Does Your Child In Toe?

intoe-2Childhood developmental milestones are a huge concern for parents. Everyone wants to make sure their little one is hitting the landmarks they should be. Crawling, walking, and running; these are all things we assess to ensure our child is where they should be. So it comes as no surprise that when something appears amiss we are quick to look for confirmation of normalcy.

 

intoe-1As Certified Pedorthists we assess gait patterns in people of all ages and young children are no exception. One of the most common reasons for a pediatric assessment is worry regarding in-toeing. It is important to remember that in-toeing is very common in young children due to the structural position of their hips and legs at a young age. In the majority of children these structural positions resolve by eight years old.

 

intoe-3It is possible to aid in correcting childhood in-toe. A specialized orthotic called a “gait plate” is used to gently guide the child toward a more straight foot position. In addition it is important to use well-structured footwear, verbally encourage pointing the toes forward with walking and reinforce sitting with legs crossed in front of them. The commonly seen “W” position, when sitting can encourage the continued internal rotation that perpetuates in-toeing.

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Elbow Tendonitis- Golfers elbow or Tennis elbow?

fareenI have been an avid tennis player and golfer my whole life and I consider myself in pretty decent shape. When I developed elbow tendonitis, it was debilitating! I was so sore after a round of golf, I couldn’t even lift a cold drink can to my mouth! I would take the can and place it on my elbow for some relief instead. I didn’t think much about it, but then it started to affect every aspect of my life. I couldn’t carry grocery bags, my briefcase, anything. More importantly, it hurt a lot when I was trying to hit a forehand or swing a golf club. Icing and some active release and massage certainly made a big difference and it was a “good pain” during treatments! But I needed something to make sure that I could still play – yes, I know I’m supposed to rest it, but if it flared up in the middle of a competition I needed something more than Advil to help me get through. Cue the Epitrain elbow brace from Bauerfiend. Don’t know what it is about German engineering, but this brace saved my round many times! It’s an easy to wear, simple pull on piece that works for either golf or tennis elbow , and it breathes so you can wear it in the heat and it will not smell too much ! The gel pads go right over the points of nerve entrapment on your elbow and provide instant relief. As soon as I pulled it on and started swinging I felt better right away. Not only did the pain diminish but it also gave me the confidence to swing hard which is something that I really enjoy doing when it comes to driving the golf ball!

Fareen Samji, 4 Time ILDC Canadian Women’s Long Drive Champion

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The Best Over-The-Counter Knee Brace

genutrainineeThere are so many over the counter knee braces that sometimes it’s hard to decide which one is better for you. The concept of all them are the same. Compress the area around the knee and keep the swelling down. My personal favourite is the Genutrain by Bauerfeind, for several reasons, the first being that it is very comfortable to wear. The knit fabric that is integral to all Bauerfeind products is breathable and washable. No more sweaty, stinky, black neoprene sleeves that feel disgusting after one use! The silicone omega pad surrounds the knee cap keeping the patella in place so that it tracks efficiently and provides a great feeling of stability around the knee. The fact that the knee cap is closed means that any swelling in the knee is dissipated nicely in conjunction with the compressive actions of the fabric. The sense of instant relief is second to none when you have the Genutrain on. It’s lightweight, fits under most pants discreetly and is very comfortable to wear. I play a fair amount of golf and badminton and my kids keep me pretty active playing with them or hiking the Bruce Trail. My knee doesn’t always hurt but when I push it too hard or am on uneven surfaces, it starts to bother me. I immediately go to my Genutrain and feel instant relief. Theoretically, the best cure for knee pain is to strengthen the muscles around the knee. My feeling is that if your knee hurts and you can’t do the exercises you need to do to stay healthy then please wear the brace. It’s lightweight, easy to slide on and it works, and did I mention it was breathable and washable!

Fareen Samji, Certified Pedorthist, C.Ped. ( c )

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Does your child have a “bump” at the front of the knee? Is it Osgoode-Schlatters Disease?

osgood-schlatter-disease1-300x297Sometimes as parents of an athletic child you get hit with so many aches and pains and you begin to wonder which ones are serious and which ones aren’t. Do you have a young athlete in your life? Have they ever complained of knee pain after competition or practice? They may have developed a common condition called Osgoode-Schlatters Disease, which even though it sounds scary is not really a disease at all. It is basically a function of the muscles and tendons not developing at the same speed. It is typically seen in pre-teen and teenage athletes who are involved in running and jumping sports and manifests itself as a lump or bump or bony outgrowth at the front of the knee.

