Tag Archives: chiropodist

New Orthotics From My Mississauga Chiropodist

I recently got new orthotics from our Chiropodist to assist my foot, knee, and hip biomechanics.  I have used orthotics from Kiran for many years and I appreciate how he approaches the health of the patient from the feet upwards. As a Chiropractor, my expertise is addressing the health of a patient from the brain downwards through the spine. This approach towards health is very important which is why I am proud to be a Chiropractor and under regular Chiropractic care. Other approaches towards optimum health are also important, like a Chiropodist or podiatrists view point of how the feet can impact the health of the body through the foot, knee, hip, spine mechanics (or from the bottom-up).

What is the Chiropody view towards orthotics?

If the foot collapses inwards (pronates), it creates an inward rotation at the shin bone and knee. This rotation impacts the health of those joints and above. The result of poor foot, knee, hip mechanics can be pain as well as decreased performance, repetitive injury, and degenerative changes to the joint causing arthritis.  New orthotics will help support the body to prevent these problems and to improve the body's ability to function and perform naturally.

Who benefits the most from orthotics?

Everyone can benefit from having prescription orthotics designed for their foot mechanics.  However, I clinically see that the people who benefit from orthotics the most are people who are on their feet all day at work or people who run longer distances.

I have personally benefited from my new orthotics.  My knees have been in much greater shape and I have been able to run to greater distances due to my new orthotics helping my running mechanics.

I hope your new orthotics will help you achieve what you want in your life,

Dr. Callum Peever Chiropractor in Mississauga at Erin Mills Optimum Health

New Orthotics

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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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heel pain picture

Ouch, My Heels Hurt!

Ouch, My Heels Hurt!

I often see patients complaining of heel spurs. More often than not, they have visited their family doctor, who have ordered x-rays and confirmed heel spurs as the cause of the heel pain and made referrals to me (Kiran Dave), as the specialist in foot disorders in Mississauga.

Today, I wanted to share with you all the distinction between the many causes of heel pain.

Patients who call my Mississauga health clinic with symptoms of heel pain usually require more time to evaluate, as often it is caused by a complex array of pathologies classified under the science of biomechanical dysfunctions. Although I am most often aware that the heel pain is not caused by heel spurs, as diagnosed by the family doctor with x-rays in hand, the condition still warrants a good biomechanical examination so as to not discount anything.

heel pain is not caused by heel spurs”

Most heel pains are caused by a soft tissue stress and strain called, Planter Fasciitis

(planter means the bottom of the foot and fasciitis means the inflammation of the planter fascia tissue). The Planter fascia is attached to the bottom of the heel bone and usually sustains strain in this area, secondary to bony structural compensations. Any stress injury stimulates repairs via inflammation, which is what causes the pain in the heel due to prolonged standing and walking. Most patients will complain of pain on getting out of bed in the morning or after sitting for a period of time. When a patient walks a little, they milk the inflammation out of the area and it actually alleviates some of their discomfort.

It is important to make the distinction that heel spurs are formed as a result of chronic Planter Fasciitis, and often cause no pain, unless the bottom of the heel is severely aggravated.

So what else could heel pains be caused from?

There are many other reasons and pathologies that will elicit heel pain. Usually, by undergoing detailed history and examination, I can always diagnose the reasons accurately and formulate the correct treatment plan.

  • Sub Calcaneal Bursitis mimics heel spur pains, but is another soft tissue injury.
  • A bruised heel can also create pain in the heels, but usually this falls into the category of a sub calcaneal bursitis.
  • Medial Planter Nerve Entrapment is also a painful heel condition, usually from soft tissue compressing the medial planter nerve. The symptoms are very different in the eyes of an experienced Chiropodist.
  • Heel bone Hairline Fracture is another reason which is normally sustained from jumping or traumatic injuries.
  • There are also some Cancerous growth elements that can,( but much rarer), also create heel pains.
  • Growing pain in the back of the heels, amongst young boys between the ages of 9 to 13 can also suffer from heel pain from a condition called Severs Disease, which is a growth plate dysfunction.
  • Pain in the back of the heel can be created by yet other soft tissue injuries labelled as Achilles Tendonitis, and/or Retro Calcaneal Bursitis.

