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Runner's Clinic | Orthotic Management | Falls & Balance
Runner's Clinic
| Q: Why do I get knee pain when I run? I never have it any other time. |
A: This can occur for any number of reasons. Running is much different than normal walking and much more stressful for your joints. When your foot hits the ground while running, within milliseconds your knee is loaded with up to three times your body weight, and it is the knee's job to absorb all the shock that isn't dispelled by the foot and ankle. Any weakness or malalignment in the kinetic chain (foot/ankle, knee/hip) will make you susceptible to pain in any or all of these joints. |
| Q: What are "shin splints," and what causes them? |
A: The term “shin splints” is a global term that encompasses a number of different lower leg disorders. Among these are medial tibial stress syndrome (periostitis), deep posterior compartment syndrome, tibial stress fractures, and exertional compartment syndrome. Most runners incur leg pain as a result of localized repetitive trauma to the musculoskeletal structures of the lower leg. The most common diagnosis in this population is that of Medial Tibial Stress Syndrome. Most cases of shin splints are due to over training or increasing running time too quickly. Some cases are caused by the shock of running on a hard surface such as asphalt or hard ground. Still others may be biomechanically related to over- or under-pronation.
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| Q: How can I get rid of my shin splints? |
A: First, what is causing the shin splints has to be determined by a physician or a physical therapist. If it is over-training, a curtailment of the exacerbating exercise would be a good start. Then begin anti-inflammatory modalities both topically (ice) and internally (ibuprofen, naproxen, etc.) as directed by your physician. If it is being caused by shock, sometimes just a shoe change or foot orthotics are needed to help mitigate road shock and/or control foot motion.
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| Q: How do I know if I'm a pronator or a supinator? |
A: First of all, pronation and supination are both normal foot motions. It is only when we have too much or too little of these motions that it becomes problematic. Usually, if you are an over-pronator, you will begin to experience some sort of lower extremity pain which onsets somewhere along the inside aspect of the foot/ankle or knee. Some people over-pronate but experience no pain. If you are an over-supinator, pain usually occurs along the outside aspect of the foot/ankle, leg or knee. This is caused by poor shock absorption since the foot cannot absorb it properly in this position. Most over-supinators experience problems early in their running careers and need special shoes and/or orthotics. |
Orthotic Management
| Q: If I wear foot orthotics, will my bunions go away? |
A: No, orthotics cannot correct pre-existing bony malalignments. They are, however, effective in preventing bunions or arresting their further development. |
| Q: Do I have to wear my orthotics all the time? |
A: That depends on the condition for which you are being treated. Some conditions are only problematic during high impact or prolonged activities. If this is the case, your therapist may only requrie that you wear your orthotics during these types of activities. Other conditions require you to wear your orthotics for most all weightbearing activities. Most people can get away with occasional wear of dress shoes (e.g. going to church, going out ot dinner, etc.) if they are diligent about wearign their orthotics at all other times. |
| Q: Can I wear my orthotics in all types of shoes? |
A: No, probably not. In order for orthotics to be effectgive, they must be worn in very supportive shoes. The last or form of the shoe is very important since it provides the base of support for the orthotic. Shoes that are straight or board lasted are best. |
| Q: What type of foot ailments can be treated by the use of foot orthotics? |
A: We treat a wide range of foot problems with foot orthotics. Remember, some type of pathology is causing the problem and if the problem can be tractd to one of a biomechanical origin, we will try custom orthotics to correct the problem. Conditions like plantar fasciitis (heel pain), tarsal tunnel syndrome, fallen arches, metatarsalgia (ball of foot pain), bunion pain, great toe pain, ankle soreness, etc. are all included. |
| Q: Can orthotics help my back and knee pain? |
A: Sometimes knee and back pain are caused or exacerbated by lower extremity malalignments. If flat or high arched feet are causing these malalignments, foot orthotics can sometimes be effective in relieving the pain by realigning the lower extremities into a more functional position. |
| Q: Will my insurance pay for the cost of the orthotics? |
A: Typically, insurance companies do not pay for the orthotic deivces. Most insurance companies, however, will pay for the exam. Whether yoru particular insurance will or will not pay for the devices can only be determined by calling them and inquiring. |
Falls & Balance
| Q: I tend to avoid doing things I used to enjoy because I am afraid that I will lose my balance and fall. Is tehre something wrong with me or is it just old age? |
A: The answer to both of those questions is no. There are a lot of older people who feel this way and it is not abnormal. As we age, we lose neurons (brain cells) that are responsible for allowing us to maintain our balance. By age 60, almost 50% of these neurons are lost. Along with this, we tend to lose some of our flexibility and reaction time. These factors all cause a decrease in balance and confidence in our ability to react to perturbations to our balance. With added safety awareness and an active lifestyle, some of these factors can be eased enough to allow some individuals to be more confident in their daily activities. Others may need to seek professional help like the Human Performance Lab to overcome their confidence problems and be given advice as to what they need to resume their normal lives.
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| Q: If my doctor sends me to the Human Performance Lab for a balance/fall risk assessment, what should I expect? |
A: Typically, this assessment takes approximately 75-90 minutes to complete. It involves a complete medical history, physical exam, balance screening and, if then deemed appropriate, an equilibrium evaluation in the Smart Balance Master. |
| Q: What is the Smart Balance Master? |
A: The Smart Balance Master is a computerized device that through a series of tests can determine in what system or systems of balance your deficit lays. Humans have three systems of balance: somatosensory (gravitational pull on the body), visual, and vestibular (inner ear). When any of these three systems are compromised, a balance problem ensues. The Balance Master also has a treatment mode that can be programmed to a specific patient's needs. |
| Q: What are some of the common risk factors for falls? |
A: Clinicians categorize fall risk factors as either intrinsic (factors that are due to our bodies) or extrinsic (factors that have to do with our environment). Intrinsic factors would include: loss of flexibility and coordination, muscle weakness, balance deficits, vision impairment, medications, gait anomalies, and decreased cognition. Some Extrinsic factors would be: insufficient lighting, loose or plush rugs, small pets, stairs, bathrooms without handrails and debris in the walkways. |
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Q: My doctor told me I should us a cane while walking. I walk just fine around my house; why do I need one?
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A: You may be fine when you are at home in familiar surroundings, but that is much different than when you are out on uneven terrain or without something to grab on to if you lose your balance. Your physician knows how much of an inconvenience it is to carry a cane, so if he or she orders one, it is necessary. |
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