Osgoode-Schlatters develops when the quadriceps muscle group pulls excessively at its attachment on the tibia. This happens easily in young people because their bones are growing at such a fast pace. The patellar tendon attaches into the tibial tuberosity, which has yet to fuse to the rest of the tibia. As the quads contract they pull the tuberosity away at the growth plate causing a lot of pain.

The good news is Osgoode-Schlatters will not last forever! It can occur on an off throughout puberty but typically lasts 12-24 months. If your child has been diagnosed with Osgoode- Schlatters your best approach is physiotherapy, taping or bracing, cushioned custom orthotics and supportive sports specific footwear.

Shannon White, Certified Pedorthist. C.Ped ( c ) Milton Orthotic & Wellness Centre

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Don’t let arthritis slow you down – “motion is lotion”

GenuTrain

GenuTrain®

I have worn a custom knee brace for my knee injuries and as a therapist and brace fitter I feel a certain kinship with my clients. When I injured my ACL playing soccer, I was so afraid that my soccer playing days were over. The pain was so intense and I was sure I would never get back on the field. Once I got my custom brace and finished my rehab, I was back! Without my custom knee brace to give me the stability I wanted, I would never have felt safe enough to return to the same level. But what I didn’t know at the time was that I would probably develop arthritis in my knee! When you are young and active, no one ever tells you that may get injured! No one ever tells you that the wear and tear on your joints could lead to premature arthritis! I quite often see patients who are still young, in their late 40’ s and 50’s who have stopped doing their activity because of arthritis in the knee. A lot of them will gradually gain more weight due to the drop in activity level and the weight gain doesn’t help with the increased joint pain one bit. It’s kind of like a vicious cycle- how do you stay active to stay healthy when arthritis in your knee prevents you from doing the activity you love? Well, motion is lotion – the more you are able to move, the more nutrients you send to your joints. Yes, it’s hard to move when you have bone on bone and the knee hurts when you walk. There are so many Osteoarthritis braces like The Thruster or the The Offloader that has a hinge that you can crank up to increase the amount of offloading on the joint space. The relief is almost instantaneous. There is no reason to let Arthritis slow you down, motion is lotion!

Stefanie Deboer, Certified Pedorthist, Burlington Orthotic Centre

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Are Your Shoe Choices for Your Kids Causing Bunions?

normal-vs-bunionMost people don’t think of Bunions when they think of children’s feet! However, I see a fair amount of bunions in children (kids, you can thank your parents for some of that!). Bunions affect the alignment of the big toe as well as lead to bone growth on the inside of the foot near the big toe joint. In my experience children with bunions usually have flat feet, very flexible joint articulations in the feet, and are involved in sports that either require tight fitting footwear or cause repetitive stress to the first toe joint (cleats, skates, dance). When we work out, we stress our muscles and they respond to the stress by growing bigger. Same thing happens in bone. When you stress the big toe joint by rolling onto it when your arches collapse or by wearing a tight cleat or skate that rubs along the side of the toe, you are creating stress to that bone and if you have hereditary factors you are going to stimulate the growth of the bone in the big toe area. Probably one of the worst cases I saw of adolescent bunions were in a 14 year old girl who skates 5x per week and whenever she takes off her skates there is marked redness in the bunion area. When she is not in skates, she is in a Puma style flat shoe. Most of the kids I see nowadays are unfortunately not wearing well structured shoes and this leads to a big discussion about style when I try and educate them about the virtues of a good shoe. Parents, you are not held harmless on this one! There have been many a conversation in my assessment room on footwear when the parent says to me “she’s never going wear a running shoe, she only wears flats.” If you have a family history of bunions and your child’s foot is flexible, they are at risk of bunions. Help them, work with them to find a compromise. I certainly am not suggesting that your child wear an ugly orthopedic shoe! The difference a good Asics, Brooks or New Balance running shoe can make to your child’s feet is quite significant, and with the cool colours and styles nowadays surely we can find a compromise. My goal for bunion treatment is accommodation to limit any future growth. This begins with footwear education as well as supporting the arches of the foot to take the pressure off the big toe.

