Common Disorders
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Did you know the foot has 28 bones, 37 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that most Americans will experience a foot problem that will require the care of a specialist at one point or another in their lifetime.

A prescription foot orthosis is an in-shoe brace which is designed to correct for abnormal foot and lower extremity function (the lower extremity includes the foot, ankle, leg, knee, thigh and hip). In correcting abnormal foot and lower extremity function, the prescription foot orthosis reduces the strain on injured structures in the foot and lower extremity, allowing them to heal and become non-painful. In addition, prescription foot orthoses help prevent future problems from occurring in the foot and lower extremity by reducing abnormal or pathological forces acting on the foot and lower extremity. A prescription foot orthosis is more commonly known by the public as a "foot orthotic".

Podiatrists prescribe two main types of prescription foot orthoses for their patients, accommodative orthoses and functional foot orthoses. Both types of prescription foot orthoses are used to correct the foot plant of the patient so that the pain in their foot or lower extremity will improve so that normal activities can be resumed without pain. However, accommodative and functional foot orthoses are generally made using different materials and may not look or feel the same. Both types of prescription foot orthoses are nearly always prescribed as a pair to allow more normal function of both feet [similar to having both the left and right wheels of a car realigned in a front end alignment].

Excessive tightness of the calf muscles can contribute to many foot problems and some knee problems. The Achilles tendon attaches the calf muscle to the back of the heel. As the calf muscle tightens up it limits the movement of the ankle joint. When there is not adequate range of motion at the ankle during walking or exercising the foot joints are forced to move in an abnormal fashion. The foot is forced to flatten and the forces generated into the ball of the foot are extreme in nature. Over time, this repeated strain results in a variety of foot problems. The calf muscle has a natural tendency to tighten, as we get older. Exercise also causes the muscle to tighten.

Calf muscle stretching is very useful in the treatment of many foot disorders and for the prevention of foot problems. The typical runners stretch, by leaning into a wall, is helpful. An alternative method of stretching is to stand approximately two feet from a wall. Facing the wall, turn your feet inward so you are pigeon toed. Lean forward into the wall keeping your heels on the floor and the knees extended. Also keep your back straight and do not bend at the hips. Hold the stretch for 10 seconds and do the stretch ten times in a row. Do the stretching three times each day. Always stretch the calf muscles following any form of exercise. If the stretching causes pain it should not be performed. The stretch should be felt in the body of the muscle not in the Achilles tendon or the back of the knee. If you are unable to perform the stretch properly consult with a doctor or physical trainer.

As all runners know, running begins with a good foundation. And where do we find that foundation? At the ground level where the rubber meets the road.

In other words, your shoes, the pieces of leather and rubber that separate your feet from the hard concrete of the road.

Let's look at the anatomy of a running shoe, and the four sections of the shoe that make it complete.

The uppers of the shoe may be made of leather or, for the lighter shoes, a synthetic which is lighter, washable and breathable (to reduce heat from the foot). Another component of the upper is the tongue of the shoe, which should be padded in order to cushion the top of the foot against lace pressure. At the back of the shoe, the ankle collar should also be padded to prevent rubbing and irritation of the Achilles tendon.

Activities such as football, basketball, soccer, field hockey and lacrosse show the high incidence of injury to the great toe joint on artificial surfaces. Other non-sporting causes include change in shoe gear, limited range of motion of the great toe joint, and sometimes flat foot conditions.

Mechanism of Injury

There are two mechanisms of injury for turf toe. The most common cause is hyperextension of the great toe joint. The great toe joint is hyper-extended as the heel is raised off the ground. An external force is placed on the great toe and the soft tissue structures that support the great toe on the top are torn or ruptured.

Physical Signs and Symptoms

Symptoms of acute injury include pain, tenderness and swelling of the great toe joint. Often there is a sudden acute onset of pain during push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the great toe and will dramatically increase the healing time.

Guest Editor, Dr. Alan Ng 
1994 World Kyuk Too Ki Heavyweight Bare Knuckle Champion
Second Degree Black Belt Enshin Karate
First Degree Black Belt Shidokan Karate

With the new popularity of athletic activities involving the martial arts, a variety of injuries will occur that are not seen with mainstream athletics. The diversity of the martial arts can be broken down into two different types of training. The traditional martial artist or kickboxer's training will involve a series of activities. A training session will involve stretching, basic techniques and combinations, bag and/or pad training, forms or kata, and finally sparring. A new type of training has become very popular in today's society is aerobic kickboxing otherwise known as "tae Bo". This type of training or exercise involves utilizing martial arts technique combined with traditional aerobic exercises. A class of aerobic kickboxing will combine stretching, basic techniques and combinations in an aerobic type format.

Once upon a time, carbohydrates were classified as sugars or starches. Today, carbs such as fruits, vegetables and grains are classified by their glycemic effect: that is, their ability to elevate blood sugar. The Glycemic Index (GI) ranks carbs according to their ability to elevate blood glucose. It was originally developed as a tool to help people with diabetes. Today, several popular diet books and magazines have expounded upon the virtues of avoiding carbs such as carrots, potatoes, and white bread because they have a high glycemic effect. Supposedly, they quickly elevate blood sugar, stimulate the body to secrete too much insulin, and this, in turn is said to promote fat storage.

Question

Should I stop eating bagels and pasta? I've heard they are fattening because they quickly digest into sugar, which raises insulin and encourages fat storage. Is that true?

When excessive stress is placed upon the ball of the foot, a hairline break (fracture) of a long metatarsal bone may occur. This occurs most frequently to the second, third, or fourth metatarsal but can occur in any bone. Frequently, the injury is so subtle that you may not recall any specific occurrence. These fractures were at one time referred to as "March Fractures" in soldiers, who developed foot pain after long periods of marching. Stress fractures can occur during sports activities, in overweight individuals, or in those with weakened bones such as osteoporosis.

Diagnosis

A typical presentation for someone with a metatarsal stress fracture would be pain and swelling in the ball of the foot, which is most severe in the push off phase of walking. Pressing on the bones in this area of the foot will reproduce the pain. X-rays taken during the first two to three weeks after the injury often will not show any fracture. A bone scan at this stage will be much more sensitive in diagnosing the early stress fracture. The decision to order a bone scan will be up to your doctor. Often times the diagnosis can be made based upon clinical findings, thus making the bone scan unnecessary. After several weeks, an x-ray will show the signs of new bone healing in the area of the stress fracture.

Ankle sprains are one of the most common joint injuries runners experience. The injury can occur when one rolls over a rock, lands off a curb, or steps in a small hole or crack in the road. Usually the sprain is only mild, but on occasion it may seriously injure the ligaments or tendons surrounding the ankle joint. Management of this injury relies on early and accurate diagnosis, as well as an aggressive rehabilitation program directed toward reducing acute symptoms, maintaining ankle stability, and returning the runner to pre-injury functional level.

General Anatomy of the Ankle

The ankle is comprised of three main bones: the talus (from the foot), the fibula and tibia (from the lower leg). The three bones together form a mortise (on the top of the talus), as well as two joint areas (on the inside and outside of the ankle), sometimes called the "gutters". The ankle is surrounded by a capsule, as well as tissue (the synovium) that feed it blood and oxygen.

Some of the more important structures that hold the ankle together are the ankle ligaments.