Most of the above conditions eliciting heel pains are created from faulty structural or biomechanical dysfunction of the foot, resulting possibly from other body structures such as knee, leg, hip or back.

Treatment for heel pains

Treatment really depends on what the diagnosis is and what mechanisms are involved in eliciting the symptoms of pain.

Other factors include:

  •         What activities the patient is engaged with
  •         Occupation
  •         Footwear type
  •         Other symptoms involved

So much more is factored into making a unique treatment plan that works for the patient.

Any of the selections of treatment are discussed and the patient educated, so that patient can make a full and informed decision as to what works best for them. More often than not, the patient selects orthotic devices, which are custom made using accurate techniques, and approved by insurance companies. Custom orthotics will help not only heal the foot, but also other symptoms, and so remains the favorite choice by many. Nonetheless, a good and thorough examination is still the determining factor.

Take action quickly when suffering with heel pains

I would always suggest coming in as early as you can when you get any of the above symptoms, so that it can be accurately diagnosed and treated to prevent more advancing conditions that can stop you in your tracks. For example, when you have plantar fascial heel pains in one foot which are left unattended, it will eventually move into the other foot due to compensatory mechanisms. Referred pain can also continue to other structures.

By having your feet checked early, I intend to help you prevent other larger issues, such as back, hip, knee, leg, and ankle pains.

Get educated and informed about your feet, so we can help you take the right step forward.

Kiran Dave D.Ch
Chiropodist

Chiropodist Foot Care Specialist



What are are Heel Spurs?

A bony spur that projects from the back or underside of the heel bone (the calcaneus) and that may make walking painful. The walking is especially painful after a period of non weight bearing rest.

Calcaneal spurs at the back of the heel are associated with inflammation of the Achilles tendon (Achilles tendinitis), and cause tenderness and pain at the back of the heel, which is made worse by pushing off the ball of the foot.

Calcaneal Spurs at the bottom part of your heel bone under the sole (the plantar area) are associated with inflammation of the plantar fascia. The plantar fascia is the bowstring-like tissue that stretches from the heel to the forefoot underneath the sole.

These spurs can cause localized tenderness and pain that is made worse by stepping down on the heel. Calcaneal spurs and plantar fasciitis can occur alone, together, or they can be related to underlying diseases that cause arthritis, such as reactive arthritis and ankylosing spondylitis. In some cases, back, hip, knee and leg dysfunction can propagate heel pains or vise versa.

What can be done about heel spurs?

Treatment is originally designed to decrease the inflammation and avoid re-injury.

It is commonly suggested that heel lifts can be used to reduce stress symptoms on the Achilles tendon and relieve painful spurs at the back of the heel. Also, donut-shaped shoe inserts can be used to take pressure off any plantar spurs. Infrequently, surgery is done on chronically inflamed spurs.

However. most practitioners misunderstand and misdiagnose heel pains as heel spurs, when it is in fact planter fasciitis, so it needs to be looked at in a more holistic manner.

Our chiropodist eventually finds that for people suffering with calcaneal spurs or and planter fasciitis, he is required to make prescription orthotics to control the very cause and not just the symptoms. He finds that the other recommendations for the spurs only have limited benefits and can allow the original cause to progress as they may not be addressing the original underlying cause.

Our chiropodist suggests that it is always better to control the aetiology via good bio-engineered prescription orthotics. The approach is to do a full and extensive examination of the entire lower limbs, find the dysfunctional causes (and there is usually more than one cause), and educate the patient sufficiently, so that they can make an informed decision on what may work best for them.

What is a heel spur? Our Chiropodist explains.

involuted toenail, description

Cut Them Short Please- Painful Involuted Toenails

“Cut Them Short Please”- Painful Involuted Toenails

“Cut Them Short Please”- This is a common request from my patients on cutting their toenail short for all the wrong reasons.

This often offers an opportunity for me to educate my patients on why this request is not such a good idea for them, and I wanted to share it with you all, so that the community would better understand how to prevent more painful, nail problems.

First, we must understand that there is an integral relationship between the nail plate, the nail bed and the flaps of skin on either side, known as the sulci.

involuted toenail, description

 

We must also appreciate the function of having nails, which is protection and sensation. Both of these functions are compromised when the nail is cut short.