Steve Lawcock, Certifed Pedorthist, Burlington Orthotic Centre

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ACL Knee Injury – Getting Back To The Field

ACL Knee InjuryI have been playing competitive soccer ever since I can remember, and I like to move fast. I guess that warranted my dad’s nickname for me, “Scooter!”  Never once did I ever think I would be needing reconstructive surgery on my knee to repair my ACL that was fully torn.  I was just winding up for a shot, planted my leg and twisted and that’s when I felt my entire joint open and crumbled to the ground. I had never felt pain like that as I heard the “pop” in my knee and instantly knew something major had happened. As a kid playing rep sports, you think you are invincible! Who knew that girls are more predisposed to ACL injuries than boys because we have a wider pelvic angle? I certainly didn’t at that time.

After a year of waiting, I finally had my knee repaired and soon after I was getting fitted for my first Bledsoe ligament instability brace. I was so amazed at how light this brace was. When you look at them they appear bulky and restrictive, but the magnesium frame was so light and the brace was custom made so it moved perfectly with my leg. This brace became a part of me, and helped in my recovery process.

I was motivated to get back into playing soccer again but I was quite afraid of pushing my knee too hard. I didn’t want to go through the pain that I had just gone through!  The brace was literally a helmet for my knee and gave me the stability, control and confidence to get back into what I loved doing most, playing soccer.  I had to make sure there were no metal hinges showing or exposed on the brace, and thankfully they all come with outer covers to make sure the brace is in compliance or the refs wouldn’ t have let Scooter back on the field!

Stefanie DeBoer, Certified Pedorthist, Burlington Orthotic Centre

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Heel pain after a growth spurt?

Sever's DiseaseParents work so hard in trying to get their kids active and keep them active, so it is quite disheartening for a parent when their child complains of pain. Sever’s disease is typically seen in children between the ages of 8-15, with the majority of my patients being boys in the 9-12 age range who are very active or involved in sports. The pain is quite marked when you prod around with your fingers at the back of the heel.  I see a lot of cases of Sever’s in young athletes wearing cleats where the action of the cleat digging into the ground causes a further stretch of the Achilles tendon which then pulls on the heel bone even more. Usually the pain appears to start at random and is reported as worse during activity or shortly thereafter, with rest helping alleviate symptoms. When asked to point to the area of pain, almost every patient is quick to point to the back of the heel. This disorder commonly follows a growth spurt. This is because bones tend to grow faster than the muscles and tendons of the lower limb. This growth spurt can cause the Achilles tendon to become tight, which puts extra tension on the heel bone and can lead to inflammation of the growth plate in the heel. Some cases can be chronic and if little recovery has occurred after 1-2 weeks I would recommend an assessment for further treatment. When watching a child with Sever’s walk, I quite often will see the ankles rolling inward, and the heel coming off the ground quickly. Footwear needs to be evaluated to make sure it is stable and supportive like the Asics Kayano. Even a cushioning shoe like the Asics Nimbus can make a big difference with a well-made foot orthotic to control the ankle rolling inwards.  If your child has symptoms of Sever’s pull them out of their activity for a week and the rest should make it better. If they are in rep sports and the demand on their bodies is high, a physio routine and some icing will complement the orthotic and footwear therapy nicely.

Steve Lawcock, Certified Pedorthist, Burlington Orthotic Centre

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GenuTrain: Active Support for Knee Relief and Stabilization

Very few people know the effect of supports on motion sequences as well as Prof. Dr. med. Albert Gollhofer. Although the results confirmed his assumptions, the head of the Institute of Sport and Sport Science at the University of Freiburg was still surprised by what the current study revealed.

GollhoferBiomechanics were the main focus of the cross-sectional study. Why?

Prof. Dr. Gollhofer: The laws of biomechanics are the foundation of every movement. Going against them can lead to chronic complaints. People with typical bandy legs (extra-large varus angle) are very likely to develop medial compartment osteoarthritis. The higher knee adduction angle places more strain on the medial joint segment than on the lateral segment. When you succeed in straightening the knee with the help of a support to regain a symmetrical gait pattern, you can slow down the development of deformities.

How can a support influence the gait?

Prof. Dr. Gollhofer: One way is through its proprioceptive effect. That is, through the mechanical stimuli it exercises on the soft tissue during movement. This creates feedback which is sent to our central nervous system and causes the muscle actions to change. The aim is a functional result. In the present case, the magnitude of the effect surprised me, although I was aware of the potential of the GenuTrain due to previous studies.

Proprioception requires the relevant receptors to be stimulated. There are many of these in the joint., the connective tissue, the muscles….

