and may have less blood supply.  Foot pain can be the first sign of trouble in many illnesses related to aging, such as arthritis, gout, diabetes, and circulatory disease.

Gender

Women are at higher risk than men for severe foot pain, probably because of the style of footwear, and possibly because of wearing shoes that may be too narrow and too shallow with an elevated heel.

Older Women —Severe foot pain appears to be a major cause of general disability in older women. In one study, 14% of older disabled women reported chronic, severe foot pain, which played a major role in requiring assistance for walking and doing daily activities.

Pregnant Women —Pregnant women have special foot problems from weight gain, swelling in their feet and ankles, and the release of certain hormones during pregnancy that cause ligaments to relax. These hormones help with childbearing, but can weaken the soft tissue structure of the feet.

Occupational Risk Factors

An estimated 120,000 job-related foot injuries occur every year, and about one-third of them involve the toes. A number of foot problems have been attributed to repetitive use at work. These include:

  • Arthritis of the foot and ankle
  • Toe deformities
  • Pinched nerves between the toes
  • Plantar fasciitis
  • Adult acquired flat foot
  • Tarsal tunnel syndrome

Sports

People who engage in regular high-impact aerobic exercise are at risk for planter fasciitis, heel spurs, sesamoiditis, shin splints, Achilles tendinopathy, and stress fractures.

Medical Conditions

Certain conditions increase the risk of having foot pain, these include:

Diabetes People with diabetes are at particular risk for severe foot infections, due to impaired circulation, nerve function, reduced sensation and bony and skin changes and therefore must take special precautions.

Excess Weight Anyone who is overweight puts increased stress on his or her feet and is at risk for foot or ankle injuries, as well as knee and back problems.

Other Medical Conditions Many other medical conditions, such as osteoarthritis, rheumatoid, arthritis, gout, spastic and collagen diseases can predispose people to foot problems, as do some other inherited abnormalities.

Smoking A 2000 study reported that smokers are at higher risk for blisters, bruises, sprains, and fractures, most likely because they tend to be less fit than nonsmokers. Smokers may also heal less quickly, which affects some foot surgeries.

 

The message is clear. Execute preventative screening of your foot today. Don’t wait until it breaks. Let’s prevent it before it breaks. A detailed visit to the Foot clinic of Erin Mills Optimum Health is a good place to start, where an educational exam and consultation will be the best “Step” forward to better health.

By Kiran Dave D.Ch. Chiropodist / Foot Specialist in Mississauga at Erin Mills Optimum Health

Chiropodist Foot Care Specialist

 

Common Foot Issues – Bunions

Common Foot Issues – Bunions

Our friendly Mississauga Chiropodist, Kiran Dave, works with many common foot issues, such as Bunions.  Here he discusses what they are as well as their cause and treatment.  If you have more questions or need to investigate further, he will be happy to investigate your foot problem with you.

What are bunions?

  • Most commonly found in the female gender, but also seen in males.
  • Appears as a hard lump at the great toe joint with a misaligned big toe.
  • Bunions are progressive and can cause discomfort, especially in a bad shoe, like a pump.
  • Bunions also lead to hammertoes and clawed toes.

What is the cause of bunions?

The cause of a common foot issue like a bunion can be poor biomechanical function, hereditary and poor footwear.  Consult with our Mississauga foot specialist to investigate what is causing your foot issue.

What are the treatments for bunions?

The preferred treatment for bunions, which is most successful, is prescription orthotics. It is non invasive, simple and effective with good footwear.

Surgery can also be performed to correct the problem, but it is not the first recommended option.

For more information related to your common foot issues schedule a consultation with Kiran Dave.

Chiropodist Foot Care Specialist