Wise words from a wise woman lead to happy patients and practice with foot foundation orthotics
One of the best pieces of advice my great-grandmother passed down to my mother was to “take care of your feet and your hands.” I never met this great-grandmother my mom lovingly called “Nanny,” but she sure knew what she was talking about! As a young girl I took these lessons from my mother to mean “moisturize and take care in the trimming of nails and cuticles and hope you never have to worry about the dreaded bunion.” I wasn’t one to don polish or have a mani-pedi on the regular as some of my girlfriends did, and, as I was a competitive youth soccer player and eventual college athlete, I focused my foot care on performance, discovering foot foundation orthotics and some basic aesthetics and hygiene.
Foot foundation orthotics: fighting repetitive strain
Having suffered through unilateral Osgood-Schlatter disease, severe shin splints, stress fractures and plantar fasciitis off and on as a youth athlete, long-term relief finally came from a chiropractor who recommended custom orthotics.
I was 15 years old and burning out physically and mentally from five years of reoccurring and repetitive strain injuries. Once I found custom orthotics, it changed my life both on and off the field, for they had an orthotic that fit in my cleats! I still play soccer and am still wearing foot foundation custom orthotics 25 years later. They made me appreciate my feet, and now as a chiropractor, the value of my hands is unquestionable. Like I said, Nanny sure knew what she was talking about.
Changing patients’ lives
For me it is impossible not to consider custom orthotics for my patients. It has proven to be a missing link to chronic and reoccurring issues, and as I said earlier, can be personally life-changing.
I urge you to remind yourself and your patients that our feet do a lot of work. Just getting out of bed and putting our feet on the floor can be the best or worst part of a person’s day. What I find most comforting about addressing one’s feet is that whether the patient is a senior, an athlete, a child or an adult, the importance of the proprioceptive input being received is vital for all of us. The feet have the highest density of proprioceptors in the body, second only to the spine.
Mechanoreceptors in the joints along with the muscle spindles of the foot muscles play a huge role in positive support reflexes and a variety of automatic reflexive reactions. These include the flexor/extensor reflex, which forces the leg to comply as a stabilizer. Weight-bearing activity compresses the joints and muscles, evoking reflexive activity in the extensor muscles, and inhibition of the flexor muscles. The common denominator for all of us bipedal folk is exactly what Nanny said — we need to take care of our feet (and our hands), and I would add, so they can take care of us.
The role of a stable foundation
Besides the proprioceptive input communicating to your brain and body where you are on the planet, our feet are also responsible for holding up our entire skeleton. If the feet have altered functionality, the entire chain upward is going to pay a toll eventually.
If the pillar of a building is shaky, or in our case, the lower limb has proprioceptive imbalances, specific supports are needed to help achieve balance and proprioceptive symmetry. Adaptation both positive and negative play a role, of course, but as one worn-out tire on a car will cause the car to veer in one direction, or cause wear and tear on a compensating tire, your knees, hips, pelvis and low back will take on that stress and could overload in a negative way, potentially causing injury.
We are not truly symmetrical beings. Growing up in earthquake land in the San Francisco Bay Area, I know a thing or two about steady foundations not being rigid and always symmetrical to achieve stability. Buildings that will likely sway, like our bodies will move, need to adapt to stabilize in a balancing act because if we don’t, the rigidity will fatigue, and when overloaded will fall.
The importance of custom stabilization
In my professional experience, 90% of people pronate, and many over-the-counter orthotic brands are available to assist with this condition. What I love about custom orthotics is the way they identify the difference that can occur foot to foot.
With leading manufacturers, the height differences of the arches of each foot are compared on their report after using one of their scanners or kiosks, and this factor specifically can illustrate to a patient their need for a more custom orthotic and one that addresses more than the singular medial arch and issue of overpronation.
Also, the diversity of the product line is what will stand the test of time with patients. For those wanting to don heels to church or work or just out on the town, the leading manufacturers have a custom foot foundation orthotics specifically for that. There are custom orthotics for tight-fitting flats, athletics, and for those of us trekking through the back country, along a river or training for a triathlon, there are waterproof options.
Are you doing all you can to support your patients young and old? Are you counting on the built-in support from their footwear? As a previous footwear department manager from my days in retail before chiropractic school, I know shoe companies are not building a supportive shoe. Almost all of them count on a customer purchasing a supportive insole of some kind, especially the more active person. Are you addressing and adjusting the feet of everyone in your office?
As chiropractors we know that joint adjustment (especially the spinal joints) has a direct and immediate effect in normalizing receptor responses. Given the magnitude of sensory input, it’s no surprise the feet are to be included with the spine as containing the most receptors and have distinctive nerve circuits that demand our attention. Again, I am reminded of the wise words of Nanny, “Take care of your feet….”
Happy patients make happy practices
So how do you do this, and how often? Can your senior patients stand and walk with confidence? How about after a fall?
My heartstrings were strummed with an elderly female patient early in my practice. She was very active, more so than the average 20- and 30-year-olds whom I see regularly. One day, she tripped while shopping with her daughter and granddaughter. She did a course of physical therapy which was focused on strength and balance and she had improved, but she still wasn’t hiking as she used to, and she couldn’t paddleboard the way she could before her fall.
Less bothersome to her was some residual pain in her SI joint. She was frustrated and started to believe she would never get back on the water with confidence. I scanned her feet as I did with all my new patients, and when we saw that one foot had significantly less of an arch than the other, I convinced her to try a pair of custom foot foundation orthotics in her water shoes specifically, but also suggested she wear a pair in other shoes. I adjusted her and her feet and she slowly broke in the custom orthotics. Within two weeks of wearing them she was back up on her feet on her board and loving life again. Happy patients make happy practices, and if we all followed Nanny’s advice, I think we’d all have happier practices.
REBECCA WILDER, DC, is a graduate of Ripon College in Ripon, Wisc., and attended Life Chiropractic College West in the San Francisco Bay Area of California where she grew up. She currently practices at Balanced Chiropractic & Physical Therapy in Charlottesville, Va., and is a member of the International Chiropractic Pediatric Association (ICPA).