Prof. Dr. Gollhofer: We are concentrating on the mechanoreceptors. These are mainly located in the muscles around the knee and in the capsular ligaments. We play these proprioceptors together like an orchestra and “a good sound” is created when they coordinate the muscle contraction process appropriately and functionally. Injuries can cause particular problems at this point., however. We know that pain is conducted via the pathways of what we call group III afferents. These pain pathways strongly disturb the “good sound,” the rapid intermuscular interaction. Yet if we can improve the guidance of the joint by using supports, these afferents will send fewer signals, which restricts the pain. And this has an immediate effect on the gait.

To what degree are these rapid reactions only psychological?

Prof. Dr. Gollhofer: Only to the extent that the central nervous system knows: I am not alone. Reflexes in the peripheral areas are constantly regulating muscular control., every fraction of a second. This can be seen in the leg swing and stance phases, for example. Even before the body weight bears down, that is at the end of the swing phase, neuromuscular control ensures that the leg extensors are pre-activated in order to immediately provide for the necessary stability in the stance phase.

“This cross-sectional study proves that the GenuTrain has cross-joint effects.”

(Prof. Dr. med. Albert Gollhofer)

This also involves the ankle….?

Prof. Dr. Gollhofer: Of course, the ground reaction vector works from below. If the force is incorrectly introduced into the system, the possibility of counter-reactions in the knee is decreased, which is even worse further above. A stable gait comes from the bottom up. It makes sense to think about a bottom-up strategy using an ankle orthosis together with the GenuTrain, for example, for general instabilities. This cross-sectional study proves that the GenuTrain has cross-joint effects. The biomechanical influence of the support on the knee joint also causes significant changes to the hip.

Can the results of the study actually be transferred to real situations?

Prof. Dr. Gollhofer: When you measure specific effects in laboratory conditions, you ask yourself: How long will the effect last in everyday life? That’s exactly what we are trying to establish with a long-term Genu­Train study. Of course, we also know that all externally introduced changes to ingrained conditions will encounter a biomechanical state that has been established over years.

A patient who has an extreme varus deformity in the knee joint has adapted to a specific pattern with their ligaments, muscles and tendons. We can’t change that all at once. Patterns of movement and long-term adaptations in the soft tissues can only be coupled to new conditions over a long period of time. We also expect this from a support system. Ideally, the long-term study will show that constantly wearing the support over a long period of time causes the tendon and muscle lengths to return to a biomechanically balanced state. This would convince patients in everyday life. The initial results of our long-term study actually seem to confirm this type of effect.


 

The original on the knee: GenuTrain

Shaping functionality

GenuTrainThe active support consists of an anatomically-shaped compression knit with a ring-shaped, functional cushion, the Omega pad. The pad relieves pain by transferring the therapeutic pressure of the support from the kneecap to the soft tissues of the knee region. Two nubs on the lower edge of the pad, the Hoffa pads, exert regulated pressure on the infrapatel­lar fat pad and stimulate the sensorimotor receptors located there. This supports the pain-relieving effect. Furthermore, direct pressure on the kneecap is relieved. The lateral wings of the pad form an omega symbol (O). Their role is to ensure that the meniscus parts are held in an anatomical position, which also reduces pain.

Secure hold for the knee joint

When walking or running with the Genu­Train, the muscular contractions cause the pressure exerted by the support to increase and decrease, resulting in an effect similar to an intermittent compression massage. This stimulates the metabolism and helps reduce swelling and effusions of blood more quickly. In addition, wearing the support stimulates the proprioceptors in the soft tissue of the knee and on the skin. The surrounding muscles are activated and long-term stabilization for the joint is achieved.

High level of comfort

The material and shape of the GenuTrain knee support have a functional design for optimal effect and a high level of wearing comfort. The breathable, skin-friendly knit adapts to your every movement., without constricting or slipping. The material is soft and elastic at the edges of the support and in the sensitive area at the back of the knee. Lateral spiral stays ensure that the knee support keeps its shape during movement. Integrated donning aids make the supports easy to put on with little effort.

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Compression Socks: Protection from Overloading

Whether in competitive or amateur sport., more and more athletes are relying on compression products for preventative care. In this area, compression stocking specialist Bauerfeind offers its customers a strong sports stocking duo for endurance and stop-and-go sports.

Compression Sock Performance

The Compression Sock Performance sports stocking meets the needs of endurance athletes.