Also, when the nail plate is cut short, the sides of the leading edges of the nail can and often do create problems against the soft sulci skin, especially if you are wearing shoes that are often tighter in the forefoot. Toes that are deformed and squashed together or over crowded, will also create pressure from the sides of adjacent toes and create painful problems.

In addition, when the nail plate is cut short, the nail plate is often caused to involute, which means it has more tendencies to curve into the sulci, pinching the nail bed, and sometimes, scooping the nail bed in-between the curled nail. The sulci tissue also has the effect of forcing down the side edge of the nail, further increasing the curling.

The end result is irreversible, painful and often ongoing irritation. It limits wearing certain shoes, and even tight hose is uncomfortable. I have also had patients report that the bed sheets also cause pain and discomfort. It can also limit activity such as simple walking.

Treatment is not always easy as involuted nail requires skill and patience, as it is often painful. The nail edge is required to be separated from the very close proximity of the nail bed and the sulci tissue.  This requires special instruments, patience and lots of education.  Often, the patients opt to have the nail cut short to avoid the pain as it grows, not understanding that the problems is further perpetuated.

An involuted nail is often mistaken as an ingrown toenail, but it is not. Treatment attempted by inexperienced people (such as self or a family member, pedicurists, aesthetician, foot care nurses and even family doctors) can and often do more harm than good. When treated incorrectly, involuted nails has led to full blown ingrown nails, which are far more severe and very painful with a full complement of inflammatory signs.

When the situation is too severe and ongoing treatments are too painful, the option to surgically remove the offending nail is considered under local anesthesia. However, not all patients qualify due to compromising medications and health issues.

I hope this serves you well to better understand the nature of involuted nails. Regulated specialists, such as a Chiropodist, will give you the right advice, examination and treatment when it comes to preventing such discomforts and promoting healthy, happy feet!

Kiran Dave D.Ch.
Mississauga

Chiropodist Foot Care Specialist

Chiropodist Kiran Dave

Anterior Compartmental Syndrome Addressed By Our Chiropodist In Mississauga

Anterior Compartmental Syndrome Addressed By Our Chiropodist In Mississauga

A Patient presented to our chiropodist office in Mississauga with a diagnosis of Anterior Compartmental Syndrome, which they received from sports medicine doctors previously. The anterior compartmental syndrome was experienced by this patient as severe burning pain in the shins of the legs on running activities. The patient was sent to our foot clinic in Mississauga for orthotics.

The chiropodist at our foot care clinic in Mississauga enjoys educating all his patients in a simplified fashion so that they better understand their symptoms and also collaboratively create a customized treatment plan that has a higher probability of success for the patient. Below is a summary of the patient encounter with the foot specialist to share with you:

Initially, the patient was given a brief biomechanical examination following a detailed history of the issues and any other medical conditions. The biomechanical examination is when the chiropodist observes how the patient moves through their walking gait, sitting, and standing postures. The chiropodist does observer the feet, but also the entire body from the bottom up.

A detailed and a very simplified summary of the findings were reported to the patient with the aid of visual drawings and anatomy models. Questions were encouraged and addressed.

The diagnosis was explained as soft tissue strain (tendonitis) of a specific muscle responsible for supporting foot collapse (pronation). The muscle in the leg and foot (Anterior Tibialis) was fatigued due to overuse, in trying to prevent the foot from collapsing, especially during running.

In addition, the tired and overworked muscle required more food and oxygen at a faster rate than could be provided. The increased blood supply, attempted to offer this, thereby giving rise to a hot feeling in the area.

Due to the vigorous nature of the activity of running, there was insufficient exchange of oxygen which precipitated anaerobic respiration with the bi-product being lactic acid giving rise to the burning pain. It is akin to having a ‘stitch’, which many runners can relate to.

So collectively, the chiropodist was able to grow on the overall diagnosis for the patient from anterior compartmental syndrome to a combination of anterior shin splints and an inability of the diffusion of oxygen to meet the vigorous demands of the muscle in an environment of overuse.

As the foundational education supported the symptoms, the treatment was much clearer for the patient to understands and appreciate. In this case, the patient required prescription orthotics to support the pronation of the foot, to allow the muscle in the front of the leg to function more efficiently, preventing overuse and strain.

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

Chiropodist Foot Care Specialist