Anyone who participates in long-distance running or cycling is familiar with the feeling of heavy, tired legs. This is caused by the vessels expanding and losing their tension. With the new Compression Sock Performance, available from summer 2014, endurance athletes can now give their veins the ideal support. The sports stocking’s pressure profile is based on medical standards. The continuous compression decreases from ankle to calf, which improves venous reflux and the removal of lymphatic fluids. At the same time, the gentle compression stabilizes the calf and reduces typical muscle vibrations, thus preventing premature fatigue. Better support is provided for muscles over long distances, so they can continue to perform more effectively.

Quicker recovery

The Compression Sock Training sports stocking provides protection in stop-and-go sports.

The Compression Sock Training sports stocking provides protection in stop-and-go sports.

The positive impact on circulation and the muscles protects the vein system when it is under persistent stress, which in turn promotes a quicker recovery. Just how much endurance athletes benefit can be seen in a medical study* carried out during the 2011 Paris Marathon. The participants wore the previous model of Compression Sock Performance, which is identical to the new sports stocking in terms of compression strength and therapeutic gradient. They reported less muscle pain, a reduced feeling of swelling, and much better muscle recovery in the first four days after the race. Their calf veins had not dilated during the race despite the increased strain.

The knit of the Compression Sock Performance is made of fine, breathable microfiber. It can regulate heat and channel moisture away from the skin, creating comfortable micro-conditions. This has a twofold benefit during sporting activities. In addition, the microfiber makes the new sports stocking particularly light., yet still hard-wearing.

Stability for the ankle

The Compression Sock Training sports stocking is especially designed for stop-and-go sports, meaning sports that involve rapid turning and jumping movements such as football., basketball., or tennis. It features special functional zones with gentle compression. The stocking’s taping zone helps to create a feeling of greater stability in the ankle, while its muscle-toning zone specifically stimulates the calf muscles during movement. This is particularly important in these ball sports that put a great deal of stress on the ankle, because a sense of instability can quickly take the fun out of exercise – especially in people with a previous injury or naturally weaker ligaments.

The Compression Sock Training uses the same active principle as a tape bandage to create a feeling of improved stability in the ankle. The “taping zone” with a “figure of eight” design wraps around the instep and heel. The firmer, compressive knit stimulates the skin’s sensors and the deep sensors in the muscles, tendons, and joint. The improved proprioception supports the ligaments and improves coordination, providing greater security when changing direction quickly. The stocking therefore also offers increased protection from injuries.

Muscle stimulation

In the calf area, the “muscle-toning zone” also exerts gentle compression at certain points and counteracts tiring muscle vibrations. Its asymmetrical anatomical shape specifically stimulates the muscles during movement., facilitating gentle muscle building.

Like the Compression Sock Performance, the Compression Sock Training’s heel cushion eases the strain on the Achilles tendon and protects this sensitive area from pressure and rubbing when it is under great stress. Additional toe, forefoot and heel padding absorbs impact and ensures a firm grip in the shoe. The stocking’s high-quality breathable Lycra Sport material guarantees the required moisture transfer during sporting activity and creates pleasant conditions for the feet.

Simple size selection

The appropriate size of the Compression Socks Performance and Training is determined by the shoe size and the calf circumference, as the leg muscles of athletes can vary considerably. The Compression Sock Performance is available in black, white, and Rivera, a shade of turquoise. The Compression Sock Training is available in the color combinations Coal/Rivera, Silver/Rivera, Coal/Polar, and Silver/Polar.

Compression Sock Performance 2Compression Sock Performance

  • Compression over a large area, consistent therapeutic gradient that complies with medical standards
  • Improves circulation and protects the veins from overloading
  • Reduces muscle vibration (due to the compression) and prevents premature muscle fatigue
  • Ideal for use with the ErgoPad run & walk sports foot orthosis
  • Recommended for endurance sports

Compression Sock Training 2Compression Sock Training

  • Compression at certain points in the taping zone around the ankle and muscle-toning zone on the calf
  • Improves coordination thanks to its stabilizing effect on the ankle and calf muscles
  • Reduces muscle vibration (due to the compression) and prevents premature muscle fatigue
  • Ideal for use with the ErgoPad ball & racket sports foot orthosis
  • Recommended for stop-and-go sports with quick changes of direction

For further information on these and other Bauerfeind products, visit www.bauerfeind.com.

 


*Allaert F .A. et al., Effects of elastic compression in French compression class II (18-21 mmHg) on the adaptation of muscular stress and recovery of marathon runners, Phlébologie 2011, Vol. 64, Number 4.

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